В Южной Каролине призывают разделить управление медицинским университетом и клинической системой

South Carolina hasn’t been afraid to periodically restructure major public institutions when their size and responsibilities outgrew existing governance models. We saw this with the Department of Transportation this year, and in 2023, when the Legislature broke the Department of Health and Environmental Control into separate agencies with clearer missions and oversight. Today, one governing board is responsible for overseeing both MUSC's academic mission and Medical University Hospital Authority’s statewide enterprise. Together, they function as a public university, health care system, research hub, major borrower and increasingly dominant participant in South Carolina’s health care market, with facilities stretching across much of the state. The scale of this business is often underappreciated. MUSC and MUHA now oversee an organization with an annual independent budget of $8.3 billion — an amount equal to roughly 20 percent of South Carolina's entire state budget. Yet unlike state government itself, which operates under multiple layers of legislative, executive and public oversight, MUSC's academic and health care operations remain concentrated under a single governing board with no other state oversight. This is not a criticism of MUSC’s physicians, nurses, researchers or staff, nor of academic medicine itself. South Carolina benefits from all. The concern is structural: Is the current governance structure the best way to support both MUSC's academic mission and the authority’s health care enterprise? Signs of strain are becoming harder to ignore. The Hospital Authority has taken on billions of dollars in debt while expanding aggressively into fast-growing, urban and suburban markets. At the same time, questions about quality metrics, patient safety, academic rankings and long-term financial exposure have become more common, while MUSC’s educational and research missions compete with the demands of managing a sprawling statewide enterprise. None of this means MUSC is failing. It does mean South Carolina may have outgrown the governance assumptions that existed when MUSC was a much smaller and less commercially expansive institution. These concerns are not merely theoretical. During this year's legislative session, questions about MUSC's governance structure led to a proposed budget amendment to study whether separate oversight of the university and health-system functions would better serve the public. Although the amendment was not adopted, 26 senators voted to continue debating the proposal — evidence that governance questions surrounding MUSC are gaining attention among legislative leaders. South Carolina’s health care environment is changing rapidly. The repeal of certificate of need, shifting federal reimbursement pressures, increasing industry consolidation, pending repeal of non-compete clauses for physicians, debates about scopes of practice and growing public financial exposure are reshaping the health care marketplace far faster than the state’s oversight structures have evolved. In that context, maintaining a single board for both the academic enterprise and the commercial health system is no longer a neutral choice; it is a governance decision with direct consequences for patients, students, taxpayers and competitors. South Carolina should move beyond simply examining this question and seriously consider establishing separate governance and oversight arrangements for MUSC’s academic mission and its health care enterprise. Separate boards — one focused on the university’s educational and research responsibilities and another on the health system’s operational, financial and competitive footprint — would provide clearer lines of accountability, reduce conflicts of interest and better align oversight with the distinct risks each side now carries. This is not about weakening MUSC. In many ways, it is about protecting its core strengths before continued institutional sprawl further erodes them. Strong institutions require not only strong leadership, but governance frameworks capable of evolving as missions expand and stakes rise. MUSC has become one of the most consequential public institutions in South Carolina. That fact alone argues for a serious, deliberate move toward separate boards that match the scale, complexity and public impact of what MUSC has become. Dr. Marcelo Hochman and Dr. Brian Cuddy are Charleston-area physicians and founders of the S.C. Health Policy Forum. Dr. Cuddy is also a former chairman of Roper St. Francis Healthcare.