September 25, 2014

How to Choose a Doctor

Over the past few years, I’ve chosen many new doctors and specialists. Most have been recommendations from other doctors I respect.

I’m 85. And in the weeks ahead, I expect to select a few more doctors.

In fact, the selection process never seems to end. It pops up again and again -- when we move to a new city, start a family, become disenchanted with doctors we have, care for an elderly parent, or develop new symptoms ourselves.

Our relationships with healthcare professionals end only when we die… unless we’re organ donors.

Have you chosen a new doctor or specialist recently? How did you make your decision?

I snooped around and found several lists of tips for finding and choosing new doctors.


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From the Associated Press:
  • The insured typically look in-network. Some insurers are starting to score their providers on certain quality and cost measures. Ask what your plan's listing means.
  • Check if the doctor is board-certified, which indicates particular expertise in an area such as internal medicine, gynecology, allergy and immunology. You don't want plastic surgery from a primary care physician, said Doris Peter, director of Consumer Reports' Health Ratings Center.
  • Check if a doctor has been disciplined by the state licensing agency. The Federation of State Medical Boards has a directory of state boards, plus a license search service for a fee.
  • If you need surgery or a specific procedure performed, ask how often the doctor provides that treatment to patients like you. Studies show volume makes a difference.
  • Interview the doctor. Do you want someone who discusses the pros and cons of tests and treatments upfront? Avoid physicians who discourage seeking a second opinion, said Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice. Also, ask if the doctor has any financial relationships with drugmakers or device manufacturers, said Consumer Reports' Peter.
  • Ask about specific health conditions. What percent of their diabetic patients have their blood sugar under control? Do they follow national guidelines on cancer screenings? That's the kind of information many quality programs are seeking. Fisher said physicians can't work to improve patients' outcomes if they don't track them.
  • Team-based care makes a difference, he said. Is there a nutritionist to help diabetics control blood sugar? Someone who calls to tell the blood pressure patient he's overdue for a check?
  • Ask how a primary care physician and specialist will coordinate care, perhaps via electronic medical records, so you're not prescribed conflicting medications or duplicative tests.
  • Ask about after-hours care. Will the person who answers the phone have access to your medical record?
  • Check if your state has any report cards to track health care quality. The nonprofit National Committee for Quality Assurance publishes online directories of doctors recognized for providing high-quality care for certain diseases or who are affiliated with "patient-centered medical homes," practices it recognizes as meeting certain requirements for coordinated care.

Get a go-to doctor
More and more insurance plans require that you choose one physician to serve as your main resource. That go-to person can not only help you with day-to-day health problems such as the flu or a sprained ankle but also refer you to specialists when necessary and, important, oversee all of the care you get.

“It may seem like a burden or restrictive to have to choose a primary care provider,” Orly Avitzur, M.D., medical adviser to Consumer Reports, said. “But everyone needs a project manager, so to speak, to help you navigate our confusing health care system.”

Growing research suggests that people who have a strong relationship with a physician not only report greater satisfac­tion with their care but also may enjoy better health. That makes sense, because having good communication and col­lab­oration with the doctor who oversees your care can help make sure you get the tests and treatments you need, and avoid common problems, such as getting duplicative or contradictory treatments from a legion of specialists.

See our Guide to doctor Ratings and our list of state-by-state resources for more on how to choose a doctor.

Let the search begin
If you know a doctor, nurse, or health care professional, ask for the names of doctors or practices in your area whom they like and trust. That can be more in­sightful than recommendations from friends or family. You should also consider what kind of doctor you want. Someone who can care for your whole family? Someone who focuses on women or older people (see below)? Here are some other things to consider as you search for Dr. Right.
  1. Check your insurance. Use your insurer’s directory or search on its website for doctors in your network. Because doctors often add or drop plans, call the office to verify that the doctor still accepts your insurance. (If you are choosing a health plan, use our insurance rankings to compare plans.)
  2. Consider hospital affiliation. Your choice of doctor can determine which hospital you go to, if needed, so find out where the doctor has admitting privileges. Then use our hospital Ratings to see how that facility compares with other hospitals in your area. 
  3. Look for board certification. Being certified through the American Board of Medical Specialties means a doctor has earned a medical degree from a qualified medical school, completed three to seven years of accredited residency training, is licensed by a state medical board, and has passed one or more exams administered by a member of the ABMS. To maintain the certification, a doctor is expected to participate in continuing education. To see whether a doctor is certified, go to certificationmatters.org.
  4. Watch out for red flags. They include malpractice claims and disciplinary actions. Even good doctors can get sued once or twice, but “you certainly don’t want someone who has had a lot of malpractice claims,” Avitzur says. Common reasons for being disciplined include substance abuse and inappropriate sexual behavior, though it can be hard to know exactly why a doctor was sanctioned. Most states let doctors prac­tice while they receive treatment. See our state-by-state list of links to state medical boards and other resources or checking up on doctors. 
  5. Consider compatibility. More than half of Americans focus on personality and relationship when choosing a physician, according to a 2014 survey from The Associated Press and the NORC Center for Public Affairs Research. (Just 29 percent said the delivery of care or the patient’s health outcome was most crucial.) Use your first visit as a litmus test. Some factors to consider: Does the doctor listen to you without interrupting? Does she fully answer your questions? Does she explain your diagnosis and treatment, and specify a date for a follow-up visit?
  6. Ask about drug reps. Many doctors let representatives from pharma­ceutical companies into their offices to pitch their drugs. That not only takes up a lot of the doctor’s time but also may inappropriately influence his choice of drugs. “That can get patients started on a brand-name medication that may be more expensive or may not be the best one for them,” Peter said. Moreover, a doctor’s attitude toward drug reps can indicate how committed he is to practicing according to the best evidence, not pressures from industry.
  7. Find out about office policies. Ask how long it takes to make an appointment for a routine visit (it should be less than a week), whether they offer same-day appointments, and how long patients are kept in the waiting room. Once you’re a patient, if the reality doesn’t meet your expectations, consider shopping around. That’s important not only to save you time but also for your health. In practices that waste patients’ time, research shows that “patients are less likely to follow up on recommendations to prevent or manage chronic conditions,” said L. Gordon Moore, M.D., chief medical officer at Treo Solutions, a data analytics firm.
  8. Scrutinize the staff. They are the people who will schedule your appointments, check you in and out, give the doctor your messages, and address insurance concerns. Look for a staff that’s friendly, efficient, and respectful. “Health care is a team sport,” said Lois Margaret Nora, M.D., J.D., and president and CEO of the American Board of Medical Specialties. “People should expect quality in their doctor and the system in which the physician practices.”
  9. Factor in technology. Electronic health records let your doctor track your medical history, share info with spe­cialists, and monitor all of your drugs. Many doctors also have a patient portal, a secured website that gives you 24-hour access to your health information, al­lowing you to book and track doctor appointments, get lab results, request prescription refills, and e-mail questions to your doctor. The government requires that health information be protected with passwords, encryption, and other technical safeguards. Still, ask how your information will be safeguarded. (Read our article "The Doctor Will E-mail You Now.")
Where to go for doctor information
Consumer Reports has started to rate primary care doctors, using data from physicians, health plans, employers, hospitals, and consumers. But the effort is now limited to four states—California, Massachusetts, Minnesota, and Wisconsin. (See ourGuide to doctor Ratings.) We also provide Ratings of heart surgery groups, using data from the Society of Thoracic Surgeons.

Here is a quick guide to some other sites that provide information on doctors.

  • AMA DoctorFinder. Basic information on more than 814,000 physicians in the U.S. You get information on specialty training, board certification, and more. But there is no information on patient outcomes, disciplinary actions, or communication skills.
  • AngiesList.com. User reviews on an A through F scale, sometimes based on a limited number of responses, for categories such as availability, punctuality, staff friendliness, and effectiveness of treatment. Requires an annual membership fee ranging from $3.50 to $10, depending on services you select.
  • Castle Connolly. Ratings of “top doctors” based on peer nominations, research, screening, and other factors. Search by name, location, hospital, specialty, or insurance.
  • Healthgrades.com. Comprehensive, easy-to-use site that allows searches by name, procedure, specialty, or condition. Includes info on education, affiliated hospitals (and ratings on the hospital itself), sanctions, malpractice claims and board actions, office locations, and insurance plans. Ratings on topics such as patient satisfaction and wait time are based on patient feedback, which can be limited.
  • National Committee for Quality Assurance. Reliable information on doctors who meet important standards in measures such as being a patient-centered medical home, care for heart disease, diabetes, and back pain. NCQA verifies a doctor’s licensing, but other data is self-reported.
  • Physician Compare. Information from the federal Centers for Medicare and Medicaid Services for people looking for health care providers who accept Medicare. Provides information on board certification, education, and group and hospital affiliations.
  • RateMDs.com. Search for doctors by name, sex, ZIP code, state, and specialty. Includes information on training as well as patient ratings on staff, punctuality, helpfulness, and knowledge. It has links to medical board records where you can get information on disciplinary actions. Patients can post questions and answers about doctors. Ratings are based on patient reviews.
  • Vitals.com. Find doctors by specialty, condition, insurance, name, and more. You’ll get the lowdown on a doctor’s awards, expertise, hospital affiliations, and insurance as well as patient ratings on measures such as bedside manner, follow-up, promptness, accuracy of diagnosis, and average wait time. There’s also a patient-comment section.
  • U.S. News & World Report. No ratings of doctors, just basic info on a physician’s years in practice, hospital affiliation, training, certification, licensure, insurance, and awards.
  • Yelp.com. User reviews that give doctors one to five stars. Doctors can’t pay to alter or remove their reviews, though it is hard to tell what the reviewer’s relationship is to the doctor and doctors can get high ratings with just a few responses.
Questions to Ask a Doctor
In the process of selecting a family physician, you should draw up a list of basic questions to ask the doctor and consider the following:

  • Will the doctor treat all family members?
  • Is the doctor covered by your insurance plan?
  • Does the doctor provide care during pregnancy and perform deliveries?
  • Does the doctor have staff privileges at a nearby accredited hospital?
  • Does the doctor perform surgery? If so, what kind?
  • Does the doctor encourage preventive medicine, such as routine checkups, immunizations, and follow-up tests?
  • Does the doctor make emergency house calls for bedridden family members?
  • Does the doctor have office hours that are convenient for your family, especially for those who work or attend school?
  • What arrangement does the doctor have for a substitute when he or she is unavailable?
  • What are the fees for the various services?
  • Is the doctor certified by the American Board of Family Practice (or a specialty board of another area)?
The answers to these questions, along with the recommendations of friends and neighbors, will help you select the right doctor for you and your family.

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