How to Choose a Doctor

Generalist or specialist?

Everybody needs a doctor who performs routine health exams and can treat common, everyday problems like the flu and muscle sprains. Such primary-care doctors— typically a family-practice physician or general internist—should also coordinate and oversee any care you get from specialists for severe or complicated problems, such as cancer or heart disease.

Some people, however, may want to get their primary-care from a physician with special expertise or training. For example, people older than 65 or so may want to seek out a geriatrician, especially if they have multiple age-related problems, such as hearing loss, cognitive decline, and urinary incontinence.

Women going through a difficult menopause or considering having a child may opt to use an obstetrician/gynecologist as their primary-care giver. And people with certain chronic disorders that require frequent monitoring and medication adjustment could consider doctors with special training in those problems; for example, someone with diabetes may consider an endocrinologist, and an individual with rheumatoid arthritis may prefer a rheumatologist. Before you select a specialized physician for your primary-care, however, make certain that he or she will perform the more general tasks required of a primary-care physician.

Historically, doctors who specialize in the types of care the Institute of Medicine recommended--family doctors, pediatricians, and internists--earn much less for interacting with patients than specialists who do procedures that take the same amount of time. This pay gap has persisted, for economic and political reasons, despite repeated efforts to reduce it. New medical school graduates, often saddled with six-figure student loans, are increasingly opting to forsake primary-care for the bigger paycheck they can earn as specialists. This is even more reason for exhaustive due diligence when searching for a caregiver.


SEEKING A SURGEON

You may find yourself in search of a qualified surgeon for any number of medical procedures, from simple minimally-invasive scopes to major life-saving surgeries. Ask your primary-care doctor to recommend a surgeon, if necessary from the list of doctors approved by your insurance company. For complicated or unusual problems, ask for the name of a recognized expert or search the medical literature to find someone who has published major articles about your problem. Then contact that physician and ask him or her to recommend someone in your locale.

Finally, talk with the prospective surgeon and ask how many operations of the type you need he or she has performed. Studies suggest that experience leads to higher success and lower complication rates. When deciding on a surgeon, remember that caseload may be more important than a surgeon's age. An analysis of Medicare data for nearly 461,000 patients found that while surgeons over age 60 with low surgical volumes had higher patient mortality rates on some procedures, those who continued to maintain high surgical caseloads had comparable outcome with surgeons ages 41 to 50.

Also ask if the surgeon can provide references from patients willing to speak with you. Find out which hospitals the doctor admits patients to, and check their quality. Better hospitals tend to attract better doctors.