Out of Practice

Dr. Frederick Barken has retired from his solo practice as a primary care physician. He is an adjunct instructor in health policy at Ithaca College. Visit his website at frederickbarkenmd.com.

"Barken puts a highly personal spin on issues in health policy and health care, such as dealing with aging patients, dishonest insurance companies, and the patterns of physicians' own personal lives. Those seeking a readable, understandable, and personal primer on debates about primary care and American health care will be both educated and moved by this outstanding book."-Library Journal, 1 May 2011 "This compelling plea for primary care medicine reveals a disturbing situation: primary care medicine is collapsing, a victim of economists' tenets of maximized efficiency, profit, and productivity. The system will be further strained by the large numbers of aging baby boomers. Barken uses his own experience as a physician who retired early at age 51 due to dissatisfaction with the current situation to illustrate the state of his profession... In the end, he says, American health will be saved by its most important virtue: a strong physician-patient relationship."-Publishers Weekly "Barken does an outstanding job of chronicling the challenges widespread in practicing primary care medicine in the early 21st century... He offers an astute analysis of how the current cultures of medicine, financial reimbursement, and medical malpractice ... have effectively diminished the capacity of primary care physicians to do what they do best... Barken is at once on target and engaging. His writing is logical and concise, and he intersperses detailed critiques of the system as a whole with interesting (and entertaining) case studies from his practice. For each problem he perceives, he suggests plausible and thoughtful solutions... Reading Out of Practice is an excellent way to begin envisioning how the system can be changed to provide primary care."-William Ventres, MD, MA, Journal of the American Medical Association (26 December 2012) "It was a great pleasure to read Out of Practice. It is brilliantly written: lucid, vivid, even picturesque. It ought to be the first required reading for entering medical students and for new faculty as well."-Barbara Starfield, MD, Johns Hopkins Bloomberg School of Public Health, author of Primary Care "Primary care physicians should be at the center of our medical care system, but they are fast disappearing. Frederick M. Barken's engrossing account of his former professional life as a primary care doctor in upstate New York tells us why. This is the best description of general medical practice by a physician that I have ever read."-Arnold S. Relman, MD, Professor Emeritus of Medicine and of Social Medicine, Harvard Medical School and former Editor-in-Chief, New England Journal of Medicine "This book comes during a critical time of health reform when over 30 million newly insured persons will have greater access to care, but may be unable to find a primary care provider. Dr. Frederick M. Barken's narrative critically illustrates the importance of provider-patient relationships in primary care and sets forth the challenges we will all face if we fail to consider this part of the therapeutic milieu in new and emerging models of care and payment. To continue to lose primary care providers such as Barken, multiplied, will be our loss and will be bad for our health."-Julie Fairman, FAAN, RN, University of Pennsylvania School of Nursing

• Introduction: The Doctor Is Out1. A First Visit with the Doctor2. "Tell Him Not to Drive"3. Polypharmacy: The Problem with Pills4. Poly-Doctoring: A Doctor for Every Disease5. A Bubble Off6. On the Road Again7. The Supply Side8. All in the Family9. Practice/Malpractice10. You Get What You Pay ForEpilogueNotesReferencesIndex