Beyond Primary Care: Choosing a Medical Specialist
Most people use a family physician, internist, obstetrician-gynecologist, or pediatrician as their primary care doctor. Primary care doctors, sometime called generalists , manage their patients’ healthcare and help them make medical decisions when problems arise.
But sometimes, a person develops a medical problem that requires a physician with a more narrow focus. These specialists have received additional training to become experts in a specific field, and they see far more patients with conditions related to their area of expertise than their generalist colleagues. Examples of specialists include oncologists (for cancer), cardiologists (for heart disease), and surgeons.
If you have a medical condition that requires specialty care, your primary care doctor will likely make a recommendation of whom to see, which you may simply choose to accept. However, there are many specialists out there, and you may wish to do your own investigation to determine which one is best for you.
Make a List of Specialists
The first step is to make a list of potential candidates. Your friends, family members, or coworkers may know of a trusted specialist. Fortunately, there are also a number of organizations and services that can provide you with a list of medical or surgical specialists from which to choose:
- American Medical Association DoctorFinder —an online database that allows users to search for doctors by name or by medical specialty
- American Board of Medical Specialties —a directory that lists doctors’ names, along with their specialty and background
- American College of Surgeons Membership Database —an online list of surgeons that is searchable by physician name, location, or specialty
- Association of State Medical Board Executive Directors Docfinder —provides data on doctors who are licensed in certain states
- Medicare Participating Physician Directory —a database of Medicare physicians that is searchable by doctor name, location, or specialty
- Disease-specific organizations and professional agencies—these resources (eg, National Cancer Institute , American College of Cardiologists ) may provide lists of specialists and sub-specialists in different geographic areas
- Insurance companies—your insurance provider should be able to provide you with a list of specialists that are covered under your plan
- Local hospitals—their patient referral services can provide a list of specialists that practice in that hospital
- Local medical societies—they may have lists of doctors in different specialties
- Public and medical libraries—they usually have print directories of doctors in different specialties
- Local phone books—local specialists are listed under the heading “Physicians”
- Doctors or other health professionals—doctors, nurses, and other healthcare professionals who work with specialists may be able to provide recommendations via phone or in person
Narrow Your List
Once you have made a list of specialists in your area, you will need to narrow it to two or three doctors who meet your specific needs. Below is a list of factors you may want to consider when choosing a specialist. Prioritizing this list and adding to it will help you choose the right doctor for you.
Training and Background
There is always a debate over the question of which specialist to choose: a young doctor fresh out of training, but with limited experience, versus an older doctor with years of experience, but who is possibly out of touch with the latest developments in his or her field. Fortunately, all doctors (including specialists) are required to participate in continuing medical education throughout their careers. While there are many fine doctors graduating from specialty training programs, generally speaking, the more experienced your doctor is with cases like yours, the better. This is especially true of surgeons and other highly technical physicians who require a lot of practice to perfect their skills.
Ratings by Consumer and Other Organizations
More and more doctors are being rated by consumer organizations and other groups devoted to quality healthcare. One such service, http://www.bestdoctors.com , uses a national survey method to solicit doctor recommendations from other prominent doctors. Other online services like this are http://www.ratemds.com , http://www.mdnationwide.org/performance.htm , and http://www.healthgrades.com , the latter two of which charge a fee. While this information can be extremely useful, it should not be the only criteria used to judge a physician, since these organizations may rely on rating systems that are not entirely accurate or fair.
Privileges at Certain Hospitals
If you want to be treated at a specific hospital, narrow your list to only those doctors who practice at that hospital. Keep in mind that if you’re looking for a surgeon, she can only be as good as the technical support the hospital provides. Therefore, it is important to know how many of your surgical procedures the hospital performs per year, and how well their patients do (eg, mortality rate).
Coverage by Health Plans
Unless you are prepared to pay for your treatment out-of-pocket (which is simply not an option for most of us), only consider doctors who are covered by your health plan.
Board certification is required for essentially all specialties. To become board certified, a doctor must complete a variable number of years (3-7 years) of additional training beyond their internship and pass an exam in their specialty. Since virtually all practicing specialists must meet these criteria, board certification will not be useful in distinguishing among them.
Membership in a Medical Society
Almost all specialists are members of a medical society (eg, American College of Surgeons). Doctors who have fellowship status in a medical society have demonstrated outstanding achievement in their profession in the eyes of their colleagues. Although this is a nice thing, it does not automatically mean they will provide you with higher quality care than those physicians who have not achieved the same status.
Ideally, your doctor should to be able to speak the same language you do. For non-English speakers, this will not often be the case. If you cannot directly communicate with your specialist, it essential that you find a practice and hospital that have high quality translation services.
Decide on a Specialist
When you have identified one or more specialists who meet your needs, the next step is to make an appointment. If your list includes more than one doctor, call each doctor’s office and ask what regular office hours are, how long it takes to get an appointment, what the typical wait in the doctor’s office is, whether the doctor or nurses give advice over the phone, and any other questions that are important to you.
When you visit your specialist for the first time, bring a list of questions. You want to be completely comfortable with your doctor, since you will be working closely with her when making decisions about your treatment.
American Medical Association
Medicare Participating Physician Directory
The College of Physicians and Surgeons of Ontario
Cardiovascular specialists and your health care. American College of Cardiology website. Available at: http://www.acc.org/media/patient/cardio.htm . Accessed June 12, 2006.
Choosing a doctor. Agency for Healthcare Research and Quality website. Available at: http://www.ahcpr.gov/consumer/qntascii/qntdr.htm . Accessed June 12, 2006.
Choosing and using a health plan. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/CONSUMER/hlthpln1.htm . Accessed June 12, 2006.
FAQ: find a doctor. National Library of Medicine website. Available at: http://www.nlm.nih.gov/services/doctor.html . Accessed August 26, 2008.
How to find a doctor or treatment facility if you have cancer. National Institute of Cancer website. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility . Accessed June 12, 2006.
Last reviewed June 2008 by
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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