Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first centuryùtheir work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicineùlarger numbers of younger, female, and foreign-born physicians.
"Practice Under Pressure could not be more timely. Timothy Hoff has written a concise, compelling examination of the work of primary care based on integration of qualitative data and published quantitative findings. Hoff interviewed 88 PCPs, residents, and students, as well as 2 nonphysician leaders. The book's power emanates from these narratives."
---Journal of the American Medical Association
"In this timely book, Timothy Hoff presents a survey of ninety primary care physicians. They speak their minds—and hearts. Hoff explains how, in a generation, our family doctors gave up hospital practice and found themselves boxed into fifteen minutes of face time with patients in the office: the business model that favors technology over talking and thinking. Primary care, which we need more of, cannot compete with the higher prestige and earnings of specialties like surgery and radiology. This book will help everyone—professionals, the public, and politicians—to grasp the nettle. Meanwhile the US healthcare system hardly deserves a passing grade."
---ForeWord Reviews
"Sociologist Timothy Hoff takes us to the heart and soul of the primary care crisis in America. Through personal stories, he reveals the daily frustrations and the deep compassion of these dedicated physicians."
"The erosion of primary medical care is of increasing concern for the organization of our health care system, for patients, and for issues of access and cost. In this book, Timothy Hoff looks at this issue through the perspectives of primary care physicians and provides useful information for understanding significant changes in medical care and future challenges."
"This is the best book on primary care to come along in years. Hoff's recommendations for improvement are grounded in the everyday experience of primary care providers and what they and others will need to make such improvements reality."
Preface
1. The Transformation of Primary Care in the United States
Part I 2. A Typical Workday in Primary Care 3. How the Primary Care Workday Has Changed 4. Leaving Hospital Work Behind 5. The Routine and Nonroutine of Primary Care Work
Part II 6. Younger and Older Physicians in Primary Care 7. Women in Primary Care 8. International Medical Graduates in Primary Care
Part III 9. The Medical Home 10. No Quick Fix
Appendix
Timothy Hoff is associate professor of health policy and management at the University at Albany School of Public Health.
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