Choosing a Primary Care Doctor

Why you should have a primary care doctor

Your primary care doctor is the person you can feel comfortable speaking to about all your health concerns. Your primary care doctor is the person you will visit the most.

Your primary care doctor is the person to provide routine physicals and treat you for non-emergency illnesses like the flu. Your primary care doctor is someone who can refer you to a specialist best suited for your situation.

♦ If you don’t have a primary doctor or are not at ease with the one you currently see, now may be the time to find a new doctor.

Whether you just moved to a new city, changed insurance providers, or had a bad experience with your doctor or medical staff, it is worthwhile to spend time finding a doctor you can trust and feel at ease with.

People sometimes hesitate to change doctors because they worry about hurting their doctor’s feelings. But doctors understand that different people have different needs. They know it is important for everyone to have a doctor with whom they are comfortable.

Primary care physicians frequently are family practitioners, internists, pediatricians or geriatricians. A pediatrician will focus on children while a geriatrician is a doctor who specializes in older people.

There is a growing shortage of primary care physicians. It is not uncommon to call a doctor's office and hear "we are not accepting new patients." Don't get discouraged.

What you are looking for in a doctor?

A good first step is to make a list of qualities that matter to you.

• Do you care if your doctor is a man or a woman?

• Is the doctor’s education important to you?

• Is the school he or she graduated from important to you?

• Do you care if the doctor is an MD or DO?

• Is it important that your doctor is associated with a specific hospital or medical center?

• Do you prefer the doctor speaks a certain language?

• Are you looking for a doctor who has an individual practice or one who is part of a larger group?

Think about your list and decide which is the most important for you.

Some terms to you should know:

Family Practice – refers to a family medicine doctor. This is a physician who has completed a three-year residency program in Family Medicine. The physician is trained to provide primary care to patients of all ages. They are best described as generalists.

Internal Medicine – Internal medicine physicians (Internists) typically treat adults and specialize in the prevention, diagnosis and management of disease and chronic conditions.

This is a physician that has completed a three-year residency program in Internal Medicine. Most go on to receive some specialty training.

They should not be confused with a Specialist, who concentrates his or her study and practice on a very specific field.

General Practice – General practice physicians are similar to family practice physicians. Although the term tends to be associated with older physicians and/or physicians that did not pursue additional training after their standard internship.

For older physicians, advanced residency training may not have been available at the time they graduated. It is something that is now being pursued with vigor.

This is also a category where you will find many osteopath physicians. The name is distinguished by the abbreviation DO instead of MD.

• An Osteopathic Doctor, DO received their training from an osteopathic school. A Medical Doctor, MD received their training from an allopathic school.

D.O. schools, typically have less stringent admissions requirements than M.D. schools. That does not make a DO any less qualified than an MD but it is a consideration many patients have.

• DO’s receive much of the same training as MD’s. DO’s receive additional training in manipulation of musculoskeletal tissue, which MD’s usually do not.

DO’s are trained to take a more holistic approach by considering a patient’s environment, nutrition, and body as a whole.

• DO physicians tend to be primary care physicians whereas MD’s tend to specialize.

In the U.S., the vast majority of physicians are MD’s.

DO’s tend to practice more in the rural areas and MD’s in the urban areas.

Pediatrician – A pediatrician cares for children. This is a physician that that has completed a three-year residency program in pediatrics.

He or she will be your child's primary care physician. A pediatrician is trained to diagnose and treat a broad range of childhood illnesses from minor health problems to serious diseases.

Most people see a a pediatrician during their child’s youngest years. Your child will see the pediatrician quite regularly during the first year, after which visits will be less frequent.

♦ The Affordable Care Act requires all individual health insurance plans to cover 31 basic preventive services for children at no cost.

Learn more about preventive services for children.

OB/GYN - These doctors specialize in caring for women. They provide annual screenings, as well as prenatal care and labor and delivery services for pregnant women.

GYN stands for gynecologist. This is a physician that specializes in women's reproductive health.

OB stands for obstetricians. This is a physician that cares for women during their pregnancy and just after the baby is born. They also deliver babies.

Some women use their OB/GYN as their primary care doctor.

Six tips for choosing a primary care doctor

1. Is the doctor In-Network?

The doctor needs to be in your health insurance’s network of providers. If the doctor is not in your plan’s network you can expect to pay much higher out of pocket costs. Depending upon the type of insurance plan you have, seeing out-of-network doctors could cost you a lot of money. You need to be familiar with Plan Types and Cost Sharing.

2. Will the doctor be able to treat your condition?

Consider your health condition when looking for a doctor. If you have a specific health condition like diabetes that needs monitoring you may want to choose an Internal Medicine physician who has a special interest in diabetes.

If you are looking for your child’s doctor you would be looking for a Pediatrician.

3. Ask for Referrals

Ask your friends and co-workers for a suggestion. If you have a specialist ask your specialist.

If you cannot ask anyone, then ask your insurance company for someone in your network. You won’t know if they are good but you can check their educational background. You can try several online doctor rating sites to see what other people are saying. Use caution here because not all reviews are true.

4. Is the doctor’s office close?

How far are you willing to drive to see the doctor? Do you want the doctor to be close to your home or office? Is it easy to take time off from work to see the doctor?

5. Language

Does the doctor speak the language you are most comfortable with? You need to be able communicate your needs and you need to be able to understand the doctor. Communication is critical to having a good relationship with your doctor and keeping yourself healthy.

6. Visit the Doctor

It is unlikely you will be able to actually see the doctor without making an appointment. But it is helpful to visit the doctor’s office and meet the office staff.

You can catch the office environment just by walking in the door. Think about questions to ask and pay attention to how the staff responds.

You will need to be dealing with these people a lot should you choose this doctor.

How to find a doctor

You put your trust in your family doctor. So, when you need to see a specialist you should ask your family doctor for a recommendation first.

If you are looking to change to a new family doctor, ask your friends and family for a suggestion.

Your insurance company will suggest a doctor and this is an important part of your search because if the doctor is not in your network of preferred providers you will have to pay more money to see the doctor.

You want to find a wonderful doctor but also one you do not have to be afraid of seeing due to high cost.

♦ If you are on Medicare, finding a doctor can be especially difficult.

There are a number of online review sites. Most people think of review sites for restaurants and other merchants.

There is a growing number of sites that tailor reviews toward doctors and hospitals. Unfortunately, there are still very few people who submit reviews about their doctors.

♦ A common problem with any review site is knowing if the review you are reading is true.

This has become a big problem for shopping sites in particular. People are being paid to write glowing reviews for a product or service they may never have tried.

• Others may leave negative reviews for their competitors.

Keep an open mind when visiting these sites, because these sites do not verify the authenticity of the reviews. A valid email address is often the only requirement for rating a doctor.

• Doctors have complained that without the ability to confirm whether ratings and reviews are actually composed by real patients, there is a big opportunity for abuse or fraud.

It is highly possible a patient harboring a grudge or a competing practice could leave damaging reviews.

On the other hand, office staff or doctors may write positive reviews to boost their online reputation.

Online Doctor Reviews

Most people rely upon suggestions from a friend or relative when choosing a doctor. But when there are no suggestions, more and more people are turning to online rating sites for help.

These sites focus mainly on reviews from patients. Some pull data from the Center for Medicare and Medicaid Service (CMS).

The sites are free to search. They make money from advertising by pharmaceutical companies, medical device manufactures, hospitals and doctors who try to promote themselves. The amount of ads can be quite distracting but be patient because you can gather some useful information at these sites.

Be cautious, never trust one site for all your information. If you find a doctor you think might be good for you, compare reviews at as many sites as possible.

The most popular sites are HealthGrades, Vital, RateMDs, Yelp and Google.

Try searching first for a doctor you are already familiar with so you can get a feeling for how the sites work. From our personal experience, we found when we read views on doctors we are familiar with the reviews at Yelp came closest to describing our own experiences and the ones appearing on HealthGrades were a bit overly nice.

These web sites are not perfect. The information you find can be helpful. But don't rely on it entirely. Read what we found at the most popular review sites.

What to look for in a review?

A small number of patients actually write reviews. This is not like reviews for restaurants where you may find hundreds of comments.

It is more likely that you will find a doctor with less than a dozen reviews and many doctors with none at all. The lack of reviews should not be the sole deciding factor when comparing doctors.

Leaving reviews for doctors is still pretty much a new concept for people. People tend to write them after they had a really good experience or a really bad experience.

Unless prompted by their doctor, people just don’t think about writing reviews. That said, there are now companies offering promotional services for doctors to encourage their patients to leave positive feedback.

This skews the number of reviews toward the doctors who invest money actively promoting themselves.

• Reviews touch on the subject that is most important to the person at the time. A bad review because someone had to wait more than they expected does not tell the whole story. It is important to read as many reviews as possible to get a better understanding of what the doctor or the practice is like.

Some things to looks for in reviews:

Trustworthiness

Trust is vital to having a good relationship with your doctor.

People who report not trusting their doctor are more likely to not explain everything to the doctor. If the doctor doesn’t know everything he or she may not be able to give the best care.

Patients who do not trust their doctor are not likely to follow the doctor’s suggestions.

Look in the reviews for comments about trust.

Helpfulness

Does the doctor make his patients feel like he/she really cares?

Does the doctor listen to the patient?

Does the doctor answer the patient's questions?

Does the doctor explain medical conditions in a way the patient can understand?

Does the doctor have good bedside manners?

Does the doctor spend enough time with the patient?

Does the doctor rely on physician assistants too much?

Does the doctor push additional testing too much?

Does the doctor have a treatment plan?

Does the doctor try to quickly pass the patient off to a specialist?

Office Environment

Is the office staff friendly or rude?

Is it difficult to make an appointment?

Are wait times long?

Is the office aggressive to get payment?

Are there billing errors?

Education

Where did the doctor earn his MD?

Is the doctor an MD or DO?

Did the doctor pursue any post-graduation study?

Insurance

What insurance plans does the doctor accept?

Other issues

A lot of doctors get low marks for wait times. A long wait time should not translate into a bad doctor. In fact, many of the best doctors are overbooked.

A doctor who spends more time with a patient is likely to get low marks from people in a hurry but high marks from people who value the additional time spent with the doctor.

Having to wait weeks for an appointment is pretty normal for a popular doctor, especially if you are a new patient. A doctor that seems to always be away at conferences or often re-schedules appointments is a red flag.

• Spending hours on the phone trying to straighten out a mistake on a bill is very frustrating. And if this problem repeats again and again even the best doctor will lose patients.

These days most billing is outsourced. We should not quickly blame the doctor. However, the doctor has a fault if he or she is aware of problems and does nothing to fix them.

• Having a friendly and courteous staff is almost always associated with a friendly and courteous doctor. The saying "birds of a feather flock together" really seems to be true.

• Education is important but so is experience. Most sites list where the doctor went to school. If the doctor is in your network your insurance company should be able to confirm this information.

• Most review sites do not have reliable data on the insurance plans that doctors accept.

♦ Insurance plans and doctor participation can change every year so keeping current is very challenging for these sites. This information is critical to making a decision.

If the doctor doesn’t take your insurance, you really should find another doctor that does.

The way to know if the doctor takes your insurance is to call their office and ask. If the office staff says yes they do, don’t stop there. Call your insurance company and reconfirm the doctor is really in your plan’s network.

You do not want to get caught with an out-of-network expense.

Disciplinary Actions

If you are trying to find out if a doctor has had any lawsuits or disciplinary actions taken against him or her it would be best to contact your state’s medical board.

Unfortunately, the methods the state medical boards follow can vary from state to state. This has led to a lot of complaints about medical boards letting bad doctors off with a slap on the wrist.

Most medical boards will report completed investigations and penalties paid. There is also an online database run by the Federation of State Medical Boards (FSMB). All disciplinary action is supposed to be reported by the states.

The site is called DocInfo. You can search by name and state.

The site also contains a directory of state medical and osteopathic boards so you don’t have to hunt for this information.