Sciences, which offers degree programs in various fields including nursing and health-care administration. The medical school graduated its first class in 2014. More than 5,000 applicants competed for 42 slots in the class that entered the school this fall. The Virginia Tech Carilion Research

Institute, meanwhile, has attracted $80 million in federal funding. In October, the institute broke ground on a new $67 million, 105,000-square-foot building, which will allow the institute to nearly double its number of research teams to 51. Those teams are working on research that’s advancing medical knowledge and creating bioscience spinoff companies. Carilion is stimulating the local

economy in new ways. “Where we are right now was a brown field in a flood plain,” Agee says in her corner office that’s steps away from the medical school. “It’s now a thriving medical research and education complex. Across the street was an old silo and a flood plain. It’s now a fully occupied apartment building.” Restaurants, stores, a coffee shop,

an outdoor performance venue and a kayak launch on the Roanoke River have sprung up near those apartments. A few blocks away, Carilion has turned a former grocery store into an institute for orthopedics and neurosciences. “We took an abandoned building and made an amazing, thriving, gorgeous place,” Agee says. New businesses are springing up near there, too. Carilion Roanoke Memorial Hos-

pital anchors one end of the newly des- ignated Roanoke Innovation Corridor. It stretches to downtown Roanoke, the Virginia Tech Carilion health sciences and technology campus, past the Jef- ferson College of Health Sciences to the former Gill Memorial Hospital, now a business accelerator. The medical school and research

institute are the engines of the innova- tion corridor. Agee says the magic for- mula to getting those facilities built was “hard work. Having a story to tell. Hav- ing vision. Being able to do something. Building.” For a while, she says, she and Carilion’s then-Chief Medical Officer, Dr. Mark Werner, worked 90 hours a week “traveling all across the country tell- ing our story. Bringing people in … The

first few people are real important … It’s a step at a time.” So far, she says, things are going even

better than she’d expected. “I think this is more than we even envisioned. I think we had good vision and execution, but, happily, it’s come together better than the traditional sum of its parts.” It has the potential to be even better.

Agee sees the 10 four-year colleges and three medical schools that are less than 60 miles from her office as under-utilized assets. “We kind of forget that in our region we have more college-aged people than anywhere else in the state. So there is a vibrancy here that I don’t think we’ve harnessed well, and I see that as part of the future as well,” Agee says. “I think that’s incredibly exciting.” Carilion and Virginia Tech also

work to build the regional economy through tools such as the VTC Innova- tion Fund. Created in February, the fund has $15 million to invest in what it calls “life sciences and disruptive technology opportunities” that are within 150 miles of Roanoke or that have a strong connec- tion to Virginia Tech or Carilion Clinic. Agee says she and Virginia Tech

President Tim Sands share a vision. “We understand that the economic ecosystem is important to both of us,” Agee says. Being the region’s largest employer

carries responsibilities. “It makes us accountable to a wide region in Virginia,” Agee says. “It’s a responsibility we feel every day. It makes us understand that we do need to grow the region in order for us to continue to provide the kinds of clinical expertise and sophistication and primary care and access to care in an affordable way that we think people want and we want to be responsive to that.”

New role for hospitals? Things aren’t so upbeat in all of

Carilion’s coverage area. Its hospital in Tazewell County is losing money. It’s a small facility. With only 56 beds, it’s not even the largest hospital in Tazewell County. Tazewell’s unemployment rate in September was 5.5 percent. Neighbor- ing Buchanan and Dickenson counties were at 6.9 and 6.5 percent, respectively. Virginia’s unemployment was 3.7 percent that month. That part of Virginia’s economy is

changing as coal — which has lost tens of thousands of jobs to automation, energy market forces and environmental regulation — fades. Medicaid expansion helped rural hospitals in some depressed areas across the country, but Virginia didn’t expand Medicaid under Obam- acare. So, that’s a lifeline Southwest Virginia doesn’t have. “I think the next frontier has to be

Southwest Virginia and how to do things differently,” Agee says. “It’s clear we can’t keep doing the same things economically that worked in the past … It is tough in Southwest Virginia. I think there’s more attention being paid to that than in a long time. I think it will bear fruit in time.” In the meantime, Carilion is chang-

ing its focus in Tazewell to more primary care. It’s also contracted with the U.S. Department of Veterans Affairs to serve veterans in the area. Rural hospitals are likely to change a great deal, Agee says. “I think our utility and dependence

of hospitals, especially small hospitals, will decline,” she says. “I don’t think that’s a bad thing. I think we can provide really good care in new ways. The whole idea of technology is exploding … I think that’s going to change the way we do things. I think settings like urgent care, where you don’t need a whole hospital, are going to be the wave of the future. “I think we’ve got to find more

sophisticated, perhaps technological, ways to deliver care that’s less dependent on hospitals. That said, hospitals are important to the economy. Hospital care is still really important.” And things may not be as dire as

some portray them. “Even with all the conversation,” Agee says, “only two hospi- tals have closed in Southwest Virginia.”

Grandmother’s example As a woman rising over a four-

decade career through an organization and industry dominated by men, it’s almost a given that Agee faced challenges because she doesn’t a have Y chromo- some. Mentioning the old line about Ginger Rogers doing everything as well as Fred Astaire, only backwards in high heels, Agee says, “Certainly in my busi- ness there’s been some gender bias.” One source of Agee’s resilience was


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