For many people in Buncombe County, Dr. William Hathaway was a familiar face on TV. In his previous role as chief medical officer of Mission Health, he regularly spoke with the media and updated county commissioners on the spread of COVID-19 and COVID-19 deaths in the community.
During the past year, Hathaway settled into a new role: CEO of the nonprofit Mountain Area Health Education Center. Western North Carolina’s local AHEC is the largest of the nine centers in the state, with over 1,000 employees and a budget of over $100 million, according to Hathaway.
Running a large nonprofit is a departure from Hathaway’s professional training. Originally from Wisconsin, he attended college at Middlebury College in Vermont and earned a medical degree at the Medical College of Wisconsin. He first came to North Carolina for his residency program at Duke University, then moved to the Asheville area in 1999 to practice cardiology at Asheville Cardiology Associates and Mission Health. He became chief medical officer of Mission Health in 2013 and chief medical officer of the North Carolina division of HCA Healthcare, which purchased Mission Health, in 2019. He joined MAHEC as CEO last year after serving on its board of directors since 2014.
Hathaway spoke to Xpress about having an impact on the community’s health care, how the opioid epidemic affected him as a cardiologist and his excitement over becoming a grandparent.
This interview has been condensed for length and edited for clarity.
Prior to joining MAHEC as CEO, you were a cardiologist for over 20 years. Why did you specialize in cardiology?
I knew I wanted to be the kind of physician my grandfather and father were, [having] longitudinal, longstanding, long-term relationships with their patients — the sort of traditional family doctor. But I also knew that I navigated toward the sickest patients and the most acutely ill patients. I love the ER and the intensive care world and I love imaging and procedures. Cardiology allows you to see patients when they come in as sick as they’ll ever be, hopefully get out of the hospital, and then you have the opportunity for that longitudinal care where you focus on their preventive measures. [I wanted] the variety and the intensity and the depth of relationships that you can create with your patients.
That sounds quite different from the administrative work that’s required of you now. How do you make sure that you’re still doing meaningful work?
[I was encouraged by] some work we did in 2005 that got published in the Journal of the American Medical Association. The trial looked at collaborative efforts across the entire state for the treatment of patients with heart attacks. Instead of waiting until the patient got to the hospital and saw the doctor and then starting care, we wanted to initiate the care in a very systematic and organized fashion — when EMS or first responders went out there, they notified the [hospital], and really sped up how care was delivered. We set up protocols that have since become adopted nationwide [and] are now standard of care. That was the first time I realized that one of the biggest rewards you can get is recognizing that you’ve impacted the delivery of care for people you’ll never meet.
When I left Duke, there was a guy named Rob Califf. Rob was my mentor and he now runs the FDA. Dr. Califf asked me when I initially went into practice: “Don’t you want to make a difference?” I thought, “I’m going to make a difference! I’ll make a difference every day with my patients!” And then I realized what he was saying. He [meant], don’t you want to change how medicine and care is delivered? Becoming the chief medical officer gave me at least hope that I would have some influence over what happened regionally in Western North Carolina. And the same is true for MAHEC. This is an organization that has a broad impact on so many different people, not the least of which are those who are most in need in our community — either because they’re sick or they have fewer resources and less access to care.
Opioid misuse is one of the biggest health care challenges affecting WNC. How has the opioid crisis impacted you personally and professionally?
When I was actively practicing cardiology, we saw a change in the cases that we took care of related to intravenous drug utilization. There’s a condition called endocarditis, which is an infection of heart valves or other parts of the heart related to bacteria getting in through needle injections and then infecting the heart. It’s a serious and devastating condition. Pre-IV drug use, we may see a handful of these cases a year. As the IV-drug crisis escalated, we would have half a dozen in the hospital at a given time. You either require surgery to fix the problem, or six weeks of IV antibiotics, or both. These are patients who are typically under- or uninsured. [We were] trying to figure out how to handle and manage these patients, and get them the care that they needed.
Personally, my best friend’s son passed away from an accidental drug overdose as a junior in college. Totally devastating and not expected. Affluent family. Just saying that to exemplify that it affects all parts of the spectrum. We typically tend to associate it with another demographic, but it’s impacting everybody.
Are you optimistic about the opioid settlement funds that are coming to counties in WNC?
When I look at the opioid dollars that are available, I’m grateful that they’re available, but I harbor no illusions that it’s a limitless supply or anywhere near enough money to [solve this crisis]. It’s just a chronic problem we’re just going to have to keep dealing with, day after day.
MAHEC is a huge institution with so many regional initiatives and educational opportunities. How do you stay on top of everything that’s happening?
The key to leading is having a fantastic leadership team. I think about [President] Ronald Reagan. I think history would judge him as a reasonably good president. He surrounded himself with smart people, right? That’s the key: Surround yourself with people who are way smarter than you are. My job is to steer the ship and not know everything that happens on it.
Is there a program you’re particularly proud of?
That’s like saying, ‘Pick your favorite child. Who’s your favorite grandchild?’ [laughs] A new leader comes into a successful organization, and the biggest fear you have is you’re going to break something. So I asked people, “What are the most important things about MAHEC? What are the things we have to maintain?” [I learned] there’s this universal commitment to doing what’s right for the patient. So, taking on the opioid epidemic — there’s no money in that. But it’s important, and our community needs it. And our commitment to mental health, because there’s a mental health crisis in this country, and the patients need it.
What are you excited about for the future?
In 2024, [MAHEC will] turn 50. We’ll whoop it up and have parties and celebrations and really acknowledge all that has been done. I’m also excited about my grandson. I had a grandson four months ago! And we’re getting a puppy.