Has the gatekeeper system forced primary care physicians to treat patients with illnesses that are complex beyond their expertise? A quarter of primary care doctors worry about the care some of their sickest patients receive because, they say, in some cases it might be better delivered by a specialist.
In the New England Journal of Medicine, researchers at the Kansas Health Institute reported 30 percent of primary care physicians said the scope of primary care has increased in the last two years; 24 percent thought the care provided by generalists is "greater than it should be."
The Washington-based Center for Studying Health System Change, which funded the study, says the way physicians' practice revenues are derived is related to their level of concern. Capitated primary care physicians worry more about the scope of care expected of them than gatekeepers who derive the bulk of their practice revenue from discounted fee-for-service schemes. Only 16 percent of physicians who have no patients for whom they serve as gatekeepers expressed concern about scope of care.