How to pick a primary care physician when there's lots of options?

January 25, 2017 8:12 AM

Time to find a new primary care physician. I have good insurance, but that means I have a lot of options. How do I choose?

My previous primary care physician is no longer practicing in my area. I've been procrastinating on finding a new one — it's now been about two years since my last physical.

So: look for doctors who accept my insurance. I have good insurance, so yay for that, but it means I have a lot of options. Look for internal medicine or family practice. (I'm a 40-something male.) Look for those in a convenient location for me. Look for those accepting new patients. No particular preference for the doctor's gender.

Even with all those restrictions, I have a choice of about ten doctors, among three different practices. Online ratings or reviews aren't very helpful — and seem to depend more on the website than the doctor. (Rating website A has them generally in the range 4.6-4.8 out of 5, based on alleged patient feedback; rating website B has them generally in the range 3.3-3.7 out of 5, also based on alleged patient feedback.) Written reviews tend to be blandly positive and indistinguishable. (They all listen to their patients and spend sufficient time with them and truly care about them. Great.)

All are affiliated with or at least have admitting privileges at various area hospitals. I haven't gone to look up hospital ratings in depth yet, but my gut impression is that none of the hospitals are much better or much worse than the others. Should that be something I take into account? I don't have any conditions which I would expect to require hospitalization in the near future, but you never know.

I'd like to find a doctor I feel comfortable with, but I don't know if there's any way to judge that short of meeting them. I don't think I had a great relationship with my previous PCP, for no reason I can adequately verbalize; I had a better one with the PCP I had before that.

So, any advice on how to pick one? Just at random? I was thinking of contacting the practice with the most available doctors (about five available doctors meeting my criteria) and say, "I have ongoing issues X and Y; would you pick the doctor best suited for those issues?" Except X and Y are common issues, and they might, quite reasonably, say "all of our internists have experience with X and Y."

posted by DevilsAdvocate to Health & Fitness (13 answers total)

I'd try the closest one or the most convenient. Get a physical, give them an interview.

Ask about things important to you. See if you like their affect and manner.

If everything doesn't seem just right, go to another one for your physical next year.

The point is, this is not a marriage or a contract, don't be afraid to shop.
posted by SaltySalticid at 8:30 AM on January 25, 2017 [2 favorites]

You could ask when they have an appointment for you and just decide it that way -- some may have one right away, another not for weeks. Or you may ask the receptionist about a physician's soft skills. When I had to pick a new gyno I asked the receptionist at (large university ob/gyn practice) which doc was warm and gentle. She immediately said, "Oh, you want Dr. X" and that's how I decided.
posted by BlahLaLa at 8:43 AM on January 25, 2017 [3 favorites]

Obviously there's huge variance among doctors of any age, but given your limited information, you should pick the youngest doctor with at least a few years of post-residency experience. Studies find that, on average, younger primary care doctors are "more up-to-date on clinical developments and current standards of care," whereas "older doctors were more likely to order unnecessary tests, fail to order necessary tests, or fail to counsel patients appropriately on preventive health strategies." A younger doctor is also less likely to retire soon.

And then apply SaltySalticid's advice.
posted by Mr.Know-it-some at 8:43 AM on January 25, 2017 [4 favorites]

When I was in your situation, I went with the practice that I could get to by foot or bicycle from my office. I've saw a few physicians within that practice before settling in with one that I'm happy to work with on my health issues.
posted by Doc_Sock at 9:05 AM on January 25, 2017 [1 favorite]

My PCP is a sole practitioner. Once, when he was on vacation, I saw his "covering doctor" which was actually a family practice with 3 or 4 docs plus a nurse practitioner. I have various specialists who are all in multi-doctor practices. If I had to start over, I think I'd favor the bigger office. On average, they are better about scheduling and paperwork. A "covering doc" has your entire history available. If the doc moves on, the records are still there. On the downside, I suppose a young doc is more likely to start there and move, so perhaps there is a higher risk of having to do the doc choosing thing again.

I went to a dermatology office that was a multi-doc practice. It seemed like every time I tried to schedule an appt, I got "Sorry, Dr. X is all booked up for 3 months, but I can get you in with Dr. Y today." Dr. Y being the youngest and freshest face. So that's a risk with a big practice.
posted by SemiSalt at 9:09 AM on January 25, 2017 [1 favorite]

Generally, I go with the place that has the most pleasant scheduling experience. The practice with a scheduler who is warm, informative, and not rushed is probably run better than one with a cranky rushed scheduler who isn't able to take the time to answer questions. Obviously everyone has a bad day, but when you have a wealth of options it's an easy way to narrow the field.

I also look for larger practices with several providers. I've found them easier to get same day appointments during peak flu season. Most practices will let you see a few before settling with one provider, but some are very strict about staying with the initial physician. Obviously you can decide if that's a deal breaker or not.

Some random amenities that you may appreciate: online scheduling, receiving your reports via an app or email (if you're comfortable with that), ease of contacting your physician directly ( I can directly message my PCP through their app, some places have an online portal).
posted by ghost phoneme at 9:12 AM on January 25, 2017

I'm a big fan of doing all my medical stuff with the same public hospital and its clinics. I never have to think about where to go or arrange for my records to be sent from one office to another, and there's no issue they can't handle. It helps that I really like the PCP I chose at random when I first started going there, but if I didn't, it would be easy to visit another. I like knowing that the staff can and will ask each other for help, since it's so simple for them to do so. Plus everybody's paid by the hospital, so their time isn't taken up with the work of running a business.
posted by asperity at 9:22 AM on January 25, 2017 [1 favorite]

I've found that I get along waaaaaay better with doctors close to my age (although my favorite was twice my age, just very young at heart). And it might be less than rational, but for any HCP but a surgeon doing something complex, I'd prefer a doc I feel like I get along with. They are more helpful when you're in the office and more likely to give good customer service when you need a fast prescription refill because you lost the paper, or whatever. This makes me more likely to go to them with little things that are probably nothing but are something every once in a while. It also means you recommend people to them, which they love.
posted by radicalawyer at 9:24 AM on January 25, 2017

I'd look to see if they did their residency in family medicine or internal medicine. My particular preference for my PCP is for someone who trained in family medicine, but your preference might be different.
posted by ocherdraco at 11:45 AM on January 25, 2017

I finally found a great GP by magic but ...

I'd go with the closest / easiest to schedule. And go in for a physical and get to know them. If you know the type you like try asking the reception or asking to speak to the nurses or physicians assistants. They know the doctors and their personality types. That's what I did when picking my therapist.
posted by Crystalinne at 12:01 PM on January 25, 2017

Do you have any friends you could ask? I found my beloved PCP, gynecologist, dentist and optometrist all via friend recommendations. Personal recs are the way to go in my experience.
posted by hapax_legomenon at 3:30 PM on January 25, 2017 [2 favorites]

I work in medicine and pick my doctors based on whether or not and the extent to which they read things outside of medicine-related topics (literature, history, sociology, anything). It makes for more pleasant visits and (in my own totally subjectively and unscientific assessment) correlates with how inclined they are to entertain alternative possibilities and listen to my complaints with a compassionate ear.
posted by gemutlichkeit at 6:36 PM on January 25, 2017 [1 favorite]

Ask trusted friends, then try like hell to get the GP that a trusted peer [hopefully] loves.

Age is a crapshoot. Younger docs can be maddeningly pedantic and fearful of making mistakes (hence ordering more tests), whereas older docs generally have more wisdom and experience, and can be much easier to deal with since they are not necessarily going to throw common sense out the window in favor of a much more rigid construct of thinking about treatment as drilled into them during residency. An older doc understands the miseries and perils of aging, of child-rearing, and a lot of other things that a newly-minted doctor will be unable to do much about except repeat what they learned from a book. Much of primary care is not book knowledge but rather experience and judgement.

Start somewhere and get a relationship going so you have access for basic care. If over time you find yourself wanting a more substantial relationship then look elsewhere.
posted by docpops at 10:39 PM on January 27, 2017