Practice Under Pressure

Price: $24.95  

Subtitle: Primary Care Physicians and Their Medicine in
the Twenty-first Century
Author: Timothy Hoff
Subject: Health and Medicine
Paper ISBN: 978-0-8135-4676-6
Cloth ISBN: 978-0-8135-4675-9
Pages: 208 pages
Publication Date: October 2009
Series: Critical Issues in Health and Medicine

Awards:

Outstanding Academic Title, Choice, 2010

Praise for Practice Under Pressure:

"Practice Under Pressure is a well-written book which serves as a space to showcase the changes in primary care. It would be wise for any medical student or new physician thinking about primary care and for all patients to read this book in order to understand what to expect before walking through a primary care physician's office door."
—Journal of Health Care for the Poor and Underserved, November 2010

"Highly Recommended."
—Choice

“Designating primary care physicians to serve as gatekeepers for referrals is relatively simple, requiring only a yes/no decision. Making them pivotal figures in delivering health care is an assignment of very different magnitude. But as Timothy Hoff tells us in Practice Under Pressure, we might need to rethink that strategy.”
—Health Affairs

"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, June 2010

Read

Read an Excerpt from Chapter 1, pages 1-6

Read an Excerpt from Chapter 1, pages 16-24

Listen

Timothy Hoff discussing health care reform on The Health Show (11/14/2009)

Timothy Hoff discussing health care reform on The Health Show (11/26/2009)

Timothy Hoff discussing health care reform on The Health Show (11/29/2009)

Timothy Hoff discussing health care reform on The Health Show (4/8/2010)

More Praise for Practice Under Pressure:

"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."
—Stephen M. Shortell, Blue Cross of California Distinguished Professor of Health Policy and Management and Dean, School of Public Health, University of California, Berkeley

"This important book serves as a wake-up call to those who would reform health care delivery around primary care physicians (PCPs).  It is essential reading, given that any real change to our health care system must confront the actors at its center - - physicians. Timothy Hoff takes us inside the PCPs' world to understand what their work consists of, what the real problems are, and where current change efforts must focus to be successful."
—Lawton R. Burns, The James Joo-Jin Kim Professor of Health Care Management, The Wharton School, University of Pennsylvania

"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."
—Bruce Bagley, M.D., former president, American Academy of Family 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."
—David Mechanic, professor and director of the Institute for Health, Health Care Policy, and Aging Research, Rutgers University

"Calling primary-care medicine the "unsung hero of our health care system" and writing that no other part of that system "is in greater trouble right now," Hoff (health policy & management, Univ. at Albany Sch. of Public Health) attempts to look at the problems and possible solutions. He conducted 95 hour-long interviews with primary-care/generalist physicians, medical students, residents, and medical leaders. The interviews are synthesized as he discusses the diminished status and incomes as well as the demographics of this group, which has been overtaken by a system geared toward specialty care. The causes include primary-care physicians' image devolving into one of practitioners who are less thoroughly trained and knowledgeable. Few medical students now express an interest in primary care. Hoff acknowledges a turnaround will be difficult but suggests such things as an emphasis in medical schools on the field, an increase in reimbursement for preventive care, and the need for a more defined primary-care field. VERDICT Clearly and logically presented, this book will most likely be of interest to those in the primary-care field, health-care administration, and medical education."
—Dick Maxwell, Porter Adventist Hosp. Lib., Denver

"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

"Clearly and logically presented, this book will most likely be of interest to those in the primary-care field, health-care administration, and medical education."
—Library Journal 

Why a book on primary care? “Because,” according to Timothy Hoff, “there is no other part of the health care system that is in greater trouble right now, and no other part that plays such an important role in people’s lives. Primary care always receives less attention than sexier specialty counterparts like surgery and emergency medicine.”

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 twentyfirst century—their work, stresses, hopes, expectations, and values. Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicine—larger numbers of younger, female, and foreignborn physicians.

Primary care doctors may not deal with acute life-and-death situations on a minute-byminute or daily basis; their value is in health promotion and prevention—giving patients the best chance to live long lives and avoid serious illness. But, for many Americans, the notion of prevention is out of vogue in a society that gets unhealthier by the year. Hoff even suggests that our increasing use of PCPs as mere gatekeepers to highly specialized services is furthered by a primary care physician community that has adapted to their evolving and politically constrained environment in ways that further their own demise.

There is no simple, quick fix to what ails primary care and its practitioners in the United States today. Practice Under Pressure champions medical education reform and a rebranding of primary care careers, a new business model for delivering primary care services, and individualized attention to and support for groups that will soon dominate the ranks of generalist medicine, such as women and foreign-born physicians. In this first-of-its-kind sociological analysis of the primary care system in the United States, Hoff helps inform the current policy debate around national health reform and the key role of preventive care in producing greater access and quality within the U.S. health system.

Timothy Hoff is associate professor of health policy and management at the University at Albany School of Public Health.

Relevant Links:

http://www.healthshow.org/archive/week_2009_08_02.shtml

http://www.timesunion.com/AspStories/story.asp?storyID=829283&category=OPINION

http://www.timesunion.com/AspStories/story.asp?storyID=816870&category=OPINION