[What does it feel like for a physician to be a gatekeeper?].

BACKGROUND

Doctors increasingly act as gatekeepers. We have studied the effect that this function has on the doctors themselves.

MATERIAL AND METHODS

Analysis of 24 questions from large surveys of representative samples of Norwegian doctors in 1993 and 2000.

RESULTS

Six out of seven doctors sometimes or often met unrealistic demands from patients. More than one third experienced stress because of patient expectations about help for non-medical problems. Nearly 50% had adjusted medical certificates in order to help the patient. More than 50% sometimes or often gave more weight to patients' wishes than to their own medical judgement. 86% had chosen to come in for work themselves when they would have certified as sick a patient with the same symptoms and working situation. The proportions were significantly smaller among older doctors and doctors with a high level of job satisfaction.

INTERPRETATION

The gatekeeper role has important influence on doctors' job satisfaction. A possible generation effect may imply that society will meet problems more often in the future when assigning gatekeeper functions to doctors.