Primary care physicians create continuity in health care. As your "family doctor," they deliver recurring, preventive care, document medical history and monitor health risks through time. They advise through life's cycles and crises. And as gatekeepers, they guide their patients to specialists, therapists and other care providers.

The dilemma in our growing Sarasota-Manatee community is finding one who accepts new patients. Of the more than 1,300 physicians who practice in Sarasota and Manatee counties, only about 400 practice primary care, and many of those have all the patients they can handle.

Further narrowing your options, if you are insured, you must choose your physician from the insurer's network. Seniors insured through the traditional Medicare plan can self-direct to any physician who accepts payment from the federal program. And private pay consumers, of course, can pick and choose.

"The important thing is to do it before you get to the emergency room," says Dr. Bruce Berg, dean of the Florida State University School of Medicine's Sarasota campus. Berg and two other experts-Jean Opsut, a registered nurse with 33 years of experience and director of quality management and case management at Englewood Community Hospital, and Robert J. George, D.O., associate dean of academic affairs at the Lake Erie College of Osteopathic Medicine in Bradenton-offer some guidance in finding a good primary care physician.

All three agree that if you're starting from scratch, you should begin with the Sarasota and Manatee medical societies and hospital physician-referral lines. Many hospitals and large physician groups also post profiles of their physicians on their Web sites. (If you're insured, your insurer will provide you with a panel of physicians.)

Board certification is a good sign. "Board certification is one indication that they have taken the time to get the additional education and training in their specialty," Opsut says. "Most insurance plans require board certification [of the physicians in their network]."

To check a physician's credentials, use state regulators' and professional organizations' Web sites. (See accompanying story.) On these sites, you can verify a physician's Florida medical license, education and training, academic appointments, board certifications, proceedings and disciplinary actions, and professional liability paid claims.

The discovery of paid claims or disciplinary actions "would make you think twice about whether this is the kind of person you would want to take care of you," Berg says.

Opsut says a physician's affiliation with a hospital can be another positive indication of a physician's skill. Physicians seeking patient-admitting privileges or being considered for direct hire undergo a rigorous credentialing process at hospitals.

After research, narrow your choices to four to six physicians who are accepting new patients. "People have preferences," Berg says; he even knows Southerners who only consider physicians trained at Southern universities. Then ask friends, relatives and any community contacts for opinions.

Pick one and make an appointment. Take a list of issues to talk about. Opsut says a primary care physician should have "excellent communication skills, be compassionate and caring." But, she says, the ability to communicate is paramount. "It has to be someone you can talk with and share things with."

"If the person is curt and short and not considering you above all other issues, then that physician may not be the one for you," Berg says. "Some people don't object to an autocratic physician," he adds, but they're in the minority these days.

Says Dr. George, "During the appointment, you are going to know how comfortable you will be working with this person." If you're not comfortable, move on to your other finalists.

Most of the region's 1,300 or so physicians are specialists. The Sarasota area has a greater number of specialists per 1,000 residents than most U.S. communities.

"We have one of the highest concentrations of people older than 65. Older patients tend to require more care, usually for more than one condition. They may have to see different specialists four or five times a year," says Marc Lazarus, president of R&L Health Care Advisors, a Sarasota-based consulting firm. "Could the market use more primary care physicians? Absolutely. However, it's a struggle to recruit primary care docs here for a variety of reasons."

New physicians deciding where to practice can peruse reports that show the patient demographics of U.S. communities. The Sarasota-area data show that about 70 percent of the patient population is insured by Medicare. That's inviting for specialists, but not for primary care physicians. Medicare reimbursements to primary care physicians lag behind those to other specialists.

For debt-strapped medical school graduates, "Primary care is a hard sell," says Berg. "Government funding doesn't favor primary care."

"If you're a new doctor, $100,000 in debt from medical school, you weigh those considerations," Lazarus says. "Not enough medical students are choosing primary care."