1 Southern California Permanente Medical Group, 13652 Cantara Street, Panorama City, California 91402
To the Editor.
The recent report in Pediatrics1 of a random survey of American Academy of Pediatrics Fellows, titled "Barriers to Pediatric Referral in Managed Care Systems" paints a picture of managed care with brushstrokes which are much too broad. Managed care is an extremely heterogeneous entity and the authors of the report do not emphasize sufficiently the fact that pediatricians in certain types of managed care systems practice with no barriers to appropriate referrals for subspecialty or inpatient care.