Spontaneous peritonitis due to group B streptococci.

legitimate objective for planning. Our data confirm that dermatology has evolved in Ontario as largely a primary-care specialty. A study in 1970 indicated a marked maldistribution of dermatologists in Manitoba with a large concentration in Winnipeg.9 It also showed that the inhabitants of Winnipeg received per capita about six times as much of the dermatology service dollar as did Manitobans outside of Winnipeg. The most obvious reason for the concentration of neurologists in urban centres is their need for access to diagnostic facilities and neurosurgical services, but they may also choose more densely populated areas because a purely consulting practice requires a larger population base than a practice in which some patients are self-referred or have conditions at the "edges" of the specialty's scope. Dermatologists, on the other hand, are much less dependent on hospital support services, and their predominantly mixed practice, involving a good deal of primary care, can be carried out in a more sparsely populated area. It is not surprising, then, that the dermatologists we surveyed were more strongly represented than neurologists in nonmetropolitan areas; in fact, their distribution closely resembled that of the internists described in our previous paper.3 Training more dermatologists would not necessarily correct the present maldistribution, as they might continue to set up practice in large cities and include primary care in their services. However, if dermatology were restricted to being a consulting specialty there would probably be an adequate supply of dermatologic services even with the present supply of practitioners, and the competitive forces of the marketplace might force some redistribution. This strategy would be especially timely in the present era of budgetary constraints, when it is considered wasteful to train specialists to provide primary care.10'1' Although this change would require considerable administrative effort and the passage of time, there is at present no financial incentive for medical specialists in Ontario to confine themselves to an entirely referral practice. The fee schedule is the most potent device for changing the pattern of practice.