Unlocking specialists' attitudes toward primary care gatekeepers

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.