Wineka column: Dr. Smith earned respect over years at hospital

Published 12:00 am Friday, January 14, 2011

Physicians, while intelligent, also can be a stubborn, independent and strong-willed bunch.
Years ago, Rowan Regional Medical Center President Jim Freeman looked for someone to be his hospital’s first full-time chief medical officer to deal with these kinds of personalities collectively.
He turned to Dr. David N. Smith, even though in the minds of his physician colleagues it would mean a transition from “one of us, to one of them.”
In other words, a thankless job.
When Smith agreed to leave his private practice in internal medicine and become a hospital administrator, “I was elated, to say the least,” the now retired Freeman recalled recently.
“I think he liked it, and it was a new challenge to him.”
Rowan Regional Medical Center held a huge reception last week for Smith, who has just retired as chief medical officer — the vice president of medical affairs, in hospital lingo.
He held the position for 13 years, and hospital officials credit him with improving quality, diversity and the number of specialty physicians at the hospital. He plugged on through several administrations and the merger with Novant in a style his friends and peers say was gentlemanly, professional and forthright.
Freeman said Smith told him what he needed to hear.
“I made plenty of mistakes, but I would have made many more (without Smith’s counsel),” Freeman said.
Like his father before him, Smith was a trailblazer for the hospital.
His father, Dr. Jay Leland Smith Jr. — long a family practitioner in Spencer — became the hospital’s first contract physician for the emergency room and paved the way for physician coverage of the ER.
David Smith has now set the standard for chief medical officers to come.
“In 22 years, I’ve never heard anyone say one negative about Dr. Smith,” either as chief medical officer or as an internist in private practice, Dr. Steve Proctor said.
“I just think it’s amazing.”
• • •
David Smith lived the kind of boyhood you might expect in a railroad town such as Spencer.
He always seemed within sight of tracks and Southern Railway’s Spencer Shops repair facility, whether it was from his home on Rowan Avenue or his father’s family practice on Fourth Street.
“I thought sheets were supposed to be gray,” Smith said of the dirt that would collect on laundry hanging out to dry.
Smith always walked to school, as did most kids in Spencer. His first job was at Bailey’s Rexall Drugstore, where he mopped floors and performed other tasks until becoming a delivery boy at 16.
One summer, he served as a swimming pool lifeguard. In a summer home from college, he worked the third shift at N.C. Finishing Co. for $1.25 an hour. Other summer jobs while in college included work at Yellowstone National Park and a stint as a garbage collector in Spencer.
Smith spent as much time outside his father’s office as inside. He mowed the grass and painted the fence every year.
Spencer was a busy place with the Shops in full operation. “Everybody knew everybody,” Smith said, and how could they not know his father, who was basically on call all the time?
Dr. Jay Smith Jr. delivered some 2,600 babies before he retired. “He never complained about the work,” David Smith says.
And that’s the way the son recalls his own days in private practice.
“We didn’t know we didn’t have a life,” he says. “We thought we had a life.”
• • •
For a brief time, Smith actually considered geology, not medicine. But it took only one geology course at Wake Forest University (then Wake Forest College) to redirect his interest to biology and a pre-med discipline.
Smith would finish at the Bowman Gray School of Medicine in 1966. During his first summer in medical school, he worked on a research grant in microbiology. His second summer, a Duke University “externship” sent him to work at Rowan Memorial Hospital for two months.
After serving an internship at Baylor University Medical Center in Dallas, Texas, and a two-year stint with the U.S. Army Medical Corps (at Fort Hood), he returned to North Carolina for a three-year residency in internal medicine, which culminated with a one-year term as chief resident in medicine.
Smith assisted his father in Spencer for three months (July-September 1967) before reporting to the Army.
In 1972, Smith became board certified in internal medicine and returned to Rowan County, entering private practice in Salisbury with Drs. Roy Agner, Paul McCubbins and Larry Gish.
He could have practiced, of course, anywhere in the country.
“I didn’t see a good reason to move away from something I knew,” he says.
• • •
By 1979, Smith opened a solo practice in internal medicine.
When asked to name some of his mentors in medicine, Smith includes his father, Agner, and Drs. Henry Miller, Earl Watts and Jack Felts from Bowman Gray School of Medicine.
“David has been loved by his patients and has loved his patients all of his career,” Dr. Stephen Wallenhaupt, Novant’s chief medical officer said.
Dr. Chris Agner, who joined the practice that included his father and Smith in 1978, described Smith as a good judge of character and an outstanding clinician. He came to respect him greatly as a chief medical officer, Agner said.
“He’s obviously well-trained,” Freeman said. “But he’s more than well-trained. He’s just a good doctor.”
Smith said he missed his patients when he left private practice, but he never missed negotiating with insurance companies.
• • •
Smith witnessed a lot of changes at Rowan Regional over almost four decades and even his 13 years as chief medical officer.
“I got here before CT scans did,” he said, “and everyone thinks that is basic now.”
He said the hospital’s merger with Novant “helped us immensely.” And though designated hospital beds are probably down from a decade ago, because of the changes in medicine, Rowan Regional’s medical staff has doubled to more than 300, including 225 who are “very active,” Smith says.
As vice president of medical affairs, Smith oversaw credentialing, dealt with measurable quality practice standards, established standardized order sets and settled physician disputes.
Early on, he played a large role in recruiting physicians until the merger with Novant made it more of a corporate responsibility.
Freeman said he wanted Smith for the job as chief medical officer because he was a highly respected member of the medical community. Someone else would have taken a long time to make the transition from private physician to administrator, Freeman said, but Smith seemed to grasp the job within a month.
He probably knew he had “gone to the dark side,” Freeman said, when physicians shut him out of some of their meetings.
Current Rowan Regional President Dari Caldwell said testimony to Smith’s evenhanded approach was that she often heard doctors complain that he favored an opposing group. She would then go to that department and hear it make the same complaint — that Smith was too cozy with the others.
Smith told Caldwell that as long as he could keep everyone guessing, he figured he was doing a good job.
• • •
Dr. Tom Trahey has taken Smith’s place as chief medical officer.
In retirement, the 70-year-old Smith hopes to travel with his wife, Wanda, and golf occasionally.
In his younger days, Smith was an avid ocean sailor, but he hasn’t owned a sailboat since 1997.
Smith already has arranged to continue his long volunteer relationship with the Community Care Clinic by working there 21/2 days a week over 40 weeks of the year.
At his recent retirement reception, the mayors of Salisbury and Spencer read proclamations in his honor, and Salisbury Mayor Susan Kluttz announced that Jan. 6 was David Smith Day in the city.
U.S. Rep. Mel Watt, D-N.C., sent best wishes through his chief of staff.
Caldwell also presented Smith with a framed picture of the hospital. In the margins were signatures and notes from all his co-workers.
“It’s been a terrific ride,” Smith said.
Contact Mark Wineka at 704-797-4263, or mwineka@