Choosing a physician can be difficult because what you value may differ depending on what service or treatment the physician is providing. What you are looking for in a physician may be different for a primary care physician (internal medicine, family practice, pediatrics), maternal care (obstetrics), or specialist physician. Even among specialists, different things may be important to you in choosing a physician that will perform a procedure but that you are unlikely to have a long-term relationship with, such as a cardiac surgeon, and a physician that you may see for many years, such as a nephrologist (kidney doctor) or oncologist (cancer doctor).
This is where ProNobis Health can help. We will assist you with choosing a physician by helping you think about the ART as well as the SCIENCE of making a choice. We will provide you with information to help you understand some of the general differences between physician practices. We will also talk about what may be important to you in choosing a physician (the ART) and also where you can find reliable information about physicians (the SCIENCE).
Your Primary Care Physician (PCP)
In general, everyone has a primary care physician (PCP). Your PCP is your primary relationship to health care. Your PCP may be an internal medicine physician or a family practice physician. If you are under 18, your PCP is usually either a pediatrician or a family practice physician. Family practice physicians see both adults and children, and they may also provide obstetric care.
The kind of insurance you have will often determine who your PCP is. Sometimes you can choose whatever PCP you want, though there may be different levels of co-pay. Primary care physicians often partner with other physicians in groups, some of which may be small (2-3 physicians), while some are very large (hundreds of physicians). They may also be part of a mixed primary care and specialty care group, often called multispecialty. Often these larger groups, whether they be only primary care or multispecialty, have many physicians and multiple locations.
Who your PCP is will often determine what hospital you would be admitted to and/or what specialists you would be referred to. This may be determined by what kind of insurance plan you have. When choosing a plan, it is always important to know if you can choose any PCP, if you have to choose among groups, or if there is only one group, but that you can choose any physician in that group.
One of the positives to the large multispecialty group for a PCP is that consultation with a specialist can be very easy since the physicians in the group all work together. One of the other positives is that it may be relatively easy to see another physician if yours is not available, or visit another location if that is more convenient. A downside is that the large groups may feel impersonal or mechanical.
Choosing a Primary Care Physician (PCP)
Choosing a PCP: The Logistics
When choosing a PCP, whether it be a small group or a large group practice, there are some practical things to consider. These things are usually not determined by the physician, nor are they usually under her or his direct control. However, they are important things to think about when deciding on a physician.
- Location: Where is the physician located? Is the office easy to get to? Is there parking or public transportation? Are there multiple locations?
- Where are labs and other tests performed? Are these done in the office, at an affiliated hospital, or some other site?
- If you need care after hours, on holidays or weekends, how do you get it? Is there an affiliated urgent care? Is an advice line or video chat available? Having to go to a hospital emergency department (ED) for urgent but not emergent health concerns can be frustrating. Ask in advance how care is delivered when the office is closed.
- Are same day appointments available, either with the physician or with another practitioner? How do you get care when you need it that day?
- Is e-mail available for communication? Are video visits available if you don’t need to be seen in person? Many things can be handled either by e-mail or a video visit. These are great ways to ask questions, get refills, and generally communicate with your doctor without having to visit the office.
- As mentioned above, find out about referrals for specialty care. Are there are specific specialists that you would be referred to or can you choose anyone you want? The same is true for which hospital you would go to if you got sick or needed an operation. This may be determined by your insurance, not the doctor herself or himself.
- What is the co-pay for an office visit? Will the PCP’s office bill your insurance company or you do you pay and then get reimbursed?
Choosing a PCP: The ART
Once you find out which PCPs are available through your insurance, and you learn some of the general logistics about their practice, you can start looking closely at them individually. At ProNobis Health, we want to help you think through your values, the things that are important to you in your relationship with a physician, particularly your PCP. You and your PCP may have a relationship that lasts for many years. Your PCP may be with you during some of the most difficult phases of your life. Like any relationship, it is important to think about the things you want in a PCP.
- Gender: For some people, the gender of their PCP is very important. This could have to do with comfort during an exam, or talking about personal matters. Most medical groups recognize that some patients have a gender preference in a PCP and will try to accommodate it.
- Age: Some patients prefer a PCP around their own age, while others may prefer someone older or younger. Your preference may be based on who you feel you can relate to best, who you feel is closest to residency and has the latest ideas, or who has the most experience and wisdom.
- Culturally Sensitive Care: Some cultural groups have specific ways of viewing the doctor-patient relationship, or they have unique beliefs related to illness and treatment. If this is important to you, then finding a doctor who either shares or understands your culture will lead to a much better relationship. If there is no such doctor available, then at least find a doctor who is open to your cultural beliefs and will respect them.
- LGBTQ: Similar to culture, some LGBTQ patients want to find a physician who shares their experience, or who at minimum understands and respects them. There are aspects to caring for LGBTQ patients that not all physicians may have experience with, or be comfortable with. Not just in terms of sensitivity, but also in order to provide the best possible care, it can be very important to have a physician who is familiar specifically with LGBTQ health.
- Religion: Because some religions have firmly held beliefs about medical care, particularly those which forbid certain treatments or procedures, it is important to find a physician who either believes similarly or who understands and will respect your beliefs. This can be particularly important if there is an emergency or a situation in which you are unable to express your wishes. Having a physician who knows you, and knows and respects your religious convictions about certain procedures or treatments, will lead to a better relationship and better care.
- Languages Spoken: For patients whose first language is not English, particularly when it comes to complicated medical discussions, it can be very important to find a physician who speaks the language you are most comfortable with. This may also coincide with your cultural beliefs, but it does not have to. If there is no physician who speaks your preferred language, then ask about the availability of interpreter services. It will be frustrating to you and your physician if you are not able to communicate effectively because of a language barrier.
- Alternative Therapies: Finding a physician who is knowledgeable about and comfortable with alternative therapies is very important to some patients. This includes therapies such as acupuncture for pain, or other non-medicinal remedies.
Choosing a PCP – The Science
CMS Physician Compare
For PCPs that accept Medicare, the Centers for Medicare & Medicaid Services (CMS) requires that they, or the medical group to which they belong, report basic information. CMS then reports some of this information on their website, Physician Compare. There you can find information about PCPs or the group to which they belong. Because not all PCPs report the same information or in the same way, what you are looking for may not appear on their profile page. Also, some information that PCPs report is not publicly available on Physician Compare.
Here is some of the information that may be available:
- Innovative model participation
- Electronic health record technology participation
- Health care performance (preventative care, patient safety, care planning, diabetes, heart disease, respiratory disease, behavioral health)
- Patient survey scores
If the PCPs you are considering don’t have specific information on Physician Compare, it does not mean that they are not high quality, or that they do not report. Physician Compare has not consistently rolled out their public reporting.
State Medical Boards
You can research your PCP on the medical board site for the state where the PCP practices. The information that most medical boards make public is whether the physician has been disciplined for anything by the board. Some may also make malpractice settlements over a certain amount of money publicly available. Many very good physicians have had a lapse in good judgement that got them disciplined or have been sued for an unintended adverse outcome. Keep that in mind when you review the medical board information.