At no time in the history of our specialty have our diplomates faced greater complexity or more rapid transformation of the health care delivery system, nor such incredible uncertainty and dynamism in their future roles within it.1 In addition to tackling the most complex clinical encounters,2 graduates now leave training expected to immediately understand a health system shaped by such towering forces as rapidly increasing consolidation, value-based and alternative payment models, measurement, internecine scope-of-practice battles, disruptive delivery innovations, genomics, big data, artificial intelligence, and machine learning. Furthermore, the pace of health system change seems to be accelerating, as central players-such as Integrated Delivery Systems, Haven, Google, CVS, Optum, and HCA-grow in number, size, and market influence.
