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November 24, 1993

Primary Care as Part of US Health Services Reform

Author Affiliations

The Association of Canadian Medical Colleges Ottawa, Ontario

JAMA. 1993;270(20):2432. doi:10.1001/jama.1993.03510200038014

To the Editor.  —In the article entitled "Primary Care as Part of US Health Services Reform,"1 the authors include the following sentences: "New licenses to practice would be issued only where predefined physician-to-population ratios have not been reached. This is done in a number of countries, and in Canada it is part of a social contract between the academic medical center and the community."We are not quite sure what this jargon means, but it leaves the impression that medical schools in Canada are involved in restricting the issue of licenses to practice medicine. We would like to inform your readers that in Canada, provincial licensing authorities are responsible for issuing licenses and provincial governments have made, and are making, a number of attempts to control the number of physicians practicing. These attempts include limiting the number of billing numbers awarded (without which physicians cannot be paid for their