Cross-sectional survey mailed in the fall of 1997 to 12,707 adult patients who were members of managed care plans and received care from 10 large physician groups in California. Referral barriers were analyzed as predictors of patients' ratings of their physicians. Twenty-three percent reported that their primary care physicians or medical groups interfered with their ability to see specialists.
Patients value the first-contact and coordinating role of primary care physicians.
However, managed care policies that emphasize primary care physicians as gatekeepers impeding access to specialists undermine patients' trust and confidence in their primary care physicians.