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These days one of the highest priorities for Duke's marketers is making the medical center's recent acquisition of Raleigh Community Hospital work. Raleigh is the most populous city in the area--more than 60% larger than Durham. Even though Raleigh is a mere half-hour drive to the east, Duke had only about 3% of that market. Since luring Raleigh residents to Durham would be hard--marketing studies showed people like to get routine medical care locally--Duke decided simply to commandeer a Raleigh hospital and use it as a base of operations. Today, only half in jest, Duke administrators refer to Raleigh as the "Eastern Front." The war for market share between Duke, WakeMed and a third, the private institution, Rex Hospital in Raleigh, is heating up.
High on the list of things keeping Swinney up at night are "carve-outs." These are private medical clinics--like Cancer Treatment Centers of America--that compete for a specialized piece of the business and threaten to steal the most lucrative medical work, leaving Duke with money losers like the emergency room. Swinney's answer is to adopt more of a "service-line strategy"--trying to get Duke to think less like a large department store and more like a collection of boutiques in a mall. One idea is to spin off individual practice areas from the monolithic medical center, giving them separate buildings or entrances. That's how marketers think.
Not everyone at Duke buys into Swinney's strategy. Rheumatologist Rex McCallum numbers himself among those who are worried that marketing is turning medicine from a profession into a business. But the grumbling noises are fading. When some of the young doctors McCallum helped recruit weren't as busy as he wanted, he picked up the phone and called Swinney's department--to ask about running some ads.
--By Adam Cohen