By Mark A. Kelley, MD |06/27/16
Choosing the right physician is an important step.
First, let’s review a few definitions. All doctors are trained in a specialty like internal medicine, pediatrics or surgery. We term these doctors “specialists”. Beyond their specialty, some doctors have advanced training in fields such as cardiology, plastic surgery, pediatric intensive care, etc. These doctors are “sub-specialists”.
Here are some things to consider when choosing a physician:
1. What kind of doctor are you looking for?
Primary Care – If you want a doctor who can treat most common illnesses, a primary care physician is a good choice. These physicians are specialists in internal medicine, family medicine or (for children) pediatrics. You want your doctor to be nearby if you are sick. Therefore, most people prefer that their primary care physician be convenient to their home. Usually that doctor also has staff privileges at your local hospital.
Sub-specialty Care – (like joint surgery, cardiology) – most hospitals have sub-specialists in both surgery and medical fields. Your primary care physician will know them in your community and you can also ask around as suggested above. Be aware that some sub-specialists will only see patients referred by another physician.
What Most People Do: Choosing a primary care physician is good first step. He/she will get to know you personally and understand your needs. Shopping around for a sub-specialist for every problem is unnecessary if you have a good primary care physician. That doctor can handle most common conditions and will also refer you to a subspecialty expert if necessary. For recommendations about specific doctors, it can be helpful to ask friends (particularly those in health care).
2. How can you judge the quality of the doctor?
Finding information about physicians is easy, thanks to the Internet.
Finding the Doctor’s Practice Site – You can perform an online search for the doctor by name and find their office location and other details. Be sure to add the doctor’s degree to their name (usually “M.D.” or “D.O.”)
Credentials – all doctors have the same credentials: medical school, specialty training (residency), medical license and, in most cases, specialty board certification. You can find this information from their hospital’s website, the doctor’s practice website or from national listings.
Public Quality Reporting – there are ratings of physicians’ quality that come from the federal government. These reports are still under development and most experts feel that they are not yet very precise.
“Best Doctors” Ratings – some commercial companies publish listings of the “best doctors” in a region or across the nation, often for a subscription fee. These ratings concentrate on sub-specialists and are usually based on physician polling. These sources can vary in quality and consistency. In addition, many excellent doctors are not listed in these directories.
Consumer Ratings – consumers are now rating doctors through websites such as “Yelp”. This new movement is gaining some traction with consumers. Most of the feedback is focused on the doctor’s bedside manner and how the practice is organized. This is helpful in judging the “user-friendliness” of the practice. However, these ratings may not be reliable in judging the clinical skill of the physicians.
The Physician’s Professional Experience – As with all professions, experience matters in medicine. However, there are other issues to consider. A new physician may be more available and also more up-to-date in the latest medical advances. A senior physician who practices only part-time may not have as much experience as a younger colleague who practices full-time. Regardless of age, physicians who perform surgeries and other procedures must perform them regularly to maintain their skills.
What Most People Do: The most trusted source of information about a doctor still comes from a physician or a relative/friend. However, many folks will also check on the physician’s background from the online sources above. When you select a physician, ask the him/her about their experience, particularly in performing procedures. One rule of thumb: a practicing physician is usually good at what they are do now—not what they did years ago.
3. How can I see an expert at a famous medical center?
Most large medical centers are teaching hospitals with multiple missions: providing medical care, educating future physicians, and performing medical research.
Often, these hospitals are owned or affiliated with a university. This allows them to recruit experts in complex and challenging medical conditions.
Seeing such an expert may not be difficult. Many centers are open to self-referred patients although some still require a referral from your doctor. A good approach is to look at the hospital’s website and find the “How to Make and Appointment” section.
What Most people Do: – The process is easier if you use your own physician to recommend and orchestrate the referral. Sub-specialists at large centers are more likely to expedite physician referrals from physicians. With your permission your doctor will send your records to the medical center expert and help coordinate your care.
4. How do I know the doctor accepts my insurance?
Doctors accept most insurance plans but you should check the details. If you are looking for doctors who accept your insurance, contact your insurance company–either by phone or on their website. Most companies list their participating doctors on their website or in a printed directory
Once you select a physician, it is best to verify the insurance information by calling the doctor’s office. You do not want any surprises when you arrive at your appointment.
As noted in a previous blog, check to see if you insurance includes a “narrow network”. This means that you must see doctors within that network. If you get treated “out-of-network” you may have to pay extra charges out-of-pocket.
Some of these networks have a limited number of doctors and hospitals you can use. Others are “wider”, with more options. Your insurance company can provide this information.