How do I choose my doctor?

In general, you will be choosing between two different specialties for your child - Pediatrics and Family Practice. Just because a doctor is trained in Pediatrics, it does not mean they are a better doctor - but they will almost certainly have more experience with chidren, and more knowledge of serious pediatric illnesses.

Both doctors spend three years after medical school in training. Pediatricians devote all their training to children, while Family Practice doctors split their time between adults and kids. Pediatricians, on the other hand, have zero training with adults. So if it is important to have a doctor that can take care of the whole family, there is really only one choice - Family Practice. If, however, you want someone with more extensive and broader experience with children, then a pediatrician is probably the way to go.

This is an important consideration because where you train has a huge impact on how you practice. Medical training is an intense three-year process where you must learn the framework that you will use for the rest of your career. There are some great doctors who train at smaller programs and some terrible doctors that train at large academic programs. However, if you want a doctor with the broadest experience, strongest knowledge base, and most up-to-date standards you should consider where they trained. In most cases, large academic training programs will recruit the best and brightest from medical school. They also tend to be the places where the best and brightest work after they complete their training. Cutting edge medicine takes place at large academic programs.

U.S. News and World Report publishes an annual report of top programs in Pediatrics. You can bet if your doctor trained at one of these programs they are well trained. If they did not, it does not mean they did not receive good training and they may well be a great doctor - but I suggest you look into the program where they trained and "decide for yourself."

Most doctors work 9-5, 4 and 1/2 days a week. This is great if you need to see your doctor during the 36 hours they happen to be working. But what about all those other hours in the week? Many practices are a combination of doctors and mid-level providers (PA, nurse practitioners, etc.). This allows for expanded hours and many practices offer "extended" hours and weekend appointments.

Your child will almost certainly need to be seen at some point in the evening or on the weekend. If your doctor does not offer extended hours and weekends that means you will have to go into the ER. This is an experience that will certainly be frustrating for you and your child. You will probably have a very long wait, you will not be able to see your doctor, and depending on the ER you may expose your child to all kinds of unnecessary tests and treatments.

My advice is to find a doctor who has at least limited hours on the weekend. If you don't, start planning which ER you want to visit when your child is sick on the weekend and read my page on the ER so that you can avoid the typical pitfalls of the ER.

As I mentioned above, most practices these days are a combination of providers. If your doctor is not available then you will likely see someone else in your doctor's practice. If it is a doctor, then I would use the same tools mentioned above to evaluate them.

These days though, many practices are being staffed by physician assistants(PAs) and nurse practitioners(NPs). These are not physicians and they have considerably less training than physicians. In most cases, they are really only qualified to take care of common childhood illness. Complex pediatric illness requires more training and more importantly, more experience. In all honesty, most of the things that PAs and NPs care for can be cared for at home by Smart Parents.

The biggest draw back of PAs and NPs is their tendency to over-test and over-treat. There are obviously exceptions, but this has been my general experience. The biggest advantage, however, is that each PA or NP in the practice essentially doubles the number of times your child can be seen in the office. Thus, almost all practices that offer extended hours and weekends must have some PAs or NPs.

My advice? Place extended hours higher on your list of priorities than always seeing your doctor. In my mind it is better to see a PA on Saturday than it is to go into the ER.

The waiting room in most pediatric practices is about the last place I would ever want my child to be. At any given time there are probably 5 or 10 kids running around with any number of CONTAGIOUS illnesses. This is the best reason to avoid the doctor's office whenever possible. However, if your child is sick and you feel they need to see the doctor, then you really don't have a choice.

Some visits to your doctor are for routine "well" visits. If your child is not ill and you put them in a waiting room full of sick kids, you can bet they will be in a few days. To combat this problem many practices now offer separate waiting rooms for sick visits and well-child visits.

This is essential in my mind. It may not be a deal-breaker when picking your doctor, but if your doctor does not offer separate waiting rooms you should ask if you can wait outside and have them call you when they are ready to see your child.

This is a big deal in my mind. Laziness has infiltrated medical practice and many doctors are opting to no longer take calls at night. Instead they are diverting your calls to a "nurse hotline." The hotline is fine for simple questions and I encourage parents to use this service if it is offered. However, there is nothing that the nurse will tell you that cannot figure out on your own if you are educated about routine pediatric illness.

The real problem is that many practices are no longer allowing the hotline to divert calls to your doctor. Instead the hotline nurse, following a rigid protocol, will instruct you to take your child to the ER. In my mind it is unacceptable for a nurse to advise you to seek medical care in the ER without talking first to your doctor. If your doctor has your child's best interest in mind, then they will do everything possible to keep them out of the ER.

My advice? If you cannot talk to your doctor (or one of their partners) after-hours, scratch that doctor off your list. I feel like this is about the best indicator out there for what kind of doctor you are dealing with.

In most places you will have little choice on which hospital your doctor uses. However, how you doctor uses the hospital is an important consideration. Many hospitals now are staffed with a Pediatric Hospitalist. A Hospitalist is a Board Certified Pediatrician who only takes care of hospitalized pediatric patients. They may take care of your child should they need to be in the hospital and will communicate with your doctor when they are discharged.

There are many pros and cons to this system. The biggest con is that many doctors have become lazy and will admit patients on Friday afternoon to the Hospitalist service simply because they do not want to have to try and coordinate the care over the weekend. The biggest pro though is the care delivered by a Hospitalist is generally very good. You child will likely spend less time in the hospital and have less tests and treatments.

My advice? Pick a doctor who uses a Hospitalist service. However, should your child need to be admitted to the hospital, make sure that it is not something that could be managed by a follow up visit over the weekend. If you get the sense your doctor is just being lazy, you may want to reconsider your choice of doctor.

Sadly, many pediatricians are losing their newborn skills. Mostly this is because hospitals are now staffing the newborn nursery with either Hospitalists or Neonatal Nurse Practitioners. Both of these hospital-based health care providers will probably take very good care of your baby. However, there is no substitute for YOUR doctor meeting your brand new baby while you are still in the hospital. If you are planning to have an 18+ year relationship with this doctor, it only makes sense that it will begin in the newborn nursery.

My advice? Find a doctor who will see your baby in the well-baby nursery. This is just a general indicator that your doctor's priorities are ordered correctly. If your doctor isn't able to see your baby, don't panic. Your newborn will likely get excellent care by the hospital-based practitioner.

My answer to this question is NO. Doctors are busy enough. They do not have time to be interviewed several times per day by potential clients. When your child is sick and needs to see your doctor, you do not want to have to wait until the next day because your doctor is busy trying to recruit new patients. These interviews tell you very little about the doctor and in my mind are generally a waste of everyone's time.

You should, however, ask everyone you know about your doctor. Their experience with the doctor will tell you much more than a simple interview. Spend one weekend gathering all the information mentioned above then "decide for yourself."

Remember it all starts with you ... Smart Parents ... Healthy Kids!

It is important for everyone to understand that the purpose of this website is educational - to provide information. It is not a replacement for your doctor and I am not entering into a doctor-patient relationship with any of the readers of these pages or their children. It is my goal that by providing you with easy to understand information based on the latest research you will be empowered to work with your doctor to raise...healthy kids!