It took a half-dozen visits to Charlotte before Dr. Zeev Neuwirth decided to leave his prestigious position at Harvard Vanguard Medical Associates for a new job at Carolinas HealthCare System.
“I wasn’t ready to leave Boston,” he said. “My wife did not want to move. We had lots of friends. We had established roots.”
But with each interview at Carolinas HealthCare, “it got better and better,” said Neuwirth, who joined the system in 2011 to oversee its physician practices. “What attracted me was the vision to not just be good but to be outstanding.”
Neuwirth is one of a cadre of top-notch, sought-after doctors who’ve been recruited from big-name medical centers to Carolinas HealthCare. They bring national reputations as well as clinical trials and treatments, some of which have never been offered in this region. Not only does that fill gaps in service, it saves patients from having to travel to distant medical centers for care.
Most of the newcomers have left universities with medical schools to come to Charlotte, the largest U.S. city without a medical school. But they routinely praise the virtues of working for a growing system with big plans for transforming the delivery of health care, all set in a New South city with an agreeable climate.
“There is great advantage of being in the Southeast and being in Charlotte,” said Dr. Brent Matthews, who recently became chief of surgery at Carolinas HealthCare after a decade at Washington University in St. Louis. “We really had a hard time recruiting people to St. Louis,” he said, even though that university’s surgery program is second in the country for research funding from the National Institutes of Health.
At the same time, Carolinas HealthCare has seen some high-profile departures – some not by choice. Although these former employees often decline to speak publicly, some have raised concerns about the nonprofit system’s focus on the bottom line and lack of physician input on the governing board.
Matthews, who worked at Carolinas HealthCare Center in the 1990s, said he was surprised by how much the system changed in the 10 years he was gone. Today, it’s one of the largest nonprofit systems in the country, with annual revenue of $8 billion, more than 40 hospitals, 2,500 doctors, and 11 million patient encounters last year.
Most of the new doctors have been recruited to the Levine Cancer Institute, which opened in 2012 under the leadership of Dr. Derek Raghavan. He previously led the Cleveland Clinic’s Taussig Cancer Center, routinely named one of the best in the country.
One of his first hires was a colleague from Cleveland, Dr. Edward Copelan, who chairs the Levine Cancer Institute’s Department of Hematologic Oncology and Blood Disorders. Earlier this year, Copelan and his wife and co-chair, Dr. Belinda Avalos, from Ohio State University, opened the city’s first adult stem-cell transplant center for treatment of blood cancers such as leukemia.
The list of Raghavan’s other recruits reads like a directory from major U.S. cancer centers – Dr. Edward Kim from M.D. Anderson Cancer Center in Houston; Drs. John Gerber and Michael Grunwald from Johns Hopkins University; Dr. Saad Usmani from the University of Arkansas; and soon-to-arrive Dr. Manisha Bhutani from the National Institutes of Health in Bethesda, Md.
But cancer isn’t the only service attracting talent. Others include:• Neuwirth, who is charged with redesigning the delivery of primary care and preventive care using innovations such as group appointments for patients with similar problems who can see one doctor at the same time, for a longer visit than usual, and benefit from shared discussion.
• Dr. John Santopietro, a psychiatrist who coordinated support for grieving families and teachers after the 2012 Sandy Hook Elementary school shootings. As the new chief clinical officer for behavioral health, he’s bringing mental health services into primary care offices and oversaw the opening of a new psychiatric hospital in Davidson this spring.
• Dr. Frank Arko, a Stanford University heart surgeon who designed the first branched stent graft and implanted the first one at Carolinas Medical Center last year.
Many doctors new to Carolinas HealthCare knew little about Charlotte or the hospital system when they were first contacted.
Kim, a lung cancer researcher who had tenure at M.D. Anderson, said he was proud to work at “one of the best cancer institutes in the world” and was “very much not interested” in Levine Cancer Institute. But he knew Raghavan’s reputation as a “proven winner” and came for a look.
Raghavan said Kim seemed “a little bit condescending” during his first visit. “I’d love to have you here,” Raghavan said he told the Texas doctor. “But I don’t want you to come and look down your nose at us.”
The more Kim thought about it, the more he liked what he saw. He came to Levine as chair of solid tumor oncology and investigational therapeutics, one of Raghavan’s top two lieutenants.
“People at M.D. Anderson who were close friends of mine said, ‘What are you thinking? Why are you doing this?’ ” Kim said. “But I can tell you, I’m just starting my third year, and I have not had a single thought of regret.”
Years of building and expansion led to this point.
Leaders at Carolinas HealthCare, a public, safety-net institution, regularly emphasize their commitment to caring for the poor, but since the 1980s, they’ve also focused on increasing revenue and improving facilities and services to attract patients with insurance as well as those without.
Under former CEO Harry Nurkin and current CEO Michael Tarwater, the system has grown from a dingy hospital running in the red to a well-financed, integrated system with a national reputation.
Former chief of surgery Dr. Frederick Greene, who came to Charlotte from the University of South Carolina in 1997, recalls the pitch he got from Nurkin: “We’re building something here, and it’s an opportunity to build something in your vision.”
Raghavan liked that idea too. His stated goal is to create a “showcase operation” with a decentralized approach. That means having a strong base of cancer specialists doing research and treatment in Charlotte and making their expertise easily available to patients and doctors in outlying communities.
“It’s an exciting new concept,” said Greene, who now works for the institute. “When (doctors) come from a very strong academic background, they’re always looking for something new.”
Although Charlotte isn’t home to a medical school, Carolinas HealthCare has a long academic tradition. It has had a medical residency program since the 1940s and now trains 257 residents in 12 specialties and offers fellowships in 16 others. The system is a branch campus of UNC Chapel Hill medical school, serving 254 third- and fourth-year students.
But medical schools can sometimes be slow-moving, underfunded and reluctant to change.
For example, Kim said clinical trials get approved more quickly at Levine Cancer Institute, where a single board reviews research proposals instead of having separate boards at each hospital. “If we open a study, we can have it open at all (of the institute’s) sites the next day,” Kim said. “At M.D. Anderson, it could take anywhere from 8 months to 14 months to open a clinical trial.”
Neuwirth agreed: “This organization attracts people who have a sense of urgency. … They have an itch for making health care better.”
For example, Neuwirth recently became interested in national research showing that a low-carbohydrate, ketogenic diet can dramatically improve the health of people with diabetes. He brought leading researchers to Charlotte several times and vetted the idea with other Carolinas HealthCare experts with the idea of starting a research project here.
“It would have been difficult to do this in Boston,” Neuwirth said, because of its older, established medical culture. But when he brought the idea to system leaders, he said they told him: “What are you waiting for?”
Across the region, other medical providers have noticed what’s happening at Carolinas HealthCare.
“They are recruiting big names,” said Dr. James Boyd, a cancer specialist who practices at Charlotte’s other hospital system, Novant Health. “And that’s good for Charlotte. Patients don’t want to drive to Duke. They want to stay home (for treatment).”
But Boyd, whose oncology group is one of the few not owned by a hospital system, said he likes the freedom to refer patients to other specialists. “If I think there’s a better one at Chapel Hill or Duke or Hopkins, I don’t feel the pressure to refer internally.”
Charlotte “has been blessed with outstanding medical professionals,” said Boyd, who has been here since 1985. But he said he wishes the two hospital systems “had a little bit better working relationship” instead of competing for patients, services and equipment.
Cost of business
Former stars at Carolinas HealthCare have left, not always by choice, and complain that business-minded leaders, rather than medical leaders, dictate how the system operates.
Dr. Jeffrey Kline used to work at the Carolinas Medical Center emergency department and was vice chairman of research before he chose to leave in 2012 for a similar position at Indiana University School of Medicine .
In his exit interview, Kline said he made clear he thought the Carolinas HealthCare board should include doctors or scientists who understand the value of “knowledge creation.” Instead, he said the board is made up mostly of businessmen whose priority is to reinvest in money-making programs more than research.
“They’re putting their money in getting the best cancer doctors they can buy right now,” Kline said. “The revenue is always going to be in cancer, hearts and neurosciences.”
Kline added that Carolinas HealthCare “pays attention to national numbers in terms of salary, and they do a good job of paying an above-average salary but not too high. … They get a lot of good doctors who can’t stand the Boston winters or the Chicago winters anymore.”
Raghavan, the cancer institute leader, said money was not a major motivation for the scientists he has recruited. Instead, they’re attracted by the “unique model” for delivering care and about working for the “oncology rock stars” he hired as department and section leaders. He added that some local oncologists who joined the Levine Cancer team “had actually taken a reduction in salary, and in others the salary had remained similar.” That resulted from a change in practice, a decrease in patient care in exchange for doing research, he said.
Carolinas HealthCare declined to disclose doctors’ compensation, citing state law that requires disclosure only for its highest paid executives.
State-supported UNC Chapel Hill medical school publishes salaries for all positions. They include: chairman of surgery, $650,457; medical director of the comprehensive cancer center, $457,838; and president of the UNC Faculty Physicians group, $482,525. It’s difficult to compare jobs and compensation among hospital systems because salaries vary with the size of the institution and the scope of the job.
The 2014 Medscape Physician Compensation Report, released annually by WebMD Health Corp., shows orthopedic surgeons are the highest paid specialists, with average compensation of $413,000 a year. Family physicians are among the lowest paid, with average compensation of $176,000. The survey does not include physicians who combine clinical practice with executive leadership.
One of the reasons doctors might be leaving medical schools for Carolinas HealthCare is the “uncertainty in the marketplace,” said Dr. Kevin Schulman, a health policy researcher at Duke University. With money tight for research and education, Schulman said he’s seen doctors leaving Duke for other opportunities.
“Practice offers that might not have looked all that attractive in the past – to leave one of these big institutions – might look more attractive now.”
Also, with more systems using electronic medical records,“you don’t have to be at a special place to do clinical research anymore,” Schulman said. “You could easily envision a doctor both running a busy practice and doing clinical research. … We want research to be based on real patients and real health care settings.”
He could have been describing Carolinas HealthCare.
Dr. Roger Ray, the system’s chief medical officer, recalls seeing the “building blocks of a forward-thinking, transforming, relevant organization” when he came to Carolinas HealthCare eight years ago. Now he sees other doctors reacting similarly.
“In turbulent times, which our industry is clearly in,” Ray said, “the stability that comes from a large, well-functioning system is increasingly important to lots of folks.”