21st Century Medicine: A New Calling For Physicians

Health care delivery systems in the United States are undergoing rapid transformation as we move forward into the 21st century. Health plans are preparing to compete for 30 million new members who will be eligible for health insurance in state exchanges beginning January 2014. Hospitals and physicians are continuing their transition to electronic health records and are increasingly exchanging health information with each other. Primary care physicians and community health centers are enhancing access and coordination for their patients by establishing medical homes. Hospitals are improving patient safety and transitions of care when discharging patients from their hospitals. Physicians and hospitals are forming partnerships through accountable care organizations to take responsibility for improving quality and reducing costs. Health care teams and physician extenders are assuming greater responsibility for coordinating and managing health care for patients.
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For physicians, these transformative changes can be both challenges and opportunities to help shape the future of health care and health in this country. Some feel threatened by, and are resistant to, many of these changes. Others view the changes as opportunities to exercise new forms of leadership, to become leaders of teams and integrated care delivery systems, and to re-focus the relationship between a physician and patients on providing “care” - meaning compassion and healing.
As leaders of the National Council of Asian Pacific Islander Physicians, we view these changes as a new calling for Asian American, Native Hawaiian and Pacific Islander physicians to practice what we describe as “21st century medicine.” In our view, 21st medicine consists of five characteristics:

  1. Physicians are leaders of health care team who recognize, utilize, coordinate, and reward all members of their team to work at the highest level of their licenses, training, and education.
  2. Physicians are partners with their patients, sharing information, knowledge, decision making, and mutual responsibility, tailoring and following up on jointly developed care plans that include and engage the patient, family, caregivers, and community.
  3. Physicians are proactive partners with other health care providers, sharing responsibility for coordination of care, measurably improved health care quality outcomes, and stewardship of health care resources that ultimately reduce individual and societal costs.
  4. Physicians are proactive partners addressing relevant social determinants of health with local neighborhood, education, employment, housing, land use, transportation, social service, faith, cultural, and other community partners.
  5. Physicians are trained and supported in becoming adaptive leaders and lifelong learners1, continuously learning, seeking improvement, and being responsive to change.

According to the 2010 Census, Asian Americans, Native Hawaiians, and Pacific Islanders are the fastest growing racial population in the U.S. Numbering 4% of the U.S. population in 2010, Asian Americans, Native Hawaiians and Pacific Islanders are expected to increase to 7% of the U.S. population by 2025.2 Often lumped together in available data, Asian Americans, Native Hawaiians, and Pacific Islanders are extremely heterogeneous, with nearly fifty separate countries of origin, speaking over one hundred different languages and dialects, and including indigenous Native Hawaiians and Pacific Islanders, fifth generation Chinese Americans and Japanese Americans, and recent refugees from Southeast Asia, Burma, and Tibet.3

The health status of Asian Americans, Native Hawaiians, and Pacific Islanders are bimodal, with some groups enjoying relatively good health while others experience some of the greatest health disparities among all racial and ethnic populations, especially Native Hawaiians, Pacific Islanders, and Southeast Asians. 4,5 Cervical cancer incidence rates are among the highest in the U.S. for Laotian, Samoan, Vietnamese, and Cambodian women. Hepatitis B chronically infects approximately 1.5 million people in the U.S., and Asian Americans and Pacific Islanders account for over half of the chronic hepatitis B cases and resulting deaths. Native Hawaiians are over five times as likely to experience diabetes and the highest rate of deaths due to cancer compared to other residents of Hawaii. In California, Pacific Islander children have the highest rates among all children who are overweight or obese.

And while as a broad collective category, 17% of all practicing physicians in the U.S. are Asian Americans,6 there is significant and persistent underrepresentation of Native Hawaiians, Pacific Islanders, and Southeast Asians among physicians.7,8 And there is a dearth of Asian Americans and almost no Native Hawaiians or Pacific Islanders in the leadership of academic medicine,9 federal and state health departments, health plans, and hospitals.10

Given these data, Asian American, Native Hawaiian, and Pacific Islander physicians are ideally suited to lead the medical profession towards the model of 21st medicine we have articulated. The collective “overrepresentation” of many Asian American groups among physicians is the foundation for a new paradigm about physician-population representation, in which the more relevant questions should be how many physicians are providing patient care, and how many are providing that care to underserved and disparities populations. Similarly, new measures of leadership should not be how many deans and department chairs, health officers and commissioners, C-suite titles, and medical directorships are achieved, but how effective physicians are in partnering with their patients, leading their teams, and partnering with other health care and community providers. The ultimate measure should be whether physicians are actively contributing to achieving the triple aim of the best possible patient experience of health care, optimal population health, and reduced health care costs.11

Today’s changes in health care delivery systems call for new models of physician leadership. The National Council of Asian Pacific Islander Physicians amplifies that call to Asian American, Native Hawaiian, Pacific Islander, and all other physicians, to take up the challenge of practicing 21st century medicine.


1 Heifetz, RA. Leadership Without Easy Answers. (Cambridge, MA: Harvard University Press,1994)
2 Humes KR, Jones NA, Ramirez RR. Overview of Race and Hispanic Origin: 2010. U.S. Census Bureau (2011).
3 White House Initiative on Asian Americans and Pacific Islanders, What You Should Know About Native Hawaiians and Pacific Islanders.
4 Office of Minority Health and Health Disparities, Centers for Disease Control and Prevention.
5 Asian & Pacific Islander American Health Forum, Native Hawaiian and Pacific Islander Health Disparities (2010).
6 Boukus ER, Cassil A, O'Malley AS. A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey, Center for Studying Health System Change, Data Bulletin No. 35 (2009).
7 “Two isle students accepted to UH medical school,” Hawaii 24/7 (June 14, 2012) (26 of the population of Hawaii is Native Hawaiian or Pacific Islander; 3 percent of physicians practicing in Hawaii are Native Hawaiian or Pacific Islander).
8 Grumbach K, Odom K, Moreno G, Chen E, Vercammen-Grandjean C, Mertz E. Physician Diversity in California: New Findings from the California Medical Board Survey, (2008). (significant underrepresentation of Samoan, Cambodian, Lao, and Hmong physicians in California)
9 Association of American Medical Colleges, Striving Toward Excellence: Faculty Diversity in Medical Education (2009). (only 3.8 percent of medical school department chairs are Asian American, and no deans of 237 medical schools are Asian American, Native Hawaiian, or Pacific Islander)
10 American Hospital Association and Institute for Diversity in Health Management, Diversity & Disparities: A Benchmark Study of U.S. Hospitals, (2012). (Asian Americans are 2% of hospital executives, 2% of hospital boards; Native Hawaiians and Pacific Islanders are near 0%)
11 Berwick DM., Nolan TW, Whittington J. The triple aim: Care, health and cost. Health Aff. (2008); 27(3):759-769

  1. Heifetz, RA. Leadership Without Easy Answers. (Cambridge, MA: Harvard University Press,1994)

  2. “Two isle students accepted to UH medical school,” Hawaii 24/7 (June 14, 2012) (26 of the population of Hawaii is Native Hawaiian or Pacific Islander; 3 percent of physicians practicing in Hawaii are Native Hawaiian or Pacific Islander)
  3. Grumbach K, Odom K, Moreno G, Chen E, Vercammen-Grandjean C, Mertz E. Physician Diversity in California: New Findings from the California Medical Board Survey, (2008). (significant underrepresentation of Samoan, Cambodian, Lao, and Hmong physicians in California)
  4. Association of American Medical Colleges, Striving Toward Excellence: Faculty Diversity in Medical Education (2009). (only 3.8 percent of medical school department chairs are Asian American, and no deans of 237 medical schools are Asian American, Native Hawaiian, or Pacific Islander)
  5. American Hospital Association and Institute for Diversity in Health Management, Diversity & Disparities: A Benchmark Study of U.S. Hospitals, (2012). (Asian Americans are 2% of hospital executives, 2% of hospital boards; Native Hawaiians and Pacific Islanders are near 0%)
  6. Berwick DM., Nolan TW, Whittington J. The triple aim: Care, health and cost. Health Aff. (2008); 27(3):759-769

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