Practice Under Pressure

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

"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."- 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 (Institute for Health, Health Care Policy, and Aging Research, Rutgers University) "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 (Dean, School of Public Health, University of California, Berkeley)

• Preface1. The Transformation of Primary Care in the United StatesPart I2. A Typical Workday in Primary Care3. How the Primary Care Workday Has Changed4. Leaving Hospital Work Behind5. The Routine and Nonroutine of Primary Care WorkPart II6. Younger and Older Physicians in Primary Care7. Women in Primary Care8. International Medical Graduates in Primary CarePart III9. The Medical Home10. No Quick FixAppendix