The changes to the Duke University Medical Center launched during Dr. Snyderman’s first term as Chancellor, however necessary, generated much resistance from a key area with the Department of Medicine threatened by change. This resistance coalesced to make Dr. Snyderman’s reappointment to a second five-year term unusually acrimonious. The opposition of Dr. Joseph Greenfield to Dr. Snyderman’s continuing leadership is a particular case in point. In the end, Dr. Snyderman won reappointment, ultimately to his full second term.