Pros
Opportunities to work on different, very cool projects. Lots of interesting collaborators and collaboration opportunities. Some DUMC employees complain about poor work-ilfe balance and incredible pressure to work around the clock, but I didn't experience this. I found that work-life balance was completely manageable.
Cons
At the time I worked there, Duke seemed to feel that employees should be honored and grateful to work at the Duke University Medical Center (DUMC), and that efforts to create a hospitable working environment were unnecessary. There was a lot of talk about going the extra mile to offer excellent patient care, but Duke itself was extremely self-serving in its policies with employees. For example, I worked in a building that had free but unlit parking, which always felt a little sketchy after dark. Duke told us that it would install lighting in the parking lot, but in exchange, it would begin charging us to park in the lot. I suppose this makes good business sense, but it also made it clear that Duke's bottom line was more important than employee safety. It was incumbent upon us to cover our own costs - Duke didn't seem to feel that these kinds of expenses were built into its profit margin. Another con is poor health benefits (my memory is that the Duke health insurance mostly covered visits to other Duke providers, so it was hard to be seen outside the system).