Joey Wahler (Host): This is WakeMed Perspectives, a limited podcast series focused on the strategic combination of WakeMed and Atrium Health. Our guest is Dr. Thad McDonald. He's a retired OB-GYN physician and Chair of the WakeMed Board of Directors. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. McDonald. Welcome.

Dr. Thad McDonald: Thank you, Joey. It's great to be here

Host: Great to have you with us. Appreciate the time. So first, how many years did you practice at WakeMed and what first brought you here?

Dr. Thad McDonald: Well, I spent about 30 years at WakeMed. I was first exposed as a third-year UNC medical student. I was lucky to be able to do three of my clinical rotations at WakeMed, and then later as a UNC OB-GYN resident. I spent about a year of my four years of training at the hospital. And I was so impressed with the hospital, especially its culture of caring, I chose to spend my career there.

Host: And looking back now, how would you sum up your experience at WakeMed?

Dr. Thad McDonald: It's really central to who I am, central to my life, central to my career. I just enjoy being a part of something bigger than myself, an organization that really cares for everyone regardless of their means, regardless of their circumstances

Host: So, what's that like to have that kind of a singular and such a significant association?

Dr. Thad McDonald: It was meaningful to me to be able to not only help folks, but I also was a teaching attending physician, and it was great for me to be able to expose other students and residents to the calling of medicine.

Host: And so, really a full all-around experience to say the least. So, how long have you been a WakeMed board member and board chair, and what first piqued your interest there?

Dr. Thad McDonald: I've been a board member for eight years. I've had the great fortune to be chair for the last three years. And when I retired, quite frankly, I really missed being a part of the hospital. And being on this board as a volunteer is a way that I could keep that relationship as well as still be around my friends and colleagues.

Host: And so, it really has been a lifelong involvement for you. And as you well know, Doctor, the healthcare industry, like so many others, faces challenges these days. But as a smaller independent health system, what are some of the obstacles unique to WakeMed that makes right now the time to explore this combination with Atrium Health?

Dr. Thad McDonald: Well, Joey, unfortunately, the deck is stacked against independent safety net hospitals like ours. Competition, especially in this area, is fierce. We are a certificate of need state, and what that means is the state of North Carolina decides who new beds are allotted to. And this is based on need and services provided. And unfortunately, CON is slowly going away, and it will go away soon. And once that happens and that protection is taken away from us, it's going to be disastrous.

We also are the largest Medicaid provider in this area, and Medicaid expansion also is slowly going away. And again, that will create huge challenges for us when that happens. Also, we're competing with Duke and UNC, both of which are much, much larger than we are.

Host: And so, how does this combination put the healthcare system in better position here to move forward?

Dr. Thad McDonald: First of all, this enables us to compete from a stronger position. Also, we are able to share not only resources but expertise. They do things, Atrium and Charlotte have services that we are not able to offer yet. Right now, we're building a cancer service so that the people of Wake County are able to stay in the county for their cancer treatment. And that's just one example of something that they will really help us build quicker and faster to provide better care for the families here in this county.

Host: Now, I know that you and yours at the WakeMed board spent significant time evaluating what's best for WakeMed's future in this whole endeavor. And so, what were the biggest or hardest few questions would you say that you were trying to address and answer along the way here?

Dr. Thad McDonald: Well, you're right. For almost two years, our executive committee, and then the task force within the executive committee, along with national consultants did rigorous due diligence in order to answer three really main questions. One, we wanted to try to understand what the future of healthcare in general looked like, and specifically, what did the future of healthcare look like for safety net hospitals like ours? Then, given the obstacles that we mentioned earlier, we wanted to ask are we financially sound enough to be able to face these challenges in the future? And then, three, if we find that we would really be financially challenged, and we do need a partner, who would best fit with our culture? So, those were the three basic things that we evaluated

Host: And speaking of which, what would you say made Atrium Health stand out and give you and the others the confidence that this is the right path forward with them?

Dr. Thad McDonald: Well, I told you we were starting a fledgling oncology service. We started back during the pandemic. And as our CEO and some of the physicians and other executives started going back and forth to Charlotte to work on our cancer program, they discovered that they felt like they were just walking out of WakeMed and back into WakeMed. They felt like they were walking into a place that was a mirror image of ours. We both have cultures rooted in service and compassion. We both have longstanding commitments to the community. And most importantly, we both share a deeply selfless mission to deliver leading-edge care for everyone.

Host: And actually, it led me beautifully there into my next question namely, WakeMed, as you mentioned, does have such a strong legacy of caring for patients regardless of their circumstances. And so, how did that mission factor into how you approached the idea of this strategic combination and trying to maintain that?

Dr. Thad McDonald: Well, our mission was central to this decision. We are a mission-driven organization. And truthfully, our mission is the lens through which all decisions are made, caring for everyone regardless of their ability to pay, caring for the least of us. And, you know, this is not just important for our community. This is important for the whole country, and will continue to be well into the future unless someday we actually have universal healthcare. And our goal, as we were answering those three questions you asked me about, was to find a way to keep this mission alive well into the future. And we feel like a strategic combination with Atrium Health is absolutely the best way to do this.

Host: You mentioned earlier that one of those three questions you asked yourselves was, what does the future of healthcare look like? I'm sure we could have a whole separate conversation and podcast just about that. But in a nutshell, for those wondering, what's the essence of the answer to that question? What is healthcare going to look like in the coming years?

Dr. Thad McDonald: I wish I had a crystal ball and I could answer that for you. But, unfortunately, now, consolidation is the name of the game. The way that reimbursement works in healthcare is kind of backwards. But the bigger you are, the better you're reimbursed by insurance companies, which kind of forces healthcare organizations to collaborate.

Just in our market, Moses Cone in Greensboro was purchased by Kaiser, which is the largest healthcare organization in the country. Duke is now working with Novant, which is probably next to Atrium, the second-largest organization in this area. Duke and UNC are doing things together. And because of that, the whole industry is moving towards consolidation.

And unfortunately, when and how that will end, I don't know. Personally, I just hope that someday we can develop some sort of universal healthcare for everyone. But politically, that doesn't seem to be very popular right now.

Host: For those joining us, Doctor, who may feel uncertain or uneasy, perhaps even a little bit anxious about this new arrangement, what would you want them to understand that maybe they don't the way that someone from the inside like yourself does?

Dr. Thad McDonald: What I would say for those still uncertain, I can say without hesitation, I completely understand. When we as an executive committee were first presented with the possibility of a combination, this was over two years ago, we were uncertain. We've always been fiercely proud of our independence and our ability to stand alone even in this fiercely competitive marketplace.

But when we put our egos aside and began our due diligence, we realized the most important thing, like I mentioned before, was our mission and keeping it alive well into the future. The uncertainty that folks have, I see as a high compliment for WakeMed, frankly. They're uncertain, because they want what's best for an organization that means something to them. And I can say, in my heart, I feel a strategic combination with Atrium Health is the best path forward for the future.

Host: And following up on that, naturally, employees may be concerned about what this all could mean for them. So, how has the board been thinking about WakeMed staff throughout this process, and what would you want them to know in particular?

Dr. Thad McDonald: Well, I would want them to know that we understand that this is unsettling. Change is unsettling for everyone. And I get it, we get it. But I also want them to understand that we feel our employees are our strength. They are WakeMed. We wouldn't be WakeMed without our employees, and I'd want them to know that how much we appreciate them, how much we support them.

And also, specifically, Atrium Health is planning on adding over 3,000 jobs locally. They're not planning layoffs, they're planning on adding jobs, and their focus everywhere is on growing and strengthening their workforce. So, I would hope that those words would help calm the nerves a little bit, but I can understand how change is unsettling

Host: Well, for employees or potential staff, I'm sure that's music to everyone's ears. In summary here, Doctor, you've done such a great job of breaking down some of the details. Overall here, what excites you most about this new combination? You've mentioned it comes with challenges, it comes with some anxious moments for sure, but it's exciting to say the least too. What's most exciting to you about it?

Dr. Thad McDonald: I just think the most exciting thing to me is together I think we can do much more and provide even better care than we are providing now. I think Atrium, quite frankly, has things they can learn from us, but there's plenty that we can learn from Atrium Health as well. I think, in the long term, it ensures that we can continue to provide this high level of care to everyone well into the future. That's what excites me the most

Host: Well, folks, we trust you're now more familiar with this combination between WakeMed and Atrium Health. Dr. McDonald, congrats on a wonderful career. Best of luck to you and everyone affected by this news. And thanks so much again.

Dr. Thad McDonald: Yeah, thanks Joey. Thank you very much.

Host: Absolutely. And to learn more about WakeMed Atrium Health and the future of healthcare in Wake County, please visit wakemed.org/wakemed-atrium-combination or keep tuning in for this very podcast, this limited podcast series, WakeMed Perspectives. If you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of WakeMed Perspectives.