Searching for the Family Doctor: Primary Care on the Brink

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.

Timothy J. Hoff (MANSFIELD, MA) 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 Said Business School. He is the author of Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health.