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'll visit the most.

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

♦ If you don't have a primary doctor, or aren't 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's 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's important for everyone to have a doctor they're comfortable with.

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

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

What are you 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 a doctor who 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 matters most to you.

Some terms 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're 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 who has completed a three-year residency program in internal medicine. Many go on to receive specialty training.

They shouldn't 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. The term tends to be associated with older physicians, or physicians who didn't pursue additional training after their standard internship.

For older physicians, advanced residency training may not have been available at the time they graduated.

MD or DO?

• A Doctor of Osteopathic Medicine (DO) trained at an osteopathic medical school. A Medical Doctor (MD) trained at an allopathic medical school.

• DOs get much of the same training as MDs, plus extra training in hands-on treatment of muscles and bones (called osteopathic manipulation). DOs are also trained to take a more "whole person" approach, considering a patient's environment, nutrition and body as a whole.

♦ After medical school, MDs and DOs now go through the same residency programs. Both are fully licensed physicians in every state.

• In the U.S., most physicians are MDs, but the number of DOs is growing fast. DOs are more likely to go into primary care and to practice in rural areas.

Nurse Practitioner (NP) – a nurse with advanced graduate training who can diagnose illnesses, order tests and prescribe medication. Many people now use an NP as their primary care provider. In many states, NPs can run their own practices.

Pediatrician – A pediatrician cares for children. This is a physician who 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 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 most health insurance plans to cover 32 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 who specializes in women's reproductive health.

OB stands for obstetrician. This is a physician who cares for women during 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 isn't in your plan's network, you can expect to pay much higher out-of-pocket costs. Depending on 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 with a special interest in diabetes.

If you're looking for your child's doctor, you'd 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 can't ask anyone, then ask your insurance company for someone in your network. You won't know if they're 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're most comfortable with? You need to be able to 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's office

It's unlikely you'll be able to actually see the doctor without making an appointment. But it's 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'll be dealing with these people a lot if 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, ask your family doctor for a recommendation first.

If you're 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. If the doctor isn't in your network of preferred providers, you'll have to pay more to see the doctor.

You want to find a wonderful doctor, but also one you don't have to be afraid of seeing because of the cost.

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

• Use the "Doctors & clinicians" search on Medicare's Care Compare website. You can see whether a doctor accepts Medicare.

• Ask whether the doctor "accepts assignment." That means they agree to Medicare's approved amount as full payment, which keeps your costs down.

• If you have a Medicare Advantage plan, the doctor also has to be in your plan's network. Check with your plan.

Online Doctor Reviews

Most people rely on 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.

There are a growing number of sites that focus on reviews of doctors and hospitals. Some also pull data from the Centers for Medicare & Medicaid Services (CMS).

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

The most popular sites are Healthgrades, Vitals, RateMDs, Yelp and Google.

♦ A common problem with any review site is knowing whether the review you're reading is true.

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

• Others may leave negative reviews for their competitors.

Keep an open mind when visiting these sites, because they don't verify that reviews are real. A valid email address is often the only requirement for rating a doctor.

• Doctors have complained that without a way to confirm whether ratings and reviews are actually written by real patients, there's a big opportunity for abuse or fraud.

It's very possible a patient holding 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.

♦ 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.

Try searching first for a doctor you already know, so you can get a feel for how the sites work. From our personal experience, when we read reviews of doctors we know, the reviews on Yelp came closest to describing our own experiences, and the ones on Healthgrades were a bit overly nice.

These websites aren't 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?

Only a small number of patients actually write reviews. This isn't like restaurant reviews, where you may find hundreds of comments.

It's more likely you'll find a doctor with fewer than a dozen reviews, and many doctors with none at all. A lack of reviews shouldn't be the only deciding factor when comparing doctors.

People tend to write reviews after a really good experience or a really bad one.

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 doctors who spend money promoting themselves.

• Reviews touch on the subject that's most important to the person at the time. A bad review because someone had to wait longer than they expected doesn't tell the whole story. Read as many reviews as possible to get a better understanding of what the doctor or practice is like.

Some things to look for in reviews:

Trustworthiness

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

People who don't trust their doctor are less likely to tell the doctor everything. If the doctor doesn't know everything, he or she may not be able to give the best care.

Patients who don't trust their doctor are also less likely to follow the doctor's advice.

Look in the reviews for comments about trust.

Helpfulness

• Does the doctor make patients feel like they really care?
• 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 a good bedside manner?
• 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 about getting payment?
• Are there billing errors?

Education

• Where did the doctor earn their medical degree?
• Is the doctor an MD or DO?
• Did the doctor pursue any post-graduate study?

Insurance

• What insurance plans does the doctor accept?

Other issues

A lot of doctors get low marks for wait times. A long wait doesn't mean a bad doctor. In fact, many of the best doctors are overbooked.

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

Waiting weeks for an appointment is pretty normal for a popular doctor, especially if you're a new patient. A doctor who always seems to be away at conferences, or who often reschedules appointments, is a red flag.

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

These days most billing is outsourced, so don't be quick to blame the doctor. However, the doctor is at fault if he or she knows about problems and does nothing to fix them.

• A friendly and courteous staff almost always goes 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 don't have reliable data on the insurance plans 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 who does.

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

You don't want to get caught with an out-of-network bill.

♦ If your insurer's directory says a doctor is in network and it turns out to be wrong, federal law says you generally should only pay in-network costs. Take a screenshot of the directory listing, and write down who you talked to and when.

Disciplinary Actions

If you're trying to find out whether a doctor has had any lawsuits or disciplinary actions taken against them, it's best to contact your state's medical board.

Unfortunately, the methods state medical boards follow 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's also an online database run by the Federation of State Medical Boards (FSMB). All disciplinary actions are supposed to be reported by the states.

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

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