Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-first Century (Critical Issues in Health and Medicine)

Through ninety-five in-depth interviews with primary care physicians (PCPs) workingin 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 century--their 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 medicine--larger numbers of younger, female, and foreign-born physicians.

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 twenty-first 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 foreign-born 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.

Library Journal

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

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 Insight Into The Everyday Lives Of Generalist Physicians In The Early Twenty-first Century, Their Work, Stresses, Hopes, Expectations, And Values. Supports This Dialogue With Secondary Data And Captures The Changing Face Of Primary Care Medicine's Larger Numbers Of Younger, Female, And Foreign-born Physicians. From Publisher Description. The Transformation Of Primary Care In The United States -- A Typical Workday In Primary Care -- How The Primary Care Workday Has Changed -- Leaving Hospital Work Behind -- The Routine And Nonroutine Of Primary Care Work -- Younger And Older Physicians In Primary Care -- Women In Primary Care -- International Medical Graduates In Primary Care -- The Medical Home : Primary Care Savior? -- No Quick Fix : An Incremental Approach To Helping Primary Care. Timothy Hoff. Includes Bibliographical References And Index. 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