by David E. Brown ’75
What began in the forest way south of the campus in the early 1950s as an endeavor to address a health care crisis in North Carolina — Memorial Hospital and, with it, schools of medicine, dentistry and nursing — had stretched into a complex of general and specialty hospitals, all on the same site, by the time Bill Roper took over as CEO of UNC Health Care in 2004.
As Roper departs this year, the system runs hospitals from Hendersonville in the west to Goldsboro and Kinston in the east, including Rex in Raleigh, which gives it a formidable presence in the Triangle. The now-10-year-old N.C. Cancer Hospital was a milestone on the campus at Chapel Hill, where now a large surgical tower and a new medical school building are in the works.
A foray into the Charlotte market did not work out. UNC worked for a year on a plan to partner with Atrium Health, the former Carolinas Health Care System; ultimately, the two couldn’t find enough in common.
The medical school, too, has grown while Roper did double duty as its dean, and it opened satellite teaching in three cities. The UNC System Board of Governors would like to see it enroll significantly more students.
Roper came to Chapel Hill as dean of the School of Public Health in 1997, and he was pedigreed: He’d run the Medicare system and been an aide on domestic policy for President Ronald Reagan, then directed the Centers for Disease Control and Prevention under George H.W. Bush.
Then-Chancellor Michael Hooker ’69 knew he was lucky to get a national health care expert who probably was on the move and who had no alumni ties — he asked Roper if he would commit for three years. Roper stayed for 22.
He was preparing to step down from this frying pan in May, when the fire came calling: He agreed in November to serve as interim president of the system that governs the state’s 15 public universities with the departure of Margaret Spellings. He’ll see his son, William, graduate from the medical school and still plans to take a year’s sabbatical, then return as a professor of pediatrics. Roper recently talked about how the dual role works, his disappointment over the Charlotte deal and modern medical education.
How did you anticipate UNC fitting into your career when you came here, and did you surprise yourself by staying this long?
Roper: Oh, yeah. Michael [Hooker] and his wife, Carmen, were instrumental in recruiting me here. They flew to New Jersey where my wife and son and I lived at the time, came to dinner at our house. Michael sat on the floor playing with Star Wars toys with my son, who was then 7. He said, “Bill, I don’t expect you to stay here forever, but I do ask you to commit to me that you’ll stay here at least three years.” He knew that I was not a native North Carolinian and didn’t go to school here or do medical training here, so to put it in casual terms, I think he probably thought we were just passing through, and he didn’t want it to be too short — he wanted me to have a substantive period here at the University. Happily, it’s turned out to be quite a long time.
How is the combined role of CEO and dean of the school working?
Roper: Splendidly well. When Jeff Haupt, my distinguished predecessor, began in the combined roles in 1998, he very much believed this was the right way to do it. If the two jobs had not been combined, I would not have been interested in the job. It’s that stark. The two parts of the organization … have to work closely together, and it’s not that we can sign a memorandum of understanding and everything is copacetic. There are daily transactions back and forth — money flows, parallel activities that have to be done together. So the person that’s in the role that Jeff had and that I now happily have had is, as George W. Bush famously said, I’m the decider.
The fact that there’s a single person doesn’t mean the arguments go away. The arguments happen all the time … but it is clear who’s the decider. Duke’s had this for a while, Wake [Forest] went to it seven or eight years ago — a lot of it after observing us — it’s the model for [Johns] Hopkins, the University of Washington, Michigan, Pennsylvania, UCLA. The major academic medical institutions in America have this kind of structure. It works the best.
Tell us about the talks toward a merger with the Charlotte system. Did you believe there was a way to make that work to UNC’s advantage? (It was concerns about survival in a business environment of lower reimbursements to hospitals that drove Roper to try to form a partnership with the state’s biggest hospital chain, Atrium, which would have been one of the country’s largest health care systems — about 60 hospitals.)
Roper: I was excited about the prospect of a major partnership with this first-class organization. So we put a real solid year’s worth of work into, first, the concept and then the high-level details and then the granular details and ultimately sought concurrence, approval from a variety of folks here and in Charlotte. So yeah, I’m disappointed it didn’t work out. The way I explained what happened, though, if you’re familiar with the term Venn diagram … [he draws two circles, partially concentric] … there are some things that are important to us and important to them that overlap, and we have agreement. We just could never get the circles to overlap. That’s not to say they are bad people or that they don’t do good work. It’s just the things that were core-important to them caused us some difficulty, and things that were core-important to us caused them some difficulty, and we just could never get it to overlap.
So finally in March … we said it was just time to part as friends and hopefully we can find some ways to work together other than this major partnership.
(Roper acknowledged some suggestions in the media that the failure of the Charlotte negotiations led him to leave.)
Roper: I’ve been here a whole lot longer than I anticipated. I’ve had a wonderful run here. The University, the region, the people of North Carolina have been great to me, and it’s just time. I was 70 years old [in July].
What changes need to be made in medical education, and where in that is UNC in a good position, and where does UNC have challenges?
Roper: We think we have a first-rate medical school and medical education program — educating physicians but also educating hundreds of biomedical scientists in everything from microbiology to biochemistry and on and on and on. We did a total overhaul of our curriculum that began to be implemented in 2014, and we fine-tuned it a little bit in the years since then, but it’s working very well, and the feedback that we’ve gotten — not only from our medical students but from faculty who teach them and folks who observe the process — is very, very positive.
We’ve had a lot of medical educators from around America come to Chapel Hill and spend time here learning what we are doing. We are a big medical school — we’re currently 190 students per class. It was 160 when I started. We want to go up into the 200s. The aspiration of the UNC System Board of Governors is for us to go to 230 students per class. We’re not able to do that entirely in Chapel Hill, so we now have regional campuses in Charlotte, Asheville, Wilmington and potentially other places.
What changed is we shortened the time in what most people still call the basic sciences. In the old days, when I went to medical school, it was four years — two years of classroom and laboratory work and two years with a white coat on seeing patients in clinics and hospitals. We shortened the first period to be a year and a half; we then compressed the clinical period and focused it so that by the time someone has been in medical school just over two and a half years, they are fully done with that introductory phase and clinical phase, and then there’s a substantial period of time still available to individually tailor the experience for whatever their goals are, whether it’s research, to work in other countries or to really bore into a particular clinical discipline — emergency medicine or surgery or family medicine or whatever. It permits much earlier in the process a young woman or man to individualize their experience in medical school.
The other thing we are doing — and others are, this is the way medical education is going — we’re spending an awful lot of time in inter-professional education so that our students are not only trained with other aspiring doctors but they are trained alongside and with nursing students, pharmacy students, public health students, dental students, so that there’s a real strong ethic of working as a team, because that’s the way physicians and other health professionals will practice.
The University’s satellite campus to the north once was seen as the best place to bring together health researchers of different disciplines. Now UNC is backing away from a research campus at Carolina North because the scientists don’t want to be split up geographically. What’s your perspective on that versus growing physical research facilities on the main campus?
Roper: It is undeniable that people who do research, who do technology in general, are asking for or demanding a different kind of environment. There was a time 50 to 60 years ago that RTP [Research Triangle Park] was this great idea — we’ll go away out into the woods and we’ll build some buildings, and we’ll attract people here, and they’ll do great things. And they did. But now look around, and what do people want? They want to be in the city — that’s what Durham has done so well of late, what UNC is now working to do on Franklin Street and on the campus: bring people together for working but also living spaces and all the amenities that go with it. That’s the name of the game these days.
Would it be easier if people were just willing to shut up and go where we want them to go? Sure, but we want to attract the best and the brightest, and they have other options, and so we believe that it’s in our interest, as one of the nation’s leading research universities, that we create an environment that will rival the same thing that’s available, whether in Durham by Duke or in Austin at the University of Texas, or on and on and on.
You concur that the best direction now is to keep research primarily on the main campus?
Roper: Absolutely. Increasingly we’re looking for ways to put things here. Not only patient care and medical education but research endeavors. There are complications that flow from that, including how many roads and parking spaces and all that. I freely acknowledge those points, and we’re working collaboratively with the town and with [facilities planners] to try to solve those issues.
What’s your take on whether the current system of largely private insurance coverage can continue to work, or do we need to move more toward the single payer, universal coverage, Medicare-for-all model?
Roper: That’s up for grabs, and I predict that over the next 10 years or so we’re going to have a major national debate about that. And I think there are reasonable debating points to be had about the two directions. On the one hand, it’s largely private-based — and I say largely, but it’s still the two big public programs, Medicare and Medicaid, [that] make up a large part of health care in America — but still a majority of health care is paid for from private sources.
A largely privately based system has the virtue of there’s opportunities for innovation in various pockets of the system that then can be brought to bear in others — private insurance can inform Medicare; Medicare can inform private insurance, et cetera. If we’re all one system, then one fears that can become stultifying and hamper further innovation. It doesn’t have to, but that’s a potential fear. The greater issue, though, that I would say is [that] health care in America simply costs too much, and finally the American public has awakened to that notion and is pushing back, and pushing back aggressively. We feel it in everything that we do. Everybody who pays us wants to pay less, a lot less, so Medicare does, Medicaid does, private health insurers like Blue Cross do, individuals want to pay less, on and on and on. And we ignore that to our peril. So we’ve embarked on a whole series of things to become more efficient and productive to achieve better outcomes at lower expense.
But one of the things that’s going to be hammered away is: What can we do to lower costs? To be sure, if everybody got their health care coverage, their insurance or whatever it would be called, through a single program that the government controlled, it would be more obvious that there’s one big lever to say we’re going to pay less. Now, is that a good idea? There’s a potential fear that that big lever would be abused and would end up hampering innovation and so on. On the other hand, the American public is mad as heck about this, and as that anger gets more, they may well say it’s time to say the heck with this, we’re going to go to a single-payer system. I don’t think that’s going to happen this year, but it very well could happen in the next decade. A lot is riding on sort of bigger political issues of who’s in control, where does this head, et cetera.
What advice would you give to the next dean and CEO?
Roper: I think I would say this is a wonderful institution; you’ve got the best job in America; understand it that way, and be proud of what you’re doing, because I surely am. It won’t be an easy job. It hasn’t been a cakewalk for me. But I just couldn’t feel more honored and blessed to do what I do every day. I’ve occasionally had people over the years say, “Boy, you must have a really tough job, and this must be hard,” and I say, “Come on, I get to work with the smartest people in the world who are focused on consequential things that are terribly important to the benefit of the people of this great state — what’s not to like about that?” I am an extremely fortunate person.
I think we are in a time of great opportunity in medicine and health care. We have the prospect of breakthroughs in diagnosis and treatment techniques. We’ve got much more information and analytical tools to review that information and [to] ask and answer questions that have never been accessible before.
There was a time — I finished medical school in 1974 — some of the people in my cohort have said, “Oh, I’m tired, I want to get out of practice, and I don’t advise young people to go into medicine, it’s too difficult.” I’m just the opposite. It is an exciting time to be in medicine, and truth be known, we have more applicants, better applicants than we have ever had before, and I believe that’s the case across the country. Young people are flocking to careers in medicine and in biomedical science generally.
As you become the interim system president, what are your thoughts about what your best value can be in that situation?
Roper: I think my chief desire is to lead the University’s system office with what I think I do best — to use the thing which you may have seen from World War II where they say, ‘Keep calm and carry on.’ I have one of those posters in my office. I think everybody around is interested in having a businesslike process, and that’s what I want to do. Secondly, I look forward to carrying out the agenda that my friend President Spellings so ably has put in place. People should not look for any kind of dramatic change. And thirdly, I’m hoping to make good on a promise that I’ve made to myself, and that is not to screw up.
I have no idea how long this is going to be, and ultimately it’s not up to me, it’s up to the Board of Governors. But I believe in public service as a noble calling, as George Herbert Walker Bush, whom I used to work for, said, and I think what it means to be dedicated to public service, among other things it means that when you’re asked to do something, unless you have a compelling reason not to do it, you pretty well ought to do it. That’s the mindset that I’ve carried through on this one.
David E. Brown ’75 is senior associate editor of the Review.
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