Selecting a primary care physician

I’m searching for a new primary care physician(PCP) now, and I wanted to bring you along on the journey.

The importance, value, and need for a primary care physician does vary based upon what sort of insurance you have, but in general everybody should have a doctor they know and trust to see whenever they have a relatively common or minor issue to be treated(such as cold and flu-like symptoms), and somebody who can help keep track of chronic illnesses(even if you need to be referred to specialists at times).

The primary care physician is supposed to be the first person you go to when something’s not right, and should be the doctor that knows you and you trust to refer you to whatever your next steps may be if needed.

The significance of a primary care physician(PCP) depends on the type of insurance you use

Health insurance plans control how much you pay to see the doctors that you want to see(as opposed to the ones who participate in the plan). These are represented by three-letter designations for the plan type, EPO, HMO, POS, and PPO. EPO, HMO, and POS programs often will require you to have a designated PCP.

That doctor is responsible for referring you to any specialists you see, meaning that they operate as gatekeepers.

If your primary care physician won’t write a referral for you to see a particular specialist, you don’t get to see that specialist.

These programs will often assign you to a primary care physician, but usually, you can select a different one, as long as that doctor is also in-network and accepting new patients.

If your insurance requires referrals, it is extra important to make sure that your doctor believes you when you talk about your condition or symptoms and is willing and able to refer you to an appropriate specialist when needed.

The main difference between these three programs is how strict they are about staying inside their selected network of hospitals and doctors, and what medications they cover.

EPOs are the most restrictive, where you only have access to doctors inside their network.

HMOs keep you in-network, but will often have some wellness programs. They also often will only work with you if you are inside of their geographic range since they often build their networks regionally.

In other words, you have access to treatment as long as you aren’t outside of your region(often a state, occasionally they only or primarily work with certain counties in the state). Many Medicaid plans now are HMOs or have an HMO option.

POS programs do allow you to see out-of-network doctors but you pay more money to do so. Because of this, it’s better to have in-network doctors to manage costs, but if you need to see a particular specialist who happens not to be in-network, you can do so at a higher cost.

The main thing is that POS programs often require your PCP to refer you to any additional treatment, so if they don’t write the referral, you can’t see a specialist.

If you are on Medicare or a PPO plan, you aren’t required to have a designated PCP, but you still want to have somebody that you usually go to, and somebody to do a wellness check with you every year.

Again, seeing somebody out of network is at least more expensive. As a Medicare patient, many doctors will accept my insurance, so I don’t need to worry too much about going out of network(but I still check prior to seeing a new doctor)

With PPO plans, your PCP is a useful guide and a professional to help you determine what specialists you may want to see, but you can disagree with them, and you can choose to go to a specialist without needing their permission or support.

The best way to select a Primary Care Physician(PCP) is from a recommendation from someone you trust

The first thing to recognize is that ‘PCP’ isn’t a title or a certified position, and there are several different types of doctors that can serve as your PCP. Family doctors, internists, geriatricians, pediatricians, and doctors of osteopathy all can be primary care physicians.

You need to find the right one for you.

Children generally are seeing family doctors or pediatricians, while adults have a wider range. The precise specialty of your doctor is less important than their availability and your trust in them.

Your best bet in finding a good PCP is to talk to people you know and trust about who they see, especially if they have a similar attitude towards doctors and treatment as you do.

With all the complexities of our current healthcare system, though, it is possible that no recommendations line up with doctors available to you, or that the recommendations you receive are for doctors you’ve already rejected for whatever reason.

While this type of recommendation is the most reliable, sometimes you just need to try to do the research on your own.

I’m in that situation. My current doctor(an internist) is okay, but I would prefer to see somebody who is geographically convenient(he is about a half-hour’s drive south), and somebody who would dig into my information a little more(my wellness exams don’t get followup and we don’t discuss my blood test results).

So I’ve resolved to look for somebody who is a better fit for me. The reason that I am seeing this doctor, though, is that he was part of the practice that I’ve participated in my entire adult life and he treats most of my adult family members.

I don’t have a lot of social connections in my area, so while I have multiple friends who could tell me about doctors in New York City, that’s not at all helpful for me.

I’m doing a cold search because of this. Already it’s frustrating. Let’s keep exploring how to do it though, because I do want to find a better fit for me, and I’m sure you want to find your best option as well!

Step 1: Learn what your options are

So, this goes back to your insurance. Since you want to feel comfortable contacting your doctor whenever you need to, your best bet is to see somebody who is inside your insurance’s network.

Your insurance company should provide you with information(usually through their website) on what doctors they work with. It’s often in the form of a search feature, and the quality of these searches varies. What you generally want to do though, is look for doctors in your area.

You may want to specify a subspecialty that you’d prefer to work with.

For example, I know that my OB-gyn is a DO and I like her mindset, so I started my search focusing on female DOs, as I have a slight preference for doctors who share my gender.

Speaking of gender preference – think about what your preferences are.

You may want a doctor who shares your identity, or at least some aspect of it.

The more diverse your identity, the harder it may be to find a doctor who shares many or all aspects, but think about what is most important for you, as well as focusing on finding offices that are more open-minded and accepting of your identity.

My top priority is a doctor who isn’t upset by my movement symptoms.

I generally prefer female doctors but am much more concerned about their empathy than their gender. Not only have I had great doctors who happen to be male, but I’ve also had a terrible experience with a female doctor.

I also want to make sure I feel comfortable talking to my doctor about my sexual health when appropriate(that mostly comes up with my obgyn), so it’s important to me that they can accept that I’m bisexual and may have multiple partners.

Most of this, I can’t tell until I meet the doctor, but by focusing on ones with positive ratings and compliments on their listening skills, I’m more apt to be on the right track.

You can make a list for yourself, or use some form of ‘compare’ feature, whatever works best for you.

Honestly, I’ve pretty much picked one or two people I thought might work, and then dug into them more, but the important thing is that you select at least one person who you think may work and research them.

If possible note down or otherwise save information about your top few options, so you can go back as needed. This process often takes a few rounds.

Step 2: make sure they fit your needs

There are a few things to check right away. The easiest one is hospital privileges, as those are usually listed on their information, and you generally know your hospital preferences.

Visiting privileges means that they can more easily get you admitted to the hospital and that once you are in the hospital, they can more easily check in with you, and often have better access to and knowledge of the doctors there.

It isn’t essential, but it’s comforting to know that if you have an emergency, your doctor can see you while you are in the hospital, and may be able to help you if you have problems there.

In my case, the nearest hospital to me is called Bayshore, but it doesn’t have a good reputation. Slightly further from me, but still a reasonably short trip(around 20 minutes rather than 10), is a hospital with a much better reputation, Riverview, which is my preferred hospital.

Generally, the times I have gone to hospitals for outpatient procedures I’ve gone to Monmouth Medical(whose reputation is similar to Riverview’s), which is even further south(closer to a half-hour drive), but still closer than any hospital would be for people in more rural areas.

So, when I look at doctors, my ideal one has visiting privileges at Riverview, but Monmouth Medical is also fine.

If they only have privileges as Bayshore, I’m leery because that’s not the hospital I want to end up in should an emergency occur, and I’d prefer to have the option of my PCP being able to support me.

When I’m looking at the list of doctors who sound interesting, those that only have privileges at Bayshore are removed or at least lower down on my list.

Find a doctor you can get to easily

You also want to make sure that your PCP is convenient, which usually translates to “close to home”.

This is the office you’re going to go to if you wake up sick or come down with something unpleasant, so it’s much better for you if the drive is short and easy.

Most search features sort by distance(though that often doesn’t take roads into consideration), so it’s relatively easy to make sure that you’re looking close to home.

If you don’t drive, take public transportation or convinience into consideration. Is the office right by the subway or bus line near your home? How easy or difficult would it be to get there by cab? However, you would likely travel, look for locations you can get to with less mental or physical effort.

What size of practice would you prefer?

Another thing to check is what their practice is like.

Some doctors are solo practitioners, others are part of a larger practice and share office space and staff, and others may be directly affiliated with a larger medical community with multiple locations.

This is really a matter of personal preference since there are positives and negatives to each. Seeing a solo practitioner means that you absolutely know what you’re going to get each appointment, but it may be harder to get in during an urgent matter, and if that doctor is unavailable you don’t have a lot of other options.

On the other hand, larger practices may be less able to give you the personalized approach, but it’s likely possible to see somebody in the practice if you need care urgently. It may not be your PCP, but they will have access to your information and are somebody your PCP has chosen to work with.

The larger the practice, the more potential options you have if you like the space, but find the doctor disappointing, but if things aren’t well-run, there’s also a higher risk of miscommunications about the details of your appointment.

Personally, I have pretty much always gone to smaller practices.

Initially, I went to an office with about 5 doctors. My primary physician retired, so I picked up with his colleague, who I had known for years(he was who I saw if I was sick and my primary wasn’t available that day), but hadn’t felt as close to.

He’s since moved to a different practice which is similarly sized, and I moved with him because he’s not bad and I didn’t have the spoons to search for a replacement then.

I have seen the nurse practitioner and another doctor at his office, but while I really like the nurse practitioner, I frightened the other doctor with my symptoms(and her anxiety then made them worse).

The last time I saw the nurse practitioner, she took pains to point out that she’s not my primary physician, which felt a little awkward, especially since I hadn’t actively tried to set extra appointments with her.

I decided that it’s time to look elsewhere.

I still want to participate in a small practice because I do like the potential for options and the likelihood that I will see somebody the day I need to be seen.

Step 3: see what other patients think about them

Many sites will share ratings and stories by patients about their experiences with their doctors.

Many insurance providers will do this, as well as independent programs like Healthgrades. If you find one or two you like, start there and look up the doctors you are interested in.

One easy way to expose yourself to their information without being pushed onto any particular platform is to do a general search for the doctor’s name. Each site that reviews doctors does ask slightly different questions, and skews towards slightly different populations – so you do want to see a variety of reviews.

Look carefully at not just the score, but how many people reviewed the doctor. The fewer reviews, the less reliable the information, and the more important it is to look at any comments made.

For the most part, people share their extreme experiences, so exceptionally good treatment or exceptionally bad are much more likely to get a review than an average or adequate experience.

Expect the scores to tend towards ones and fives rather than the middle numbers. If they have a lot of ones, you likely do not want to see them, but if there are a lot of reviews a couple of negative ones may be one-off negative experiences for reasons not always in the doctor’s control.

Take a look at the reviews and ratings, focus on what you value most in a doctor.

For example, because FND is a strange condition that few doctors understand, I don’t look for a doctor with prior experience in FND(that’s my neurologist’s job), but I do focus on finding doctors with positive ratings for listening to their patients, being compassionate and understanding, digging into mysterious symptoms, and things like that.

I’m looking for a doctor who listens well and who will respect my judgment if I tell them that a particular symptom is or isn’t FND-related. I may be willing, therefore, to go to a doctor whose patients complain about a long wait when the praise involves focused attention and the doctor being willing to take the time to really understand what’s happening.

I know that much of this will only be determined once I see the doctor, but I at least can cut out the ones that are less likely to work, and narrow down my pool of potential PCPs to likely candidates.

Some of these review sites will comment on if the doctor has ever been through a malpractice suit or had other legal issues. If they have, be leery, but the fact that they don’t have those marks against them doesn’t guarantee that they are a good doctor.

If you do not see information on that and want to check yourself, you can do so by visiting your state’s medical licensing site and looking up the doctor(s) you are interested in. Be aware that that information doesn’t cross state lines though so you cannot know if they had problems in another state from this information.

If you are very concerned on this front, you often can find a copy of the doctor’s CV and use that to check on them in other states as well.

If you like what you read, and you’ve checked out a few different sites and found them reasonably consistent, you can feel confident that that particular doctor is liked and trusted by a good percentage of their patients, and hasn’t been involved in too many nightmares for patients. These are your good potential doctors.

Step 4: Call their office

At this point, there really isn’t much more you can do through online research. Your insurance company has told you they work with that doctor, you know that that doctor has visiting privileges at your preferred hospital, you are aware of any legal issues their practice has faced, and you’ve seen what the publicly shared opinion is on this doctor.

Now, you need to call their office. You need to check on a couple of things when you call, though.

Your first question needs to be if they are taking new patients. Some doctors don’t – once they have their practice pretty full of regular patients, they don’t take any more because they want to keep their services manageable. This was the first response I received when I looked into the doctor I was most interested in.

It was unfortunate for me at the moment, but it is a sign that they are likely a responsible professional, and they may be worth revisiting if they start taking new patients again. If I don’t find a great doctor quickly, I may call her office again. In the meantime, I needed to restart the process with a different doctor.

The second important thing to ask, if they are taking new patients, is to confirm with the office that they will work with your insurance.

Every once in a while, doctors change what providers they work with, or some rule changes, and you can’t be positive that it hasn’t changed until you ask. So, just double-check with them before scheduling your appointment.

While you are on the phone with them, think about how the phone staff made you feel, and how easy it was to communicate with that office.

For example, did you get through on your first call?

If you didn’t, did they get back to you?

How long did you have to wait?

If your interactions with them felt alright and communication was relatively easy, then you may have a winner.

If scheduling the appointment was a challenge, that’s a bit of a mark against the doctor, though it still may be worth going, especially if that doctor is part of a larger medical group, and may not have full control over who they hire.

After having a disappointing phone call, I had to go back to the drawing board, and decided that I valued having a female doctor over having a DO, so I’m looking at female internists.

Today, I managed to get an appointment with a new doctor who I think sounds great.

Unfortunately, I have a long wait to see her(as opposed to the nurse practitioners or her colleague in that office), so I can take apart the details of my evaluation and experience with that doctor in late June when I finally see her.

Because I am not in an urgent situation and still have access to the office I was attending, I am alright with the wait.

If I hadn’t been, I could have gone in and seen one of the others in her office sooner, or I could have kept looking.

I generally feel like having a bit of a wait for a wellness-type appointment is pretty normal(over a month is on the high end, but I wouldn’t expect to be scheduled the same week), and again, I could have seen another practitioner in that office within a day or so if it had been urgent. This bodes well for future interactions.

Step 5: Evaluate the doctor at the appointment

I already have a post written about evaluating doctors, focusing on determining if the doctor you are currently seeing is worth sticking with. That post covers the main points, starting with phone interactions when scheduling an appointment, and going through your doctor’s follow-up care(or lack thereof).

The only thing I want to add here is that at your initial appointment, they do need to take your history and you may have some extra time to get to know them a bit.

Focus on how thorough or probing they are when you share your history – do they look bored? (not a great sign), do they ask you extra questions? (good sign if done politely)

When they are done, did you feel listened to and understood, or are you feeling discombobulated and frustrated?

Consider if they treated you respectfully or seemed judgemental. Did they give you time to answer or did they brush off what you said?

Your doctor should end up knowing a lot of intimate details about you, and you want to feel comfortable sharing information with them.

This is especially important if you are part of any minority group(not just racial, but orientation or identity(LGBT for example), religion(especially if it interacts with your health), and more).

Mention the aspects you are concerned about(especially important is any conditions you have, but anything that may affect you medically is important), and watch their response.

If they dismiss or repeatedly ignore some aspect of what you told them, you may want to look elsewhere. For example, while many doctors don’t know about FND, some out there interpret “psychogenic”(without biological origin) as meaning “made up”.

There are some who don’t understand or recognize mental health issues(these are getting fewer, and many PCPs may be willing to prescribe antidepressants and other psychological medications).

So part of your job is to make sure that if you have a condition that could be misinterpreted that your doctor won’t make that mistake.

A large percentage of doctors are white, straight, cis(as opposed to trans)gendered men. So if you are not in that category, you may want to look for a doctor that better matches your identity or for a more respectful and empathetic professional than average.

What’s important is that your doctor is willing to take your identity and needs into consideration when treating and advising you.

Step 6: Decide if you need to try again

So, you’ve seen the new doctor, and you have a sense of who they are and how their office works.

Now you need to decide if you want to keep seeing them.

If the visit went well, and you felt respected and listened to, then awesome, you probably found your new PCP.

If your insurance uses your PCP as a gatekeeper, notify them of your change(in some cases you may need to do so in advance), and usually, the change is acknowledged within a month.

If your insurance doesn’t require a PCP, then you don’t need to notify them, and you can just enjoy the peace of mind that you found the right doctor for you.

If, on the other hand, you feel uncertain about the doctor, you likely want to check out another candidate(repeat these steps on a new person).

It may feel really frustrating to start over again, but you will feel much better if you trust and are comfortable with your doctor, so it is worth doing.

If you had an exceptionally bad experience with the doctor, you may want to leave reviews on them at one or more of the sites you had discovered in your search, and restart your search for a great PCP for you!

This search has the potential to be very frustrating, but it is really important to be able to trust your doctor and know that your doctor listens to and respects you.

Conclusion: selecting your primary care physician

It is really important to see a doctor you trust and can communicate well with.

Many people seeing mediocre or bad doctors end up being bullied into inappropriate treatments, have their symptoms ignored or written off, or end up not sharing vital information with their doctor, leading to unnecessary problems.

You don’t want to be any of those people, stuck in regret after the fact.

So, instead, make sure you know what you need from your PCP and find the best one for you.

By pursuing the right PCP, you are practicing radical self-care, putting yourself in the best and safest medical hands, and making sure that you have the best chance at a good life!

Finding the right PCP for you is worth a few extra visits, as a good PCP will support you for years to come and can have a huge positive impact on your quality of life. Take good care of yourself by finding the PCP who truly is the right partner for you in your medical care.