Ep 31 How to Find a Doctor

Heather (00:05)
So you listened to my last episode on preventive healthcare and the importance of getting yourself a primary care doc and you're completely convinced by me and now you need to find that provider and are unsure about how to start. If you're going to make this effort, you want to find someone who is convenient, accessible and trustworthy.

And we'll talk today about some factors that play into those qualities. Let's start with what constitutes a primary care provider. There are actually different kinds, doctors, physician assistants, and nurse practitioners. The main difference between these three is how much and what type of training they receive to be able to see you as a patient. You may or may not actually know this, but there are two kinds of medical doctors. One is called an MD,

which stands for medical doctor,

And another is called a DO, Doctor of Osteopathy. The difference is in the training model. An MD has gone through the traditional four years of medical school followed by a required medical residency that can vary from three to seven years depending on their field. A DO will also have gone to a four-year medical school, but one that adds in a holistic whole body approach that includes more training

in especially musculoskeletal work like chiropractics as an example. They then complete a traditional medical residency the same as an MD. Both MDs and DOs are doctors or physicians. For both types, this totals about 11 to 15 years of education and training after high school. Of note, some DOs continue to practice in a more holistic way while others actually leave that behind and...

take a pretty traditional medical doctor approach. It's very possible that you've seen a DO without even realizing that it's technically something a little different than an MD. Both MDs and DOs that choose to go into primary care become either an internist and see only adults, a family medicine doctor that sees all ages, or a pediatrician who sees only kids and teens.

Now there are also physician assistants or physician associates as they're now called in some states.

They complete a two to three year long master's program and then they also have the option to complete a residency, styled after a medical doctor residency, though only about 5 % of practicing PAs, as they're called currently in the US, have done so. Most complete their masters and receive more training on the job. PAs must practice with some type of physician oversight, which is state regulated.

so their level of independence varies from state to state. Their training totals six to seven years after high school. Last but not least, nurse practitioners complete a two to four year nursing undergraduate program, then typically spend one to three years working as a nurse before completing a master's or doctoral NP program for two to three years. NP's, like physician assistants, need to have physician oversight, which also varies by state.

Their training totals six to eight years after high school. Now, in addition to simply years of training that I listed above, each type of provider has what's called clinical hours that are built into their training, which means spending time with actual patients as you're learning. Because the number of years that each provider type spends in training varies, so do their clinical hours. For example, a typical physician will have 15 to 20,000 clinical hours during their training.

while a PA typically has three to 4,000 hours and an NP has five to 700 hours. Though an interesting thing about PAs, in the US, 80 % of them go on to specialize in one subtype of medicine as opposed to providing general primary care. For example, after I was diagnosed with heart failure, I had to get checked out pretty frequently in those first months and I saw a cardiology specializing PA for that. She was awesome.

and was very experienced in doing the narrow thing that I needed her to do, a cardiac exam, blood pressure evaluation, and general medication management. But often I had questions beyond that scope that she could not answer, like what the current research was at that time on one medication versus another one that was new on the market, or a question about expected outcomes over time for me, given the very specific type and cause of heart failure that I had.

I'm not knocking PAs or NPs at all, but it's important to understand that in general, their scope is a bit more narrow and limited than a physician. In Illinois specifically, both PAs and NPs have to have that collaboration agreement with a physician, which means that they can't practice fully independently. A physician has to be available to them, though not necessarily physically on site with them.

Interestingly, there's a path in Illinois for nurse practitioners to gain more independence and practice without that physician agreement after they've documented 4,000 hours of clinical time and 250 continuing education hours. This path doesn't yet exist for PAs in Illinois, which is interesting to me because they already have way more clinical hours in their training than an NP does. But because there's a shortage of providers everywhere, states are always trying to get NP's and PAs more independent practice authority.

to fill the gaps, especially in rural and underserved areas. What all of this means is that as they finish their training years, MDs and DOs have way more experience in training right off the bat and are trained in a much wider and deeper scope of specialties. So you might say, well, why see any other kind of provider? Well, a few reasons. First of all, PAs and NPs are more likely to have a more open schedule, so it's typically easier to get in to see them. But in terms of their training differences,

Imagine a first year doctor fresh out of school versus a PA with 10 or 20 years of clinical experience. It's just not an apples to apples comparison as there are so many factors that affect how a provider functions in their practice.

So the first question you have before you based on all of this is what type of provider do you want to see? I'll admit upfront that I am completely and unequivocally biased in my answer, which is that I prefer an MD or DO as a primary care provider for myself and for everyone I know. It's that breadth and depth difference in training that makes me feel that way. But look, I am a physician and I have a lot of complex medical problems and my questions are more typically physician level.

So again, I'm biased in this. I'll just say that you have to make your own choice about what you're comfortable with here and what will work given where you live, who's available, what your insurance covers, et cetera. You may have noticed that I did not mention having your gynecologist be your primary care provider or your physical therapist for that matter, or chiropractor, mental health therapist or neighbor. And that's because they should not be.

None of those folks that I mentioned have thorough and up-to-date training in preventive health care, even though they might be excellent at what they do do. Nor should you be using ChatGPT or any other AI platform as your primary care provider. Besides the fact that they are excellent actors that make it difficult for us to know when they're stretching the truth, they are not licensed to give medical advice because they are not an actual person or health provider, even though they may act like one.

Stay tuned for an episode coming soon on AI and healthcare and hear more about what's working and not working with that.

Okay, you have a provider type in mind that you're interested in. Now, where do you find that person? There are multiple angles from which you can approach finding a provider and they almost all involve websites. I'm sorry for those of you who are a bit older and struggle with technology, but this really is just where things are at now. One place you can start if you have health insurance is on that health insurance company's website so that you can find someone who you can ensure will be in your network.

Or you can look at the website for a health center that's near you. That might be a big academic medical center or a small corner clinic, or maybe it's your local CVS Minute Clinic. Maybe you live really and you have to look at the medical clinic a couple of towns over.

Regardless, most places these days have a website on which you can search for a provider. When you get to said website, you want to find a tab or section called find a doctor or find care or make an appointment. If you can't find any of those, you can instead try Googling the name of the medical facility and then the words find a doctor. For example, here in Chicago, that might mean that I would Google

University of Chicago, find a doctor. And that usually gives a link right to the page you need to get to. Now, depending on the size of the facility, you might get two results from your search or 400. We'll talk in the next section about how to pare that down and what kinds of things to look for. If none of the above works for you, there are also websites that list information about doctors in general, like healthgrades.com,

topnpi.com, boardcertified.com. On all of these websites, you can search by a certain specialty like internal medicine, for example, or for a specific doctor's name and in your zip code. I'll include links to those websites in the show notes. Lastly, ask your friends and family who they see and what they like and don't like about both the provider and the facility where they are.

You'll hear all kinds of opinions from people you ask, but word of mouth can be helpful because it involves just a smidge of that idea that I talk about so much, which is trust. You probably, or hopefully, will have at least a little bit of trust for your friend or family member about what you're asking them.

So now you're on the website of a facility or of your insurance company or perhaps one of the other sites I mentioned above. How do you begin? Every site that I looked at had some filters that you can set to narrow your search down. For example, specialty type, gender, which insurance they accept, things like that.

I'm going to review each of these in no particular order since different details will be important to different people, though I'm going to clump the things I think are a bit more important upfront and leave the things I think are a bit less important for the end. First up is what type of provider you're looking for. You may or may not have the ability to filter for MD or DO or physician assistant or nurse practitioner like we discussed above. You should be able to search though for the type of medicine practiced.

Remember, you're looking for general primary care, and this is called different things at different places. Search terms for this might include internist or internal medicine, primary care, family medicine, preventive care, or concierge care, which if you remember is when you pay out of pocket for a doctor that does not accept any insurance at all. Next up is insurance type.

I strongly recommend that you filter right off the bat for your specific insurance if you can, so as to avoid spinning your wheels and ending up with someone who ultimately can't see you. Same idea for filtering these providers who are accepting new patients. If you are one, a new patient, you might as well turn this filter on since it won't help you if you find a provider that isn't taking any more new patients. The next two, which I think are very important,

though others may not agree, are related to education and training. The truth is, medical education is on a quality spectrum just like education is for anything else. I think it's a fair generalization to say that someone who gets into Harvard Medical School with a 4.0 grade point average from college is likely to be a bit smarter overall than someone who gets into a much lesser known medical school that only requires a

2.5 GPA in college. Again, this is a generalization, and I'm not trying to knock any schools here. This is just how I see it. I look at where they completed their training, both for medical school and residency. It's a bit harder to understand and figure this out if you're not part of the medical system, but if you really want to go the extra mile on this one, you can Google what are the top 20 or 30 medical schools or residency programs in the US and see if the provider you're looking at

went to any of those. In addition to where someone was trained, I also like to look at whether or not the person is what's called board certified. After physicians, both MDs and DOs, finish all of their training in residency, they have the option to take a big test called the board exam to prove that they know everything that they should. Over three quarters of primary care doctors take this test.

Some healthcare facilities, especially academic medical centers, actually require board certification of all of their doctors, but many places don't. When someone sits for their boards, as it's called, it shows a few things in my opinion. A dedication to the intellectual and academic side of medicine, and their commitment to ensure to themselves that they know enough. Once a doc is board certified, they have to take the test again every once in a while if they want to keep the certification.

Very generally speaking, in the medical world, board certification is considered a very good thing to have. So when you're searching on these facility websites, sometimes board certification is a filter that you can turn on, but if it's not, it should be listed on the doctor's actual profile page after you've clicked on their name.

These are the big ones for me personally, provider type, insurance accepted, whether they're taking new patients, where they trained, and if they're board certified. Another detail to look for is how long they've been practicing. For me, the sweet spot is someone who's been in practice for at least five years and also isn't too late in their career either. Again, I'm generalizing. There are brilliant first year docs and brilliant 80 year old docs.

But generally getting some real life experience under your belt helps. And it does get harder as you age to stay completely on top of ever emerging new discoveries, medications and practices. Also, the older the doc, the more likely they'll retire soon and then you'll have to start over again.

Some places also let you filter for a specialty or a focus with primary care providers. This could be something like hypertension, women's health or fitness or things like that. One place near me even lists focuses like bee sting reactions, benign conditions, I'm not really sure what that means, bleaching.

bonding and all sorts of other interesting focuses. So you might want to look through that. Lastly, before we leave this section, I want to say a word about online reviews of doctors because some facility websites will actually have reviews right there. This is dangerous territory. And I suggest you take any reviews that you read with a grain of salt. Reviews are completely subjective. And since we all have different personalities,

It may or may not matter what someone else thinks about a certain provider. They may have very different values and priorities and preferences to you. Here are two real life examples of this. First, when I started as a general pediatrician, I was in a private practice with three older men with very different personalities to me.

I tended to enjoy more of a partnership model with my patients and their families, which included a lot of sitting and talking and back and forth. But at least two of my partners took a much more patriarchal approach where it's more like you just kind of do what the doctor says. Neither of these approaches is right or wrong. It's just a style difference.

But I can tell you that the patients, or rather mostly the parents, that saw those guys as their doctors didn't always love my style, and my patients didn't love theirs. All of that is okay. But my point is that people look for different things from their doctors. So their opinion and review may or may not be relative to you. Example two is that I'm on a breast cancer community group online, and very often people ask,

in a public post for recommendations for breast cancer doctors in the area. I've noted that many, many people recommend the doctor that I experienced a serious medical error with and would never see again, while at the same time, some comment that they don't like the doctor that I currently see, who I think is literally the best thing since sliced bread, and she is an unbelievably compassionate genius. So to each his or her own.

The moral is, be careful of the reviews.

All right, one last thing I want to address today is how to switch doctors. Maybe some of you are listening because you have a doctor but want to get a different one. It's okay in my book to change your doctors. Others may or may not agree with me on this and say that when you're with someone, you're with them. For me, it gets down to a few things. First, you should trust your doctor. If you're seeing someone that you don't trust, try to examine why you don't. Maybe you just don't know them well enough.

or maybe they've said or done something in the past that makes you feel untrusting. If it's the former, that's fixable. Next time you see that person, make some effort to get to know them. Ask them about their day, about their life. Remember that it is a relationship and while it's designed to be heavily one-sided, it is nice to actually get to know a person. If it's the latter that they've said or done something that you just can't get over, then it might be time to switch.

Some practices will actually not allow you to switch to another doctor in the same practice, which is a policy that drives me nuts. So if you can't do that, which would be the most seamless, then this episode is also for you, since you are back at square one.

Before I close out, here are a few loose ends that I want to address. First is that you need to be aware that no doctor or office will be perfect. Healthcare providers are just people. They may say things a bit wrong sometimes, they have bad days, they make mistakes sometimes, and the facility or clinic or practice is a business and will have business related annoyances like wait times and billing problems and communication problems.

It's important that you manage your expectations since the healthcare system is so screwy today. Also, switching providers will likely be a giant hassle. I'm not trying to deter anyone, but just be ready. In some cases, you'll have to get records transferred over to the new practice. Less of a thing these days with electronic health records, but it's still required sometimes. One thing I recommend is that you don't let them know that you're leaving until you have a new person lined up, because you don't want a gap in your care.

Also with this whole process, know upfront that you may have to wait anywhere from two to eight months to get in with a new doc, especially if nothing is urgently wrong. If you are having something wrong though, ask what the office policy is about that. For example, thank you for making that appointment with Dr. So-and-so in five months for my checkup. What do I do in the meantime if I get sick or have an urgent problem? Will that provider or someone else there see me?

Another thing is that you might want to ask questions about how the office works. Do they use an electronic medical record system? How do you leave messages? If you do leave a message for your provider, who will actually get back to you? How does urgent care work? What are the hours? What is the after hours urgent care procedure and policy? Like some places charge for nighttime calls while others don't. All right, those are all of my tips and tricks for finding a physician.

Remember, the goal is to find someone that is convenient, accessible, and trustworthy. So before you start this process, think a bit about what those qualities mean to you and what someone would need to be like to have them. Building trust with a primary care provider is the antidote to the lack of trust in the medical system today.