Patterns of practice in internal medicine in Ontario

To determine the feasibility of wholly referral practice in internal medicine within a prepaid health service, the practice profiles of 694 internists in metropolitan, nonmetropolitan urban, and rural areas of Ontario were delineated by analysis of data from questionnaires and health-insurance billing. The questionnaire showed that two thirds of internists, chiefly younger practitioners, confined themselves to a referral consultant practice; the other one third included primary care. Subspecialists practised predominantly in metropolitan areas; most general internists in such areas provided primary care, whereas most general internists elsewhere had an entirely referral practice. This pattern of practice is greatly different from that in the United States but probably similar to that in other provinces in Canada. Extension of wholly referral practice to all internists in Ontario appears feasible, provided the numbers entering residency training are controlled. The present Ontario curricula for internal medicine and its subspecialties appear suitable for such a pattern of practice.