Searching for the family doctor
Visiting Associate Fellow Professor Timothy Hoff’s new book, Searching for the Family Doctor: Primary Care on the Brink (Johns Hopkins University Press, 2022), has just been released in the UK. Writing from Boston, he assesses how primary care can adapt at a time when family doctors are increasingly overburdened, bureaucratised, and burned out.
Tim weaves together the early history of the family practice specialty in the United States with the personal narratives of modern-day family doctors. By formalising 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, Tim shows 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, Tim 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.
Exploring how to save primary care by giving family doctors a fighting chance to become the generalists needed, Searching for the Family Doctor is for anyone interested in the troubled state of modern medicine.
Professor Timothy Hoff is a Visiting Associate Fellow of Green Templeton College. He is Professor of Management Healthcare Systems and Health Policy, D’Amore-McKim School of Business, Northeastern University in the United States.
On Tuesday 24 May at 18:45 Tim will speak as part of the Management in Medicine Programme on Update from the USA: what’s next for digital health after a pandemic?
Find out more
Review of Searching for the Family Doctor as published in the San Francisco Chronicle
Excerpt in Medscape: How ‘Amazon Thinking’ Is Reshaping Primary Care
Excerpt in Medical Economics: Family physicians versus the health system
Interview on ‘Family medicine and the fight for the soul of health care’ for The Podcast by KevinMD
