A review of the literature over the past few decades reveals an increasing interest in the evaluation of the quality of care rendered by physicians. The majority of studies1-5of the quality of medical care in the United States have been in organized settings, such as hospitals or group practice. The initial work in hospitals was stimulated by the American College of Surgeons. This was followed by the accreditation program of the Joint Commission on Accreditation of Hospitals. A decade ago the American College of Physicians6-8undertook the task of attempting to evaluate the work done in hospitals by internists. In their progress report7they stated "by systematic critical review of the records of patients hospitalized, competent clinicians could render reasonably satisfactory judgments." In England9,10especially, and also in Canada,11considerable work has been done in examining the practice of private physicians in their own