The health care delivery system is in a state of constant transition. During the past 100 years, the patient-physician relationship has changed as a result of the outbreak of an influenza epidemic; the onset of 2 world wars; the invention of penicillin, which is associated with the knowledge of infectious organisms; the development of imaging and diagnostic testing; the development of Medicare; the expansion of insurance; and the invention of the computer. At each of these intervals, physicians have adapted to new concepts of health care delivery. However, the medical community has sometimes resisted change.¹ 

Participants in the health care system are growing increasingly concerned with the health care delivery system. Patients and employers are growing concerned with access to affordable care. Physicians are growing concerned with being able to provide the quality care that their patients need. Payers are growing concerned with the need for increased efficiencies. Despite these different concerns, all of these participants have at least 1 thing in common—a desire to improve quality.² 

Evolution in the delivery of health care services is driven by scientific and technological discoveries, emergent patient needs, and market forces. The patient-physician relationship, however, is a constant and must remain at the core of any health care quality improvement initiative. The American College of Osteopathic Internists, which sought to provide a tool to enhance professional competence in and adaptability to the changing health care delivery system, has developed the Phoenix Physician training program to better prepare residents in training and practicing physicians for the changes yet to come. Included in the Phoenix Physician training program are a curriculum that will be initiated nationwide in internal medicine residency programs and a year-long Physician Leadership Certificate Course that will launch at the American College of Osteopathic Internists' 2012 Annual Convention and Scientific Sessions in October. 

The delivery of health care services for much of the past century has focused on the development of medical schools, research centers, and large hospitals and the science of patient care. An emphasis in recent years has been placed on the development of an infrastructure that houses the technological needs of the US health care system.³ The societal value placed on developing the current medical system has resulted in the use of vast financial resources. 

The financial assets used to develop science and technology are more limited now, as society's focus shifts toward individual, patient-centered care. Excellence is defined by clinical outcomes, interpersonal relationships, teamwork in a multidisciplinary system, and patient satisfaction. This approach represents a fundamental shift from episodic acute care models and has become an integral part of the federal Patient Protection and Affordable Care Act.⁴ Several provisions in the new health care reform law seek to strengthen the primary care system and encourage the widespread adoption of patient-centered medical home models of care. Central attributes of patient-centered medical homes include enhanced patient access to a regular source of primary care, stable and ongoing relationships with a personal clinician who directs a care team, and health services that emphasize prevention and chronic care management.⁵ 

A substantial portion of health care dollars is spent on chronic disease management.⁶ Ferrer et al⁷ found that evidence-based studies have demonstrated improved outcomes and decreased costs in systems led by primary care physicians. An adequate supply of primary care physicians is associated with better health outcomes, such as lower mortality, higher life expectancy, and better self-rated health status.⁸ Other factors such as financial incentives, however, have led to the growth of specialists in various fields. Reimbursement disparities favoring specialists at a time of escalating medical education costs devalue medical generalists and primary care physicians.⁹ The result has been an increasing shortfall in the number of primary care physicians available to meet growing needs. This shortfall has occurred at a time during which cultural shifts toward patient-centered care are increasing the importance of patient-physician relationships.¹⁰ Unfortunately, at least a quarter of the Medicare population has difficulty finding a primary care physician.¹¹ 

Reliance on other members of the health care team has increased to meet the growing demands of our society. Primary care physicians, however, have the unique education and training needed to coordinate care with specialty physicians and manage complicated, multiorgan-compromised conditions. 

A number of challenges confront our current health care system. It will take a nimble physician to adapt to the changes needed to provide high-quality, cost-efficient care. These changes will take time to develop and implement. The American College of Osteopathic Internists has developed a training process to meet these challenges. Out of the ashes of the old system will rise the Phoenix Physician—a new physician leader of a patient-centered system that will maximize available resources to provide high-quality care while respecting the patient-physician relationship.