Charlotte’s first four-year medical school emerged from a high-profile failure. In August 2017, Carolinas HealthCare System, Charlotte’s largest employer, and UNC Health Care announced a merger that leaders of both organizations said would transform health care in North Carolina “by creating the most comprehensive network of primary, specialty, and on-demand care in the Southeast.”
The announcement was banner news throughout the state, and in Charlotte, it raised the possibility that the city would finally land an institution that civic leaders had said for years it needed: a four-year medical school. In 2015, a Pittsburgh-based consulting firm hired by a group of Charlotte health care and business leaders concluded that, as the nation’s largest city without one, Charlotte needed a med school to meet population growth and compensate for doctor shortages through the region. The firm, Tripp Umbach, recommended a partnership between UNC Charlotte and the UNC Chapel Hill med school’s Charlotte location, a small campus for third- and fourth-year students. But the UNC system decided a partnership with Carolinas HealthCare offered better opportunities for growth throughout the state, especially in rural areas.
Between the hosannas, officials sounded a few notes of caution. The two systems still needed to work out some basic details, like how the joint operating company would function and what it would be called. “This is like a marriage,” UNC Health Care CEO Bill Roper told reporters. “What we’re describing to you today is, we just got engaged. The wedding is still several months away.”
Neither party made it to the altar. By March 2018, UNC and Carolinas HealthCare—by then renamed Atrium Health—had ceased negotiations, mainly because they couldn’t resolve questions about who would control the combined systems’ spending. The two systems, UNC Health Care said in a release, “have determined that we cannot satisfy our mutual organizational goals through a proposed partnership and joint operating company.”
Into this subdued atmosphere, a little less than a year later, stepped Dr. Rasu Shrestha. The native of Nepal—and holder of both a medical doctorate in radiology and an MBA—had established himself as a leader in health care innovation and information technology in his nearly 12 years at the University of Pittsburgh Medical Center, which had expanded from 12 hospitals to 40 during his tenure.
Atrium Health President and CEO Eugene Woods announced Shrestha’s hiring as executive vice president and chief strategy officer in December 2018. “As Atrium Health looks ahead to how we can reimagine a brighter and bolder future for care,” Woods said, “Dr. Shrestha will help us develop the strategy and innovation to bring health, hope, and healing to more people.” Shrestha started in February 2019. Woods and other members of the system’s leadership council quickly communicated that the “brighter and bolder future” included a four-year medical school campus in Charlotte—and that the most logical partner for such a venture was Wake Forest Baptist Health, which operated its own renowned med school a mere 90-minute drive away in Winston-Salem.
“One of the first conversations that we had, Gene and myself and others in the CEO council, was, ‘All right,’ you know, ‘What’s next? Is there a “there” there in terms of the two systems coming together?’” Shrestha tells me in late April. He and the other council members examined data on Atrium’s capabilities in patient care and clinical studies and Wake Forest Baptist’s ability to conduct research and educate medical students, as well as the culture of both institutions. “It was pretty evident early on,” Shrestha says, “that … we had to do this.”
As designed, the campus will include not just classrooms and administrative offices but apartments, shops, hotels, and green space to make it accessible to the community at large.
Atrium and Wake Forest Baptist announced their plan for a Charlotte med school campus in April 2019 and the formal merger of the two systems under the Atrium name in October 2020. (Wake Forest Baptist Health, an affiliate of Wake Forest University, is the academic health system that owns the med school in Winston-Salem and a major hospital, Wake Forest Baptist Medical Center; it refers to itself as “Wake Forest Baptist” to avoid confusion with the university.) Along with the med school, Woods said, “our vision is to build a Silicon Valley for health care innovation spanning from Winston-Salem to Charlotte.” This past March, the partnership revealed the school’s planned location: a 20-acre site in midtown, next to Interstate 277 and with easy access to uptown and surrounding neighborhoods. It’s expected to break ground in early 2022 and open in 2024, and its timing grants it a distinction no one could have planned for—the project, acknowledged as a long-overdue addition to Charlotte and a fallback plan from the collapsed Atrium-UNC partnership, is expected to be the first four-year medical school campus in the United States in the post-COVID era.
Woods, citing another Tripp Umbach estimate, said last year that the med school would generate $5.2 billion and 43,000 jobs over the next two decades, which led retired Bank of America Chairman and CEO Hugh McColl to refer to the project as “the most transformative initiative in the history of Charlotte.” Whether it is or not depends on time and how to calculate degrees of transformation, and who’s doing the calculating. But its potential is immense—not just to generate economic growth in Charlotte and the region but to embrace new ways to research disease, health care, and learning about both, on the heels of the most devastating public health crisis in a century.
“I’ve seen a lot of combinations in my career, but the uniqueness of Atrium in its clinical depth and breadth, and then on the Wake side, the research and academic acumen and the clinical prowess that really adds to the legacy Atrium already has—I think that is really, really unique,” Shrestha says. “And it allows us to then bring new medicines and treatments to patients in half the time and advance economic equality in ways that we’ve not done before.”
Few would assume that an economic development asset in the packed and pricey city center would concern itself much with economic equality. But the idea is built into the med school’s conception.
From Pittsburgh—a city known nationally as a former industrial giant transformed into a hub for research and development and information technology—Shrestha knew med schools and hospitals can enhance cities’ cachet. But they don’t benefit the broader population without direct connections to the public and diversity, both economic and ethnic, in the schools’ student bodies. Officials at both Atrium and Wake Forest Baptist knew about the infamous 2014 Chetty study that ranked Charlotte 50th among the 50 largest U.S. cities in economic mobility, and they aim to orient the med school as much as they can toward the community.
They’ve designed their efforts to meet financial and physical goals. When the combined systems announced the site selection in March, they also revealed a new fund to help pay for poor students’ health sciences education throughout the Atrium system. The Bishop George E. Battle Jr. Scholarship Fund, named after a longtime community leader and former chairman of the Charlotte-Mecklenburg school board, will begin with $5 million in seed money and aim to match that amount from donations by the time the med school opens.
Plans for the physical complex, detailed in Atrium’s rezoning petition to the city in March, reflect the same kind of idea. As designed, the campus will include not just the school proper but as many as 1,000 apartments, 600 hotel rooms, shops, green space, a walking track, and places to eat and drink—the sort of mixed-use “village” concept in vogue among urban developers nationwide but not generally affixed to medical schools.
“When we’re talking about this rich ecosystem that we’re trying to foster through the medical school, through the innovations that we’re trying to bring in place, the economic impact that we’re trying to create, the social impact that we’re trying to address—it is really the community’s medical school,” Shrestha says. “I think that’s the unique element of what we’re trying to build in this post-pandemic era.”
Ideally, the overall benefits would extend far outside the city limits. Wake Forest Baptist officials signed on eagerly in part because they saw a chance to expand their system’s geographic reach, says Dr. Julie Ann Freischlag, dean of Wake Forest School of Medicine, CEO of Wake Forest Baptist, and, under the Atrium partnership, chief academic officer. The Wake Forest Baptist system, based in a city smaller than and northeast of Charlotte, tends to draw a more rural patient population from other parts of North Carolina, as well as Virginia, West Virginia, and Tennessee. Combining the systems and training more doctors in an urban environment to the south can help “marry two big groups of patients,” Freischlag says, and allow graduates in both cities to practice in urban and rural areas that desperately need doctors.
Whichever population graduates choose to serve, they’ll emphasize the value of preventive care: a general program of healthy eating, exercise, regular medical checkups, vaccinations, and other ounce-of-prevention practices that help people stay healthier for longer. It’s a boon for everyone but a pronounced need for people who lack easy access to doctors. Both Wake Forest Baptist and Atrium see extensive education in preventive care as a lodestar for the combined systems and a key to hold down health care costs—another way medical training can reinforce economic equality, Freischlag says: “Health care is never going to be affordable if everybody’s sick.”
Atrium and Wake Forest Baptist officials, and the Charlotte economic development leaders who can boast of a new addition to the city’s showroom, speak triumphantly, excitedly, about the med school plans. “It’ll be a major competitive advantage for us to be able to say that we’ve got this world-class health care research asset that’s here and that’s growing and sustaining our community,” the Charlotte Regional Business Alliance’s president and CEO, Janet LaBar, tells me in April. It’s a counterpoint to the dismay some of the same officials felt when the Atrium-UNC Health Care merger fell through, and when Charlotte took an even harder shot to its image six weeks before that.
In January 2018, Amazon announced that it had selected 20 cities as finalists for its coveted East Coast headquarters. The list, picked from 238 applicants, included several growing Southern cities, including Atlanta, Austin, Nashville, and Raleigh. It did not include Charlotte. “When I tell you I am literally shocked we didn’t make a 20-city list, I can’t overstate that,” Tariq Bokhari, a Charlotte City Council member and owner of a financial technology firm, told The Charlotte Observer. But the primary reason was simple and well known: Charlotte lacked the research and development infrastructure, mainly in major research universities, that other urban areas could claim. (Amazon eventually selected Arlington, Virginia, as the winner.)
Charlotte’s Amazon pitch, led by what was then called the Charlotte Regional Partnership, pushed a video that starred local spoken-word poet Boris “Bluz” Rogers and popularized the hashtag #CLTisPrime in an attempt to cast the city as a progressive player with a highly trained and eager workforce. Later that year, the regional partnership—which coordinated economic development efforts in the 16-county Charlotte region—merged with the Charlotte Chamber to form the Business Alliance, which unified city and regional economic development efforts. The new organization hired LaBar to lead it in March 2019, and she says the med school plans—“that last piece of the puzzle”—support the image Charlotte tried to sell to Amazon three-plus years ago.
“When you have a base of research and discovery in your market, that can truly be something that will catalyze additional economic activity,” LaBar says. “What’s exciting about it for us as an alliance, as the voice of business and as an economic development organization, is that we have something new to say and share to the world. … It’s similar to Charlotte (Douglas) International Airport. Like, this is how much of a driver this is going to be for our region.”
Specific estimates of economic impact, like the $5.2 billion and 43,000 jobs that Woods cited in March, are notoriously speculative. But Atrium officials say Charlotte can build on a core of skilled workers it already has and which the med school can complement: “Health care is the second-largest talent cluster in the city, with 47,000 clinical workers,” Shrestha says, “and that’s not including the business side of health care.” The city has an additional 21,000 people who work in data sciences, he adds, which makes Charlotte “ripe for innovation and for the things that we’re doing right now in medical education.”
LaBar says she’s confident that a med school will enhance Charlotte’s ability to attract even more jobs and corporate expansions as it competes with cities like Atlanta and, for that matter, Raleigh. She spent a decade working on economic development projects in Phoenix, including a new University of Arizona medical school, which held its first classes in 2007 and, she says, has opened development doors for that city. But how successfully the Charlotte med school can do the same depends on time and variables that can’t be calculated yet; for now, she says, a better comparison might not be Charlotte and competitor cities but Charlotte and itself a decade ago. Strong research and development hubs spin off not just jobs but unexpected opportunities for entrepreneurs to establish medical and data science startups, she says, which matches Woods’ “Silicon Valley” vision.
“This is so much bigger than just intrastate or intra-regional competition. Who knows what this is going to look like in five years?” LaBar says. “But this is going to be dramatically and remarkably different.”
Then again, if ever there was a season for health care professionals to adjust on the fly, this is it. When the time of COVID began in March 2020, leaders at Atrium and Wake Forest Baptist had to scramble to meet the pandemic’s demands on public health but, oddly, discovered an advantage in planning for the Charlotte med school. It gave them time to hone things like curriculum and technological advances and envision how a post-pandemic med school might operate. The overall merger began to bear fruit immediately, too: The two systems exchanged vaccine doses, and Atrium sent Wake Forest Baptist testing kits it lacked.
The partnership also allowed the key players to simply get to know each other better, albeit over Zoom. “We really didn’t have many places to go, right? We were sort of stuck at home,” Freischlag says. “We were able to really work the last six months … talking about what we can do, looking at where our strengths are. How do we recruit new talent? How do we partner? It’s given us a window to spend much more time with each other than we would have.
“So we actually are helping each other in many different ways in how to manage this crisis—and it’s been very helpful to sort of have a partner in crime, because it was lonely getting through this pandemic.”
As a large health care consortium, Atrium could offer Wake Forest Baptist advice on mass vaccinations and other large-scale pandemic efforts, while Wake Forest Baptist could quickly share its spear’s-tip research. Wake Forest Baptist has conducted a number of COVID clinical trials, including a study of the effects of the Moderna vaccine on high-risk people, like the elderly, racial minorities, and essential workers. Some of the lessons from the collaboration will work their way into med school curricula and can form the basis for future public health programs. “When it really hit in December, January, we all banded together against the virus,” Freischlag says, “and it felt so much better than being alone the summer before.”
The pandemic might also serve as a kind of breakwater that separates medical education as practiced before and after. Atrium is exploring how it might use advanced technology to save time, money, and aggravation for faculty and students—by, for example, perfecting video classes for students simultaneously in Winston-Salem and Charlotte, or by using virtual and augmented reality programs to replace cadavers and better illustrate the relationships among blood vessels, muscles, and bones to anatomy students. Medical education has become “stagnant,” says Shrestha, 47, since his med school days in the 1990s. “Today, there’s very little AI built into the curriculum of medical school,” he says. “One of the things that we intend to do here is really make sure that is taught alongside the specifics of how we approach diseases. … Eventually, they’re going to get out to the real world, where technology is in the fabric of how we practice care.”
The central idea is to use the “fresh start” aspects of the Charlotte medical school—first in Charlotte, first post-COVID—as a springboard to see how far doctors, administrators, and educators can push the edge of what such a school can achieve. Can it train medical students in new and better ways in a country hungry for medical innovation? Can it educate students to better consider not just the medical but the economic and ethical dimensions of health care? Can a school not just happen to improve quality of life for a whole city, or whole region, but adopt that as a goal?
The systems’ leaders say they’re committed to trying. The project wouldn’t have happened without a willingness to span all kinds of distances. “You have all these people with these experiences, you bring them together,” Freischlag says, “and you come up with something more amazing than we could by ourselves.”
Greg Lacour is the senior editor of this magazine.