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March 25, 1998

Gatekeeping: Good or Bad, but Never Indifferent

JAMA. 1998;279(12):908-910. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325

To the Editor.—In the article by Dr Halm and colleagues,1 the authors made several assumptions that may not be true. For example, they stated that physicians with fewer years in practice were more accepting of gatekeeping because they have "less entrenched expectations about a traditional, fee-for-service medical marketplace" than their more seasoned colleagues. But physicians who have been in practice for a longer time may simply feel a greater attachment to their patients and as a result were more sensitive to some of the gatekeeping rules such as those that regulate the use of consultations.