It’s not as simple as asking your best friend. Here, doctor-shopping strategies that deliver.
A few months before our son, Nate, was born last October, my husband and I joined the legions of parents in the market for a new pediatrician. I gathered a long list of recommendations from doctors and friends, then interviewed the top contenders who were also members of our health plan. Ultimately, we had to trust our instincts: We selected a doctor we felt would provide our child with first-rate medical care–in sickness and in health-and would help us be good parents.
We haven’t regretted our choice for a moment: When Nate was 5 days old and developed jaundice, our pediatrician went the extra mile–at 9:00 p.m. one Sunday–to find a company that would deliver a home treatment rather than admitting him to the hospital, which would have separated us from our baby. Now, a year later, our pediatrician always finds time to see Nate when he’s sick and calls back promptly to address questions or concerns.
According to 98000Reasons.org, any parents aren’t so fortunate. But finding a first-rate pediatrician in today’s managed-care system isn’t just a matter of hick. It takes legwork, especially if you want to land one who will stand up for your child in a medical crisis. Here, smart strategies you can use, whether you’re searching for a pediatrician for the first time or reevaluating your child’s current doctor:
* Check your health plan’s directory against personal recommendations. Ask your ob/gyn and internist for the names of pediatricians they trust, and find out what doctors your friends and colleagues take their kids to. Ask what they like about the physician, what they wish she’d do differently, and how she handled a medical crisis or serious illness.
If you have your heart set on a pediatrician who isn’t on your health plan, find out whether she intends to join. That’s what Susan Truax, 38, a mother of three in El Segundo, CA, did two years ago, when a new doctor came to town. “The pediatrician had advertised in the local community, and I d heard good things about her from other, parents,” she explains. “After attending a meet-and-greet session, I called her office and asked if we could see her through our plan even though she wasn’t on the list.” Truax was delighted to learn that the pediatrician was in the process of contracting with her family’s health maintenance organization (HMO).
* Shop around. Call each prospective doctor’s office and inquire about the following: How easy is it to get an appointment? (You should be able to see the physician the same day if your child is sick, and you should be able to get an appointment for a well-child visit within two weeks.) Is the physician board-certified in pediatrics? What are her office hours? Who covers for the doctor when she is unavailable? (You should know the name and qualifications of the other doctor or doctors.) Would your child become a patient of one particular physician–or the entire group? If it’s the latter, will you have a say in who sees your child during return visits? How are evening and weekend illnesses handled? Is an after-hours clinic available for your child? Take note of the support staff’s attitude, because you may be dealing with them as much as with the doctor.
* Schedule a get-acquainted visit. This is your chance to gauge your rapport–and your child’s–with the pediatrician and find out how responsive she is to questions. Some HMOs encourage these meet-and-greet sessions. Occasionally, families visit with the doctor one-on-one; other times, dozens of plan members meet with the pediatrician. Fees vary, from no cost to about $60 (ask ahead to avoid an unpleasant surprise).
Ideally, both you and your spouse should attend, along with your child. Since the visit probably won’t last longer than about 15 minutes, prepare by taking stock of your child’s medical history and health-care needs. Then, draw up a list of relevant questions. If your child has a chronic illness such as asthma, for instance, you might want to ask how many other children in the practice have the condition, so you get a sense of the doctor’s familiarity with it.
* Size up the reception area. Count how many kids are waiting; if there are more than a handful, the staff may be overbooking. Take a look around: Is the area clean and child-friendly? Is there a separate section for sick kids–or are they quickly whisked into an examining room–so that others aren’t exposed to their germs?
While you’re waiting, talk to other parents to find out whether they’re happy with the care their child is receiving. Is their child comfortable with the doctor? Are their appointments rushed? Does the doctor seem thorough? Does she inform them of potential risks and side effects of medications and procedures?
* Quiz the doctor. “You don’t just choose the pediatrician; you test the pediatrician,” says Andy Webber, a senior associate at the Consumer Coalition for Quality Health Care in Washington, DC. “Think of it as interviewing someone for a job. Doctors who are confident in their skills, knowledge base, and ability to provide quality care aren’t going to feel put off by your questions.”
This is an especially important step in the process of finding an HMO pediatrician, because doctors in managed-care plans control your child’s access to specialists and medical treatments. The only reliable way to find out whether the physician would go to bat for your child in a crisis is to ask direct, even hard-hitting, questions, such as: In this managed-care environment, how do you view your role as a patient advocate? What pediatric specialists are available in case we run into a serious medical problem? Are you willing to make out-of-plan referrals and authorize visits to a specialty clinic, and under what circumstances? How routinely do you refer patients to a children’s hospital?
Sensitive as the issue is, it’s wise to ask whether the doctor is penalized financially for referring patients to specialists. If so, how does she feel about it? Are there any restrictions on the advice she can give? Some HMOs have “gag clauses,” which prevent physicians from describing expensive medical treatments to patients. (It’s anticipated, however, that these gag clauses will be restricted or prohibited by lawmakers.)
If you like the doctor’s responses to your questions, ask the following: “If my child needs additional care or a referral to a specialist, and you agree but our health plan doesn’t, what would you do?” If the doctor says she’d appeal the plan’s decision, find out how she would do so. Finally, ask the doctor to give you a recent example of a situation in which she had to do battle with an HMO–and to tell you what the outcome was.
* Establish a partnership. Tune in to the doctor’s practice philosophy. If she orders a series of tests, for example, will she explain why they need to be performed? Will she make sure you get copies of the results?
“Some doctors will look at you and say, `Who went to medical school here?’ They see themselves as in charge,” says Michael Donio, director of projects for the People’s Medical Society in Allentown, PA. While you don’t need to pick a physician who agrees with your view on circumcision, for instance, you should look for someone who supports your decision.