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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Unlocking specialists' attitudes toward primary care gatekeepers.

E Pena-Dolhun¹, K Grumbach, K Vranizan

¹Department of Family and Community Medicine, University of California, San Francisco, USA. Penae@fcm.ucsf.edu.

The Journal of Family Practice

|December 18, 2001

Summary

Specialist physicians" attitudes toward primary care gatekeepers are influenced by payment methods and practice settings. Salaried physicians and those with capitation income showed more favorable views, suggesting financial interests shape gatekeeper perceptions.

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Area of Science:

Health Services Research
Medical Economics
Physician Relations

Background:

Managed care plans often designate primary care physicians (PCPs) as gatekeepers.
This gatekeeping role can create tension between PCPs and specialists.
Understanding specialist perspectives is crucial for effective managed care strategies.

Purpose of the Study:

To investigate how specialist physicians in California perceive the PCP gatekeeper role.
To determine if these attitudes are associated with specialists' payment structures and practice settings.

Main Methods:

A cross-sectional survey was conducted using mailed questionnaires.
A probability sample of 1492 specialists across seven disciplines in urban California was targeted.
Attitudes were measured using a summary score derived from specific survey questions, analyzed with chi-square, t-tests, and regression.

Main Results:

A total of 979 specialists completed the survey (66% response rate).
Specialists' attitudes toward PCPs as gatekeepers were mixed.
Salaried physicians and those with higher capitation-based income reported more favorable attitudes toward gatekeepers (P = .13 and P = .002, respectively).

Conclusions:

Specialist attitudes toward PCP gatekeeping are significantly influenced by financial incentives and practice environments.
Referral restrictions associated with gatekeeping can impact specialists' financial interests.
Policies encouraging alternative payment models (beyond fee-for-service) and integrated practice settings may foster better alignment between PCPs and specialists.