MD 2.0: Physician Leadership for the Information Age

MD 2.0: Physician Leadership for the Information Age
Grace E. Terrell, MD, MMM, FACP, CPE, FACPE and J.M. Bohn, MBA

The following is an excerpt from the new book by ACPE Fellow Grace Terrell and collaborator J.M. Bohn, published by the ACPE.

The Beginning

The time is now.

We are at the beginning of what we expect will be the single fastest transformation of any industry in U.S. history. In this tidal wave of change demographic and socioeconomic forces colliding with the status quo will radically alter the landscape of the health care delivery system in ways that were inconceivable a decade ago. Our nation is addressing a number of critical issues, including recovery from the Great Recession with its housing and mortgage crisis and the near-collapse of the world’s financial system, a polarized political leadership, rapid demographic changes brought on by the aging of the population and immigration, terrorism, and health care financial reform. Among these competing national priorities, no individual issue in America has posed as pressing of a concern and heightened importance for the public as those that directly impact their personal well-being and health.



The election of President Barack Obama in 2008 brought landmark reform efforts for our nation’s health care system, while the subsequent national elections of 2010 brought to office a new set of legislators who ran their campaigns on the promise to repeal this legislation. While political debate continues on the funding, necessity, and timing of many aspects of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), it is currently the law of the land, and the underlying focus on the rapidly accelerating health care costs in the current fee-for service system will continue to drive the health care market to more cost-efficient delivery models regardless of the partisan political debate in Washington.


In 1960, U.S. federal government spending for education as a percentage of gross domestic product (GDP) was 3.7%; for defense it was 10.1%, and for health care it was 0.3%. In 2008, federal government education spending as a percentage of GDP increased to 4.6%, defense spending had decreased 5.1%, and health care spending had increased to 4.6%. Since 1960 the federal, state, and private expenditures for health care services and goods in the U.S. haves accelerated from 5.2% in 1960 to 17.6% in 2009. Factoring in the impact of the Affordable Care Act, national health expenditures (NHE) as a percentage of GDP are expected to reach 19.6% by 2019.

While the uninsured segment of the American population stood at 49.7 million in 2010 and the projected impact of insurance market reform will bring this number down to 24.4 million by 2019,5 this population segment will continue to challenge health care providers when their lack of access to basic health care services inevitably leads them to the emergency departments of our overburdened hospitals.

More than a decade has passed since the release of the Institute of Medicine’s (IOM) landmark report, To Err Is Human in 1999 that cited the high number of medical errors occurring throughout our health system. Even today with significant resources having been dedicated by health care organizations, government agencies, not-for-profit organizations, and physician practices across the country to launch and conduct major quality improvement initiatives, our nation’s health system still faces significant challenges with eliminating medical errors.

The economic incentives of a fee-for-service health care system drives overutilization of profitable services by health care providers, which the private payers respond to through managed care, and the governmental payers respond to through regulation. These counter measures to overutilization lead to increasing frustration on the part of physicians and other health care providers, who perceive less freedom to practice medicine unfiltered by externally imposed constraints. Along with the anxieties provoked in providers by the current punitive tort-based malpractice system, physicians face very low professional morale. The current self-reported professional morale among physicians is dismal, with only 23.1% reporting professional satisfaction in the current practice environment. Regardless of professional morale, demographic and socioeconomic changes will continue to drive the health care delivery system reform an serves as justification for continued innovation and our need for strong, diplomatic and collaborative leaders among physicians to improve the health of our current and future patients.

To learn more or to buy MD 2.0: Physician Leadership for the Information Age, click here.