A Time of Transition

“The only constant is change” is a commonly used quote and a very fitting description of the current state of our organization. As we pass the one-year anniversary of being a department, settle into the newly formed Duke Health Integrated Practice (DHIP), which became effective on July 1, 2023, and work through the dissolution of the Private Diagnostic Clinic, PLLC (PDC); this period marks the beginning of a new chapter for Duke Health and the faculty and staff at Duke.

With change can bring a sense of uncertainty. However, we can also take this time to envision possibilities and opportunities of a more aligned and integrated academic medical center. The formation of DHIP formalizes the physician practice as part of the Duke University Health System, resulting in one unified organizational structure and pay source for Duke physicians. The initial phase of work, coined the “lift and shift,” saw the transition of functional and operational areas from the PDC to DHIP. Yet, the full realization of alignment and integration will require patience and perseverance. 

There has been a concerted attempt to make the transition as seamless as possible; nonetheless there are a number of real differences in DHIP. With physician clinical and academic effort under one umbrella, the way this is reported has changed from total professional effort, measured in hours, to a system which tracks faculty effort using a new unit of time called calendar months or person months.

The creation of DHIP has also resulted in new benefit changes, including increased paid parental leave. All DHIP physicians are now eligible to participate in federal student loan forgiveness programs, which was previously not available to PDC members, based on the PDC’s for-profit designation. The health system and School of Medicine’s non-profit status has removed this barrier.

Additionally, the financial reporting of clinical revenue is another area that will change considerably. The PDC had a cash-based accounting system, while the DHIP will use an accrual-based accounting methodology to book clinical revenue. The difference between the two approaches lies in the timing of when revenues and expenses are recognized.

Despite these changes, the Department of Emergency Medicine continues to focus on achieving excellence across the core domains of clinical care, research and education. The commitment to our mission - to create inclusive access and deliver the highest quality care; to lead in innovation, knowledge creation, and translation; and to educate and learn in collaboration with students, trainees, patients and communities - remains resolute. And that hasn’t changed.

As we look forward, the opportunity exists for greater coordination and collaboration across the clinical enterprise at Duke Health. Creating this future will take intentional and diligent effort and will require engagement from all members of our team. I’m confident that together we can realize our vision and deliver on the potential of the Duke Health Integrated Practice.