Synopses & Reviews
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.
Review
"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."
Review
"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
Review
"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."
Review
"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
Review
"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
Review
"
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."
Review
"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."
Review
"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."
Review
"In the Public Interest is a fascinating study and a remarkable achievement from one of the top sociological ethnographers working in the field."
Review
"Ruth Horowitz has long been recognized as an acute ethnographer. This book announces her as a major public sociologist, investigating quality and justice in healthcare – for both patients and physicians."
Review
"The body of scholarly literature devoted to the role and function of state medical boards is not especially deep. Accordingly, when a book appears adding to that body of literature scholars and the medical community cannot help but take note. This is particularly true with the publication of
In the Public Interest. Horowitz is uniquely positioned to deliver thoughful analyses of medical boards' collective functioning from multiple perspectives, including that of public board member, educator, and sociologist.
In the Public Interest contributes meaningful insight on all three counts."
Review
"Ruth Horowitz has written an important and engaging appraisal of the present mechanisms available to monitor (and sanction) the work of physicians. She has performed an indispensible service to medical sociology about a subject that gets rare attention, much less observation. Every medical ethicist and sociologist should read this book."
Review
"Horowitz deepens our understanding of the legislative processes and inner workings of medical societies. Descriptions of board conversations highlight the personal insecurities, cultural biases, and professional protectionism that must be overcome to take appropriate disciplinary action to prevent further harm to patients."
Review
"One area where traditionally medical professionals have maintained tight control is in the disciplining of their own colleagues.
In the Public Interest sheds light on this and a range of other issues through a study of the work of medical boards in the United States."
Review
andquot;This is a really important, well-organized, and timely book by some of the best thinkers on the subject. It would be hard to gather a more knowledgeable group on this topic.andquot;
Review
andquot;A comprehensive must-read for those who truly want to understand the
Review
andquot;Given the current debate on health care policies in the US, this volume is both timely and informative. It is also very accessible to readers without a background in the health care industry. Highly recommended.andquot;
Review
andquot;The Health Care Safety Net in a Post-Reform World provides food for thought for policy makers and providers striving to understand and strengthen the safety net's post-reform role.andquot;
Review
"This book contributes to the ongoing debate about the regulatory activities of the medical profession and offers an insight into the principles that inform public and patients' engagment."
Synopsis
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.
Synopsis
In the Public Interest investigates the mechanisms that democratic societies have used to certify that those working as licensed doctors are properly trained and supervised as they deliver critical services to the public. It analyzes the workings of the crucial public institutions charged with maintaining the safety and legitimacy of the U.S. medical profession and provides prescriptive measures, addresses problems in need of reform, and suggests new procedures, resource allocation, and education in medical oversight.
Synopsis
How do we know when physicians practice medicine safely? Can we trust doctors to discipline their own? What is a proper role of experts in a democracy? In the Public Interest raises these provocative questions, using medical licensing and discipline to advocate for a needed overhaul of how we decide public good in a society dominated by private interest groups. Throughout the twentieth century, American physicians built a powerful profession, but their drive toward professional autonomy has made outside observers increasingly concerned about physicians’ ability to separate their own interests from those of the general public.
Ruth Horowitz traces the history of medical licensure and the mechanisms that democratic societies have developed to certify doctors to deliver critical services. Combining her skills as a public member of medical licensing boards and as an ethnographer, Horowitz illuminates the workings of the crucial public institutions charged with maintaining public safety. She demonstrates the complex agendas different actors bring to board deliberations, the variations in the board authority across the country, the unevenly distributed institutional resources available to board members, and the difficulties non-physician members face as they struggle to balance interests of the parties involved.
In the Public Interest suggests new procedures, resource allocation, and educational initiatives to increase physician oversight. Horowitz makes the case for regulations modeled after deliberative democracy that promise to open debates to the general public and allow public members to take a more active part in the decision-making process that affects vital community interests.
About the Author
Timothy Hoff is associate professor of health policy and management at the University at Albany School of Public Health.
Table of Contents
List of Figures
List of Tables
1. The Health Care Safety Net in the Context of National Health Insurance Reform
Part I
2. Dr. StrangeRove; or, How Conservatives Learned to Stop Worrying and Love Community Health Centers
3. Reinventing a Classic: Community Health Centers and the Newly Insured
4. Applying Lessons from Social Psychology to Repair the Health Care Safety Net for Undocumented Immigrants
5. Community Health Center and Academic Medical Partnerships to Expand and Improve Primary Care
6. Examining the Structure and Sustainability of Health Care Safety-Net Services
Part II
7. Safety-Net Hospitals at the Crossroads: Whither Medicaid DSH?
8. The Safety-Net Role of Public Hospitals and Academic Medical Centers: Past, Present, and Future
9. The Declining Public Hospital Sector
Part III
10. Achieving Universal Access through Safety-Net Coverage
11. Public Coverage Expansions and Private Health Insurance Crowd-Out: Implications for Safety Nets
About the Contributors
Index