President Ellen M. Granberg offers her perspective on the announcement and the work leading up to this agreement.
Q: When did you decide that a fundamental change in the relationship with Medical Faculty Associates, Inc. (MFA) and Universal Health Services, Inc. (UHS) was needed?
A: When I arrived at GW in 2023, it was clear that we had a long-standing academic medical partnership with real strengths and a financial structure that was no longer sustainable. As we reviewed the trajectory of MFA’s operating losses and the growing scale of university support required to keep the system running, it became evident that incremental adjustments would not be enough. We needed a fundamental reset that protected our mission and GW’s financial future. The agreement we announced today establishes a sustainable framework and provides financial certainty over a defined five-year period, rather than continued reliance on open-ended university support for the MFA.
Q: Why did you come to that conclusion?
A: The underlying math simply wasn’t working. Despite efficiencies MFA put in place, there was a significant and persistent shortfall between what it cost to provide physician services and the revenue MFA received for those services under the existing structure. GW stepped in—over and over again—because we were not going to walk away from patients, students, faculty or staff doing extraordinary work. But a model that requires the university to cover large structural losses year after year after year is not a model that can be sustained responsibly. Our obligation is to be excellent stewards of this institution so we can continue to invest in students, faculty, research and our public mission in D.C. I knew that addressing this structural imbalance would be a critical job for my administration.
Q: What were your goals in the negotiations?
A: We set clear priorities from the start, which guided us at every stage of the negotiations. These were:
- Protecting patient care: Limit disruption and prioritize continuity of care for the community that relies on MFA clinicians.
- Maintaining the academic and educational enterprise: Ensure the continued strength of GW’s Undergraduate (UME) and Graduate Medical Education (GME) programs, while protecting and growing the university’s medical research portfolio.
- Creating a sustainable financial framework: Provide the university with greater financial certainty while ensuring all affected MFA team members and their patients are supported through the process.
Q: Did you achieve them all?
A: Yes. We achieved the core outcomes we needed: a sustainable framework, continuity of clinical services and a structure that maintains faculty roles and supports our education and research missions. At the same time, I want to be candid—agreements like this involve trade-offs. No one gets everything they want. What mattered to me is that we reached an outcome that protects the people and the missions we are responsible for and that positions GW well for the future.
Q: What’s different about this new agreement with UHS, and how does it protect GW from continued large financial losses?
A: This agreement supersedes the current agreement signed in 2022. The 2022 agreement was a much longer-term arrangement that became financially unsustainable for GW due to the financial losses of the MFA. Since 2022, GW has made loans to the MFA despite its losses to support the educational requirements of the medical school and to sustain the operation of the MFA’s clinical enterprise. Moving forward, GW will no longer be faced with uncapped costs associated with clinical care delivery.
The new agreement limits that financial exposure. Clinical practice operations at GW Hospital, Cedar Hill, and affiliated outpatient sites will move from the MFA to Capital Medical Group, a new physician-led nonprofit created by UHS. If Capital Medical Group generates losses, those losses will not be borne by GW. In addition, the new agreement is time-limited to five years and caps GW’s total commitment to this transition to $230 million over that period—less than half of the current rate of losses and over a much shorter period of time.
Q: What other options did GW consider before negotiating this agreement?
A: Any agreement had to provide financial certainty for GW, safeguard SMHS’s academic and research missions, and provide a sustainable path forward for clinical operations at GW Hospital. Both GW and MFA considered and analyzed numerous methods and scenarios for meeting all these objectives, and this new agreement reflects the path that GW, UHS and MFA could all agree on.
Q: What do you say to people who criticize the result?
A: I would understand why people might have strong reactions. This is personal—it affects careers, training pathways, patient relationships and institutional identity. My job is to listen carefully, take those concerns seriously and also be honest about the constraints we face. The status quo was simply not sustainable and continuing it would have created an unacceptable level of financial risk for the entire university. This agreement is about securing our academic medical mission for the long term while protecting patient care in the near term. I respect that people can disagree about elements of the structure, but I believe strongly that doing nothing was not an option—and that the agreement we have reached with MFA and UHS is the responsible path forward.
Q: Why are you continuing the relationship with UHS for five more years?
A: Because stability matters—for patients, for students and for our faculty and staff. The five-year, renewable structure provides a defined and sustainable framework that supports continuity of care, places physician practice operations under UHS financial responsibility, and preserves the UME and GME programs at GW Hospital with GW’s medical faculty serving those programs.
Q: How will this agreement affect the School of Medicine and Health Sciences and its academic mission?
A: The school's mission—focused on educating future health professionals, advancing research and improving the health of our communities—will not change. MFA clinicians moving to Capital Medical Group will retain their faculty appointments at SMHS and will continue to provide academic instruction and training and engage in research. GW will continue to fund education activities in recognition of the vital role that faculty play in teaching and mentoring students, residents, fellows and researchers at SMHS. We will continue to conduct medical research sponsored by the federal government, industry and others at non-UHS sites, and we are working with UHS to develop the new policies, procedures and access needed to continue conducting research at GW Hospital and affiliated outpatient sites. This agreement establishes a sustainable structure for clinical and academic operations—securing stable training sites, strengthening the learning environment and reinforcing our commitment to excellence in academic medicine.
Q: How does this commitment to medical education align with providing healthcare in the District of Columbia?
A: Academic medicine depends on strong, durable partnerships to support our efforts in medicine, education and discovery. The agreement provides a sustainable, long-term structure for the education of physicians and health professionals and continued access to exceptional care for patients in the District. As part of the transaction, Capital Medical Group will provide clinical services at Cedar Hill Regional Medical Center. GW is committed to ongoing engagement in community health initiatives in Ward 7 and Ward 8 to promote health equity and improved health outcomes in the community.
