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Mary E. Klotman portrait
Mary E. Klotman, M.D. Photo by Chris Hildreth

Mary E. Klotman, M.D.

Dean, School of Medicine; Executive Vice President for Health Affairs, Duke University

By MARY E. KLOTMAN, M.D., Dean, School of Medicine; Executive Vice President for Health Affairs, Duke University

In a lot of ways, Duke’s history is my history. I came here as an undergrad from New York and stayed for medical school, residency, and fellowship. I was beginning to shape my career during the ’70s and early ’80s, which was precisely when Duke was undergoing a dramatic expansion in scope and influence as a national leader in academic medicine.

Visionary leaders like Dr. Jim Wyngaarden and Dr. David Sabiston invested in bringing top scientific talent to Duke and creating a unique environment that launched the careers of countless trainees who went on to become leaders in medicine across the country. Since I had little insight into careers in medicine, I was so fortunate to have landed in a place that opened my eyes to what was possible, and I benefited from so many role models. When you train at Duke, leadership is built in as part of the plan.

What they were doing here even then, and what I’ve tried to build on ever since, was weaving together science and clinical medicine. That was unique at the time. You were exposed to a physician-scientist career path as a medical student. The third year of medical school was set aside for research. At the time that was very novel, but we’re still doing it today.

There was a culture of science in medicine on the wards at Duke that was unique at the time. I interacted with so many great physician-scientists doing bedside teaching, and that set a career path for so many of us. The idea that you could actively enlist the latest science to come up with solutions for patients, and that what you saw in the clinic could inform science, opened avenues I didn’t know were possible. It all came together when I cared for the first HIV patients at Duke and thought, “I want to be a physician-scientist studying this challenging disease.”

I did that for about 20 years at the National Institutes of Health and Mount Sinai before I came back to Duke in 2010 as chair of the Department of Medicine. But you can draw a straight line from what I learned as a medical student and resident to what we’re doing at Duke now. I learned how important the physician-scientist was in generating advances in patient care, and soon after I became dean of the School of Medicine in 2017, I created the Office of Physician-Scientist Development. In the ’70s and ’80s these things were being done department by department; now we have a more centralized structure and support from the dean’s office.

The broader version of that is what we’re primarily focused on now, which is integrating our missions of research, education, and clinical care in a deliberate and coordinated way – and we have added community partnerships as one of our core missions. We need to connect the clinical mission back to the research mission, embed our students and trainees in that environment, and connect our work with the community around us. That integration of missions is where the magic happens in academic health care. It’s what makes a place like Duke so important to the overall health care landscape. While academic health centers make up only 5 percent of health care facilities in the country, we deliver 25 percent of the care to uninsured and under-insured patients, and we are where research gets translated into better treatments.

While the model Duke exposed me to as a trainee is still the model that defines success today, how we organize and deliver on that model must evolve to maximize our success. When I was a trainee, your primary identification and work was within a single department. The driver of success now in both science and delivery of care is a team approach that crosses disciplines. Biomedical challenges are best addressed by drawing from advances across disciplines in a collaborative approach, with team members exploring different aspects of the problem and working together collectively to develop a solution. The same holds true for health care, where we can maximize the health of individuals by integrating care across disciplines.

Duke is a bigger, more complicated place than it was when I started here, and we face new challenges. But it is incredibly exciting to be a part of a place that can play such an important role in improving outcomes, saving lives while training tomorrow’s workforce. That’s what brought me to Duke in the first place, and it’s why I love doing what I do here now.