That's not true, at least not with Kaiser and at least not with my doctor. When I see specialists for my chronic conditions, I go directly to them. When I have a new problem, I can discuss it over email or phone with my generalist and he'll either see me or send me straight to a specialist. My husband and child both go to a different location/doctor in the same system and have similar experiences. And believe me, we see a shitlot of specialists.