Healthcare today in the United States is too often unaffordable, unsafe, impersonal, uncoordinated, and wasteful. There is considerable overuse, underuse, or misuse of healthcare resources. As a result there is an increasing emphasis on demands for improvements in patient safety, the consistent application of evidence-based medical practice, initiatives to reduce variation, requirements for public reporting of data to include patient satisfaction, and efforts to audit processes of care in an attempt to influence clinical outcomes. The Joint Commission and other regulatory bodies have become the enforcers of these expectations. Pay-for-performance initiatives have quickly morphed into no payment for failure to perform. The payer community, led by Medicare, will no longer pay for "never events" or for hospital readmissions within 30 days for the same condition.

The movement towards employing physicians represents a unique opportunity to transform the physician culture. Physicians currently exist as an “I” wherein individual autonomy is the transcendent value. There is no collective identity within the physician culture. The “I” must be transformed into a “We” wherein the physicians accept a collective identity and a willingness to allow representatives to act on their behalf in pursuit of the greater good. Ultimately, true integration occurs and the physician “We” transforms into a physician–healthcare organization “Us.”