Physician-leaders must excel in clinical medicine as well as the complex management settings that dominate healthcare. Identifying talented individuals early in their careers and providing clinical and management training – as well as focused mentoring – is critical to developing the next generation of physician-executives.  The Management and Leadership Pathway for Residents (MLPR) provides trainees with the knowledge and skills essential to bridge clinical practice and management and become skilled and effective physician-executives. 

How MLPR Works 

MLPR is a 15- to 18-month rotational experience that requires trainees to work on high-priority initiatives across Duke Medicine. These rotations are integrated into the trainee’s clinical residency program.  The structure allows the trainee to simultaneously be a clinician and develop management and leadership skills – not forced to choose between medicine or a management pathway.  MLPR trainees add an additional year of training and use existing elective and research time allowed by the home residency program. 

MLPR residents are immersed into a variety of disciplines, including, but not limited to: 

  • Health system management and operations 
  • Financial management and planning 
  • Quality improvement and safety 
  • Health system strategy 
  • Health informatics 
  • Global strategy and business development 
  • Research enterprise management 
  • Clinical service enterprise management 
  • Supply chain management 

These management rotations are project-based, with a clear work product that can be produced in three to six months.  In addition to their individual responsibilities, trainees typically work on a team with other senior health system management, and are fully engaged with the work of that group during the rotation. 

Through advanced management and training experiences, residents: 

  • Experience the full breadth and depth of a health system and understand healthcare issues beyond a given specialty, hospital, or training program; 
  • Learn the clinical, research, and educational enterprises of an academic health system within the framework of financial, managerial, regulatory, and entrepreneurial forces; 
  • Acquire expanded knowledge of administrative, financial, and organizational issues related to the management of health at individual, system, community, and population levels; 
  • Participate in senior-level working groups, meetings, and retreats, with unprecedented access to the nerve center of a world-class academic health system, its three hospitals, numerous clinical centers and institutes, and school of medicine; 
  • Interact with other MLPR trainees to explore project ideas and other areas of common interest; 
  • Collaborate with a growing cohort of physician-executives at Duke Medicine; and, 
  • Are assigned a mentor – a senior leader at Duke Medicine – who provides guidance, resources, connections, context, ongoing feedback and advice throughout training and help manage the transition from trainee to faculty. 

What Makes MLPR Unique 

  • Experience based ⇒ not didactic 

  • Integrated into clinical training ⇒ not a choice between medicine or management 

  • Mentoring and access to senior leadership 

Rather than a didactic or theory-based approach to teaching management skills, MLPR employs direct immersion. Residents work in a broad variety of units and divisions across both the school of medicine and the health system.  They function as junior physician executives and they develop knowledge of operations and hone leadership skills. These direct experiences in a broad range of settings make MLPR unique among leadership training programs. 

Current Residents 

Sample Resident Projects: 

  • Framework for the establishment of a multidisciplinary standardize care model for Aortic Dissection patients using the DMAIC principles and statistical tools 
  • Business plans for purchasing capital equipment 
  • Research and analysis of Duke’s opportunities for participation in the CMS bundling initiative 
  • Clinic workflow analyses including role of EMR 
  • Optimizing reporting of patient safety and quality data 
  • Design new models of care delivery and payment 
  • Analysis of 2012 election to project the effects of fiscal cliff, sequestration, Affordable Care Act, etc. on health system priorities 

Resident Publications 

  1. Lehman, EP and Guercio, JR.  The Step 2 Clinical Skills Exam – A Poor Value Proposition.  New England Journal of Medicine 2013;368:889-891. 
  2. Lehman, EP and Guercio, JR.  Correspondence: The Step 2 Clinical Skills Exam.  New England Journal of Medicine 2013;368:2239-2240. 
  3. D’Arrigo, T. “Grooming residents to be hospitalist leaders: Programs increasingly offer business, management training.” ACP Hospitalist, Feb 2013. Available at: 
  4. Dolor RJ, Patel MR, Melloni C, Chatterjee R, McBroom AJ, Musty MD, Wing L, Coeytaux RR, Ross AK, Bastian LA, Anderson M, Kosinski AS, Sanders GD. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Comparative Effectiveness Review. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I) AHRQ Publication No.  Rockville, MD: Agency for Healthcare Research and Quality. January 2012. 

Resident Presentations 

  • “Team STEPPS 101″ Team STEPPS National Conference, Dallas, 2013 
  • Meaningful Use and Preparing for Maestro Care” February 2013, Department of Geriatrics, Geriatrics Grand Rounds, Duke University Hospital 
  • “The Federal Fiscal Cliff, Duke’s Financial Slope, and You.” Duke University School of Medicine, Department of Medicine, Noon Conference, January 30, 2013 
  • “Complex Problem Solving” Department of Medicine, Noon Resident Conference, Duke University Hospital, May 2012 
  • “Duke University Health System: Confronting Our Fiscal Slope.”  Executive Management Committee, Duke University Health System, December 19, 2012 
  • “Low Health Literacy: A National Crisis” Academic Half-Day, Department of Medicine, Duke University Hospital, October 2011 

ACGME and Program Competencies
MLPR addresses the six ACGME competencies: 

  • Patient care: Residents continue to provide supervised care on inpatient wards and in outpatient clinics in the home residency program. 
  • Medical knowledge: Residents acquire expanded knowledge of administrative, financial, and management issues related to the diagnosis and treatment of disease at individual, system, community, and population levels. 
  • Practice-based learning and improvement: Residents manage the interface between clinical care and the business of medicine. 
  • Interpersonal and communication skills: Residents continue to develop written and oral presentation skills. They build coalitions and partnerships while navigating the complexities of Duke Medicine. 
  • Professionalism: Residents demonstrate professionalism by working with non-clinical team members and both leading and taking direction from them. They endorse the ethical principles that are most important in healthcare delivery from a systems perspective. 
  • Systems-based practice: Systems-based practice is the cornerstone of MLPR.  Residents navigate the clinical enterprise functions within a framework of financial, managerial, regulatory, and entrepreneurial forces. 

MLPR addresses two additional core competencies: 

  1. Research and scholarly activity: Each resident develops a working understanding of management and research needs of the health system; develops a practical understanding of the existing research programs and institutional review protocols already in place; understands the historical, economic, and cultural issues that may effect research initiation and implementation in the relevant health care facilities and communities; and leads a final project that involves one or more management disciplines. 
  2. Professional Growth: Each resident demonstrates commitment to continuing education; identifies areas for personal and practice improvement; demonstrates receptiveness to instruction by non physicians and other managers; facilitates the education of learners within the system by serving as a teacher and role model to medical students, other residents, and others; demonstrates the ability to discuss medical errors from a systems perspective and a willingness to learn from these errors; begins a process of self-analysis that fosters an awareness of the additional stress that can be encountered when combining management with clinical practice; and develops a personal system for stress reduction and coping mechanisms for the inevitable management errors one encounters in this setting. 

Applying to the Program 

Each year MLPR selects up to two residents for inclusion in the program. Applicants must have begun residency training at Duke to qualify; most apply in the winter of their internship year. Interested trainees must have a record of excellence in their training program; a graduate degree in management (e.g. MBA, MHA, etc.) or a minimum of two years’ management/administrative experience; a sense of maturity with respect to career goals; and a history of taking responsibility and delivering results. 

Application deadline for 2016 is February 1. If you have questions about the MAT application, contact Ro Thorne, Project Manager, at or 919.943.9685. Qualified residents who submit all required application materials by February 1, 2016 may be selected for interviews with MLPR faculty. Application materials may be found here. 


Program Leadership 

William J. Fulkerson, Jr., MD, MBA 
Program Director 
Professor of Medicine 
Executive Vice President, Duke University Health System 

Devdutta Sangvai, MD, MBA 
Associate Program Director 
Assistant Professor Family Medicine, Pediatrics, Psychiatry 
Associate Chief Medical Officer, Duke University Health System 

Krishna Udayakamar, MD, MBA 
Associate Program Director 
Assistant Professor of Medicine 
Director, Duke Medicine Global 

Adia Ross, MD, MHA 
Assistant Program Director 
Medical Instructor, Department of Hospital Medicine 
Assistant Medical Officer for Quality, Duke University Hospital Office of the CMO 

Ro Thorne 
Project Manager