*Also found in the Cape Girardeau County Area Medical Society Directory, are physicians who offer 31 other medical specialties.

The days of house calls by the family doctor may be a distant memory, but the demand for family medicine is still strong in Southeast Missouri. So strong, in fact, that the recruitment of primary care physicians is a priority for both hospitals and private medical practices in Cape Girardeau.

The executive director of the Cape Girardeau Area Medical Society, Lois Kasten, said the primary-care doctor is often the gatekeeper between the patient and the specialist.

Southeast Missouri Hospital Administrator James Wente said there is a shortage of family doctors, especially in rural areas.

Primary care medicine usually falls under the practice classifications of family practice, internal medicine and pediatrics, Kasten said. While all three of these are found in the Cape Girardeau County Area Medical Society Directory, there are also 31 other medical specialties that currently have practitioners.

"Primary care certainly has the advantage of cost control," Wente said. "But the disadvantage is that individuals lose some freedom as to how and with whom they want to approach their health care."

The surrounding area looks to Cape Girardeau for specialized care, said John Fidler, chief executive officer of St. Francis Medical Center.

"Because primary care physicians do refer cases to specialists, we must have specialists that are competent and of the caliber that you would find in a metro area."

Wente said Cape Girardeau is blessed with a strong group of medical specialties and sub-specialties, and Southeast Missouri Hospital alone, has 180 doctors representing most specialties.

Both hospitals continue to recruit specialists to complement their respective staffs.

Fidler said this is important to maintain the standards set for specialized care.

"We have to be able to compete with Memphis and St. Louis," he said.

However, overpopulation of specialists in metropolitan areas has helped specialty recruitment in Southeast Missouri.

Specialists in many cities aren't as busy as they need to be, Fidler said, so they are moving to outlying, smaller cities, such as Cape Girardeau to increase their patient load."

Wente said Cape Girardeau has specialists in endocrinology and infectious diseases, specialities not normally found in a community of this size.

"Yet," he said, "they aren't just visiting here once a week. They live here, raise their families here and have a stake in the health care delivery of our community."

Even though Cape Girardeau doesn't have enough primary-care doctors, Fidler predicts the problem will be corrected, but possibly it will take 10 years.

"But both hospitals are working toward that goal," he said. "We're currently working together with the University of Missouri-Columbia medical school to develop a family practice residency program in Cape. Doctors could train here and then decide if they would like to stay."

Wente said that it's important to remember doctors retire.

"We have to plan for change," he said. "We have a duty to find ways to phase in new physicians as others prepare to leave the medical community. So, we recruit to maintain as well as to expand in certain areas where there is a demonstrated need."