PubMed · 4014248
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M F Ivey. 1985. Practice perspective on practitioner-educator relationships.. https://pubmed.ncbi.nlm.nih.gov/4014248/
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CONTEXT: Nearly all managed care plans rely on a physician "gatekeeper" to control use of specialty, hospital, and other expensive services. Gatekeeping is intended to reduce costs while maintaining or improving quality of care by increasing coordination and prevention and reducing duplicative or inappropriate care. Whether gatekeeping achieves these goals remains largely unproven. OBJECTIVE: To assess physicians' attitudes about the effects of gatekeeping compared with traditional care on administrative work, quality of patient care, appropriateness of resource use, and cost. DESIGN: Cross-sectional survey of primary care physicians SETTING: Outpatient facilities in metropolitan Boston, Mass. PARTICIPANTS: All physicians who served as both primary care gatekeepers and traditional Blue Cross/Blue Shield providers for the employees of Massachusetts General Hospital, Boston. Of the 330 physicians surveyed, 202 (61%) responded. OUTCOMES MEASURES: Physician ratings of the effects of gatekeeping on 21 aspects of care, including administrative work, physician-patient interactions, decision making, appropriateness of resource use, cost, and quality of care. RESULTS: Physicians reported that gatekeeping (compared with traditional care) had a positive effect on control of costs, frequency, and appropriateness of preventive services and knowledge of a patient's overall care (P<.001). They also felt that gatekeeping increased paperwork and telephone calls and negatively affected the overall quality of care, access to specialists, ability to order expensive tests and procedures, freedom in clinical decisions, time spent with patients, physician-patient relationships, and appropriate use of hospitalizations and laboratory tests (P<.001). Overall, 32% of physicians rated gatekeeping as better than traditional care, 40% the same, 21% gatekeeping as worse, and 7% were of mixed opinion. Positive ratings of gatekeeping were associated with fewer years in clinical practice, generalist training, and experience with gatekeeping and health maintenance organization plans. CONCLUSIONS: Physicians identified both positive and negative effects of gate-keeping. Overall, 72% of physicians thought gatekeeping was better than or comparable to traditional care arrangements.
Many studies have tried to explain why professionals experience difficulty when dealing with, and in treating efficiently situations connected with death. We studied levels of personal fear among physicians in general hospitals and addressed 2 questions: Does exposure to death on professional and personal levels, affect the level of the fear of personal death which physicians experience? Is there a relationship between personality variables, represented by the repression-sensitization dimension, and level of fear of personal death? A sample of 233 physicians from 22 general hospitals who specialized in oncology, internal medicine, surgery, psychiatry or pediatrics was studied. Each answered 4 questionnaires with regard to demographic information, fear of personal death, level of repression-sensitization and exposure to the death of relatives and significant others. There were no differences in level of fear of personal death of physicians according to specialization, but those who had been exposed to death on the personal level, feared less their own death. With respect to the personality variable, tendency to sensitization, it was found that those who were sensitized exhibited a higher level of the fear of their own death compared to those who were repressive. Of the various demographic variables examined (sex, level of religious observance, age, number of children, health, professional experience) it was found that those: with many years of professional experience, who were relatively older, who were nonobservant religiously and who were in good health, had lower levels of personal fear of death; gender was not a factor.
Physicians in 3 atlantic provinces say the linking of provincial sales taxes with the GST exacerbates the inequity physicians face because it yet again adds to their overhead costs. Physicians in Nova Scotia have already won an annual rebate to compensate them for the heavier tax burden. Doctors in the Maritimes warn that heavier taxes make recruiting there even more difficult.