HCA Healthcare
December 08, 2022


Source: Nashville Business Journal
Author: Joel Stinnett
Date: December 8, 2022

‘THE ULTIMATE ENTREPRENEUR’ HCA Healthcare co-founder Dr. Tommy Frist Jr. is arguably the city’s most-impactful executive in its history. It was no accident.

Dr. Tommy Frist Jr. is known for revolutionizing health care, but the 84-year-old may have also pioneered something that’s as popular with college students today as TikTok or avocado toast: the “gap” year.

Decades before Gen Zers began taking semesters-long sabbaticals from school and years prior to Mark Zuckerberg or Bill Gates dropping out of college to launch startups, Nashville’s most successful businessman walked away from Vanderbilt University in the middle of his college career.

“Being the first of five children, Dad really worried that his first son had dropped out of school,” said former U.S. Sen. Bill Frist, Tommy’s younger brother by 14 years. “He had left school because he was an entrepreneur. … This is a really important part of his early life. He was a serial entrepreneur before we really knew what that meant.”

Frist eventually returned to Vanderbilt, but in the interim, he began a business selling advertising space on desk blotters, which would sit on the lobby desk inside freshman dorms and advertise local businesses to new students. In the coming years, he also launched a trampoline park business, before founding HCA Healthcare Inc.in 1968 alongside his father Dr. Thomas Frist Sr. and businessman Jack Massey – unofficially launching what is today a $95 billion health care industry in Nashville, with more than 500 area health care companies, employing more than 328,000 people.

From a $5.25 million investment, HCA quickly grew, posting $29 million in revenue in its first year and going public on the New York Stock Exchange. Frist, a former Air Force flight surgeon, was CEO of the company twice and chairman of the board when HCA orchestrated a $33 billion leveraged buyout in 2006, the largest in history at the time.

Today, HCA (NYSE: HCA) is Middle Tennessee’s largest publicly traded company, according to Nashville Business Journal research, with nearly 11,000 local employees and $58.75 billion of revenue in 2021. The company operates 182 hospitals across 20 states and the United Kingdom, more than any for-profit hospital operator in the U.S.

But some of the key principles Frist used to make HCA successful were those he learned during his time away from school, his brother said. He grew his desk blotter advertising business to 111 universities throughout theU.S. by flying his two-seater Stinson airplane from community to community, much like he would later do at HCA to scout or buy hospitals, building his empire.

“He said, ‘The only way I can make money [advertising on desk blotters] is to do it in 50 places or 100 places,’” Sen. Frist said. “He took things to scale. It was an example of understanding scale: When there’s one hospital, that’s good. But let’s now take it to 300 hospitals. … They were good learning experiences.”

Because of his unprecedented impact on the city’s economic landscape, as well as his philanthropic efforts and personal business success, Tommy Frist was honored this week with the Nashville Business Journal’s Most Admired CEOs Legacy Award.

We recently sat down with the legendary entrepreneur to learn what aspect of health care today needs to be fixed, what he misses most about being a CEO and what kind of business he would launch today if he were a young entrepreneur. The following Q&A has been edited for length and clarity.

When you look at Nashville and the way you, your family and HCA have influenced it, what are you most proud of? That we’ve played a role in improving the lives of others. Giving back money to worthwhile causes, but also just attracting good people into Nashville.

When you talk to your children and grandchildren about how the Frist name should be carried on in Nashville, what do you tell them? I tell them that it’s hard to be a Frist. You have to run a little bit faster, walk a little bit faster, because the expectations are greater of somebody that has the Frist name.

When you look back at the early days of HCA, what’s your favorite story to tell about building HCA? I don’t have any favorites. The whole life is such a rush, exciting. One of the neat things is we’ve been able to take the blessings of what HCA has been to the family and address issues that might not otherwise be addressed in the community. It could be an art center, it could be the Nashville Zoo, it could be a whole host of things, and hopefully you bring a little value added to the city.

Is that how you have thought about your life, finding ways you could add value to the city or to people? Absolutely. I’ve been very goal-oriented my entire life. From the time I was a child, I set personal goals. From daily goals, to weekly goals and stretch goals that may be over several years.

Did you learn that from your parents? No, it came natural. I like to win.

If your father and Jack Massey could see HCA now, what would they think about it? I think you could ask the same question about Nashville itself: They wouldn’t recognize it. They would think they were in Atlanta or Dallas or somewhere else. Same way with HCA. There’s no way possible, no matter how much you’d like your dreams to come true, they wouldn’t recognize HCA. They’d be very proud of it, very pleased.

The Legacy Award, to me it’s an award really not to me, but to [former CEOs] Jack BovenderRichard Bracken, Milton Johnson and now [current CEO] Sam Hazen. It’s kind of remarkable, if you throw me into the mix, to have five people over 55 years really put their imprint on the city, the state and on health care in general in this country.