The objective of this exploratory study was to compare elderly persons likelihood of visiting a family doctor/general practitioner or a medical specialist and the association of that likelihood with socioeconomic factors and health-related quality of life (a measure of perceived need) in Canada and the United States. The data were obtained from the 2002-2003 Joint Canada/United States Survey of Health. The main dependent measure was whether respondents saw a medical specialist or a general practitioner during their last health care visit. U.S. patients in the highest household income group were more likely to have seen a specialist during their last health care visit, after adjusting for potential confounding factors. Further, visits to a specialist in Canada were determined by need rather than by household income. In Canada, likelihood of specialist visits by elderly persons is systematically related to the burden of illness (need) and not systematically related to income. In the United States, the opposite is the case. These results suggest that there may be important lessons from Canada on the organization of health care services.