But I understand what you're saying. Insurance gates these but could do so with their own tech rather than relying on the third party. Could help with keeping loss ratios at the minimum.

I can get into local dermatologists without problem. But an endocrinologist takes a referral (because there are so few, and they’re all fully booked).

I have no idea what good GPs serve besides flu testing. Sounds unfair but they generally seem uninformed about pretty common medical conditions.

I work in insurance. In my experience, the fact that you have to go to the doctor for a referral discourages people from getting said referral.

So the tradeoff is that you would get fewer referral-specific visits (i.e. person going to their GP to get a specialist referral) at the likely expense of more specialist visits.

Never had a problem just calling them up and making an appointment. Insurance never cared either.

In all fairness, I’ve been seen similar specialists for a while. That might make the situation different. “Continuing care.”

I've seen a lot of doctors who insist patients must be making up things when they say "but XYZ", and my question becomes...so what?

If someone credibly lies to you and gets codeine or ritalin or something once or twice...that's not really significant, in terms of negative outcomes.

If someone lies to reach a medical professional, then you treat them like any other bad customer interaction and stop doing business with them after some point.