A family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice. Ken Runciman, MD, says he reluctantly eliminated about 100 patients in two separate draws to avoid having to provide assembly-line service or extend already onerous work hours. It was not the first time such methods have been employed to determine medical service in Canada: This year alone a new family practice in Newfoundland held a lottery to pick its caseload from among thousands of applicants, and an Edmonton doctor selected names randomly to pare 500 people from his heavy caseload.