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Med school looks to add its 13th department

The School of Medicine has never taken the creation of a new department lightly.

After months of proposals and years of preparation, the Division of Orthopaedic Surgery will upgrade its status from division to department, pending the Board of Trustees’ approval at its May 14-15 meeting, said Dr. James Nunley, orthopaedic surgery division chief. The School of Medicine currently has 12 clinical science departments, seven of which were founded in 1930 at the school’s inception, said Dr. Michael Cuffe, vice president for medical affairs for the Duke University Health System.

“The decision has been unanimously approved at every level so far, so it’d be pretty extraordinary to have it turned down [by the Board],” Nunley said.

He added, however, that the Board could reject the proposal if it detects a flaw that was previously undiscovered.

The Division of Orthopaedic Surgery has been interested in becoming a department at Duke since the early 1980s, Nunley said. Becoming a department will allow the group to follow a commonly accepted national model for medical departments and have a seat at the table on decisions about resource and space allocation.

Almost 90 percent of medical schools across the country have orthopaedic surgery departments, Cuffe noted.

Duke’s orthopaedic group—which currently has around 50 clinical faculty members—has a research portfolio that would put it in the top three to five departments in the country, Cuffe said. He added that Duke orthopaedic surgery has performed excellently in all three of the medical center’s areas of focus: research and education, the Private Diagnostic Clinic and the Duke University Hospital.

Research is most important within the medical school, and the hospital and PDC—an independent practice of the faculty physicians—are important for clinical practice, he said.

“They are a large department and they deserve [the departmental status],” Cuffe said. “We don’t do this very casually.... Three years ago, we put together principles [for becoming a department] for what is best in terms of education, research and the clinical practice.”

Before the Department of Dermatology was approved February 2009, there had not been a new department since 1991, when the Radiation Oncology Department was created, Cuffe said.

Duke Orthopaedic Surgery has grown significantly over the past 25 years, Nunley said, adding that the division now has 50 faculty and 150 physicians in surgery, compared to seven faculty and 50 physicians in 1980. Because of its steady growth, Nunley said he believes orthopaedics should have a stronger voice in decisions regarding operating room space, equipment and research labs.

In order to get to the current point in the approval process, the department upgrade proposal was brought before multiple committees, Cuffe said. The proposal was then presented to the Academic Council, which endorsed it March 18.

If approved by the Trustees in May, the School of Medicine will make orthopaedic surgery an official department July 1, 2010, Cuffe said, adding that the PDC and university hospital will follow suit.

Nunley said the importance of orthopaedic surgery is evident in current statistics. Thirty percent of doctor visits are musculoskeletal related, and projections show that there will not be enough orthopaedic surgeons by 2020 to treat hip fractures in women with osteoporosis, he said. He added that change to departmental status will help with faculty training and retention and hopefully expose medical students to orthopaedic surgery earlier in their education.

Cuffe said he is confident in the division’s chances.

“I think [this process has been] driven appropriately,” Cuffe said. “It has been followed very closely, very slowly, very deliberately. We’re really excited, as is the dean, that we’re going to have a [new] department. It will be very good for the medical center.”

Nancy Andrews, vice chancellor for academic affairs and dean of the School of Medicine, declined to comment. Dr. Victor Dzau, chancellor for health affairs and president and CEO of DUHS, could not be reached for comment.

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