Of politics, not in politics

A recent UNC-Wilmington request to establish a third taxpayer-funded medical school within the UNC system recalls an earlier and defining chapter in North Carolina higher education.

As Harry Truman said, the only thing new in the world is the history you do not know.

In the mid-1960s, a major–and major doesn’t do it justice–political controversy began over the establishment of a medical school at East Carolina University in Greenville. The proposal pitted influential East Carolina supporters against powerful alumni of the University at Chapel Hill, home to the only public medical school at the time. The Greenville school had strong legislative support and the endorsement of governor Bob Scott.

Vernon White, a state senator and leading advocate of the school, was centrally involved in the heated political discussions. Senator White would later reminisce about the role of William Friday, founding president of the 16-campus University of North Carolina, who had gone to Raleigh to address the General Assembly after the final decision to start the school was made.

“It’s time now for all of us to move on,” Friday told the General Assembly. “We’re going to make it as fine a facility as we can … we need it focused on preparing doctors who really will care for the people in North Carolina. I am here to share with you what this will cost.”

“That ended it,” said Senator White. “You could just feel the tension, the politics, evaporate from that room. It was at that moment my admiration for Bill Friday began”.

Of politics, not in politics

President Friday would often remark that the university was of politics but that it should never be in politics. He inherited in 1972 great institutional tensions in the new system. Yet he managed to navigate among divided campuses, board members, legislators, and competing regional ambitions while shielding the university’s freedom.

It’s easy today to underestimate how difficult—physically and mentally—that balancing act was. Friday’s success came from relentless conversations, long-term relationship building, a small senior team with academic credibility, and an uncanny understanding of the university and the publics that sustain it, especially the professoriate.

A system functioning as a system

Once it was under the new system, the medical school in Greenville evolved quickly, though at great taxpayer cost. The Area Health Education Centers, President Friday’s preferred–and much less costly–way of addressing statewide healthcare shortages, developed in tandem in Chapel Hill. In Greenville, a one-year school with a phased curriculum was approved and funded. After their first year, the ECU students transferred to Carolina for their last three years. A division of health affairs was created as a foundation. Full accreditation was achieved in 1981.

By the time we finished counting, over $75 million (at least $500 million in today’s dollars) was required to establish the school.

The curricular and administrative expertise at Carolina’s medical school was indispensable in expediting the process. Individuals whose names are memorialized on buildings and centers on Carolina’s medical campus were crucially involved. As many states have now realized, new medical schools are developed more effectively, faster, and cheaper when they operate under the academic and administrative auspices of an already accredited medical school.

That was a university system functioning as a system and a governing board governing with a statewide perspective.

Re-emergent tensions

The tensions surrounding the proposed UNC-Wilmington medical school are not new. North Carolina’s campuses have long pursued institutional ambitions while the UNC system has tried to balance statewide priorities, political realities, and finite taxpayer resources. The question is whether the system still serves as a place where those competing interests are carefully evaluated before they harden into political outcomes.

We don’t have Bill Friday anymore. We do have the statewide institution he created, though it’s no longer in Chapel Hill and it’s increasingly difficult to recognize it. Its central staff has grown and tends to micromanage the campuses. Its governing board is pulled into political disputes that complicate governance but it’s still a space where discussions can happen. Campuses are obviously pursuing their own ambitions, and not just in Wilmington.

The reality of enthusiasm

It’s understandable the Seahawks are enthusiastic about the possibility of a medical school. Half a billion taxpayer dollars diverted from other towns and cities in North Carolina–and from other critical public needs–would be an economic windfall for Wilmington.  And while a medical school might elevate a regional institution’s profile or status, the relationship between medical schools and the main campus is complicated.

Medical schools today are part of large, stand-alone complexes, corporatized entitiesseparate from the campuses that house them. The school in Greenville, for example, is widely known as the Brody School of Medicine. It’s financially and operationally associated with the former Vidant Health, rebranded as ECU Health in 2022. ECU Health is legally independent from ECU and has its own “CEO,” nine hospitals, and 12,000 employees, compared to 5,700 faculty and staff on the ECU campus. Medical schools, like athletic departments, historically have siphoned donations away from other parts of the campus. And like with athletic departments, campus chancellors have little to do with their management or control.

North Carolina is a wonderful place but, like the rest of America, faces many challenges: high cost of living; clean drinking water; housing affordability; public safety; increasingly difficult student behavior; rural hopelessness; unsafe bridges and impossible traffic. Bill Friday’s achievement was insisting that decisions in the university be guided by statewide purpose, institutional autonomy, and transparently sensible stewardship of resources.

Proponents of the new school have been lobbying aggressively, perhaps seeking a unanimous endorsement from the UNC system’s governing board. That board now faces an important choice about how coherently it wants its member universities to function.

We may soon discover how many millions of dollars North Carolina taxpayers are willing to pay for institutional ego.

Dr. Art Padilla served as a senior administrator at the University of North Carolina System headquarters and later at NC State, where he was chairman of the Department of Management. He has taught at UNC-Chapel Hill, NC State, and the University of Arizona, winning several teaching awards and recognitions, including the Holladay Medal, the highest faculty honor at NC State.