Nation's Primary Care System and Physicians Remain Key to Effective Health Reform

UAlbany researcher's new book examines critical role of primary care physicians and their work in America

Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century argues that the ability of primary care physicians to meet demands placed on them has decreased significantly.

ALBANY, N.Y. (December 14, 2009) -- As the work of primary care physicians becomes more central to effective health reform in the United States, a new book by Timothy Hoff, associate professor of health policy and management at the University at Albany's School of Public Health, highlights a primary care system in crisis.

Hoff's book, Practice Under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century (Rutgers Press), argues that primary care physicians are the unsung heroes of our health system, but their ability to meet the demands placed on them has decreased significantly. The book details the need for medical education reform, a rebranding of primary care careers, and greater physician engagement in various forms of complex care in order to help revitalize the U.S. primary care system. The book comes out as President Obama and Congress work to overhaul U.S. health care policy to provide coverage for millions of uninsured Americans and lower costs.

Through interviews with 95 general practitioners, the book examines the everyday work, stresses and expectations of today's primary care doctors, who, Hoff explains, are increasingly  marginalized and used as mere gatekeepers to specialists, even as they struggle to survive financially in a system that forces them to practice assembly-line medicine. The book details how primary care physicians, when given the right tools, motivation, and reimbursement, remain the critical ingredient for good preventive care that lowers costs, while managing care for patients with chronic disease, behavioral health problems and sick individuals in need of complex care.

"I was motivated to do the research and write the book because our country relies heavily on a well functioning primary care system so that people live longer and stay healthier, and such a system is critical to making health reform work affordably," said Hoff, a former health care consultant and hospital administrator." That system has been largely left to wither in favor of high-cost, high-tech specialty medicine that waits until we get sick to meet our needs."

Hoff 's book is designed to encourage better understanding of the everyday realities of today�s primary care system, so that sound policy can be developed to change those realities in favor of a more patient-centered system of care.

"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," said Bruce Bagley, M.D., former president of the American Academy of Family Physicians.

Practice Under Pressure recommends incremental and innovative strategies for reform, such as a wider scope of work for primary care doctors, and targeted recruitment of  women and foreign-born physicians -- groups that already have a keen interest in becoming primary care physicians.

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