Donald Gintzig has led WakeMed Health & Hospitals for 13 years and is only the fourth CEO in the Raleigh, N.C.-based system’s 65-year history. During his tenure, he has navigated industry headwinds ranging from COVID-19 and workforce shortages to mounting financial pressures reshaping healthcare nationwide.
Now, he says one of the most consequential decisions of his tenure is positioning WakeMed for the decades ahead.
On May 1, WakeMed and Charlotte, N.C.-based Atrium Health shared plans to combine into a single system. The proposed combination would bring nonprofit WakeMed under Atrium Health — also a nonprofit and part of Charlotte-based Advocate Health — and includes a $2 billion investment in Wake County, N.C., to expand facilities, grow the workforce and broaden care access statewide. Wake County commissioners have delayed a vote on the proposal.
Mr. Gintzig told Becker’s the decision followed years of planning, financial analysis and discussions about how WakeMed could continue expanding access and investing in long-term community needs while remaining financially sustainable.
He discussed the factors that convinced him the timing was right, concerns about governance and community oversight, and why he believes the proposed deal will shape healthcare in the region for decades to come.
Editor’s note: Responses were lightly edited for clarity and length.
Question: You’ve said publicly that WakeMed will survive without this deal — but you don’t think it will thrive. Walk us through the specific moment or data point that convinced you the time to act was now, while you were still in a position of strength, rather than waiting.
Donald Gintzig: It really started when we began putting together our master facilities plan, where we identified opportunities to put infrastructure in place to continue improving the health of the community. Many organizations don’t plan 10-plus years ahead on all the facilities they need to grow, increase access and meet community needs. That was a pretty sizable number.
On top of that, this came during the early part of COVID-19. We were ground zero for COVID-19 in North Carolina — the state’s first patient, on March 13, 2020, was at our hospital. We are a community safety-net system, and when staffing shortages hit, we used external staffing to make sure we kept more than 300 beds open beyond what we had the internal capacity to support, because that’s who we are. We were feeling the financial stress of that at the same time.
During COVID-19, we boldly started a cancer program for this community because, while there is excellent cancer care in the Triangle, not everyone could get care everywhere. We launched a medical oncology program to complement our surgical oncology program, and it took off right away — 10,000 patients in a year or two. Then we needed that third leg of the oncology stool to continue improving community health. We sent out a request for proposal to every major health system in North Carolina that offered those services, and only one responded — Atrium.
During those discussions, we learned Atrium shares our mission of caring for all and sounded as much like us as we did. We started looking at what we could do together around oncology and cardiology. A few years earlier, Wake Forest Baptist had joined them, and in my discussions with people there, it didn’t sound like a smaller group joining a bigger group. It was: “This has been the best thing we’ve ever done. They are who they say they are in terms of caring for the community, and they’re a very well-run, mission-focused organization.”
I’ve been doing this for more than 40 years, and there have always been headwinds. But we also looked at what we knew we needed to invest and what we knew our capacity was to borrow — and there was a gap.
The biggest issue is our primary safety-net campus in southeast Raleigh, an underserved area where life expectancy is more than 10 years lower than in other parts of Wake County. Financially, rebuilding portions of a hospital campus that are 65 years old is not easy to take to the debt market. The thing about borrowing is they want to get paid back.
Versus having access to a significant portion of your future capital needs without having to repay it because you’re joining a family that will help support those investments. That’s why I talk about surviving versus thriving. WakeMed is strong, but my concern was that the investments needed to meet the demands of this growing community far exceeded what we and outside experts believed we could support on our own over time.
Q: Wake County commissioners will appoint eight of the 14 board seats, but Atrium as sole member can remove any board member for being “disruptive” or acting contrary to the corporation’s interests. In plain terms, what actually protects WakeMed’s community mission if priorities diverge five years from now?
DG: It’s just like every other board — the local board has that ability, not Charlotte or anyone else. The county still approves the majority of the board members, as it does now. It also has special powers to hold Atrium accountable for meeting the terms of the agreement.
There are provisions preventing Atrium from spinning North Carolina operations off and selling them. Our charity care provision, which was key to the transfer agreement, is maintained, and I think it’s likely to increase because Atrium has a more generous charity care policy.
WakeMed will remain a 501(c)(3) community hospital. Like many organizations, WakeMed has a sole member, and that member’s responsibility is to act as a steward to ensure the organization’s mission, purpose and success are maintained.
Q: Announcing a deal of this magnitude — where the structure itself requires explanation — is its own leadership challenge. How did you think about the sequencing of that communication, and what have you learned from how it landed?
DG: The process needed to happen this way. Our board spent a couple of years evaluating it. Their board evaluated it. We worked through the terms, conducted due diligence and agreed to move forward.
Once we agreed we wanted to join each other’s families, the next step was getting the county to amend the transfer agreement. We educated county commissioners, involved their attorneys and worked through the details. Once that process was complete, the proposal was ready to go on the county agenda — and once it was on the agenda, it became public.
That generated excitement, concern and questions from people who deeply care about WakeMed and wanted to understand what this meant for the organization.
The early headlines — “Atrium buys WakeMed,” then “Atrium acquires WakeMed,” then “Atrium controls WakeMed” — created an opportunity to explain clearly what this is and what it isn’t. This is not a sale. This is WakeMed choosing to invest in the future of the community from a position of strength.
I have no problem standing in front of anyone and talking about what this means and why I believe it’s important for the community. In my opinion, this is the most important thing we’ll do over the next 50 years for the health of this community, especially for the uninsured, underinsured and marginalized.
The easiest thing for me to do would be to work two or three more years, retire and let someone else deal with the challenges ahead. But that’s not what leaders do, because this isn’t about me.
The last thing I would want is to come back years later and hear people say, “It’s never been the same since you left. Look at all the challenges we’re facing.”
This is not the easy thing for me or the organization to do. It’s the hard thing, but it’s the important thing. This isn’t a Donald thing. This is a WakeMed thing for our community.
Q: HR 1’s Medicaid cuts came up in your board’s early deliberations. How much did that specific policy shift change the urgency of the timeline, and how are you advising peers at comparable systems who are watching this play out?
DG: It really had nothing to do with HR 1. We started this before HR 1, but there’s always going to be an HR 1. There always has been.
One of the first things I did in healthcare was cost reports, back when hospitals were reimbursed based on cost. Then TEFRA came out, then DRG-based payment, and every time people thought the world was going to come to an end. Healthcare is resilient and incredibly important.
The pressure is figuring out how to lower healthcare costs while still providing excellent care. There isn’t one specific challenge driving this. The challenges are ongoing because costs continue rising.
The federal government doesn’t want to pay more. State governments don’t want to pay more. Employers don’t want to pay more. Insurance companies don’t want to pay more. At the same time, everything tied to healthcare costs more — drugs, supplies, labor and construction.
The answer isn’t getting bigger for the sake of being bigger. It’s getting stronger for the sake of your mission.
When people ask me how we lower healthcare costs, my answer is: Don’t get sick. A healthy person costs less than a sick person. A lot of what we can impact in people’s lives — and in our children’s and grandchildren’s lives — is helping people stay healthy in the first place.
That’s where we begin lowering healthcare costs — not through cuts, but by figuring out how to invest as much in keeping people healthy as we do in caring for people once they’re sick.
Q: You’ve been clear this is about where WakeMed is in 10 to 20 years. What does your own role look like as integration progresses, and what does success look like for you personally as a leader when you’re sitting across the table from Atrium leadership as a subordinate entity for the first time?
DG: Atrium has said they don’t want to move forward without our leadership team in place, so I have agreed to stay on and help lead the organization through the integration process for a number of years.
Then the goal is positioning this organization for whoever follows me to lead it successfully long into the future.
I’m the fourth CEO in 65 years, and I’ve been here 13 years. That’s what I want for future leaders — the opportunity to support an organization with a mission centered on relieving suffering, helping people heal and helping people stay healthy in the first place.
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