Choosing Well: Patient Challenges in Choosing a Physician in a Rapidly Changing World
Earlier this week the Wall Street Journal published an article describing challenges today’s patients face in choosing a primary care provider. Primary care provides the backbone for our medical system and is an integral part of prevention–thus conferring a significant savings in healthcare dollars over the long run. For most patients, finding the right provider can be a daunting task. More and more patients are looking for new providers as physicians retire or modify current practice models. Analysts predict that if the current iteration of government reform continues on its planned “phase in” schedule, there will be a significant shortage of primary care physicians by 2014. It is important that patients are able to find the right physician to care for them and establish a care relationship now.
Primary care models are changing as the healthcare industry moves forward toward the currently legislated reform. The system will soon be flooded with new patients and practicing physicians will have difficulty absorbing the expected large increases in volume. Many physicians are leaving private practice to work for large hospital systems. Others are starting “concierge” practices where patients pay premium prices for preferred “round the clock” cell phone access and house calls. Still others are opting to move into employer based clinics and work to provide care to company employees. These medical landscape changes have resulted in confusing and sometimes difficult choices for patients.
Historically, most patients find new physicians by “word of mouth” recommendations from friends, family, and colleagues. Although this remains an integral part of the process, there are other considerations and other sources from which a potential patient can find a primary care provider. In the digital age, online reviews of physicians are easily available. However, these online reviews may be biased by disgruntled patients, former employees and competitors. Most online review sites are not regulated and may not provide a clear picture of the skill and expertise of the provider. Other online resources including websites of individual state medical boards can provide information regarding any pending actions or complaints against a particular physician or healthcare provider. In addition, a google search of a particular physician can provide links to his or her website, scholarly articles, TV and radio appearances or other relevant press.
Choosing a physician is a lot like choosing a spouse. The best medical care often results from a well established long term relationship. Just as in a marriage, to be most effective, the physician and patient must be able to communicate, work together to achieve common goals and (at times) engage in difficult discussions. The choice of the perfect physician match is not a new issue and was addressed in an article in the New York Times in 2008. Many of the points made in the article remain relevant today as well and are included in the list below. It should go without saying that the first step in physician selection is to determine which physicians are included in your insurance’s provider network.
So, what are some helpful hints for choosing the physician who is the best fit for you and your needs?
1. Determine what your goals are. Do you have multiple medical problems and are you looking for frequent care and visits? If so, you may consider larger practices that are owned by a hospital system with multiple providers that can accommodate same day visits. Alternatively, are you relatively healthy and really only need a yearly physical exam and care when acute illness strikes? Then a different system such as a small group private practice or concierge practice may be the right thing for you.
2. Determine what style of care you are looking for. Questions to ask yourself include: Do you want a physician who is very conservative or more aggressive? Do you want a provider who orders frequent and multiple tests? Do you want a physician who involves lots of specialists in your care or simply handles most concerns himself?
3. Consider the importance of the location of facilities and hospitals. It is important to understand where you will receive care. The office should be in a convenient location. Additionally, it is important to ask if the doctor who cares for you will be caring for you in the hospital as well. Today, it is common for your primary care doctor to focus on outpatient care while turning you over to a hospitalist physician for times when you are admitted to the hospital. Patients must also ask where they may be hospitalized if required. It may not always be the closest and most convenient facility. Many providers have relationships with particular hospital systems and patients may be directed in a particular pattern.
4. Evaluate the physician’s practice information processing and consider the ease of two-way communication. It is important to understand how your physician handles medical information. For some patients with multiple providers, it may be important that the primary care doctor is digitally connected with other specialists so that medical records, test results and referrals can be easily accessed and immediately available. In addition, patients may prefer a particular way to communicate, schedule appointments and receive test results. For example, there are some primary care practices that use email and internet portals to schedule appointments, deliver test results and communicate follow up information.
Healthcare is rapidly changing. Primary care physicians (as well as specialists) are facing more challenges as healthcare reform evolves in the US. Practice models are more diverse and healthcare delivery is becoming more technologically innovative. For patients, choosing the right provider to meet their particular healthcare needs can prove challenging. Outcomes are improved when providers and patients “connect” well. Now, more than ever, it is important that patients are able to “choose wisely” and find a primary care provider with whom they can bond and develop a life-long relationship. For many patients, navigating the current healthcare environment is akin to navigating a ship in rough seas. A good primary care physician can make the difference between shipwreck and safe passage.