Health Insurance - Choosing a Doctor

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It is important to choose your doctor with care, because quality varies. For example, the Pacific Business Group on Health asked patients of California doctors' groups how they rated their care. The results? More than 80 percent of the patients said they were satisfied with their care. But fewer than two-thirds were happy with the ease of getting that care.

This chapter can help you choose a primary care doctor who will meet your needs and give you quality care. The information also may be useful in choosing any specialists you might need. Primary care doctors are specially trained to serve as your main doctor over the long term. They provide your medical and health care, help you stay healthy, and help to manage your care. Your primary care doctor can refer you to specialists (doctors who treat only certain parts of the body, conditions, or age groups) if you need them.

Quick Check for Quality

Look for a doctor who:

Is rated to give quality care.
Has the training and background that meet your needs.
Takes steps to prevent illness-for example, talks to you about quitting smoking.
Has privileges at the hospital of your choice.
Is part of your health plan, unless you can you afford to pay extra.
Encourages you to ask questions.
Listens to you.
Explains things clearly.
Treats you with respect.

Internists and family physicians are the two largest groups of primary care doctors for adults. Many women see obstetricians/gynecologists for some or all of their primary care needs. Pediatricians and family practitioners are primary care doctors for many children.

Physician assistants, nurse practitioners, and certified nurse midwives are trained to deliver many aspects of primary care. Physician assistants must practice in partnership with doctors. Nurse practitioners and certified nurse midwives can work independently in some States, but not others.

Doctors and Health Plans

If you already are in a health plan, your choices may be limited to doctors who participate in the plan. But if you have a choice of plans, you may want to first think about which doctor(s) you would like to use. Then, you may be able to choose a plan that has your choice of doctor(s).

Decide What You Want and Need in a Doctor
What is most important to you in a doctor? A few ideas are listed below. Add your own to create a list that will help you choose a doctor who is right for you.

My doctor must be highly rated by a consumer or other group. You will want to find out who did the ratings. Is the information reliable? Who collected it? Does the group have something to gain from the ratings?

Notes:

____________________________________________________________

My doctor needs to have experience with my condition(s). Research shows that doctors who have a lot of experience with a condition tend to have better success with it.

Notes:

____________________________________________________________

I want a doctor who has privileges (is permitted to practice) at the hospital of my choice.

Notes:

____________________________________________________________

My doctor must be part of my health plan.

Notes:

____________________________________________________________

Additional items:

____________________________________________________________

Make a List of Doctors

If you are in a managed care plan, check the plan's list of doctors first.
Ask doctors or other health professionals who work with doctors, such as hospital nurses.
Check the "Physician Select" service of the Web site of the American Medical Association. This can give you lists of doctors, by specialty, who practice near you. You can also check on training and board certification: http://www.ama-assn.org/aps/amahg.htm.
Call a doctor referral service at a hospital. But keep in mind that these services usually refer you to any of the doctors on the staff of that hospital. The services do not have information on the quality of care these doctors provide.
Some local medical societies offer lists of doctors who are members. Again, these lists do not have information on the quality of care these doctors provide.
Ask family, friends, neighbors, and co-workers.

Write your list here.

Name: _________________________________

Telephone: ____________________________

Name: _________________________________

Telephone: ____________________________

Name: _________________________________

Telephone: ____________________________

Check on Quality
Once you have a list of doctors, there are several ways to check on their skills and knowledge, and the quality of care they provide:

Find out if a consumer or other group has rated doctors in the area where you live. Again you will want to find out how reliable the ratings are.
Information on doctors in some States is available on the Internet at http://www.docboard.org. This Web site is run by Administrators in Medicine—a group of State medical board directors.
The American Board of Medical Specialties (1-800-733-2267) can tell you if the doctor is board certified. "Certified" means that the doctor has completed a training program in a specialty and has passed an exam (board) to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors also may be certified as specialists. You can also check the Web site at http://www.certifacts.org. (While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from doctors who are not board certified.)
Call the American Medical Association (AMA) at (312) 464-5000 for information on training, specialties, and board certification about many licensed doctors in the United States. This information also can be found in "Physician Select" at AMA's Web site: http://www.ama-assn.org/aps/amahg.htm.

Contact the Doctors' Offices
When you have found a few names of doctors you might want to try, call their offices. The first thing to find out is whether the doctor is covered by your health plan and is taking new patients. If the doctor is not covered by your plan, are you prepared to pay the extra costs?

Below are some questions you might want to ask the office manager or other staff. You may have some additional questions. Note that some of these items might have more to do with the health plan than with the doctor's office.

Things to find out from office staff:

Which hospitals does the doctor use?

Doctor A: ____________________________________