COPING WITH CHANGE - PHYSICIANS IN PREPAID PRACTICE

This paper examines the efforts of physicians to cope with changing role expectations particularly the integration of gatekeeping expectations. The subjects of the study are US physicians who are members of a prepaid practice group that is affiliated with a Health Maintenance Organisation. The respondents say that they are committed to gatekeeping; however, they complain about the frustrations associated with this function. They differ in the extent to which they complain. The paper focuses on factors which account for this variation. Two factors are discussed in detail - specialty differences and structural characteristics associated with the office site. The discussion begins with a review of the general sociological literature which employs the gatekeeping concept.