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Ideas and Opinions |

The Internist as Gatekeeper: Preparing the General Internist for a New Role

JOHN M. EISENBERG Jr., M.D., M.B.A.
[+] Article and Author Information

This article is based on comments made on 25 April 1984 at the meeting of the Association of Program Directors in Internal Medicine, Atlanta, Georgia.

▸Requests for reprints should be addressed to John M. Eisenberg, M.D.; Section of General Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street; Philadelphia, PA 19104.


Philadelphia, Pennsylvania


©1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;102(4):537-543. doi:10.7326/0003-4819-102-4-537
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To reduce health care costs, some third-party payors have enlisted primary care physicians as gatekeepers to medical care. In gatekeeper systems, primary care physicians must approve all care provided to their patients. This approval is a condition of payment for the service, with the usual exception of true emergencies. The gatekeeper approach, sometimes called the case-manager plan, extends the responsibility of primary care physicians from coordination to control of medical care. However, for the plan to stimulate cost-effective medical care, it must overcome obstacles that threaten its ability to save money and provide high-quality medical care. If internists are to serve as gatekeepers, then medical educators must ensure that the necessary attitudes, skills, and knowledge are taught to students of internal medicine.

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