Your relationship with your doctor is slightly different than your relationship with, say, a mechanic. Or a pharmacist. Or a carpenter, caterer or customer service representative. Because while all of those people help you, a doctor helps you. The person who scrutinizes your physical health should go under slightly more scrutiny themselves than the person changing your car oil.
Whether you are looking for your first primary care physician or switching providers, the process of finding a general practitioner is not as daunting as it may seem. Like any other dilemma, often the best place to start is to ask around.
“With general practitioners, it mostly goes by reputation in the community and by referrals from other patients,” says Dr. Kenneth Ackerman of ProHealth Care Associates in Great Neck.
One of the first things to consider is whether your insurance plan will cover a physician. “If you have a plan that requires referrals, then by all means, you have to have a primary care physician that is part of your insurance plan,” Ackerman says.
Insurance companies have lists of general practitioners to choose from. Once accessible through provider books, this information can now be found online.
“You first want to go with your insurance company,” Angela Gonzales, senior reporter for the Phoenix Business Journal, says. “That’s what I do—I’ll go onto this list [of physicians covered by my insurance] and then I’ll copy all of those names and e-mail it to somebody and say, ‘Who should I go with of all these people?’ and then they’ll say, ‘These five people are great, this one is the best.’”
Some of the main insurance companies covering Long Island includes Fidelis Care, EmblemHealth, a merger of Group Health Incorporated (GHI) and Health Insurance Plan of New York (HIP); UnitedHealthcare, including Oxford Health Plans and Health Net; BlueCross BlueShield; Aetna; 1199SEIU; Medicare; and Medicaid. That group “covers about 90 percent of the lives in this area,” Ackerman says.
“I think most of us really want a primary care doctor who’s in our plan,” says Dr. John Connolly, president and CEO of Castle Connolly Medical Limited, and publisher of America’s Top Doctors. “For example, in many plans, if you’re admitted to a hospital by a doctor that’s not in the plan, even if the hospital is in the plan, you still have to pay yourself.”
If patients choose physicians not covered by their insurance, they will not get the same benefits, Ackerman points out. “The costs can just mount up,” Connolly says.
Whether or not a physician is covered by an individual’s insurance, word of mouth can be extremely helpful. “When I’m looking for my own doctor, that’s the first thing I do—I call somebody and say, ‘Hey, who are the best doctors at your hospital?’” Gonzales says.
Patients can also find out how a practitioner stacks up to their peers. “Some companies can [go] so far as to rate the physicians with a star system,” Ackerman says. He describes UnitedHealthcare’s rating system, which considers quality and efficiency based on claims experience. Gonzales detailed CIGNA’s rating process that encompasses a cost value rating and a quality distinction, among other criteria.
It is important patients do their homework before selecting a doctor as well, Ackerman adds. He encourages individuals to check doctors’ backgrounds to see if they have been disciplined, have lost their license or have a restricted license. Malpractice information can be found on the New York State Department of Health’s website as well as on Castle Connolly Medical Limited’s website.
Connolly recommends checking board certification, medical school info, and residency location on the American Board of Medical Specialities’ website, www.abms.org. He also urges patients to be assertive consumers and ensure that a doctor’s affiliated hospital has a good reputation in the community. Hospital comparisons can also be accessed online.
“[If] they’re not on staff at a hospital, unless they’re a psychiatrist, for example, I would generally avoid them,” Connolly says. “It’s very important that if you are ill and you are hospitalized that your physician be able to guide and direct your care.”
In addition to checking a doctor’s history, patients can also consider geographic location and gender when making their decisions. Ackerman highlights other important aspects to consider, including years in practice and hours of availability.
“You can even call the office and see what their policies are on things,” he says. A new patient could, for example, ask how long it would take to get an appointment.
“My opinion about this whole thing,” Ackerman says, “is that if you find a primary [care physician] that you can relate to, and that can recognize you and that knows you back, and you have a relationship; that’s invaluable.”