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:
- 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.
- 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.
- 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.
- 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.
- 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
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
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.