Practice Under Pressure : Primary Care Physicians and Their Medicine in the Twenty-first Century

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-by-minute 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.