Marc L. Boom, M.D., president and chief executive officer of Houston Methodist Hospital, sat down with William F. McKeon, executive vice president and chief strategy and operating officer of the Texas Medical Center, to discuss the role healthy competition plays in advancing patient care and how maintaining a clinical practice provides him a unique perspective in the world of hospital administration.
Q | Tell us about your early childhood.
A | I was born in Englewood, New Jersey. My folks immigrated to the United States just before I was born, so I was the child of immigrants in northern New Jersey, and my father worked in Manhattan. Actually, at that point I think my father worked in Florham Park, New Jersey, for Exxon, if I remember correctly, and later in Manhattan.
So they were both born in Belgium in the midst of WWII. Both very young, so they don’t have big memories of the war, but my father has some vague memories of getting ushered into the house because a Canadian plane was in a dogfight with a German plane right over the neighborhood. It got shot down in his neighborhood. He remembers, as a four-year-old, seeing this stuff. And my mom’s older brother, he’s 86, so he was born in probably 1931 or ’32, remembers it vividly.
Q | Growing up, were you always interested in the sciences? I know you eventually ended up as a biology major at UT.
A | Yes, I always liked the sciences. I was never much into English or other subjects, they were never my favorite. So I was very interested in science, and it’s funny, people ask me when did I decide to go into medicine, and it’s more just like an ‘aha’ moment, and I can’t really tell you why. But it’s more that I was just really fascinated by medicine. So by my junior year of high school, I was telling my parents that I wanted to be a doctor. Now, with an engineering father, and thinking it would be really cool, I decided I wanted to do biomedical engineering. I ended up at UT, which I was thrilled to go to.
Q | So how did you meet your wife, Julie?
A | We met as juniors in a pathophysiology class. She was from Dallas, I was from Houston. Sitting with two or three people in between us who we both knew, but we didn’t know each other. We’re talking a 200-person lecture hall with the long tables. And one of them said, ‘Oh, have you met?’ And we chatted on the way out, and it turned out her sorority and my fraternity were having a mixer/match that week, where on Tuesday night you have a cocktail party and the whole purpose is to find a date for the match, and then the match would have some theme on Saturday. Well, she had an exam the next day, and she came with one goal: to see if I would ask her out. And I went with one goal: to ask her out. She told her friends she would only stay for 30 minutes because she had to study. My wife was a good influence on me, studying-wise. So we met there and married four years later and now we are at 25 years with three wonderful children. Julie is a very successful academic pediatrician at Baylor and Texas Children’s Hospital.
Q | What led you to Baylor?
A | We looked around the country and knew we were probably going to stay in Texas. There was no couple’s match, but we knew we were getting married by then. In medical school, we were never Marc or Julie, we were Marc and Julie, so we looked around within Texas, and Baylor was our first choice.
Q | What shaped your discipline once you got to medical school?
A | I had no idea what exactly I wanted to do, or if I had an idea it was totally wrong. When I was in high school and said I wanted to be a doctor, it was actually more that I wanted to be a surgeon. And in college,
I actually spent summers doing the usual kind of pre-med stuff. I spent two summers at MD Anderson, and then I did the heart surgery program at Texas Heart Institute. There is a picture of the 10 of us in the program with Dr. Denton Cooley, and me with my eyes closed. Not the best picture, but that was pretty neat. But looking back now, it was the start of me realizing I didn’t want to be a surgeon. Because while it was pretty interesting, there were moments of sheer boredom punctuated by lots of excitement.
So I did that and then went to medical school, and I really got grabbed by internal medicine. I loved the intellectual challenge. I loved the diagnostic puzzles. In fact, my two favorite parts of medicine are the diagnostic puzzle part of it and the relationship part of it. I ended up doing primary care and I love knowing people through their lives and helping them with a myriad of things. One day it is one thing and the next it is something totally different that you are helping them with and guiding them through.
It’s kind of special having come back here and working my way into this position. There are still a bunch of people in significant leadership positions here who taught me in medical school, either in lecture halls or one on one. Our chair of OBGYN, who just retired about a year ago, Alan Kaplan, the first time I stepped into an operating room as a medical student, and the first time I stepped into an operating room at Houston Methodist, was with him. It was actually my first clinical rotation out of basic science, watching him. And many years later, he was our chair and I got to work with him that way. So there are lots of great ties like that.
Q | When you were at Massachusetts General Hospital, at what point did you decide to go
A | With the benefit of hindsight, it was actually clearly while I was still in medical school that I became interested in the business side. And I say it’s sort of in my DNA. My grandfather left the farm, became a cabinet maker, built a business. My father, an engineer, ends up on the management side after a few years. My brother is an attorney, and ends up on the management side after a few years. I’m a physician and end up on the management side. So we have all got our trade, and then we do that. And to different degrees, we keep that trade. I still practice, so I have kept that, too.
I knew I wanted to be involved in leadership in medical school. But I didn’t know quite what that meant, and actually, I owe a lot to Ralph Feigin, a major mentor for me. So Ralph was always really good at attracting great students from Baylor to stay in his pediatric program and convincing great students to go into pediatrics. My wife was going into pediatrics, so he had his eye on her to be there, and he was trying to convince me to go into Med-Peds [combined internal medicine and pediatrics] because he knew I didn’t want to do pediatrics. He knew I had this interest in leadership, and I thought that meant I wanted to be an academic chair someday. That’s what I thought it meant at the time. But of course, those were the role models you have in that setting. So he offered for me to spend six weeks in my fourth year of medical school, right around the time we were turning in our match list, doing his administrative rotation that was normally reserved for the top third-year pediatric residents. For about a month, I followed him around. I remember going to board meetings, city council meetings, helping him write book chapters. It was a really cool experience. He had it all, from a leadership, academic and pediatric base. One of the two smartest physicians I have ever known.
I went to Mass General and thought I wanted to be a cardiologist because everyone at Mass General was in cardiology. And I liked cardiology, I enjoyed it. My wife wanted to do neonatology, and we, at one point, had a heart to heart, and about three weeks before the match list for fellowships was due, she said, ‘I want to start a family, and I don’t know how to do that as a neonatologist. It’s just brutal.’ And I said, ‘I don’t think I want to be a cardiologist. I want to do something a little different than that.’ I was getting this administrative bug, and I had figured out that there were other tracks, and I had done some research and knew someone at Mass General and figured out that there were a number of people who went the business track to get into leadership.
So we backed out of the match two weeks before we had to turn in our lists, and that summer started doing research into options. Wharton was ranked number one in business schools at that point, but more importantly, it had the oldest health care management track in the country. I was 28 years old at the time, and they specifically took about 45 health care people, of which usually four or five were physicians or were in an M.D./ MBA program. So I applied to Wharton and decided, ‘If it’s meant to be, it will be.’ So I became a general medicine fellow, while working on my MBA. I did both simultaneously. My wife worked as a pediatrician at CHOP (Children’s Hospital of Philadelphia). So that was busy.
We had our first child two months in. My first round of final exams were Monday, and my wife went into labor at 11 p.m. on Saturday night. So as she is in labor on Sunday, and then, as our first daughter is born, I am sitting there during the quiet time studying for my exams and multitasking.
Q | Often when physicians go on to be administrators or leaders, they leave clinical practice altogether. It is really unique that you stayed with it. Has that proven to be helpful to you as you lead this organization?
A | Very much so, and I love that. In business school, I knew I wanted to stay working on the provider side, whether hospitals or physician practices. I didn’t want to go into managed care, which was hot at that time. I could have gone consulting. I could have gone finance. There were people doing lots of things. But I knew I was interested in the provider side, so I started working 50/50 clinical practice and administration
in Houston for a joint venture between Baylor and Methodist. And really since 2004, when the administrative side was ramping up so much, I took what was a very robust 20 percent practice—a typical primary care doc, if you look at their panel, let’s say 3,000 is pretty busy, we counted up my active patients and it was over 800 at that point—and had to ramp that way down. It was hard to do.
But in 2004, I went to family, friends and some patients that I had a longstanding connection with and said, ‘Hey, would you like to stay with me and my small boutique practice here while I spend most of my time administratively?’ And that’s what I did. So for about 12 years now, I have had about 70 patients in my practice. Most of them are the same as they were 12 years ago. I have picked up some. I have three-generation families in many cases now. So it’s really neat. I love that part of what I do.
I joke with my head of IT that I’m his worst nightmare, because I’m a CEO that actually uses his IT system. And he comes back and says, ‘No, it’s the best thing ever.’ Because I get what has to be done. I am doing the same exact training as every single one of our physicians. We are in the midst of an Epic transition. I won’t use it nearly as much as they do, obviously, but I will use it. Especially on the outpatient side. I don’t really do inpatient anymore, but I will follow along with some patients of mine when they are in. And I am actually going to do all of the training for the inpatient side, too, because I want to be part of the experience.
That is a real tangible example of why it does help. I order tests, I consult with the radiologists, the tests come back to me, all of those things. So I get a chance to hear from patients in a different voice. And then the other part, very selfishly, even in the midst of some crazy stressful day, when you are dealing with this or that, when you go over there, only one thing matters, and it’s the patient that I am sitting with in the room.
Q | Having now been at the helm of Houston Methodist for many years, what are some of the most challenging moments and some that you are most proud of?
A | I think one of the absolute most challenging was Tropical Storm Allison. At the time, I was CEO of what was called Methodist Diagnostic Hospital, which is our West Pavilion building right across the street, and had already recommended to my bosses here at the time that we merge it into main Houston Methodist, because it made no sense to have a hospital catty-corner across the street. We were blessedly almost unaffected by the storm, as was most of that side of Fannin. So our Scurlock and Smith Towers had relatively minor issues, and Diagnostic had minor issues.
But the devastation that happened in the medical center was just jaw-dropping. And I’m not just talking Houston Methodist, I’m talking the med center as a whole. To see something that was so alive and vibrant one day, and to see the force of nature and what that can do. That was quite an experience. In many ways, it was one of the darkest hours in this institution’s history, and in many ways, it was one of the brightest, because people just pulled together and did what they had to do. People put the institution before themselves, and they put their patients before themselves, and it really helped launch some of what we have done culturally within the institution. It was one of the catalysts for our I CARE values and deepening our emphasis on our faith basis of care. So it was a tough, tough time. But like many disasters or difficult times, they either fracture something or pull it tighter. And in our case, it really pulled us together. So that was a heck of a moment.
Q | When you look at the growth here, and how Houston Methodist has really extended out into the community, was that a natural byproduct of success and growth around excellence in care and quality? Or is that the new model?
A | I think the answer is somewhat all of the above. We have, obviously, a very rich history. We will be 100 years old in 2019, so we are really preparing for how we are going to celebrate. And we talk about our vision for the second century, which is unparalleled safety, quality, service and innovation. Those six simple words really say it all from an academic institution that’s focused on patients and driving patient care. But in 1951, we were one 300-bed hospital, and wouldn’t have been that big but for Mrs. Ella Fondren, who put her foot down in the board room supporting the then- administrator who wanted to expand. And they were right. We started expanding with Houston Methodist San Jacinto Hospital. Then we decided to build a health center in Sugar Land. The idea was, here we are in the midst of HMOs, the gatekeeper model, and the hospitals are going to be passé, you don’t need hospital beds…and so they built this 20-bed health center down in Sugar Land, and it wasn’t the right model. And of course, a couple of years later, that model nationally imploded. And we re-trenched and really started focusing, and built a hospital in Willowbrook.
We learned over the next decade, and as health care evolved, and as Obamacare evolved, it became very clear that standalone, isolated, academic medical centers—whether medical school-related or not—sitting there sort of waiting for a patient volume to come to them, was a pretty risky thing to do. So in 2010, we built the West Houston facility, and it was a very different approach. But before that really, we massively expanded our hospitals in Sugar Land and Willowbrook, and have continued to expand. Sugar Land will be a 350-bed hospital in about a month. That’s a huge community hospital, and it’s not done. It will keep growing. And in 2010, we built a 193-bed hospital in West Houston, and darn if that thing didn’t just hit the ground like you wouldn’t believe.
Along the way we built another office building, now five years into it, we have pulled the trigger on a $177 million, 100-bed expansion. In a five-year-old hospital, that’s unheard of. So now we are building a 193-bed hospital in The Woodlands, and then along the way, for a variety of reasons, we picked up St. John down in Clear Lake and St. Catherine on the west side of town. Here we are today with 20,000 employees, and in the late last decade, we had under 10,000. So it has really been a remarkable growth trajectory. We are very blessed that there was a lot of good decisionmaking over time, and I think it has positioned us very well.
Q | What is your perspective of the environment in the Texas Medical Center today?
A | I think it’s a collection, unparalleled anywhere, of wonderful institutions. I think there is a lot of potential in the collaboration that happens here. From a clinical perspective, my personal belief is when we compete, patients win. And that’s what it’s all about—better care for patients. And let me be clear. When we are talking about that for Houston Methodist, yes, we are paying attention to what is happening with our competitors locally, but that is not our primary focus. We are focused on Johns Hopkins, and the Cleveland Clinic and the Mayo Clinic. Houston needs and deserves a leading academic medical center that is at the top of the top of the top of the U.S. News & World Report honor roll list. Houston Methodist is the only institution in a position to do that. We are consistently ranked as the number one hospital in Texas.
From a patient standpoint, our competition focus is elsewhere. But when we all compete, patients win. So I think that competition is good.
From an academic standpoint, collaboration is the name of the game. Every institution, I think, has to build its own robust academic enterprise, and everybody has their own areas of focus. And we turn those people loose and say, ‘Collaborate with whomever you want.’ They collaborate with every institution in the med center—including UH and Rice, as well as the more traditional medical institutions. We have something happening with everybody. We also collaborate with institutions around the country and around the world, notably Weill Cornell Medicine and Texas A&M.
What I see the Texas Medical Center focused on is how to build that collaborative environment and foster those collaborations. The part that I get most excited about is the building of the ecosystem, which is how I would describe it. So when, collectively, we can bring JLABS to the table, or we can bring other pharmaceutical or device companies, the venture capital to do this, that, to me, is how the TMC is helping build that. And we will all benefit collectively from that. Then there are some parts of it that are more architectural, geographic. We are not, at the present time, in your TMC3 activities, and really the reason is our model is translational research. Our model is embedding researchers right in with our clinical infrastructure. And we put in hundreds of millions of dollars to fund a research institute five years ago, we built with capacity, so it’s still not yet full. What I hope is that longer-term we will need more space. Short-term, we don’t. We are very excited about participating in collaborations that make a difference for patients.
Q | Any closing thoughts?
A | At the end of the day, it’s not about me. The institution is so far bigger than any one of us, even a Dr. Michael DeBakey, God bless him. He put us on a great course, and what was built is so much bigger than him now and will go on for decades and centuries, really. And that’s what we talk about, our vision for the second century. But right now we have 20,000 wonderful employees. We have 4,000 outstanding physicians, and I am absolutely confident they come to work every day saying, ‘How do we make it better for patients
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