It is not easy writing about something you have no clue about but this dude, Timothy Hoff, seems to enjoy it. Who is Timothy Hoff? Well, here you go:

Timothy Hoff is a professor of management, health care systems, and health policy at Northeastern University and an associate fellow at Green-Templeton College, University of Oxford. He is the author of Searching for the Family Doctor: Primary Care on the Brink

To summarize:

1. He is not a primary care doctor.
2. He is a management and system and policy guy. In other words, everything that has ruined primary care.
3. He is a professor or ivory tower pontificator who has NEVER been in the trenches of medicine.

So, why do I care? Well, he just wrote this recent article called How to Help Primary Care Physicians Craft Sustainable Careers in the Harvard Business Review. Wow, the HBR! It must be brilliant, right? Nope. Here are the highlights with my thought in parenthesis:

• “Burnout among primary care physicians (PCPs) is a symptom of a bigger issue: the need for health care organizations to help them build sustainable careers.” (Relying on health care orgs to build our career is like the frog relying on the scorpion not to kill him).
• “Doing so can create healthier, happier physicians who feel empowered to make better job choices, while placing more of them in work settings that support their personal values, preferences, and needs.” (Umm, Timmy, the organizations don’t care about keeping doctors happy because they are replacing them with NPs and PAs).
• “I have interviewed hundreds of primary care physicians (PCPs) in my research over the years.” (Wow, you are an expert. You are almost a family doc with that many interviews.)
• “Many PCPs with whom I have spoken over the past decade have told me about a general malaise they feel. For them, it starts and ends with what they perceive as a general degradation of their status as professionals and experts. No one seems to be paying attention to them. Everyone thinks they are invincible in their capacity for working long hours and putting up with poor job conditions. They lament that their employers see them only as high-cost cogs in the production process and want them to move their patients through the daily treadmill as efficiently as possible. They feel less empowered to control their fates.” (Great, now you are getting somewhere. You are going to recommend leaving the system, aren’t you? Nah.)
• His specific recommendaitons: Hire PCPs for fit. Emphasize work-life balance in every PCP job and workplace. Rid the PCP job of excessive administrative demands. Set strict weekly work-hour limits. Use electronic health record systems to foster cross-team communication and collaboration. Tie a portion of pay to non-clinical accomplishments. Promote professional development. Let PCP teams craft their members’ jobs.(Yeah, all of this will NEVER happen in the system so he must be alluding to Direct Primary Care.)
• “The bigger questions now for primary care doctors who plan to work in that system is how they will adapt to these realities, and what their employers will do to make that adaptation successful.” (Okay, so Timmy doesn’t get it. Primary care docs cannot adapt to a broken system where administrators devalue them.)

What does little Timmy think about Direct Primary Care? Ahhh, now I am getting to the crux of this opinion piece. Here is the article he wrote a few years ago called Direct primary care has limited benefits for doctors and patients. A quick summary of his thoughts on this:

As someone who studies doctors and how they work, I see problems with direct primary care for providers, patients, and the U.S. health care system. Here are several of them.

Lack of scalability. 

Incentives to limit care.

Patient expense.

More work for patients.

There you have it. Timmy doesn’t get DPC. He never will. Why? It would put him out of a job. He needs to pontificate about the big systems because they pay him. For a nice counterpoint to the latter article by Hoff please see Rob Lambert’s piece in Medical Economics.

Listen, DPC will never get love from the ivory tower idiots like Hoff. They are blinded by their need to protect their jobs. The fact that Hoff writes articles and books on primary care without ever having treated a patient absolutely amazes me. Yet, he keeps dropping these turds that HBR and other sites publish. It’s a vicious cycle that self-perpetuates itself.

We need to keep publishing and promoting Direct Primary Care to the public. Why? Because these ivory tower morons will continuing pushing their management ideas, system ideas, and policy ideas. This will only imprison docs forever and making them burnout more until primary care dies forever.