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.