Dr. William Fulkerson Reflects on His Illustrious Career

When William J. Fulkerson, MD, MBA, steps down from his illustrious tenure as executive vice president of Duke University Health System (DUHS) at the end of this year, he will be celebrated as one of the most influential and successful figures in Duke Health’s 90-year history.

Over the last decade, Fulkerson has overseen both tremendous growth and significant challenges in the health system – most notably the recent COVID-19 pandemic. Through it all, his talent and dedication as an executive administrator have left an indelible mark on the organization. Quite simply, it’s hard for many to imagine Duke Health without Fulkerson at the helm of the health system.

That fact would have stunned Fulkerson himself when he started his career as a clinician at Duke almost 40 years ago. “I never had a desire to run a hospital,” he said, remembering his mindset at the time. “I thought, ‘Who in the world would want to do that?’”

 

A doctor’s doctor

A graduate of the UNC School of Medicine with an internship, residency and fellowship at Vanderbilt University, Fulkerson joined Duke University School of Medicine in 1983 and quickly made a name for himself as a brilliant pulmonary medicine and critical care specialist. In 1984, he was promoted to director of the medical intensive care unit (MICU). Foreshadowing administrator roles to come, he was eventually made pulmonary and critical care division chief.

Even in these early years at Duke, there was something special about Fulkerson that others noticed and that would become foundational to his reputation for many years to come. “Doctors look at other doctors and sometimes say, ‘That’s a real doctor.’ It means you are totally committed, responsible and trustworthy,” said Ralph Snyderman, MD, former chancellor for health affairs, dean of the School of Medicine and president and CEO of DUHS. “Bill is a real doctor.”

Joseph Govert, MD, a pulmonologist at Duke University Hospital (DUH), completed his pulmonary medicine and critical care fellowship at Duke in 1993. To this day, he still remembers how as an attending physician Fulkerson bonded with patients as a native North Carolinian, familiar with the state’s culture and geography. This connection put patients at ease and allowed Fulkerson to then obtain a detailed medical history which helped to inform their care.

“He’s highly respected because of his clinical competence,” Govert said. “He’s a doctor’s doctor. People would send their family members to him and go to him when they needed care.”

Steve Smith, former chief human resources officer for Duke Health, and Mary Klotman, MD, dean of the Duke University School of Medicine and vice chancellor for health affairs at Duke, both sought out Fulkerson to care for their family members. In Klotman’s case, Fulkerson’s quick thinking had lifesaving results.

“My parents were in Bermuda celebrating their 40th wedding anniversary when my father was in a terrible moped accident. Bill consulted with the team in Bermuda and treated my father once he was flown to Durham,” Klotman said. “My dad lived until he was 94, and Bill gave my dad those 30 more years.”

Many at Duke say Fulkerson’s reputation as a trusted clinician carried weight and earned him the respect of his peers as he stepped forward into administration. Known as a physician who is entirely committed to his patients and their well-being, he maintained his clinical practice until 2019.

“Bill always works incredibly hard. He’s a wonderful clinician and maintained a clinical practice even with his administrative roles. He always works in the best interest of Duke,” said Barton Haynes, MD, director of the Duke Human Vaccine Institute.

A versatile academician

Evidence-based research is the foundation of Fulkerson’s approach to clinical care. From the earliest days of his medical career, Fulkerson applied his great intellect to understanding the roots of disease and translating that understanding into new treatments and protocols that raised the standard of care nationally. Applying for and receiving grant funding during his first year at Duke, Fulkerson investigated pulmonary emboli, a potentially fatal blood clot disorder affecting the lungs. In the years that followed, Fulkerson’s research collaborations with other leading investigators around the country defined the proper course and treatment of the disorder greatly reducing the risk of mortality. Fulkerson’s research career flourished, and he went on to receive 20 years of continuous funding from the National Institutes of Health (NIH).  

In the 1990s, the National Heart, Lung and Blood Institute put a call out for applications to create a network of critical care centers to investigate acute respiratory distress syndrome (ARDS) and acute lung injury. Fulkerson’s application was supported, and Duke became one of 10 network sites around the country, a designation it still holds to this day.

Acknowledging that patients are the providers’ partners in developing a care plan, Fulkerson joined with Rob Califf, MD, and applied for funding from the Robert Wood Johnson Foundation to better understand critically ill patients’ treatment preferences. This led to the creation of SUPPORT, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Fulkerson balanced caring for critically ill patients and conducting research with mentoring trainees. He routinely rounded on patients on Sundays, and Govert recalled joining him, learning lessons at the bedside.

“He was an extremely good radiologist, always looking over a patient’s chest X-ray,” Govert said. “I really look up to him as a role model of Duke’s work ethic and putting patients first.”

“He’s really the whole package – clinician, researcher and educator,” said Theodore Pappas, MD, vice dean for medical affairs at the Duke University School of Medicine. “He listens and is the kind of mentor that residents and fellows trust. He’s trained now-famous clinicians and hospital managers from around the country.”

                                     

Leading during a crisis

That commitment to patients has never wavered. In fact, it has become a hallmark of Fulkerson’s leadership. From 1999 to 2008, Fulkerson received a series of promotions. He became the executive medical director of the Private Diagnostic Clinic (PDC) in 1999. The next year, he was named the chief medical officer of DUH. Despite the large responsibilities of these two positions, Fulkerson carved out time in his busy schedule to see patients and even returned to school, earning his MBA degree at the Fuqua School of Business.

In 2002, he gave up his position at the PDC to become CEO of DUH and vice president of DUHS.

“The best doctor became the CEO,” said William A. Hawkins, chair of the DUHS Board of Directors. “Bill works incredibly hard. He’s honest. And he makes decisions selflessly, in the best interest of Duke’s mission.”

That focus on mission is central to Fulkerson’s approach in times when the organization is most tested. A year into his tenure at the helm of DUH, media from around the world descended on the hospital to investigate a medical error that was getting coverage in the press. Fulkerson did not shy away from their questions, instead focusing on transparency, quality and safety. He took responsibility on behalf of the hospital.

“True leaders step forward in times of crisis. The guy who came forward was Bill,” said Pappas. “It was incredibly compelling. He was the Duke leader who stepped forward. And that was my proud moment of watching what a leader is supposed to do.”

Fulkerson credits Gail Shulby, RN, MA, CPPS, whom he asked to lead quality, safety and regulatory affairs at the time, as well as Mary Ann Fuchs, DNP, RN, NEA-BC, FAAN, who was then the chief nurse at DUH, with helping correct course.

“Bill used his experience to totally reframe how we manage quality,” said Fuchs, who is now vice president of patient care and system chief nurse executive for DUHS. “He’s dedicated to quality and improving the experience for patients and staff.”

Fulkerson’s steady hand in good times and times of crisis did not go unnoticed.

 

Focused on “we”

In 2008, Victor Dzau, MD, then chancellor for health affairs at Duke University and president and CEO of DUHS, asked Fulkerson to become executive vice president of DUHS. He was looking for a partner who would help him grow the organization’s reach and reputation. That work would require building new relationships with partners, community leaders – and competitors.

“If I’m in a foxhole, I’d like to be there with Bill,” Dzau said. “He’s a respected doctor and effective administrator. We trust him. And these qualities helped him as he rose through the ranks.”

As the health system grew, so did Fulkerson. He attended the board meetings at Duke Raleigh and Duke Regional hospitals to build trust and allay the assimilation fears of staff. He met with physicians and community health advocates to grow Duke’s primary care network and improve access to preventive health and chronic disease management. To raise the standard of care throughout North Carolina, particularly in rural counties, he envisioned and helped to realize Duke LifePoint Healthcare, a quality and safety collaboration through which Duke provides guidance and support to 14 community hospitals in North Carolina, Virginia, Michigan and Pennsylvania.

Under Dr. Fulkerson’s leadership, DUHS grew by almost 50 percent and now serves more than 820,000 unique patients each year.

“How do you go from something like a big hospital (single hospital functioning as a referral center) into a gigantic, vibrant health system?” said Snyderman. “Bill helped that transformation from small to big without losing the beautiful qualities of personal interactions of how Duke Hospital was before.”

“Bill is very much people-oriented,” said Thomas M. Gorrie, PhD, former chairman of the DUHS Board of Directors. “Bill champions people and gives them the space to grow. He knows to be successful, it’s not ‘me,’ it’s ‘we.’”

An illustrious career continues

“Bill wasn’t a clinician who aspired to a position as a hospital executive,” said A. Eugene Washington, MD, chancellor for health affairs and DUHS president and CEO. “But his career followed that path at Duke, and I cannot imagine the health system would be where it is today without him guiding the way forward.”

And he’s not retiring yet. Fulkerson will continue to consult on quality and safety initiatives at DUHS and continue his tenure as a professor of medicine in the Duke University School of Medicine. An award-winning teacher, Fulkerson was recognized with the Duke University School of Medicine Honorary Alumnus Award in 2015.

When he steps down from the position of executive vice president at the end of 2021, Shulby, who has served as his chief of staff since 2008, will also move with him into his next role.

“His credibility as a practicing physician, educator and researcher has allowed us to make the strides we have and has led us to be a successful organization,” Shulby said.

“I’ve known some remarkable leaders, including General Colin Powell and General Hugh Shelton,” said Smith, who spent 27 years in the Army and retired as a brigadier general. “Bill is in that group. He’s a man of tremendous qualities and compassion.”

An executive administrator, a creator of innovative programs, a builder of state-of-the-art facilities, a respected colleague and mentor, and a collaborative broker of strategic partnerships across Duke Health, Duke University, Durham and beyond, Fulkerson says he hopes his time at the helm of the health system is remembered most for the millions of lives that were touched and cared for with excellence and compassion.  

“More than expanding the bottom line, I hope people remember the impact we’ve had on allowing healing to occur,” he said.