Greensboro’s night skyline.
Greensboro’s night skyline.

CV prep

Community profile: Piedmont Triad, North Carolina

Table of Contents

South Elm Street in downtown Greensboro. The Lincoln Financial Building is in the background.
South Elm Street in downtown Greensboro. The Lincoln Financial Building is in the background.

The Triangle area may soak up the headlines coming out of North Carolina, but that wasn’t a consideration with Tony Hampton, MD.

Instead, the Cincinnati native graduated from the medical school at the University of Kentucky, looking for a good spot to do his neonatal residency. So he put a pin on the map where his mother-in-law lived near Lake Norman in North Carolina, made a four-hour circle around it and applied to every place on the radar screen. He landed in Winston-Salem, one of the anchors, along with Greensboro and High Point, which make up the Piedmont Triad area in the northern section of the state.

Technology and tobacco in the Triad

Bordered and connected by Interstates 40, 85, 73, & 74, the Triad is home The Triad by the Numbersto roughly 1.5 million people, nine secondary cities, 12 counties, and 11 colleges and universities. Agriculturally speaking, tobacco is still king, but most Americans also recognize the region as a hub for textiles and furniture design. The interior trends introduced at the annual spring market show in High Point routinely capture international attention. Other fashion-related names like Phillips-Van Heusen, Ralph Lauren, and the Brisco Apparel Company have begun moving in to capitalize on the trend. And in the last few decades, the Triad has also given the Triangle’s Raleigh/ Durham/Chapel Hill some stiff competition for high tech industries as well. Dell came on board with a computer assembly plant at the turn of the millennium, with firms like TriQuint Semiconductors hot on its heels. TriQuint has said it will invest approximately $1.8 million over a four-year period and hire 25 employees with the average wage being in the $85,000 – $100,000 range.

Overall, more than 80 manufacturers and distributors have announced or expanded their Piedmont Triad addresses since 2004. That includes Wake Forest Institute for Regenerative Medicine, which opened its doors in May 2006 and has since produced the first lab-grown organ, a bladder, to be implanted into a human. Researchers there are also harvesting stem cells from the amniotic fluid of pregnant women to study ways to form the mature cells that make up nerve, muscle, bone, and other tissue.

It obviously takes teamwork to coordinate such a draw, with organizations such as the Piedmont Triad Partnership and the Piedmont Triad Council of Governments pulling together on a volunteer basis to work in harmony. When it comes to telecommunications, the various cities and counties in the area offer similar cable TV rates, they share training for county emergency medical services staffs, and most coordinate programs such as the Area Agency on Aging. The television station news departments address the Triad, with advertising aimed at all three cities.

“The cities realize that there are tremendous benefits in being viewed as a larger area,” says Linda Roney, the vice president of business and market development for High Point Regional Health Systems in High Point. “Together, we have hockey, baseball, coliseums, a Shakespeare Festival. Individually, it’s not so hot. By working together to not duplicate services, we have really become stronger.”

The family-friendly Piedmont Triad

The Atlantic Coast Conference college basketball tournament was held in Greensboro Coliseum.
The Atlantic Coast Conference college basketball tournament was held in Greensboro Coliseum.

Hampton certainly doesn’t regret his choice. “Winston Salem is probably one of the family-friendliest areas that I have lived in,” he says. He finds plenty to do with his 6-year-old, 4-year-old, and 15-month-old children, with the Asheboro Zoo a few miles south among their favorites. “We went to the zoo back in Cincinnati this summer and, I mean, I love it but there’s so much crammed together. Here you walk a lot because all the animals are on wide open ranges.”

The family is just three hours from a beach on the Atlantic Ocean or two hours from the Appalachian Mountains, which they hit on a regular basis. Or they can stay right in town and spend the day at SciWorks environmental center and park. His daughter takes ballet lessons while another child gets ready to start karate. “If you have a young family, it’s a great place to live,” Hampton says.

That word has quickly spread throughout the medical community. It’s a

Old Salem, a living history area in Winston-Salem.
Old Salem, a living history area in Winston-Salem.

rare day when Barbara Wolfe, the director of corporate development at Randolph Hospital in Asheboro, can’t introduce a job candidate to someone else trained in that doctor’s hometown. “Even if it’s California,” she laughs. “The comment we hear most when doctors visit us is ‘Is there anybody from here?’

“We make a point to recruit from all over the country because we believe that it’s very important when physicians consult that they approach things not all from the exact same school of thought.” And that’s good news to a pool of candidates afraid they’ll continuously lose out to graduates from Wake Forest, Duke University, and the University of North Carolina, all top-notch programs located in the state.

Alethea McCullough, the director of physician recruitment for Forsyth Medical Center, sees her share of doctors moving from the north to North Carolina to escape the cold winters, but lately she’s also seeing a stream of candidates from the West and Florida, where they want to escape the high cost of medical malpractice insurance.

That may be why they come, but they stay because of perks like the school systems and cultural opportunities.

“Typically, physicians are surprised by how big the town is,” says Wolfe. “They hear our city zip code is 50,000 (population) and they think of something really small. When they get here, they see we have a mall, choices in where to eat—they are usually fairly surprised.” Just expect the iced tea you order in those restaurants to be served very sweet—this is the South, after all. That’s the only warning Wolfe can think of about the area.

Outdoor fun in the Triad

By blending the cities, a more diverse array of arts can be supported. Triad residents enjoy the Winston-Salem Symphony, Greensboro Ballet, the Weatherspoon Art Museum, and community theaters.

Bryan Park Golf Course in Greensboro.
Bryan Park Golf Course in Greensboro.

Three-day weekends are cherished in the Piedmont Triad, with folks anxious for a chance at some hiking in good weather, skiing in the winter, or even a weekender in Charlotte (about 75 minutes straight down the interstate) to catch a Carolina Panthers NFL game. And golfing in the area is tremendous, insiders say.

Chris Spongberg, MD, a hospitalist with WFUBMC, likes to spend his off hours boating and jet skiing at Lake Norman or visiting the wineries in the area. He is often in Raleigh, and once dated a woman who lived in Charlotte. In other words, folks who live in the Triad aren’t limited to the Triad’s boundaries by a long shot.

These diverse activities, as well as great weather, are drawing a senior

Tanglewood Park, a public recreational park in Winston Salem, features a riding stable, gardens and a Bed & Breakfast.
Tanglewood Park, a public recreational park in Winston Salem, features a riding stable, gardens and a Bed & Breakfast.

population these days as well. “We consider ourselves the new Florida,” Roney says.

On the flip side, the activity and weather also draw an indigent population. The rate of people living in poverty is growing at a rate of 10 percent nationally, while North Carolina as a state is registering 15 percent increases. Thanks to the tobacco, cotton, and peach crops, health systems are also seeing a fair number of undocumented patients, too.

The hospitals do their best to serve them all. Forsyth is seeing increased numbers of patients in general, according to McCullough. “That trend also represents our biggest challenge—how to best serve the growing demand in our communities and neighborhoods. Part of that trend includes providing health care to more uninsured patients.”

Southern hospitality

Greensboro’s night skyline.
Greensboro’s night skyline.

“We have a lot of recruits who say the thing that swayed them on coming here was spending time in this community on their own, and how nice people were,” says Wolfe. “We encourage candidates to go to the Wal-Mart and stop and ask somebody what they think of the hospital or practice the doctor is interviewing with.” She’s that confident the answer from someone with no vested interest will be positive. Just be aware that the hospitality cannot make up for the fact this can be a lonely place for singles, warns Spongberg. A New York native, he came to the Chapel Hill area as an undergraduate at UNC Chapel Hill, then went to med school at UNC Greensboro. He wasn’t the typical college student—Spongberg first worked at General Electric in corporate finance before tossing that career to get a PhD in health psychology, “which started the slippery slope toward med school,” he jokes.

There’s one trend he hasn’t been able to buck yet. “They say if you come into your residency here single, you leave single,” he notes. He blames it on sheer population numbers, as the same ad he ran on Match.com in Winston-Salem generated far fewer responses than when he ran it for Raleigh.

He’s also found himself out of step at times with the conservative, religious-based demographics surrounding him. “It will be a part of your practice,” he says. “People will ask you what religion you are, and you’ll hear ‘I’m a Christian’ a lot. If church isn’t a big part of your life, it cuts off an important social outlet.”

Wolfe says a vascular surgeon recently moved away because Asheboro doesn’t offer parochial schools, and his wife wanted their children to receive a private education. Beyond that, she can’t recall any specific reasons doctors leave or turn down a job offer. As for Hampton, his only complaint is that he can’t satisfy his hankerings for Skyline Chili.

Money goes a long way in the Piedmont Triad. For starters, several of the systems use national salary averages such as Sullivan, Cotter and Associates and MGMA data as a benchmark, “because we don’t’ feel like we are competing within Piedmont for a physician,” says Wolfe. “We are competing within the country.”

All areas of the cost of living are low here, particularly real estate. For instance, Hampton likes the fact he could buy a 2,500-square-foot ranch with four bedrooms on a plot of land for $140,000. His short stint living in California, paying $880 a month to rent a two-bedroom apartment with another student, makes him appreciate the mortgage payment even more. “And I have like five times more space than we had out there,” he adds.

Hampton also looked into area’s tax system before accepting his residency position. Had he chosen Charlotte, he claims the most economical option was to live in South Carolina and drive 45 minutes to work each morning.

To keep malpractice rates in check, Forsyth, part of Novant Health, created its own malpractice insurance company in May 2007. Officials at Novant say the idea to form the company, known as New Star, initially came from surveys and interviews with doctors who expressed tremendous concerns about the dramatically rising costs of medical malpractice premiums. Some specialists reported paying more than $50,000 a year in insurance premiums alone. The move also ensures high-risk specialties like obstetrics can continue to practice in Piedmont Triad without threats of extinction.

Hospitals systems in the Triad

The all-for-one mentality shown by the Triad’s cities doesn’t extend to the hospital systems, however. Each city has its major system—Moses Cone Health System in Greensboro, Forsyth Medical Center in Winston-Salem, and High Point Regional—plus the all-encompassing Wake Forest University Baptist Medical Center. On the other hand, competition means each of the systems has carved out its particular niche—Forsyth Medical Center, for example, has an extensive single-site birthing center, while Wake Forest has a pediatric emergency and trauma center with equipment designed and sized specifically for children.

Hospitals in the Piedmont Triad take pleasure in making sure they don’t follow the leader in their quest for excellence, which means each facility is a leader on its own:

Moses Cone Health System:  A new heart and vascular center is the first clue this Greensboro system, which encompasses five hospitals and 1,100 licensed beds, prides itself on cardiology care. It is working on becoming an accredited chest pain center as well, reports Rebekah Driggers, the manager of physician and specialty recruitment at Moses Cone. It was recently awarded a stroke certification and is home to the first free-standing women’s OB hospital in North Carolina. Add a regional cancer center to its list of specialties, too.

High Point Regional Health System: This 384-bed hospital recently applied under the state’s certificate of need status to expand to a 400-bed facility. As the tertiary care hospital in the Triad, it covers a southern territory that stretches halfway to Charlotte. “And we offer a lot more specialties than you would normally find in a 380-bed hospital,” Roney points out. Count on physicians here to handle open-heart surgeries, neurosurgery, and stroke treatments—everything except transplants and major pediatric illnesses. Its sleep lab is accredited, as well as its inpatient rehabilitation program.

High Point Regional also is a magnet hospital for nursing excellence. “When it comes to turnover, we blow everybody out of the water, including our competition in the Triad,” Roney says. “We know in order to have a well-run hospital, we need nurses and so we put a lot of resources into that effort and it shows.”

Wake Forest University Baptist Medical Center:  WFUBMC is the largest health-care system in the Triad, and the region’s only academic medical center. It is comprised of the 872-bed North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the School of Medicine. This year it won the 2006-07 Consumer Choice Award for the Winston-Salem metropolitan area—a designation to honor hospitals that consumers rate as having the highest quality and image. U.S. News and World Report also consistently ranks WFUBMC as one of America’s best hospitals. Of the 169 doctors from the Winston-Salem metropolitan area included in the latest update of Best Doctors in America, almost 90 percent—that’s 149 doctors—are at WFUBMC.

Forsyth Medical Center: Welcome to the first certified stroke, hip joint replacement, knee joint replacement, and congestive heart failure programs in North Carolina. The hospital also has joined a national coalition to provide free electronic prescribing capabilities for every physician in America. The 847-bed facility will add 114 patient care beds in a new wing to open later this year.

Forsyth Medical Center and Novant Health have received numerous awards for patient care in recent years, but what makes McCullough’s list of accomplishments is the fact that the employees of Forsyth Medical Center and its affiliates received the North Carolina United Way employee spirit award.

Randolph Hospital:  Patient satisfaction scores for these 145 licensed beds in Asheboro are in the 98 percent range, so it’s no wonder Wolfe can say Randolph is one of three in North Carolina to win a national quality award for phenomenal care. Its cancer center is accredited with commendations, and the American Diabetes Association has recognized it for its quality diabetes self-management education program.

Physician jobs in the Triad

Hampton just hopes he can find a permanent position when his residency ends. At the moment, he puts his chances at a neonatal spot opening up in the next 12 months at 50/50. Recruiters may have a more positive prediction. After all, says Wolfe, “All of a sudden in the last year, our local practices have really started to recruit physicians in the double digits. For a while, there had not been such a demand. But right now, almost every primary care practice in town is recruiting.” The numbers are saying to her that not only is the population growing, but folks are choosing to stay home for their medical care rather than seek out other metropolitan centers in the state.

It’s the same story at WFUBMC. According to William Applegate, MD, MPH, the interim president of Wake Forest University Health Sciences and dean of the medical school, North Carolina is expected to grow in population by more than 40 percent in the next 25 years, so he projects a shortage of all types of doctors.

Moses Cone conducts a community needs assessment every five years in an attempt to head off any shortages in Greensboro. Right now, Driggers is helping private practices recruit in neurology, while the hospital wants to talk to general surgeons to fill some retirements in the pipeline. The reports say numbers for GI, hematology, oncology, nephrology and ophthalmology will dwindle in the near future, creating openings there.

Meanwhile, Roney says she doesn’t need any physicians at the moment, although High Point, too, brings in a consulting firm to project physician demand over three-year increments so that is likely to change in the future.

The question most physician candidates ask, says Driggers, concerns call schedules. In her case, private practices average one day in seven, with some as high as one in nine.

If he doesn’t find a permanent position and considers leaving the area, Hampton says his family will not be pleased. “My wife told me I’ll have to drag her out of our house kicking and screaming. To put it plainly,”  says Hampton, “she loves the area.”

Writer Julie Sturgeon is a regular contributor to UO.

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Julie Sturgeon

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