Kids and Health Care: Choosing the Right Doctor...and Plan Introduction

Good pediatricians are always hard to find. If you join a managed care plan, tackle finding the best children's doctor like a research project. Scour the list of participating pediatricians. Ask friends or coworkers for suggestions. Call and visit as many participating pediatricians as time allows. Even if a doctor is busy, you can tell a lot about him or her by the condition and temperament of office staff.

Choosing the right doctor is as personal -- and subjective -- a matter as any choice you can make. Some people like stern, serious clinicians; some prefer warmer humanists. As they get older, your kids will have preferences of their own -- but, when they're little, you're going to have to choose for them.

In this chapter, we'll take a look at the various factors to consider when choosing a physician. We'll consider the choice particularly from the perspective of matching the right provider with the right plan. The right combination improves the whole experience.

Cast a wide net by consulting standard reference resources that offer "Yellow Page" style lists of practicing physicians. The best known of these are:

• AMA Physician Select, the American Medical Association's free service on the Internet for information about physicians (www.ama-assn.org); and
• Directory of Medical Specialists, a book available at your local library; lists upto-date professional and biographic information on about 400,000 practicing physicians -- including a section on pediatricians. If you have trouble finding a copy, call the American Board of Medical Specialties at (800) 776-2378 for more information.

Also, there are a number of for-profit medical information Internet sites that offer information on doctors by geographic region. The best-known of these include WebMD.com and the AMA's search function called AMA Physician Select at www.ama-assn.org. Another site, Hypocrates.com also offers many useful links. But beware, when you use these sites: Many of the listings on them are paying for their placement.

Once you have the names of plan doctors who interest you, follow as many of these steps as you can:

• Ask plans and medical offices for information on their doctors' training and experience.
• Find out whether the doctor is board certified. Although all doctors must be licensed to practice medicine, some go a step further to become board certified in a particular specialty.
• Ask if any complaints have been registered or disciplinary actions taken against the doctor. To find out, call your State Medical Licensing Board or state insurance department. (Not all departments accept complaints.)
• Set up a "get acquainted" appointment with the doctor. Ask if there is a charge for these visits. Such appointments allow you to interview the doctor.
• Even if the doctor isn't available for a meeting, ask office staff about whether the doctor has any special focus within pediatrics, if the practice includes several doctors and -- critically -- which health plans the doctor accepts.

The kind of health care plan that you choose also will influence the doctor you choose -- and this goes beyond the simple fact that you'll need a pediatrician for your kids.

If you are in a managed care plan, ask your plan for a list or directory of its providers. And call the member services staff for tips on which pediatricians are their most popular; sometimes, these administrative employees can help you find a good doctor.

And sometimes the best doctor for a family with children may not be a pediatrician. The growth of managed care has encouraged a growing number of "family medicine" specialists. These doctors have training and experience in children's medicine (in fact, many have started their careers as pediatricians); but they also see adults. Their training may also include OB/GYN work and some psychiatry. The net result: A specialist with general experience in the various medical fields related to families.

Family medicine specialists work especially well as primary physicians in managed care programs -- your entire family can have the same "doctor," who's usually able and inclined to make smart referrals when the various family members need special care.

A key question to ask any doctor: Will he or she enroll in your health plan? Some will, especially if you have several children. (And, frankly, the answer to this question may have as much to do with how adept the doctor's office staff is at handling health plan paperwork.)

Managed care plans aren't the only ones that use primary gatekeeper physicians. Increasingly, even indemnity insurance plans ask members to choose a primary physician -- if only to have a recognizable name to use when reviewing medical bills. But this choice is much less important than the choice of a primary physician in a managed care plan.