To the Editor.
—For many years the basis of hospital peer review has been internally driven by physicians and nurses reviewing one another. This has been accomplished by volunteer physicians through hospital committees at no cost to the institution. To our knowledge, the real cost in terms of person-hours has never been calculated, but it has never been a concern because of willing volunteerism.As public confidence in our ability to review ourselves has eroded, the concept of "external" peer review has developed. This has the obvious advantage of reviewers' not being personally involved with the "reviewees," but also has the major disadvantage of cost. We must consider that as physicians' incomes decrease with health system reform and as demands on our time increase, the willingness of physicians to volunteer this service may diminish. At some point, reviewers both internally and externally may demand payment for services rendered.Nevertheless, up