From the President: Sparking Innovation in Health Care

This fall, Duke celebrated the fiftieth anniversary of the Physician Assistant program. Most people who see a physician assistant for a cough or a sprained ankle are not aware that the idea of a physician assistant was born at Duke. In 1959, the U.S. Surgeon General had declared a dire need in the healthcare system: a national shortage of medical personnel. Eugene Stead, who was chair of Duke’s Department of Medicine for thirty years, worked with his colleagues to devise the best way to train smart, capable young people to extend capacity at Duke and elsewhere and deliver better care to patients. They developed a professional training program that could create a new member of the health-care team “to fill the gap between doctor and nurse.” Four former Navy corpsmen enrolled in 1965 as the first students in the Physician Assistant program.

The model proved successful—not just at Duke, but also across the country. Fifty years later, there are more than 100,000 certified PAs nationwide who have trained at one of nearly 200 PA programs—and physician assistant was named the most promising job of 2015 by Forbes. Stead was ahead of his time in envisioning a team approach to health care, with doctors, nurses, physician assistants, and others working together to deliver the best and most efficient patient care. Today, Duke’s PA program remains ranked first in the nation by U.S. News & World Report.

The PA program is just one example of the ways that Duke has responded to present challenges by training for the future. At Duke, we take pride in a form of education that is innovative, collaborative, and engaged with the challenges of the larger world. Throughout its history, Duke has had faculty leaders who have been able to survey the landscape of their field, locate the challenges, identify the skills and competencies that are needed, and shape the kind of training Duke provides to be responsive to these demands.

Duke Medicine has been highly successful in this endeavor, crafting specific education paths that produce new kinds of graduates who are equipped to contribute and lead. Some of these training programs are highly pragmatic: the School of Nursing offers the nation’s only distance-based HIV-AIDS Nurse Practitioner Specialty, and its Women’s Health Nurse Practitioner Program is the only such program in North Carolina.

Other emphases reflect Duke’s commitment to developing broad intellectual expertise in the medical profession. At Duke, medical students spend their third year investigating a biomedical research question. This exposure allows students to envision a future as clinician-scientists—doctors who conduct laboratory research and use the resulting insights to inform their care of their patients. This unique aspect of the Duke medical curriculum was appealing to the government of Singapore—a nation eager to train its own clinician-scientists. Today, the signature research year is an important feature of the curriculum at the Duke Medical School in Singapore.

The latest expression of Duke’s commitment to fresh thinking in the health-care arena is the creation of the Duke-Margolis Center for Health Policy. Established with a generous gift from Duke medical alumnus Bob Margolis, the center will be based at Fuqua and will draw in faculty in public policy, law, and medicine. The center aims to facilitate “translational” policy research, so that ideas about how to make our health-care system more affordable, efficient, equitable, and accessible can be moved toward implementation at the policy level. The center’s inaugural director will be Mark McClellan, the former Food and Drug Administration commissioner and a former administrator of the Centers for Medicare & Medicaid Services. His broad perspective will be invaluable as he connects with faculty members across the university to build a multidisciplinary approach to this major national challenge.

Groundbreaking work, the kind that redefines both a field of knowledge and the teaching of that field, is made possible by visionary faculty. Stead, the founder of the PA program, introduced ideas decades ago that are only now becoming part of the conversation about health care. He was one of the first to see the value of data and evidence-based medicine. He believed that, rather than memorizing knowledge that will become outdated, medical students should be trained to seek out current thinking and be open to new approaches. Stead even foresaw the impact that computers would have on medical education and health-care delivery, stating in 1972: “We are on the brink of a major technological breakthrough in the practice of complex medicine.”

I’m proud that Duke’s eminent faculty leaders—in medicine and across the university—continue to carry on this distinguished tradition of formulating and delivering the kind of education that produces future leaders in the world.