Searching for the Family Doctor: Primary Care on the Brink

In 'Searching for the Family Doctor: Primary Care on the Brink,' management Professor Timothy J. Hoff depicts a field in crisis amid a system trending toward 'transactional,' volume-driven, ever more 'balkanized' care. The practitioner perspective illuminates a system antithetical to the preventive care that is family medicine's stock-in-trade, and Hoff's observations about the missteps behind the field's malaise are incisive. This emphasis will also serve to impart a sense of agency to the book's professional readers ― that redemption lies in setting their house in order.
―San Francisco Chronicle

Provocative and timely. Exposing the current identity crisis that family medicine finds itself in, this book explores the foundational and internal causes of that crisis rather than blaming it on external forces in the larger health care system.
―Mark E. Deutchman, MD, University of Colorado School of Medicine

Succinct, compelling, and well-crafted, Searching for the Family Doctor weaves together dozens of interviews with family physicians at different career stages. Hoff has a healthy and well-informed perspective on how family medicine represents a counterculture to American health care; he is also earnestly serious about the bleak prospects for success without major changes. An essential read for academic family physicians, health policy scholars, and anyone who thinks that the US health care system is broken beyond repair.
―Frederick Chen, MD, University of Washington School of Medicine

A masterpiece! Dr. Hoff's meticulous analysis on the essential role of the family doctor, past, present, and future, is must-read for every member of Congress and policy maker. More power to the family doc!
―Robert W. Derlet, MD, author of Corporatizing American Health Care: How We Lost Our Health Care System

With health crises becoming an increasing part of the everyday, Hoff's Searching for the Family Doctor could not be timelier. It considers what we all know to be true: relationships with primary care doctors are central to health and well-being. Hoff's excellent book reveals practical actions that may prevent primary care, as we know it, from vanishing.
―Kathleen M. Sutcliffe, PhD, Johns Hopkins University, coauthor of Still Not Safe: Patient Safety and the Middle Managing of American Medicine

Hoff, professor of management, health care systems, and health policy at Northeastern University, investigates the specialty of family medicine through archival research and interviews conducted with practicing family physicians....An excellent book.
―Choice (American Library Association)

[Hoff] piec[es] out the cognitive dissonance of practicing family medicine in a broken health care system.
―Lalita Abhyankar, Health Affairs

With family doctors increasingly overburdened, bureaucratized, and burned out, how can the field change before it's too late?

Over the past few decades, as American medical practice has become increasingly specialized, the number of generalists―doctors who care for the whole person―has plummeted. On paper, family medicine sounds noble; in practice, though, the field is so demanding in scope and substance, and the health system so favorable to specialists, that it cannot be fulfilled by most doctors.

In Searching for the Family Doctor, Timothy J. Hoff weaves together the early history of the family practice specialty in the United States with the personal narratives of modern-day family doctors. By formalizing this area of practice and instituting specialist-level training requirements, the originators of family practice hoped to increase respect for generalists, improve the pipeline of young medical graduates choosing primary care, and, in so doing, have a major positive impact on the way patients receive care. Drawing on in-depth interviews with fifty-five family doctors, Hoff shows us how these medical professionals have had their calling transformed not only by the indifferent acts of an unsupportive health care system but by the hand of their own medical specialty―a specialty that has chosen to pursue short- over long-term viability, conformity over uniqueness, and protectionism over collaboration. A specialty unable to innovate to keep its membership cohesive and focused on fulfilling the generalist ideal.

The family doctor, Hoff explains, was conceived of as a powered-up version of the "country doctor" idea. At a time when doctor-patient relationships are evaporating in the face of highly transactional, fast-food-style medical practice, this ideal seems both nostalgic and revolutionary. However, the realities of highly bureaucratic reimbursement and quality-of-care requirements, educational debt, and ongoing consolidation of the old-fashioned independent doctor's office into corporate health systems have stacked the deck against the altruists and true believers who are drawn to the profession of family practice. As more family doctors wind up working for big health care corporations, their career paths grow more parochial, balkanizing the specialty. Their work roles and professional identities are increasingly niche-oriented.

Exploring how to save primary care by giving family doctors a fighting chance to become the generalists we need in our lives, Searching for the Family Doctor is required reading for anyone interested in the troubled state of modern medicine.

With health crises becoming an increasing part of the everyday, Hoff's Searching for the Family Doctor could not be timelier. It considers what we all know to be true: relationships with primary care doctors are central to health and well-being. Hoff's excellent book reveals practical actions that may prevent primary care, as we know it, from vanishing.

With family doctors increasingly overburdened, bureaucratized, and burned out, how can the field change before it's too late?

Timothy J. Hoff is a professor of management, health care systems, and health policy at Northeastern University; a visiting associate fellow at Green-Templeton College of the University of Oxford; and an associate scholar of Oxford's Saïd Business School. He is the author of Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health.