Constantly doctor shopping

What Are Your Options?
When it comes to medical care for your child, there are generally three types of qualified providers: pediatricians, family physicians, and pediatric nurse practitioners.

Pediatricians
Pediatrics is the medical specialty fully focused on the physical, emotional, and social health of children from birth through adolescence. The primary focus of pediatrics is on preventive health care.

Pediatricians complete 4 years of medical school, followed by 3 years of pediatric residency. To become board certified, a pediatrician must pass a written examination given by the American Board of Pediatrics. Pediatricians must recertify by taking examinations every 7 years. This means pediatricians keep up-to-date on changes in children's health care. A pediatrician also must take a certain number of continuing medical education courses each year to be eligible for license renewal in the state where he or she practices.

Some pediatricians have additional training in a subspecialty area such as cardiology, critical care or emergency medicine, or hematology. These specialists usually have 3 years of additional training after their residency to be board certified in their subspecialty.

Family Physicians
Family physicians must complete 3 years of residency after medical school. Family medicine residents train in pediatrics and several other areas such as internal medicine, orthopedics, and obstetrics and gynecology. They usually spend several months training in each area. Afterwards, they are eligible to take the certifying examination of the American Board of Family Medicine. They are also required to earn continuing medical education credits and take periodic recertification examinations.

Because they train in many areas, family physicians are qualified to care for patients of all ages. This means your child would be able to see the same doctor from birth through adulthood. It also means that all members of your family can receive their primary care from him or her. A family physician will know the medical histories of all family members and may also be more aware of the emotional and social issues within your family that can affect your child's health.

When seeking a family physician, be sure to ask about age policies - some family physicians see only a few children or don't see children younger than a certain age.

Pediatric Nurse Practitioner
Another type of child health care provider is the pediatric nurse practitioner (PNP). These professionals generally have earned a master's degree in nursing and have special training in obtaining medical histories, performing physical examinations on children, making medical diagnoses, and providing counseling and treatment. Like pediatricians, PNPs may specialize in a particular area, such as neurology or endocrinology. PNPs work closely with doctors in hospitals, clinics, and private practices. The numbers of PNPs is growing each year, and approximately 18,000 PNPs actively practice in the United States.

Some parents may be hesitant to have their child receive care from a PNP, possibly worrying that the PNP is less extensively trained in children's health care. These feelings are largely unwarranted. The presence of PNPs in the practice can have many advantages. Parents often find that PNPs spend more time with them than doctors discussing health and child care issues. Plus, if a PNP encounters a more complex medical problem, he or she is trained to consult the doctor. Still, if you want to see only the doctor or feel the doctor should be consulted after the PNP has seen your child, most practices will honor your request.

When and How Should You Start Looking?
Your search for a health care provider should begin well in advance of the due date of your baby. Babies often come early and you will want to do some research to help you find a health professional whose style and personality will complement your own.

A good time to begin your search is about 3 months before the baby is expected. If you're in a managed health care plan, your choice of participating doctors who provide primary care for children may be limited, so be sure to check the plan's online list. But be aware that paper lists get outdated quickly. If you have any questions about whether a provider participates in your plan or if you are interested in a doctor who is not on the list, it's best to call the health plan directly. Also call if your child has any special medical needs that would require an out-of-network doctor.

Once you know the limits imposed by your health plan, compile a list of candidates from people you trust - your relatives, friends, neighbors, and co-workers who share your parenting philosophies. Your doctor, obstetrician, or nurse-midwife can also be a good source for recommendations.

If you've recently moved to a new area, you may not have personal or social connections established to ask for referrals. In this case, you may want to contact area hospitals or medical schools for recommendations or ask the pediatric residents or nurses where they take their children. You can also request a list of board-certified pediatricians from the American Academy of Pediatrics (AAP) and board certified family physicians from the American Academy of Family Physicians (AAFP). Local hospital "nurse line" referral services, the local medical society office, medical directories in public libraries, and the yellow pages may also be helpful.

Once you've gotten some recommendations, you can begin to check them out more thoroughly. In each state, a medical board investigates complaints against doctors and may take disciplinary action, ranging from citing a doctor for non-payment of certain administrative fees to suspending or revoking his or her license for criminal behavior.

Disciplinary action is rare but fortunately very easy for parents to uncover. In most states, the information is public and is posted by state medical boards on their websites.

Now you are ready to begin the interview process. Considering that this doctor will be the first to treat your baby, you will want to be sure that you feel comfortable with the doctor's personality, office staff, location, and environment. A prenatal appointment is an excellent opportunity for both parents to ask questions and get acquainted with the office staff.

During the interview, you should find out how the practice works by addressing the following topics:

What are the office hours? Flexibility of the doctor's schedule may be a concern, especially if you work outside the home; you may prefer a doctor who offers weekend and evening hours.
Is this a solo or group practice? If it's a solo practice and your doctor is not available on weekends or evenings, what are his or her coverage arrangements? If it's a group practice, ask about the qualifications of the other doctors in the office. Who will see your child if your doctor is on vacation or otherwise unavailable?
Does a PNP work in the office? How does he or she fit into the practice arrangement?
Which hospitals is your doctor affiliated with? Will your doctor come to the hospital when you deliver to examine the baby once he or she is born? If your baby needs to be hospitalized, who will care for him there?
How does the office handle phone inquiries during and after hours? Are special times set aside for parents to call in with questions or is there an open advice line (usually staffed by a "phone nurse") during working hours? How are after-hours calls handled? How quickly can you expect a call back from the doctor on call after you have contacted the answering service? Are after-hours calls routed to a "nurse-on-call" system? This is a service that employs a staff of nurses to give parents advice about how to handle most common childhood illnesses. If your child's illness is thought to be serious, the nurse will transfer the call to your child's doctor or a covering physician, or advise you to go directly to the emergency room. Otherwise, a record of the call will be relayed to your child's doctor the next day.
Is email an option for communicating with your doctor?
Will your child's doctor handle emergencies, or will your child be referred to an emergency room or urgent care center? Are these facilities equipped to handle pediatric emergencies?
Are lab tests done in the office? Most offices can perform basic tests, such as complete blood counts, urine testing, and rapid strep tests rather than send samples out to a laboratory.
What are the payment policies? This is especially important if you do not have prepaid health coverage. What are the fees for services? Must they be paid in full at the time of the visit or can payment plans be arranged?
What are the policies regarding referrals to specialists, in the event your child needs additional care? Is the doctor financially penalized by your health plan for referring patients to specialists, and if so, will this influence the doctor's referral practices? If you are in a health management organization (HMO), it's important to ask how your doctor handles out-of-network referrals.
Making a question checklist will help you organize your thoughts and be thorough during the interview. Some doctors offer group classes for expectant parents to learn about the practice and discuss newborn care, while others offer one-on-one interviews. Many insurance companies encourage these prenatal appointments or classes and will cover cost that may be involved; however, be sure to check with the doctor's office and your health plan about charges for meet-and-greet sessions to avoid surprise costs.

What Should the Doctor's Office Be Like?
The interview is a great time to observe office procedures. Scrutinize the reception area; how many children are waiting? More than a handful may mean overbooking, or it may simply mean the doctor is spending extra time with a patient who needs it. Is there a place where sick children can be separated from those in for a well visit? Is the area clean and child-friendly? Is the staff polite and considerate to patients in the waiting room and to people on the phone?

While you're waiting, talk to other parents to determine whether they are satisfied with the care their child is receiving. Is their child comfortable with the doctor? Do the parents feel confident the doctor is thorough and competent? The overall atmosphere in the waiting area will give you a good idea what the practice is like.

What Is the Doctor's Personality?
Another important aspect of the interview is getting a feel for the doctor's personality. Does he or she see parents as partners in a child's care? Is he or she patient and willing to explain things carefully? Do you get the impression that he or she would be supportive if you requested a second opinion? Are the doctor's age and gender important issues to you?

Good communication between a doctor and parent is essential to building a good working relationship. Is the doctor is a good listener who seems responsive to your concerns? Are you comfortable asking questions or do you feel intimidated?

You also should be sure that your parenting style matches your doctor's in the important issues. How does the doctor feel about circumcision? Breastfeeding? Alternative or integrative medicines or techniques? Use of antibiotics and other medications? Does the doctor focus on preventive care, including immunizations, child safety, and nutrition? Philosophical issues may not seem important before you give birth but if you consider that this doctor may see your child for years to come, agreement on larger issues becomes more significant.

Although you may feel overwhelmed with preparing for your baby's arrival, imagine how you'll feel after the baby is born. Choosing the right health care provider will help you feel confident your baby will be well cared for throughout childhood and beyond, and will ease some of the anxiety all new parents experience.

Updated and reviewed by: Barbara P. Homeier, MD
Date reviewed: June 2005