Need a new doctor?

Switching doctors will become more common

My family is one of those that has lost our current insurance plan. And in researching new plans, I’ve found that individual market plans, both on and off the health care exchange, have significantly smaller provider networks.

Our current doctors and hospitals are not “in network” for any of the new plans, so we will have to change.

I understand why the insurance companies need to do this. To keep premiums and out-of-pocket costs even remotely affordable (I still think they are way too high), more expensive doctors and medical centers have to be given the boot.

And if Obamacare continues on its current path, I predict that more insurance companies will opt for smaller provider networks to keep costs down. Also, we will see a return to the HMO days, when you had to have a primary care provider, and any visits to specialists had to be pre-approved by the insurance companies.

No one liked those rules 20+ years ago, which is why they didn’t last. But Obamacare’s core principles of “essential benefits” and guaranteed issue (coverage for pre-existing conditions) are costly. Insurance companies are going to be given much more latitude to impose these cost-controlling measures.

Contracts with hospitals and doctors will be reviewed and renewed (or not) annually. In the next few years, I would anticipate the need to change your doctor(s) at least once.

Except for annual exams, my family rarely uses our doctors or hospital, so although finding new care providers is a hassle, it’s hardly life shattering.

Others, especially those currently undergoing care for cancer or other life-threatening and chronic diseases, will be much more than inconvenienced. I really feel for their situations.

Finding a quality doctor

First, find a good primary care provider (PCP). This is the doctor that you see for all the routine stuff, and who will help you find a specialist, if or when you need one. A PCP could be an internist, a family practice doc, a pediatrician, or a geriatrician(for the elderly). Using a PCP rather than a specialist will save you a lot of money. 

Some PCPs are advanced-trained nurses (ARNPs) or physicians’ assistants (PAs). Insurance companies will rely more on these non-doctor PCPs in the near future to control costs and make up for anticipated doctor shortages.

So how do you go about finding a new doctor? It’s easy to get a list from your insurance company, or just google for doctors near where you live. It’s easy to ask a bunch of friends how they like (or don’t like) their doctors.

But how do you know if a doctor is one of the “good” ones, or an incompetent that manages to stay in practice only because he or she is shielded by the medical profession’s culture of silence?

That’s not easy.

If you have a friend or family member who is a doctor or nurse, and works in the same hospital or health care system you use, they would be great resources. They would know which doctors to avoid, and which they think are skilled and have personalities that would work well for you.

If you don’t have this advantage, there are a few online tools to help. No tool is perfect because there continues to be a frustrating lack of transparency about physician quality and safety. Many states have been trying to pass laws that would allow patients to access more detailed information about a physician’s medical license: Have they been sued for malpractice? Have they been disciplined by the state medical board? At this time, only Colorado has passed such legislation.

It’s the same when trying to find a good hospital. Still, the more information you can get, the better. Look for patterns: do a lot of reviews say the same thing, such as the doctor is always late or rude or polite? Was the doctor a good listener? Did the patient feel over-treated or under-treated?

DocSpot.com

DocSpot is my favorite search tool. It’s easy to use, and pulls together important information from several different sources, such as online reviews, state medical boards, and hospital directories.

You can search by city, specialty or name. Most large urban areas are covered, but DocSpot is expanding to include more locations.

Vitals.com

Vitals.com is a bit like Yelp, but just for doctors. You plug in a doctor’s name and city, and you get a rating (out of 4 stars), as well as patient reviews, credentials (education, certifications, awards, etc), office hours and locations, and which insurance plans are accepted. (I would question how up-to-date the insurance information is. Always call the doctor’s office directly and ask.)

Informed Patient Institute

The Informed Patient Institute doesn’t review the doctors; it reviews the reviewers! You can look at what physician “report cards” are available in your state, and this site will let you know (by a letter grade) how trustworthy each source is.

Federation of State Medical Boards

This page will link you to your state’s medical board. Every state will be different, but you might be able to look up individual doctor’s and see the status of his or her medical license.

If you have a doctor you like, I sincerely hope you won’t have to change! But if you do, take time to look at these online resources and talk to friends and family. The more information you have about a particular doctor, the better. Skills and judgment are important, but so is personality. This relationship is key to keeping you healthy and keeping your health care costs down.

Sláinte!

Frugal Nurse

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Comments

Need a new doctor? — 2 Comments

  1. Thanks for all of these great physician review tools! Do you predict the need to change physicians will be an ongoing issue for people enrolled through the exchange?

    • Hi Katy! Yes, I do think the insurance companies will negotiate new contracts with health providers every year, especially in urban areas where there are several hospitals or health care systems. At some low price point, hospitals and doctors just won’t play anymore. Also, I think more primary care doctors will look to direct-pay practice models (that is, not accept any insurance) and leave the insurance networks altogether. At least, that’s what a lot of my doctor friends are saying they want to do. FN