Objective: To determine physicians' attitudes, beliefs and knowledge concerning surgical care of women with ovarian cancer. Methods: A survey was created from items generated from the literature, a focus group and individual interviews. The survey was mailed on two occasions to all practicing gynecologists, general surgeons and urologists in Ontario. Results: 701 responses were received (overall response rate: 43.7%); 293 were eligible responses. The responses were analyzed in terms of four determinants of surgical care:  knowledge, practice patterns, perceived goals of surgery and barriers to accessing surgical care. These variables would be influenced by the surgeon's specialty, access to an oncologist (medical or gynecologic) at one's facility and distance of one's facility to the nearest cancer center with a gynecologic oncologist. Surgeon's specialty and dis­tance from the cancer center influenced both the intraoperative surgical plan and referral practices. The most important goals of surgery were survival and optimal debulking. The barriers to care included available operating time and surgical beds. Conclusion: We have shown that peer influence has reached a ceiling effect in ovarian cancer and novel approaches are required to ensure appropriate referrals, knowledge transfer and provincial resourcing to expert centers to provide optimal surgical care for women with ovarian cancer.