SHORTAGE OF PRIMARY CARE PHYSICIANS FELT ACROSS THE COUNTRY

Cape Girardeau is a regional medical hub - teeming with doctors and medical facilities. The region has been fortunate in attracting substantial numbers of physicians and services, but we haven't escaped a national shortage of primary care physicians. The majority of physicians pursue speciality degrees -- where the financial returns are greater and the practices often include more backup.

There are 140 members of the Cape Girardeau County Medical Society. The actual number of practicing physicians is slightly higher. But the majority of those doctors are specialists. In Cape County, family practice physicians numbers just 17. Another six are pediatricians and seven practice OB-GYN.

This shortage has been targeted by Cape Girardeau's two hospitals and the county medical society. St. Francis Medical Center and Southeast Missouri Hospital have earmarked a combined $400,000 for doctor recruitment this year alone.

It's quite an investment considering the entire yearly budget of the Cape Girardeau Convention and Tourism Bureau is $310,000. But searching for doctors is an expensive proposition.

Both hospitals search through firms, which typically charge $1,500 to $5,000 per search, and then typically bill around $100 per hour for obtaining data bases and "sourcing and searching." Other money will be spent on advertising in the numerous specialty journals, target marketing, and travel expenses for bringing prospects to town. Hospital officials estimate it costs between $20,000 and $50,000 to recruit a single doctor.

The hospitals and medical society also recently completed a recruitment video at a cost of $10,000. Physician offices in town are also doing their own recruiting.

The hospitals feel the investment is needed to compete with other medical centers - all fishing in the same new doctor pool. We hope their venture is successful.

The lack of primary care physicians has clogged local emergency rooms. This includes newcomers to town who have insurance who have found it impossible to secure a family doctor.

Nurse practioners such as Nancy Mosley have taken up some of the slack for low-income children. She practices at the Cape Girardeau County Public Health Center's Children Primary Care Clinic. The clinic, which opened last year, sees about 300 to 400 low-income children each month. These children range in age from 2 weeks to 18 years. Most of these children are on Medicaid, and most area doctors are not accepting new Medicaid patients. Before the clinic, the emergency room was their only alternative for treatment - and that treatment was often more expensive.

A new state law allows nurse practioners to write prescriptions. Again, this is a route the legislature has taken to extend primary care to more people. Nurses in 44 states now have prescriptive authority of some sort.

But the change has been resisted by some pharmacists across the state. These pharmacists say they are worried about increased liability. Many nurse practioners have backed off the practice until it is clarified. But Mosley, in effect, continues to prescribe medicine - calling in the prescriptions in the name of one of the 13 doctors who assist the clinic. Many other nurse practioners are probably doing the same thing, so the worry seems a little misplaced. We hope this matter will be spelled out soon by the State Board of Pharmacy.

Clinton's health care plan places a renewed emphasis on primary-care providers - perhaps because their costs are typically lower. That emphasis may make primary care physicians all the more scarce, and the recruitment challenges even greater.