David Zaas, MD, spent nearly two decades at Duke Health early in his career before leaving in 2020. This spring, he returned as CEO of Durham, N.C.-based Duke University Health System. In a recent episode of the “Becker’s Healthcare Podcast,” Dr. Zaas discussed how the system is protecting its research mission amid federal funding headwinds and his plans to expand access to Duke-quality care beyond its flagship academic medical center.
The conversation comes as academic medical centers navigate a particularly turbulent stretch. Federal research funding has slowed sharply: as of March 31, the National Institutes of Health had awarded 1,385 competitive grants in fiscal 2026, down 54% from the same period in fiscal 2025, according to an April analysis published in The Washington Post. The effective dismantling of the Agency for Healthcare Research and Quality, which has funded no new research projects in nearly a year, has added pressure on institutions whose clinical and research missions are tightly intertwined.
Despite the headwinds, Dr. Zaas said he is optimistic about the system’s future and the role academic medicine can play in transforming care. He discussed his priorities in a conversation with Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length. The final question was asked after the podcast recording concluded.
Question: You spent nearly two decades at Duke, left in 2020, and came back as CEO this spring. What looked different when you walked back in, and what surprised you most about how the system had changed?
Dr. David Zaas: The most amazing observation during my first few weeks is really the depth of the clinical excellence and the commitment to innovation that defines Duke Health. From my prior experience and roles here, I knew there were so many great things, but in the time period over these last seven years, the depth of expertise, the strength of the clinical and research programs, the amount and extent of the integration between the health system, our faculty practice, and the school of medicine really creates a unique environment and an opportunity for Duke to truly transform healthcare. That depth has been so impressive. In addition, there’s this commitment to innovation, the commitment to redefining what we do in healthcare, that touches all of our team members, from our physicians and scientists to our nurses, and I think that is energizing as I get to visit so many of our different clinics and hospitals.
Q: The research mission is central to what makes Duke Duke, and it’s also the part federal policy is squeezing hardest right now. How are you thinking about protecting it through a stretch like this?
DZ: It’s so important for us to realize that for Duke Health, research is our key differentiator. That commitment to academic medicine is the R&D engine that’s going to drive care transformation, and access to clinical research is really foundational, almost envisioned as a key quality measure for what we’re doing at Duke Health. Despite the turbulent times and the challenges that we face, that commitment to our academic mission, to research and education, is just a key part of our values. As we approach our centennial, the next 100 years of Duke Health are going to be shaped by the research that’s happening today. We’re looking to continue to ask: How do we strategically continue to grow and invest in our research portfolio? How do we embed research across both our academic center and our community hospitals? How do we embed it across our virtual care platforms? We want to realize that patient-centered care for Duke Health is going to involve access to the clinical research and innovative care delivery that people expect from a leading academic health system.
Q: You’ve talked about thinking beyond cost-cutting in tough moments. What’s something Duke is doing right now that you think other systems wouldn’t expect?
DZ: Other health systems would be surprised to learn about Duke’s broad commitment to expand access, create care close to home for our communities, and build a platform solution that enables access to Duke Health across the region and across the country. Duke is known as this leading academic medical center, but our commitment and our impact go so much further beyond that. As we expand into different communities and identify new partners, we adopt a few key principles: the best care is closer to home, or in your home; the best care includes access to innovation, research, and specialization, but also connects with your family and your support network. How we build our solutions and spread the quality and expertise across North Carolina and beyond is something that I think is really going to shape Duke Health for the future in a way that many academic health systems have not done in the past. We’ve redefined access as a key quality measure. We assume responsibility for the care of patients and families from the moment they reach out for our help, and we insist that Duke Health will be able to provide that.
Q: With budgets tightening across the industry, how do you keep your best clinical and research people and keep them energized about the work?
DZ: We think of three components that are important for retention: our focus on culture, innovation and this commitment to excellence that defines Duke Health. In my first few weeks, I’ve had a chance to visit our different hospitals, clinics and team members, and everywhere I go I see examples of how they’re living our culture commitments, including putting people first, being clear to empower, and adapting to improve. There’s so much more than slogans; they’re demonstrated in behaviors and in values. I get a chance to ask them why they’re here at Duke Health and what they’re most excited about, and almost universally the answer is the team they’re a part of, the excellence that they know they get to uniquely deliver, and that focus on innovation and how they are empowered to help redefine care delivery. As we continue to grow, ensuring that those culture commitments are real, ensuring that that commitment to excellence and innovation exists and thrives even despite the headwinds we’re facing in healthcare today; we’re so fortunate that that leads to some of the best growth and retention numbers we’ve seen among our teams.
Q: A year from now, what do you most want to be able to say Duke accomplished during this period?
DZ: A year from now, we’ll be able to say that Duke is really charting its own path to be the leading academic medical center committed to its people and to the patients it gets to serve. Despite the challenges, we’ll have embraced this growth mindset across our clinical and academic mission, bringing the integration of the School of Medicine, the health system and the faculty practice together as one. Duke Health will also be able to look back and see accelerated growth rates in the number of unique lives and patients that we get the privilege to care for. Living our culture commitments, investing in and empowering our people, embracing truly one integrated system. The future of Duke Health is so bright, and I am confident that we will build on the tradition of excellence and look forward a year from now to say we’re even further along in that journey to be the top academic medical center in the country.
Q: What are your other top strategic priorities for Duke Health right now?
DZ: As part of this commitment to excellence and transforming care delivery, we’re really embracing AI and digital transformation of both our business functions and our clinical functions. Duke Health is so well positioned, with the strengths of both the School of Medicine and Duke University, to truly be a national leader in helping to redefine care delivery systems and leverage technology to provide not only the highest quality but the highest value. We are embracing the appropriate use of AI to support our care teams and our patients. Combined with our commitment to really becoming a digitally enabled care platform to deliver Duke quality care to millions of Americans, that is a really important strategic priority for Duke Health. I think it’s important that leaders lead by example, and that starts with my executive team. I still practice clinically, and how I embrace ambient AI in my clinical practice is something I think about. The only way we can lead in this time of transformation is to really push the envelope ourselves on the responsible use of AI.
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