Mary Klotman, MDMary Klotman, MD, became chair of the Duke University Department of Medicine on March 1, 2010. An accomplished scientist and clinician, she previously held the position of chief of the Division of Infectious Diseases at Mount Sinai Medical Center in New York for 13 years.

This is a return to Duke for Mary -- she earned her undergraduate and medical degrees, completed her residency and a fellowship in infectious diseases, and then served as assistant professor of medicine here.

She is married to Paul Klotman, MD, also a Duke medical alumnus and still the chair of the Department of Medicine at the Mount Sinai -- they communicate with each other and their two sons, away at college in different states, via Apple’s iChat video conferencing software. Mary sat down with editors from The Abstract, Duke Medicine's faculty newsletter, to talk about her first weeks on the job.

How did you prepare for this new role?

I’ve had a lot of preparation. I’ve lived with a department chair for eight years -- I cannot underestimate how important that has been. I was also division chief for 12 years, and that combination exposed me to the broad array of issues in a large academic health care system.

The other big thing I had relative to Duke is that I made a decision about 10 years ago to get involved in the medical alumni association. I had not been really engaged with Duke once I left, because I was so busy raising a family and getting my career going. But about 10 years ago somebody asked me whether I wanted to be on the medical alumni council.

And that, over the last 10 years, has exposed me to all the big initiatives at Duke, such as creating the Duke Global Health Institute and when Duke was putting in the first CTSA grant.

That was great for me, because not only could I see what was going on at Duke, but I could compare it to what I was doing in my present job, to a very high standard. I don’t know why I made the decision, it wasn’t that I really needed to be back at Duke, but it was really a great professional decision -- I had the wonderful opportunity of meeting Dean Andrews through that.

Given that exposure to Duke, was there anything surprising once you started in the job?

The size of the Duke health care system is something that you can’t appreciate until you’re on the ground trying to figure out operations.

What I always loved about my job at Mt. Sinai was that if there was an issue, I knew exactly who to go to. I knew the structure. I knew what processes were in place. That’s the learning curve I have here.

For instance, if I want to do a quality initiative, learning what the structure of quality improvement is, I just have to find out who the players are in the department, how the department works with the hospital, how the hospital works with the health system. That’s the challenge. Every day I’m asking who does this, whose office is this, who is responsible.

What goals have you set for the department?

The broad strokes are reorganizing the department’s administration so that we are very, very responsive to needs of the faculty. One key component of that is a method for communicating back and forth.

Clinically, it’s going to be working with the PDC and working with the hospital to reorganize some of our practices. Some of that is being driven by health care reform, which is really exciting.

It means being a good partner with the health system and the PDC in anticipating changes and implementing those changes across the XX of practices within Medicine. So that’s going to require a structure that works.

We need to be more responsive because there’s change occurring right before our eyes.

What’s your biggest challenge in steering Medicine through these changes?

There’s no question going forward that the Department of Medicine in any institution is central to all the missions. To me that’s an overwhelming responsibility but also an exciting opportunity. And there’s no better place to be chair than at Duke, where you have the most incredible talent at every level.

So I feel that I’m very lucky to be here, and very lucky to have Nancy Andrews as my dean. I’m used to deans who are looking for the short term all the time, and Dean Andrews definitely has a much longer vision for the institution, which is very important in this time of both fiscal pressure and transition in health care.

A chair who thinks she is going to walk into an institution and get free rein on $50 million is not the reality anymore. The reality is that you must be a responsible fiscal manager, and I take that role extremely seriously. That is just the reality whether you are managing the clinical operations or the science or the teaching.

It is my responsibility to be fiscally responsible for the department. I don’t think that’s going to change in my lifetime as chair.

What strengths will you build upon?

Duke has all of the basic skills that any institution would need to respond to change. It certainly has the academic mass, as well as an incredible hospital and practice. Everything is there.

The big attraction for me is putting it together and working with the organization.

The other big challenge that is going to be fun is building translational research. It’s already very strong, but that’s where the growth will be, such as translational research around the oncology institute, which is a new and exciting venture. I’ll be working a lot with Rob Califf, who’s got great ideas for which Medicine is an important part.

And a lot of my working with Dean Andrews is identifying candidates to fill key research positions for building translational research. That’s like being a kid in a candy store -- you have this incredible patient population, incredible clinical service, great physicians and basic scientists, and my job is to look for opportunities to bring them together more.

How will you encourage collaboration and multidisciplinary initiatives?

A lot of that historically has worked at the ground level, individuals finding each other. But as the institution has gotten bigger and bigger, and my department has gotten bigger and bigger, that finding of the right partners has gotten challenging.

So my role, I think, is to be the point person to make those connections, particularly for some of the junior faculty and even from the day that a faculty member starts.

Basically, it’s being matchmaker who looks at an individual faculty member’s research area and thinks about what kinds of colleagues and collaborators this person going to need, because nobody does it alone anymore.

But how will you keep track of 500 faculty members?

I’m very fortunate that I have an incredible group of division chiefs. I will rely on them to make sure I meet who I need to meet, and I’ll be partners with them if we know there’s a retention issue and we need to work on keeping a faculty member. So that’s the first level.

The other level I’m trying to do right from the start is organizing smaller groups to interact with. A particular group of interest for me are the young K-awardees, the faculty who have their first level of grant support.

I’ll also schedule lunches with different groups, which gives me an opportunity to hear from them about their needs and how the department can better serve their career development. And, every time I hear about somebody who has a talent who might help the department, I’m doing a one-on-one.

So I’m mixing one-on-ones, small group lunches, and meetings with division chiefs.

I’m amazed at how many people I know already. Of course, there are challenges to meeting all faculty, not only the number but geography. I value the VA Hospital, which is an incredible resource, and I’ve already been over there. But I’ll have to put a lot of effort in making sure I engage faculty who are in different locations, such as primary care physicians.

Do you plan to continue your own research on the molecular pathogenesis of HIV-1 infection?

My first job, of course, will be being chair of the Department of Medicine. That’s something you have to accept when you take these kinds of jobs, it’s about being the chair first and not about my own career.

But I do plan to keep up my research. I kept my lab up at Mount Sinai, and I participate in lab meetings and data sessions using iChat. I probably will not physically move it here for the first six to eight months. I think realistically after a year I’ll be able to strike a balance.

I’m passionate about my research and I love the area of infectious diseases. It’s hard not to be interested in infectious diseases in general and HIV in particular. It’s such an engaging area, and has been for my whole profession.

The first case of HIV that I saw was as a house staff here in 1983 -- a young man was dying of overwhelming tuberculosis, and HIV wasn’t even identified yet. I feel like my generation really lived the epidemic, which is a tragic but amazing story. I like to think that my research is relevant, and obviously that piece was a big attraction to coming here too, because of CHAVI and Bart Haynes.