Chapel Hill, N.C.-based UNC Health is shifting how it pays academic and community physicians, as benchmarks and workforce expectations shift, according to the system’s chief clinical officer.
UNC Health has combined both arms of its physician enterprise into a single compensation philosophy: transparent, tied to individual and collective performance, and built to flex for physicians who straddle academic and community practice.
Matt Ewend, MD, president of UNC Physicians and chief clinical officer of UNC Health, joined the “Becker’s Healthcare Podcast” to discuss the redesign, along with the system’s AI documentation tools and its approach to independent physicians.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: You’ve been at UNC for about three decades, and the last few years have seen a lot of changes in AI scribes and new documentation tools. You mentioned before there are two main tools: ambient scribing and AI chart summarization. Can you share a little bit about how those two tools have changed the way clinicians go about their workday?
Dr. Matt Ewend: We’ve been troubled, as many of my colleagues have, about the increasing burden on providing clinical care and how the joy of caring for patients and the contact with patients was being lost as we added layers and layers of electronic medical record duties and charting and other requirements. With the advent of AI scribing, and now with AI summarization tools, for the first time in my career I really feel like this technology is making things better for our clinicians.
So we started with implementing AI scribing, and many of my colleagues around the country have done the same thing. We’re just this month approaching the 3 millionth note transcribed by our caregivers. So it’s a really wonderful uptake among physicians and clinicians and medical students and folks, and what we see with that is just the ability to refocus on the patient. We have wonderful testimonies from patients that say, “My doctor sat and talked with me and looked me in the eye instead of looking at the computer screen,” and the same from the physician side, where they’re really able to reengage. And then at the end, the documentation, if it’s reviewed and done well, I think is more robust because it captures everything that was said. Sometimes I’ll look at that and be like, “Oh, I forgot we talked about that. That’s really good. Let’s leave that point in there.” So that was a wonderful addition. Step one.
The second tool that we have implemented across the whole Triangle area for all of our healthcare team members, not just the physicians and the advanced practice providers, is an AI chart summarization tool. So that tool, at the start of an encounter, reads the medical records. Sometimes it’ll come back and say, “We looked at 100,000 data points,” and it can summarize for me the story of a patient, and I can tell it what to go look for. So my practice is still in treating cranial neurosurgery patients. I focus the questions I ask it on things that impact my practice. Have there been MRIs? Are there prior instances of neurosurgery? Are there medical conditions that would impact surgery? My wife is a medical oncologist. She might ask it very different questions. Tell me about the cancer. What chemotherapy has been given? What are the recent changes in the labs? And then you can just query it and ask the question, like we all do with ChatGPT or Claude. What’s the most recent weight for this patient, or whatever point we want?
So the combination of those two — ambient scribing and an AI chart summarization tool — deployed well, I think, is really making a difference for our workforce. And particularly with the AI summarization tool, it’s not just our doctors, but our nurses, our care managers, transfer center and our access referral management people are all using that to more quickly get the information they need. They say the average medical record is half the length of Hamlet. It’s very hard in a 15-minute visit to get through half of Hamlet. I didn’t get through it in all of high school; I’m certainly not going to get through it in the morning.
Q: You mentioned that the AI scribe, and possibly even the AI chart summarization, is used by medical students. I’m curious what your policy is on at what point a medical student is allowed to use that AI technology, because I know there have been concerns about ensuring they have enough clinical judgment before using that tech.
ME: The first thing is that, as an institution, UNC Health has very firm AI governance and policies. All of our applications of AI require that it end with a human being, and all of our education is that this is a tool that you can use, but that you are responsible for what you generate with it. There is a certain set of skills that we need our medical students and our residents to learn, and we don’t want to replace that opportunity with these sorts of tools.
On the other hand, I’m firmly convinced that by the time any of those folks get out into their own practice, these tools and additional ones will be embedded in the normal workflow. So we want to teach them the basic history-taking skills. We want to teach them where they find the information they need in a hurry, but I also want them to be prepared for practice and what it will look like when they finish their career.
And that practice will include ambient scribing, AI summarization and rapid access to medical information using some sort of query function, and they need to learn to be successful practicing physicians using those tools. So certainly we don’t want to cheapen the medical education or the basic skills. But I think more and more this is part of the basic skills. When I was a medical student, we could memorize or keep on a note card everything we needed to know. But nowadays it’s more about knowing where all the information is and being able to access it. The expansion of medical information makes it impossible for almost anyone to hold it all in their mind. They have to be really good at finding it quickly, and these are just tools to find the right information.
Q: So it’s less about automatically knowing everything and more about being able to identify and access the right information, which is nearly impossible to hold in your head, anyway?
ME: Right. And we need to help our learners know there are certain things you just have to know. If a patient has a sudden emergency in neurosurgery, you need to know how to treat a patient who’s having herniation — you can’t go look that up. But if there’s so much information, you can no longer prioritize. These are the things that I must know immediately. These are the things that I need to know where to find. And then I need to be inquisitive when I face something I’ve never seen before. How do I harness the whole world of information to find new information that’s never been presented to me before? Those are kind of three different skills, and we want to help develop all three of those. And not just in the medical student; even in the people who are currently practicing, the practice of medicine is changing. The skill set I brought from Johns Hopkins in 1997, when I finished residency, isn’t the one that helps me be successful today. I built on that, but we all have to be constantly evolving in the way we deliver care.
Q: On a slightly different topic than new technology tools, but in the same vein of UNC’s current status regarding the difference between employed and independent practices, physicians and clinicians: Can you spell out that dynamic in the Triangle area?
ME: Let me frame us out as it is today. We started as a single academic hospital and a faculty practice in Chapel Hill. The healthcare system came into existence in the late ’90s. We’ve now grown to be a statewide system with 20 hospitals. We have two large physician arms: our academic arm, which we call the faculty practice, and a large community arm that we call the medical group, and these two groups all practice as part of UNC Physicians. The practices are different, somewhat, in terms of the scope of practice. Our community physicians are often spread across our state. They’re very close to the people they care for. They provide rapid access, great patient experience and really good care, often treating frontline problems. Then we have our specialists who work in the community, and then we have our academic physicians who are often quite subspecialized. A number of our hospitals have independent physicians in the community who are crucial parts of practicing at that hospital.
And so, for us as a healthcare system, we want to have a way for all of those folks to contribute to the care of patients, and for us to be able to integrate that care so that the patient feels like they’re seamlessly being cared for, not being moved from silo to silo to silo. We have a large clinically integrated network that spans much of North Carolina, and it’s about 8,000 providers of various sorts. About two-thirds of those folks are employed by UNC Health or the School of Medicine, but a full one-third of them are independent doctors or pharmacists or advanced practice providers who’ve chosen to partner with UNC Health to work on quality and value.
So the first way that we have brought a partnership between independent physicians and physicians who work for the healthcare system is through our clinically integrated network, which aligns us around those really important values. Let’s take better care of folks. Let’s make it more cost efficient. And we want to be the choice partner for independent physicians in North Carolina to work with, and that expands the impact of our healthcare system and our mission to meet the state, without requiring that if you want to work with us, you have to come be employed by us. Because not everybody wants to be employed by a big system, and I don’t think all doctors should be employed by a large system. I think there is a place in … healthcare for independent groups, for community arms of big systems and for academic arms of big systems. And we have other independent folks who work at our hospitals, even if they aren’t part of our clinically integrated network. We want them to feel like they are aligned with our mission of striving for quality, great patient experience and great provider experience, even if they’re not either employed by us or part of our clinically integrated network. So we just view it as a whole spectrum, and we want to meet each group where it is and have a way that our system interacts with them that brings value to both.
Q: Has there been a recent tension between wanting to standardize as a system versus meeting the individual needs of each group, each cohort?
ME: Yes, of course. Even within our system — within the folks who are part of our team and are employed by the system — we’re always seeking a balance between trying to get care under care pathways but also allow some variability for people in terms of their own practice. I always believe in leading with data and leading with inclusiveness in the decision-making and in the process. Not everybody can be in charge of the site, but if you bring all the neurosurgeons together to decide how to solve a particular problem and give everybody a voice in that iterative process, then when you make a decision, you’re more likely to get uptake. And then we like to come back to everybody and share the data to show the success that we’ve had.
We have hundreds of care pathways deployed across our system, and we believe we can show folks where there’s been real improvement in outcomes. And then, once it steamrolls — once people see, “Oh, that’s better, and it will be better for my patients and better for me” — it removes some of the decision fatigue of making a million decisions. But it’s certainly a step more challenging to take independent physicians who work with us as part of our CIN or at our hospitals and be inclusive in the process, but also realize that the care at our hospitals, we are accountable for. So we are going to have some standards and some care pathways that we expect everybody to follow.
Q: I have one more question. I know we’re coming up on time, but I really want to ask this. It’s related to workforce. You’ve recently changed your compensation model. Can you delve into that a bit?
ME: Sure. We start out of the gate with a large academic arm and a large community arm, and the world looks at those two groups differently. If you pull the benchmarks, they’re different for academic and community physicians. So we have a single philosophy about physician compensation. It should be transparent. It should be tied directly to individual performance and the overall performance of the care that’s delivered within the hospital or the practice. It should be easy to understand. It should be explainable, and it should be tied to work standards.
Our academic physicians have a slightly different job and scope, and they take on research and education to a deeper degree than most of our community physicians. The compensation plan needs to account for that. Our community physicians often spend more time clinically engaged, and we want to make sure the plan accounts for that. And so we just tried to build on these same principles in both groups, and that would be perfect if they never interacted with each other.
But of course, academic and community are a Venn diagram, and they overlap. So the challenge has been when we have academic and community physicians sitting side by side in the workplace but on different compensation plans. So we have worked to build hybrid plans that account for that. If you’re an academic physician but you’re spending most of your time out in what really looks like community practice, we built a separate employment model. We have different compensation plans that acknowledge this is the reality of the practice you have — the work standards, the call expectations, the involvement of residents or others — and try to have it be a sort of sliding scale. I’ll be honest, it’s a work in progress, but by starting with a single philosophy across the group and building off of that, we think we’re making progress toward a better overall compensation strategy that encourages people to provide high-quality care, facilitate access for patients and push for great pay.
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