Timothy Hoff, Ph.D. is Professor of Management, Healthcare Systems, and Health Policy in the D’Amore-McKim School of Business and School of Public Policy and Urban Affairs, Northeastern University, in Boston, Massachusetts. He is a Visiting Associate Fellow at the University of Oxford’s Green-Templeton College, and an Associate Scholar at the Said Business School, University of Oxford. He is Associate Editor of the journal, Academy of Management Discoveries, and is on the editorial boards of Health Care Management Review and Quality Management in Health Care. Before going into academia, he worked for a decade in hospital administration and as a health care consultant. He received a bachelor’s degree in Business Administration and a Ph.D. in Public Administration and Policy, both from the University at Albany. Dr. Hoff studies health workforce issues (e.g., resilience), health care innovation, health care quality, primary care transformation, and clinician behavior; and is an expert in the use of qualitative methods. His recent book, Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health, is published by Oxford University Press. He has another book on the transformation of physician careers, entitled Searching for the Family Doctor: Primary Care on the Brink, being published by Johns Hopkins University Press in early 2022. He has published two other scholarly books, Practice Under Pressure and The Health Professions Workforce. He has also published over 65 peer-reviewed journal articles and obtained over one million dollars in external grant funding for his research.
Professor Hoff is the faculty director for the undergraduate health care management and consulting concentration in the D’Amore-McKim School of Business, and the business management in health care concentration for the MBA program. He conducts executive education and management consulting for a variety of organizations within the healthcare industry, in areas such as change management, leadership, health workforce issues, workflow and systems redesign, and improving the patient experience in health care. He gives frequent talks and interviews on these topics to news outlets, academics, industry executives, and medical professionals; and publishes regular op-eds on various health care issues.
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.