As Atrium pursues WakeMed, a look inside its last big North Carolina deal

By Michelle Crouch

As Atrium Health continues its push to join forces with Raleigh-based WakeMed Health & Hospitals, its leaders have repeatedly pointed to another North Carolina deal as evidence of what to expect: its 2020 combination with Winston-Salem-based Wake Forest Baptist.

“Don’t judge us by what we say; judge us by what we’ve done,” Gene Woods, CEO of Atrium parent Advocate Health, told Wake County commissioners at a meeting this summer. 

Those commissioners must sign off on the WakeMed-Atrium deal before it can move forward.  

Woods brought Kevin High, former president of Atrium Health Wake Forest Baptist, to the June meeting to make the case. High, who had been at Baptist for 33 years, told the commissioners that Atrium’s arrival brought investment, financial stability and improved quality and access to care to Wake Forest Baptist, while allowing the hospital to retain its identity.

“The best way to predict behavior is to look at the past,” he told the commissioners. “We were integrated. We were not taken over. And we became part of a larger family.”

But what happened at Wake Forest Baptist depends largely on whom you ask. While Wake Forest Baptist hospital leaders, board members and employees have publicly praised Atrium’s arrival, more than a dozen current and former employees told The Charlotte Ledger/North Carolina Health News that the years since the combination have brought tighter staffing, reduced incentive pay and pressure to cut costs.  

Several said that, in their view, those changes have hurt morale and raised patient safety concerns.

“This is the worst I’ve ever seen it at Baptist,” said one longtime nurse who declined to be identified by name because she feared retaliation from management. “The cutting of the staff, unsafe nurse-to-patient ratios… I feel like they are making all these decisions, but they don’t know what happens on the floor.”

An Atrium spokesman said staffing plans for nursing units have not been reduced since 2020 and that budgeted nursing hours per patient day have increased.

Wake Forest Baptist leaders tout investment, jobs

Atrium combined with Wake Forest Baptist in October 2020 during the COVID pandemic. At the time, Woods promised $3.4 billion in local investment over 10 years and called the combination “life-changing” for Winston-Salem and North Carolina. 

Since then, Atrium has poured money into new facilities. That includes a $426 million emergency department/intensive care unit tower, a $100 million eye institute, a community clinic in underserved eastern Winston-Salem, two freestanding ERs and a hospital under construction in Greensboro.

Atrium’s investment also “likely stopped the closing of two rural hospitals,” High told the Wake County commissioners, referencing Hugh Chatham Health in Elkin and Alleghany Health in Sparta.

“I’ve heard concerns about how healthcare deals can lead to reduced services and closures, but that has been the opposite of our experience here,” he said.

Under Atrium, Wake Forest Baptist also adopted Atrium’s more generous charity care standards, High added, “allowing thousands more patients to receive free and discounted care.”

In an op-ed published in May supporting Atrium’s bid for WakeMed, Wake Forest Baptist board chair Matt King and former chairs Don Flow and Bill Warden credited the Baptist-Atrium combination with creating more than 8,200 jobs in the Winston-Salem area. They also highlighted six credit-rating upgrades from Moody’s that restored Wake Forest Baptist’s rating to a strong AA status.

At a four-hour public hearing before Wake County commissioners last week, about a half dozen employees of Wake Forest Baptist were among more than 100 people who spoke for and against the deal. The employees pointed to improvements since the combination, including better technology, more training, fewer serious safety events, opportunities to learn from other hospitals and expanded access to care.

“In the time since we have become part of Atrium, we have been able to expand rapidly the number of patients that we’ve been able to see, and have not had any substantive changes to our staffing models,” said Libby Pearsall, chief nursing officer at Wake Forest Baptist medical center. “We’ve seen a lot of positive gain.” 

Study: Prices rose 28 percent after Baptist joined Atrium 

Prices at Wake Forest Baptist also rose after the combination, a new study indicates, outpacing price increases at other hospitals in the state. At the request of the Ledger/NC Health News, Brown University researchers, who produced an earlier study on hospital prices, pulled out data about Wake Forest Baptist to see what happened to the price of inpatient care for patients not covered by Medicare before and after Baptist joined Atrium. 

They found Baptist’s average price per patient rose 28 percent from 2020 to 2024, compared with a 20 percent increase at other N.C. hospitals. 

Brown health economist Dan Arnold said the Atrium-Baptist price increases are a good indicator of what could happen after the proposed WakeMed partnership because it involved the same large health system in the same state expanding into a different market. He suggested Wake County commissioners consider enforceable price protections as part of the deal.

Atrium did not respond to questions about the Brown University study or to concerns that prices will rise if it combines with WakeMed.  

Employees describe tighter staffing, budget pressures

A Ledger/NC Health News reporter interviewed 25 Baptist employees and former employees, from custodians and certified nursing assistants (CNAs) to administrators and nurses. Some were reached by phone; others were interviewed in public areas outside the hospital. All were asked about what has changed since the transition. 

Every employee who still worked there asked not to be named because they feared retaliation. Atrium has frequently complained to The Ledger/NC HealthNews about reporters talking to Atrium employees without the express permission of its public relations department. Previously, a spokesman told a reporter that employees who speak to the press without permission could lose their jobs.

Most workers said they noticed relatively little change in the first years after Baptist joined with Atrium. The bigger shift, they said, came after Atrium’s December 2022 combination with Midwest-based Advocate Aurora to create Advocate Health, now the country’s third-largest nonprofit hospital system, with $39 billion in revenue in 2025.

Although most workers interviewed were critical of the changes, others had more mixed views, and a few were largely positive. 

The most consistent concern was tighter staffing, with employees from across the hospital saying they are being asked to do the same amount of work with fewer people.

Three nursing supervisors who were once largely free to run their units and support other nurses said, in addition, they now regularly carry five or six patients. CNAs described being responsible for as many as 19 patients, up from six or seven before. And four employees and one former employee said they were repeatedly told their units were “in the red” and needed to reduce staffing or see more patients to meet budget goals.

Wake Forest Baptist and affiliated entities reported $344 million in revenue above expenses, which a for-profit hospital would classify as profit, for the first quarter of 2026, according to an unaudited statement provided to investors. That’s up nearly 20 percent from a year earlier.

Several employees also described reductions to support staff, including unit secretaries. One secretary said that on weekends, she is now often assigned to cover two physically separate units, which she said means one nurses’ station is unattended at times. That worries her, she said, because that’s where patient call bells ring, and sometimes the calls are urgent.

“What if nobody’s at the desk?” she said.

‘Every night, we are calling for help’

In the labor and delivery unit, a nurse at Baptist with more than a decade’s service said nurses there have historically cared for one laboring patient at a time, especially if they were in active labor or had complications. Now, she said, she is frequently assigned to two at once.

She said that’s largely because of staffing shortages she said was due to a hiring freeze on her unit and a drop in incentive pay for picking up extra shifts — a concern echoed by nurses in other units. The extra pay used to be $20 an hour on top of regular pay, she said, but dropped to $10 an hour and then $5 an hour.

“Every night we are calling for help for nurses,” she said. “No one is going to come in for an extra $5 an hour to deal with the chaos.”

The unit also has fewer CNAs and secretaries, she said, which compels nurses to take on additional tasks such as greeting visitors, stocking supplies and setting up delivery tables, while also caring for laboring patients. 

“It’s just not safe,” she said. 

Another loss, she said, has been a dedicated interpreter for the unit, even though it serves many Spanish-speaking patients.

“Before Advocate took over, we had interpreters just for our floor. They’ve taken that away,” she said. “If you have a mom come in laboring who then hemorrhages, we’re scrambling for an interpreter to tell her what’s happening.”

Anne Marie Peery, a former night-shift charge nurse in an inpatient rehabilitation unit who left Baptist in February for health reasons, said she frequently had patients of her own while also overseeing the unit. 

“It was just too much,” said Peery, who had been at Baptist for nine years. “It was taking away from patient care.”

Peery said nurses on her unit were increasingly sent to other short-staffed units. Some went to cardiac units, she said, where they were expected to care for patients who required continuous heart rhythm monitoring, even though they had little experience in recognizing and responding to potentially dangerous changes.

A CNA who also works in rehab said she is sometimes responsible for 16 patients at a time. Many need help getting out of bed, using the bathroom, eating, bathing and more.

“If three people have to go to the bathroom, two might have an accident on themselves because I can’t get to them fast enough,” she said.

Jacob Moore, a nurse who worked in the emergency room and ICU until he left in June to join the military, said he noticed the hospital started managing staffing more tightly under Advocate.  

More nurses would be placed on “on call” status or sent home when patient counts were low, he said, and would have to be called back if more patients arrived.  But he said he didn’t think nurse-to-patient ratios had become less safe in his part of the hospital: “If anything, it ebbs and flows.”

In an email, Atrium spokesman Chris Berger did not directly respond to questions about changes to CNA staffing or cuts to secretary positions and incentive pay. But he said staffing plans for nursing units at Wake Forest Baptist have not been reduced since the 2020 combination. 

“In fact, budgeted nursing hours per patient day have gone up, not down,” he wrote. “We take any report of a nurse or CNA feeling unsafe seriously, and we welcome specific examples so we can look into them directly.”

He noted that Atrium Health leads North Carolina with “A” ratings from The Leapfrog Group in patient safety, including four of the five Wake Forest Baptist hospitals. Wake Forest Baptist’s flagship hospital in Winston-Salem earned a “B” in the latest report.

Pay bumps for lower wage workers 

An internal medicine administrator told the Ledger/NC Health News that worker complaints are inevitable during transitions. She and other workers said positive changes since Atrium came in include improved technology, more resources and the installation of security scanners at hospital entrances. 

The Ledger/NC Health News also talked to multiple employees who praised recent pay increases, although some said they had been offset by higher health insurance costs.

A phlebotomist said she is making double what she was making before 2020, and three custodians and a patient transport specialist said they have received significant boosts to their hourly rates. Atrium/Advocate has raised the minimum wage of its lowest paid workers several times, most recently to $18.85 per hour in January 2026.

“The pay increases have been good,” said a custodian who started at Baptist in 2021. “They have also become more strict on policy and rules. A few people were let go for tardiness and attendance, and that’s a good thing.”

Smaller raises for veteran employees

Experienced nurses and CNAs interviewed by the Ledger/NC Health News described smaller raises, ranging from 15 cents to $1 per hour. 

“They put all this money into the facility, but they need to treat their people better,” said a CNA who got a 25-cent-an-hour raise this year despite what she said were top performance scores. That works out to an additional $500 per year. 

“25 cents is a joke. We are the ones keeping this place running and doing the hard work, putting our blood, sweat and tears into it,” the CNA said.

In response to questions about incentive pay cuts and compensation, Berger said Atrium has made “multimillion dollar investments in base compensation for the nursing team at Wake Forest Baptist.” 

This year alone, he said, nearly 2,000 inpatient nurses received an average market increase of 3.88 percent, representing $2.6 million in additional compensation in the current budget year, or a $5.2 million annual investment. 

Nurses said starting pay has risen, helping attract new hires, but raises for veteran nurses haven’t kept pace. 

Several contrasted their 1 percent to 3 percent raises in recent years to the pay of hospital leaders. Woods’ compensation surged from $17.3 million in 2023 to $25.8 million in 2024, a 49 percent jump, and the compensation of top Atrium executives rose by an average of 41 percent during that same period.   

Workers also repeatedly raised concerns about higher health insurance costs and a narrower provider network that made it difficult or more expensive to see providers outside of Atrium.

Paula Lewis, a former medical assistant in orthopedics who left Baptist in April, said she was shocked when she tried to go to her primary care physician and learned that Atrium’s new health plan excluded all Novant providers. 

“I was like, ‘Are you serious?’” she said. “I absolutely left because of the insurance. It was the final straw.” 

Mixed reactions to supply chain changes

A supply chain employee told the Ledger/NC Health News that Baptist used to have about a dozen suppliers, but now it orders everything in bulk from three or four companies. He described the changes as positive, saying they streamlined the supply chain and saved millions on shipping.

“From a budget standpoint, it made a huge impact,” he said.  “I have nothing negative to say about Advocate.”

But supply chain changes have also led to challenges, according to two charge nurses and a CNA. They said central supply is no longer open on weekends and holidays, so units have to anticipate what they might need and stock up in advance.

“If we need something quickly, we better have it in a hidden spot where we can pull it out,” a  CNA said. “Otherwise, we wait a day or two.”

During the July 4 weekend, nurses across the hospital were scrambling to find IV fluid to mix with antibiotics, one nurse said. Another said the hospital no longer stocks items that aren’t used regularly, which could mean a delay in getting critical supplies in an emergency. 

“This is a level one trauma center for goodness sake,” that nurse said. “We don’t always have burn patients, but when we do, we need those supplies immediately.” 

What can Wake County expect?

News of the proposed Atrium-WakeMed combination became public in May, when the deal was added to the consent agenda of a Wake County board of commissioners meeting. Because WakeMed was initially paid for, in part, with county dollars and was once county-owned, the board must approve changes to a hospital transfer agreement and the hospital’s articles of incorporation for the deal to move forward.

The proposed combination would give Atrium, the state’s largest healthcare provider, significant oversight over WakeMed, a nonprofit community-based system that includes five hospitals. 

After public backlash from state and local leaders, the commissioners delayed their decision to allow more time for public input. At a series of meetings this summer, supporters and opponents have debated the potential benefits against concerns about how it would affect prices and quality of care. A media blitz in Wake County and surrounding areas has local residents encountering billboards and ads in newspapers, online and on the radio, touting the benefits of the combination. 

WakeMed CEO Don Gintzig has said talking to Wake Forest Baptist helped persuade him the combination was the right move: “What I heard from Wake Forest was this is one of the best things they’ve ever done,” he said. 

But the experiences of workers inside the hospital paint a more complicated picture of what joining a large hospital system can be like for the people who work there.

One nurse who had been at Baptist for more than 20 years said the commissioners “shouldn’t just look at it from a pocketbook standpoint. They need to look at what’s best for their constituents. Come down here and talk to staff about what it’s like.”

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