Managed care forcing doctors to treat cases beyond their abilities
A report in the December 23, 1999 issue of the New England Journal of Medicine found that nearly 1 out of 4 primary care physicians feel that they are not qualified to perform the level of care their managed care arrangements expect them to.
24% of more than 12,000 doctors surveyed felt they were not capable of delivering the level of complex care that would keep the patient from having to be referred to more expensive (not to mention experienced) specialists.
Managed care plans (including government funded ones) use primary care doctors as gatekeepers to limit the number of patients going to more costly (not to mention experienced) specialists. Many times, HMOs will offer doctors bonuses for low referral rates.
38% of specialists questioned felt the primary care doctors were waiting too long to refer the patients for more specialized care. The researchers go on to say, “among specialists, more than 1 in 3 reported that the complexity or severity of patients’ conditions at the time the patients were referred to them by primary care physicians was greater than it should be.”
The study did not determine whether any patients received sub-standard care from primary care doctors who have low referral rates to specialists.