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—Dr Barkun and Ms Ryten confirm that provinces in Canada restrict the issuing of licenses to practice. It was not our intent to suggest that academic centers do this, only that it would not be in their interest to produce physicians who would be unable to obtain licenses.Dr Godfrey's comments are well taken. In some countries, specialists are not paid, or are paid less, if they see a patient without a referral from a primary care provider. Her point about provision of primary care by physician extenders might be broadened; primary care needs to be recognized as an important and intellectually challenging discipline that merits superb training, whatever the type of practitioner.Dr Goodman argues for the inclusion of dentistry as a primary care discipline. We believe that turf warfare between health-related disciplines is counterproductive in our quest to achieve a highly effective health care system. Primary
Barbara Starfield. Primary Care as Part of US Health Services Reform-Reply. JAMA. 1993;270(20):2434. doi:10.1001/jama.1993.03510200038020