Finding a Specialist

In an ideal world, we would never get sick and never need to see a doctor. Here in the real world – as those of us who have found our way to AF’s board have learned all too well – sometimes disease strikes and PCPs refer people to specialists. It would be nice if the first specialist to whom we were referred was a good fit. When it isn’t, how do we go about finding a new one?

If you are leaving one specialist in search of another, knowing why it isn’t a good fit should be helpful in finding a new doctor. Maybe the travel distance is too great. Maybe you and the doctor do not have the same native language and it hinders communication. Maybe the doctor doesn’t listen to you. Maybe you want to try alternative treatments and the doctor ridicules you for that. Maybe you have a strong preference for one gender. It could just be bad chemistry. Or maybe your insurance changes and you are forced to go elsewhere. Every person’s criteria will be unique. The key is to figure out which factors are important to you, and do your research based on those that you think really matter.

Throwing darts at a list of doctors probably isn’t the best method to use in selecting a physician. Especially if it’s someone you’ll need to see long-term.

First, go back to your PCP and ask if your doctor could recommend someone else.

 

If, for some reason, that doesn’t work, or if you want to do some research on your own first, here are some things to consider.

  • Where is the doctor located?
  • Does this doctor take your insurance?
  • Does this doctor have privileges at your preferred hospital?
  • Is this doctor board-certified?
  • Where did the person attend medical school? Residency?
  • What is the lead time for new-patient or second-opinion appointments?
  • After that, how long does it take to get an established-patient appointment?
  • Does the doctor see patients, or are patients farmed out to a PA or NP?
  • If a patient phones with a question, how long does it take to get a response? Are calls returned the same day?
  • Are special tests done in-house, or referred out?
  • Do you like the support staff?
  • Does the doctor take questions by e-mail?

Since the results are more important than a party-game, it’s important to do it right.

Location – How far will you have to drive? Is the doctor ten minutes away, or three hours? It might be worth driving farther for an excellent doctor.

Insurance – It makes sense to begin your search with doctors covered by your insurance plan. Visit your insurance company’s website and do a search by specialty. If there is only one local specialist in your insurance network, but you don’t like that doctor, then it might be worth travelling farther to find someone within your network, or it might be worth paying more money to see someone local that you really like.

Credentials – If board certification is important to you, then check the credentials of the doctor. Some perfectly competent doctors choose not to be board certified. Some doctors don’t have a good enough grasp of English to be able to pass the board exam. Some doctors don’t stay current with new developments within a specialty, so are unable to pass the board exam. If someone isn’t board certified, I’d ask why. Credentials can be checked at the American Board of Medical Specialties website.

The American College of Rheumatology has a doctor-finder feature that allows patients to search for member physicians. Obviously, ACR’s website won’t do you any good if you need a different specialty, but the AMA’s patient resources page includes a Medical Societies Directory.

Education – Physician training in the United States is different than in other countries. If this is a factor for you, then find out where the doctor attended medical school.

Appointment Lead Time – Will you be seen in two weeks, or not for three months? If the lead-time is lengthy, why? A doctor might be backlogged because the person is such an excellent doctor that patients feel it’s worth the wait. Or maybe the office is only open two days a week. The reason for the wait is just as important as its length. If the wait is lengthy, work with your PCP on interim treatment.

MD/PA/NP – I have nothing against healthcare providers who don’t have an MD after their name. A PA or NP trained by a specialist probably knows more about that specialty than an MD in a different specialty. However, there’s no point in doing all your research about a particular doctor, only to learn that the doctor will not be the one to see you. If you’ll actually be seen by a PA or NP, then that is who you need to vet. When phoning the doctor’s office, simply ask.  Some places will say, “The doctor isn’t taking new patients, but the physician’s assistant can see you.”  Other offices will say, “We don’t employ NPs or PA; doctors see all the patients.”

Phone Calls – The receptionist will claim that the policy is to return calls the same day (or immediately the following morning). Reality doesn’t always conform to policy, though, and existing patients are who will give you the real scoop. This is one of those questions that needs to be asked of patients in the waiting room.

E-mail – If being able to email your doctor is important to you, then that’s one of the criteria you need to consider. Lots of doctors won’t do email because it’s not billable, even though email could often be quicker than returning phone calls.

In-House Testing – If the RD wants x-rays, it’s nice to walk down the hall and have results in five minutes, instead of waiting an hour at an x-ray clinic and not getting results for a day or two. Since x-rays only show damage after the fact, and MRIs are the best method of detecting inflammation, at some point rheumatologists will probably switch machines. It’s a big expense, though, so I wouldn’t expect anyone nearing retirement to invest the money. Does the doctor have an in-house laboratory, or will you need to go elsewhere for blood draws? Since RA meds can cause osteoporosis, does the RD have a machine to do bone density scans in-house, or will you need to go elsewhere for dexa? There’s no right or wrong answer to these questions – just things to find out and consider when you’re making your choice.

Support Staff – When you’ve had to wait while the receptionists and nurses are gossiping about how aggravating they think the last patient was (even if you agree), or the nurse’s B.O. just about knocks you over at 8 in the morning, you might decide that it’s time to factor support-staff into the equation.

Age – Sometimes age matters, sometimes it doesn’t. You might prefer a doctor with years of experience. There are times that extensive experience is appropriate (if I need a surgeon, I don’t want to be the doctor’s first patient). Other times you might want a younger doctor. If you know that you will need to see a rheumatologist for the next 40-50 years, you might not want to choose a doctor who is 65 years old – unless you enjoy the vetting process and want to repeat this whole mess again soon. You can check your state’s licensing board for a doctor’s year of birth. Or just phone the office and ask.

Clinical Trials – Some people do not want to be a guinea pig. But if currently approved treatments aren’t working for you, it can be nice to have access to experimental treatments. Double-blind studies mean than some people get placebos, and going without treatment isn’t what people really want. But that’s not the only type of study. At the time of this writing, there is (at least) one RA medication currently given as an infusion – but my RD is part of the trial seeing if injections will work just as well. In this trial, everyone gets treated.

Rating Sites – Three internet sites with physician ratings are vitals.com, ratemds.com, and RevolutionHealth.com. Check if you want, but take the comments with a healthy dose of skepticism. A doctor sees hundreds (thousands?) of patients. Three or four comments don’t really give you an accurate picture. Visiting a few offices to talk to patients is more time-consuming than the point-and-click method, but probably worth doing.