How a Robust Community Clinical Practice Arm Can Support an Academic Health System’s Tripartite Mission

Abstract

Natural tension exists between the community clinical practice arm and the academic clinical practice arm within a large academic health system (AHS). Disparate salary structures, overlapping geography, competition for patients, and inequitable application of standards and resources can all lead to suboptimal system performance, as each clinical practice works to maximize individual outcomes. These tensions can lead to unnecessary duplication of resources and wasting time and energy focusing on internal politics and competition rather than on addressing external competitive threats, such as the influence of venture capital, virtual services, and retail entrants into the clinical space. At the same time, the health care landscape continues to shift, as physician ownership of practices has fallen below 50%, creating both challenges and opportunities for health systems. This article describes how, over the last 15 years, UNC Health has built a robust community practice arm called UNC Physicians Network (UNCPN) alongside the academic department structure that fully supports UNC Health’s tripartite mission. The authors describe how a community arm within an AHS can expand its clinical footprint and harmonize research and teaching efforts to support the AHS mission in a community setting. To accomplish this harmonization, UNCPN identified three high-priority focus areas for intentional investment in collaboration between the community and academic arms: (1) partnering to increase community-based research; (2) growing internal capacity for learners; and (3) scaling care delivery quality and population health initiatives across a wide geography. These intentional efforts have allowed UNC Health to improve the performance of all AHS missions: research, education, and population-based clinical care. Specifically, the number of community clinics that were actively participating in research more than doubled, from 23 practices in 2019 to 49 in 2023. In association with the UNC Schools of Medicine and Nursing, for the last few years, approximately 65–70 preceptors have been committing as many as 23,000 hours to teaching about 95 students each academic year. In addition, during that same period, the percentage of School of Medicine student learners precepted nearly doubled in UNCPN adult clinics (Family Medicine and Internal Medicine) and increased by 50% in UNCPN pediatric clinics. As the number of UNCPN clinicians increased from 44 in 2010 to 697 in 2024, the number of primary care–empaneled patients grew from 200,000 in 2019 to more than 350,000 in 2024, with currently more than 540,000 patients in total, inclusive of primary and specialty care, which has allowed scaling of high-quality care, leading to top-tier performance in value-based contracts.