Abolish The Gatekeeper Model Now

The health care system is the source of one of the greatest legalized monopolies in the history of this country. The worst part is, you didn’t even realize it was happening.

The current health care system utilizes a couple of different types of “gatekeeper model”. One is aimed at cost control, in which a gatekeeper is in place to help regulate referrals to specialists and other investigative or testing procedures. The second is aimed at the level of clinical practice, in which a gatekeeper is required to provide referrals in order for another health care provider to practice to the extent of their training and scope of practice.

The latter issue is a critical one in our health care system today. Why? It promotes a legalized monopoly, one that ultimately prevents patients from their right to choose a provider, while actively removing a number of professions from a truly free marketplace.

The prototypical example in this country is consumer direct access to physical therapy. Currently, most states require some level of referral for access to care. In all, just 17 states have laws that promote a patient’s free right to choose and access a physical therapist for evaluation and treatment.

Groups such as the American Medical Association have a long history of promoting the “gatekeeper” mentality within the health care system. They have resisted and/or sought to control most other professions that have attempted to provide services outside of their beloved gatekeeper model. Through efforts such as the Scope of Practice Partnership, there is a lot of behind-the-scenes work being done to make other professions subservient and gatekeeper-driven.

They have put forth many “reasons” – to legislators, and to the public - why they don’t support things such as direct access to physical therapy. They proclaim that physical therapists:

1. … don’t have the qualifications to make a medical diagnosis. Oddly enough, this isn’t something that  physical therapists want to do anyways. But it sure is a great sound bite, isn’t it?

2. … don’t have the training in differential diagnosis or know when it is appropriate or necessary to refer a patient to another health care provider. Reality check: physical therapists have been making referrals to other providers for medical conditions that are outside of their scope of practice for years.

3. … will create a patient safety issue. In states that have direct access to physical therapy, there have been no increases in medical malpractice claims against physical therapists. If this is truly an issue of patient safety, then surely some state – or country, for that matter – would have some evidence to confirm this assertion by now. As an aside, this same group isn’t terribly concerned about direct access to other health care providers that have far less training – massage therapists being a prime example.

To the uninitiated and naive, these “reasons” all sound plausible. When you have millions of dollars to promote your agenda via slick mass marketing campaigns and legislative campaign contributions, it is pretty easy to promote the message of fear.

Let’s be serious. The reason that the gatekeeper model still exists isn’t because of patient safety, training, or the like. Those issues just don’t exist. The reason is plain and simple: stakeholders that simply don’t want it to happen. At best, the situation is a bad case of 1950s-era “father knows best” paternalism. In reality, it is more about control and turf protection than efficacy or patient advocacy. It is time to call is what it is: a smokescreen for legislators, using the patient’s safety as a convenient excuse.

Let us fast-forward to 2012. We are in an era of accessibility of health care information. People are quite capable of making good decisions regarding their homes, their cars, their children, and their jobs. They make choices for services and providers each and every day. People are seeking value and a good customer experience. They are seeking education, data, and information.

So why not let them do this with their own health care?

Patients should have the freedom and the right to make informed decisions regarding their health care, and to choose their providers freely based on these informed decisions.

Physical therapists, as any other health care professional, should be an active part of the free market economy. Let all health care providers be equally accountable to the patient, and lets do so on an even playing field. Let competition, value propositions, and customer experiences drive health care much like any other industry. Then, let the consumer make the choice.

I am calling on all legislators to do what is right for the rights and freedoms of your constituents. It is imperative to abolish the current gatekeeper model in all states, and to do so now. The era of this antiquated system of paternalistic beliefs and legalized monopolies must end.

In the 2012 elections, don’t just promise us that this will change. Have the courage to do something about it.

Photo credits: QuinnDombrowski