When UNC Health and Duke University Health System, based in Chapel Hill and Durham, N.C., respectively, united to build a comprehensive healthcare campus featuring the state’s first freestanding children’s hospital, the partnership was no less than the fulfillment of a long-standing dream for UNC Health CEO Wesley Burks, MD.
Dr. Burks recently sat down with Becker’s and shared his perspectives on the project, from the biggest gaps in pediatric care it aims to address to how he sees competition and collaboration evolving between North Carolina health systems.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are the biggest gaps in pediatric care that this project aims to address, and how will North Carolina Children’s reshape access to specialized care for families across the state?
Dr. Wesley Burks: For the people that live in the Triangle that take care of kids, it’s been a dream of people that work in Chapel Hill and Durham for literally decades to have a true freestanding children’s hospital that would be competitive nationally with anybody else in the country. The idea is to create a children’s healthcare system that would have a main hospital of about 500 beds, have another building of 80 to 100 beds for behavioral health, and then have an assortment of research buildings, clinic buildings, and have enough land —150 to 200 acres — to create a park-like atmosphere for the kids and the people that work there. That’s been the dream, and I was fortunate to come along at the right time at UNC, and then our partner, Duke, and then our state legislative leaders. All of us converged and became interested and worked for about a year and a half, and then we signed our agreement recently, and we’re well on our way to doing the building.
Q: UNC Health has made significant investments in expanding its statewide reach — how does this partnership with Duke fit into your long-term vision for pediatric care, and what lessons from previous expansion efforts are informing this initiative?
WB: Behavioral health issues came to the forefront for all of the healthcare providers and institutions during COVID. It was a problem before, it radically ramped up and it’s not really dissipated post-COVID at all. And for North Carolina, there is no simple facility, almost no local facilities, to take care of kids and adolescents that need short-term or long-term hospitalization for those issues. In 2023, we opened a 54-bed facility in Butner, N.C., UNC Hospitals Youth Behavioral Health, designed around two-week stays for kids and adolescents. Others will come. But what North Carolina lacks is one central place for that tertiary and quaternary care for behavioral health, so kids that really need [care] beyond two weeks. The pediatric beds in adult hospitals for mental health in their own organization are limited throughout the state, so this gives us a central place for the kids that have behavioral health issues that really need longer-term hospitalization to be able to do it. That’s the first thing it addresses.
The second thing is creating a network so that we can work with other children’s hospitals in the state that are hospitals within adult hospitals, which is typically about 10% to 15% of the rooms in an adult hospital — what it is here, what it is at Duke, other places. And so, we would work with them so that they actually could keep more of their primary, secondary care in their hospital, and then we could partner on the tertiary-, quaternary-care kids, the needs that are there. North Carolina, in the services that fly people out of state to go get care — North Carolina leads the country in the number of people being flown out of state for that tertiary, quaternary care, high-end care, that there’s not a lot of at any one place here.
For example, [for] pediatric cardiology at UNC, there are 12 to 15 physicians. At Duke, there are 25. Each of them must cover the whole gamut of pediatric cardiology. There may be one person in one area, maybe two in another, at both places, and putting those groups together then allows groups of three or four, or five, to do certain things that then develop that quaternary expertise, and then see repetitively things that, when they’re by themselves, you may see once every few months. Now, the same people are seeing them on a regular basis and develop that special expertise. And that’s what this does. It helps there so that people can stay close to home for that quaternary care that’s needed for pediatrics.
Q: This project is being called an “unprecedented partnership.” What are some of the greatest challenges in bringing together two major health systems on a project of this scale, and what will be critical to making it successful?
WB: Some may be surprised about how much collaboration there already is between the Duke Health System and UNC Health. In pediatrics, we collaborate on a number of things. We have for a long time. And even in the adult world, the education world, there are training grants where residents and fellows do their training at both places now. There’s been a long-time collaboration between the two places. But the dream had been there for a while, that vision, and the leaders came along, recognizing that in pediatrics, it’s never going to be more than 15% of adult hospital.
Craig Albanese, MD, CEO of Duke, is a pediatric surgeon. I happen to be a pediatric allergist and immunologist. And both of us trained in children’s hospitals, so we have that personal experience to draw from. North Carolina is the largest state without a freestanding children’s hospital. It’s still growing. Within a few years, it’ll be 11 million people, and we have small pediatric hospitals that right now are not providing that highly specialized care that we should be able to.
Ultimately, we were two partners trying to come together on the vision and ensuring that both of us can come together to create this and let it go off on its own, with some attachment so we can have some influence on how it’s going long term. But we had about a year’s worth of discussion, because the people who trained in children’s hospitals and were working on it had a heart for wanting to do the right thing for kids and adolescents. We got there surprisingly fast.
Q: How do you see competition/collaboration evolving between health systems in North Carolina over the next two to three years?
WB: Our mission at UNC Health is to promote the health and the well-being of the people in North Carolina. We try to provide the best possible health care and for the people that work here, provide the best place for them to work. And so that’s trying to do that better, more efficiently, trying to provide a better patient experience for more people in the greater Triangle as part of it. But a unique part of our mission is for the rural areas in North Carolina.
In North Carolina, we’re uniquely positioned, both by our mission and by being a state institution, to be able to work with a number of local, regional hospitals that need ties to a larger institution to gain the efficiencies and gain the support during emergencies, such as a hurricane or pandemic.
It is unfortunate that even here you go 50 miles from where I’m standing, and people get different care just because of the ZIP code they live in. It may not be our ability to provide that person to person, but through collaboration, through virtual care, in lots of different ways. The person who lives 50 miles per year deserves the same healthcare, and so it’s figuring out how to best do that for the rural areas. I’d say, for each of the healthcare systems, we recognized that you have to compete and collaborate where it makes sense, that you can’t do everything that you would like to do and build it yourself. That’s not feasible in the current climate of healthcare, particularly post-COVID, and then with all the federal changes that are coming.
So, people are looking to collaborate around different projects that make sense for both of them, and we are able to do it. For example, we have a partnership with Novant around education and training. We have this partnership with Duke around the children’s hospital. Here, as well as nationally, collaboration is going to increase as people try to provide the healthcare they need and a better experience, because systems are no longer able to do it all by themselves.