Deciding on a pediatrician?
January 4, 2018 5:15 PM   Subscribe

What are the most important factors to consider when picking a pediatrician? Soon to be first time mom, and just had two prenatal meetings with pediatricians—no idea now how to pick one.

Both are solo practices and have good reviews online. Takes our insurance, etc. We don’t have parent-friends who live nearby so no personal recommendations. Both have about the same years of experience, and served as chief of staff at a local hospital.

Doctor A:
- 15 mins drive
- has an office assistant
- part of a group of other solo doctors to manage night calls/vacation time, etc
- sees under 10 patients a day, sets aside time for sick visits and newborns
- visits the hospital when baby is born
- follows vaccine schedule, doesn’t take patients who will not vaccinate
- no separate well/sick rooms
- smaller office, shares area with another doctor (unrelated specialty)
- takes texts or emails anytime

The prenatal visit went fine, I think. He mostly let us lead and ask the questions, and had reasonable responses. A bit quirky. Emphasized making time for patients (including discussing behavioral/developmental issues) and for the mom (breastfeeding advice etc).

Doctor B
- 9 minutes drive
- two nurse practitioners, one who specializes as a lactation specialist
- NPs cover while doctor is away, but he said he takes calls at any time even sick or on vacation. Also texts.
- does not visit baby at hospital when born
- forgot to ask how many patients a day, but he mentioned some times his schedule is booked and the NP is available
- used to take patients who do not vaccinate, no longer
- nice, cozy office; separate sick area

Meeting began 15 mins late. He began the prenatal meeting with a spiel going over the logistics and philosophy. He also asked about us, including child care plans and mentioned I looked well, baby seems to be measuring ok. He seemed more prepared for the meeting, or maybe the other doctor was more casual.

My partner liked Doctor B more for having the spiel and asking about us. I worry he seems much more busy, while with Doctor A I think we will see more of him. But I have no idea what factors I should consider more significantly?
posted by inevitability to Health & Fitness (14 answers total) 3 users marked this as a favorite
Honestly these both sound like great choices. The thing I love about our pediatrician is how accessible she is, both for appointments and just answering emails, but a NP is probably great for that too! Our first year had a lot of "oh no! Is this poop normal? I've included pictures of the poop!" type emails and we really appreciated feeling like we could reach out with that (often dumb!) stuff and hear back quickly. I'd probably go with option one, but like I said getting to hear from a NP would probably have been fine too.
posted by Bulgaroktonos at 5:24 PM on January 4, 2018

They both sound fine but I'd definitely prefer a practice with a sick area. And being available for texts; that's great.

On the other hand I also like the idea of other doctors covering; and I have a strong prejudice in favor of in-hospital newborn visits, as that's when my own girl's heart defect got caught.

In my parenting experience the biggest medical-related stressor has been all the stuff that goes down - inevitably! - at 11 pm on a Saturday night. So I think, whatever practice will get you more access to off-hours answers and care is the way to go.

Curious to hear what others think!
posted by fingersandtoes at 5:25 PM on January 4, 2018

Under 10 patients a day seems remarkably light, particularly in the current insurance/reimbursement environment. I would worry about how long Doctor A is likely to stay in business. Or perhaps that's 10 well-visits a day, with the remainder of the schedule being taken up by sick visits? Having the option to take your kid in for a sick visit at short notice would be huge, I would think.

You mention that they both have/had hospital privileges. Do either of them cover in-hospital consults? That's much less common than it used to be, but sometimes a doctor would have to keep scheduled patients waiting to attend to an emergent situation in the hospital.
posted by basalganglia at 5:31 PM on January 4, 2018 [1 favorite]

It doesn't matter so much for the infant period, but I'd ask about what their deal is with drop-ins for small stuff like a cold that won't go away. Our current ped (we've moved several times, it wasn't changing within one location) has 7:30am-9am open hours every other day so if you just need some damn antibiotics or something, you can bring kid in without an appointment. This has been a total lifesaver.

Personally I prefer a practice that has a few doctors, but with one that is your particular person. That way, there is always coverage.

If I were you, I'd join the neighborhood parenting social media/list serv - there is probably at least one, if not more, and ask in there. You'll want to join it anyway to pick up freebies and ask questions in the future (you'll need a ped dentist, want a sitter rec, etc.). I had gotten a personal rec from a friend for our current ped, but every few months someone asks for a rec in these social media groups and it our ped is always mentioned multiple times, which makes me happy.
posted by k8t at 5:37 PM on January 4, 2018

Response by poster: Sorry, I was mistaken. My partner said Doctor A took 12-15 patients a day. They’ve both had their solo practice for almost a decade.

I considered a group practice as well, but they seemed a bit overwhelming.
posted by inevitability at 5:48 PM on January 4, 2018

Both sound good, personally I‘d take the practice with the lactation specialist nurse (are they an IBCLC?). Both my kids were standard healthy newborns and could‘ve basically been treated by any random intern IMHO (just shots and developmental checklists), but the one issue I could‘ve used more help with was breastfeeding. Standard peds are usually not qualified to answer breastfeeding questions and it‘ super annoying to go and find an additional LC when you‘re dealing with a newborn who is not a great nursling. Of course if breastfeeding is not super high on your priority list this may not matter so much.

As for long term, I changed peds frequently due to moves and such and it‘s never been a big deal. So you can still readjust down the road.
posted by The Toad at 5:55 PM on January 4, 2018 [1 favorite]

I'd pick coverage from an NP in the same practice over a doctor from a different practice for better continuity of care.

All else equal, without any personal or professional recommendations I'd lean towards whichever doctor finished their residency most recently. It's not a guarantee they will be most up to date in their medical knowledge, but you don't have much else to go on.
posted by sputzie at 6:18 PM on January 4, 2018 [2 favorites]

This isn’t an answer but I thought I’d share that my husband and I decided to change pediatricians when my daughter was maybe 10 months old and it wasn’t an ordeal, and my daughter has had some issues. We were going to a practice a friend recommended (turns out she was taking her kid to the other doctor in the practice not that I’m bitter) and appointments never started on time (30+ minutes late was more typical). Plus the docto’s ability to do math was an issue when my husband had to correct her on dosing for something minor. We’re happy with the new practice and I’m generally resistant to change but it was a good change.
posted by kat518 at 6:49 PM on January 4, 2018

Best answer: I've had a couple of pediatrician a now, and my best advice is to judge not the doctor (both of whom are probably competent and caring), but rather the office staff. Do they seem smart? Are they professional on the phone and in the waiting area? Do they seem to understand insurance and billing stuff? Do they know how to effectively use calendars? Will they take an extra step to help you out if there's an issue?

I liked our first pediatrician's personality better, but her staff was so great that even if she'd been a total bitch I'd still like the practice. By contrast, our current office is so incompetent that we're actively looking for a new one even though we like our NP a lot. They literally forgot to submit our first checkup to insurance, they took several weeks to fax records to our daycare, and one literally twirled her hair while making excuses for the above. We tried to schedule our daughter's one-year checkup in mid-November (our daughter's birthday is December 3), only to be told their December schedule was not yet available. It's really painful dealing with them.
posted by kevinbelt at 6:57 PM on January 4, 2018 [5 favorites]

If you have a chance to get more information from them, I might consider asking them:

* If my child needs psychiatric meds in the future, will you work with a psychologist or LCSW and prescribe those meds?

* If my child needs (or wants) birth control options, will you prescribe (and/or implant) those?

* Do you offer Gardasil for boys as well as girls?

* What is your position on prescribing medications, hormone blockers, hormone replacement, etcetera for transgender children?

* If my child is intersex, how would you want to proceed regarding their gender?

* If my child needs testimonial documentation for developmental or physical disabilities (for SSDI, Medicaid waiver, etc.) will you provide that?

* Related to that, do you recommend referrals to First Steps (or other developmental and physical disability programs)? If so, what's your range for referral? (4 missed developmental goals? % under benchmark for a period of time?)

* What is the age cut-off for your practice? (Some peds stop seeing kids at 16; others 18 or older.)

In general, of the office staff is great, and the practitioners are competent, most peds will be great for most neurotypical, cisgender infants. You just definitely want to know what kind of practitioner they're going to be as your child ages.
posted by headspace at 8:00 PM on January 4, 2018

I would ask them both about their views on sleep. Do they recommend letting them cry it out, nurture, etc.? To me, after the big health issues, sleep is the most important issue you and your child will face.

In Chicago, we went to a now well known pediatrician. At the time, he had not written his books yet. He was great in that he was calming to us first time parents, he was patient with our newbie questions and he ran on time unless there was an emergency. We would call before going in to ask if the doctor was on time. His office staff was always honest about him being on time or 20 minutes late or whatever the facts were. When we moved back to NY, we went to a sole practitioner. She was terrific, but elusive. When she went on vacation which was often she had a group 20 minutes away covering. Her front desk person was part time and constantly changing.

I think you make the decision based on your comfort level with the doctor first, with the rest of the staff second and with the office size next. I agree with the responder above who mentioned that changing doctors is not a big deal either. If you are not comfortable with the one you first choose, do not hesitate to switch to another. (As an adult, I have actually switched doctors within the same practice.)
posted by AugustWest at 8:40 PM on January 4, 2018

Both options sound good, personally I'd lean towards A given the focus on time spent wuth patients and multiple doctors for coverage.
posted by emd3737 at 6:45 AM on January 5, 2018

Best answer: As the parent of a newborn who's been to the pediatrician a lot in the last two months I feel somewhat qualified to answer this question.

We are seeing a pediatrician who has a solo practice with a part time NP for coverage if he's out. The NP has been in the exam room with him on multiple times, so she's familiar with our son and his issues but has never been the one actually examining him or making medial decisions (although we'd be comfortable with her if the doctor were unavailable). He also has a couple nurses who have been great at answering questions over the phone.

What we really like is that we see the same doctor/nurses on a regular basis. That means we don't have to explain everything for every follow-up visit because we've been in often enough to remember us. He also has been great about returning calls after hours, which slightly suggests Doctor B since we don't have to explain symptoms to a new doctor who happens to be covering calls on a particular weekend. On the other hand I do worry about burnout a bit, so maybe that's a point in favor of Doctor A. My wife and I both go to a larger group practice where it's difficult to see "your" doctor on short notice - it would be really hard if our son were seeing a doctor in such a practice. Both doctors you describe seem reasonable in this regard.

Visiting or not visiting him in the hospital turned out not to be important to us. Our doctor has privileges at the hospital he was born at, but that didn't matter since he spent a couple days in the NICU and was under the care of a neonatologist. Based on our experience either everything will be fine in which case it doesn't matter who the pediatrician is at the hospital or if the baby is at all sick and needs more advanced care there will be a neonatologist involved and the choice of pediatrician also doesn't matter.

Distance to the office won't matter. We're 30 minutes away (longer if you include time to get baby ready) and it's not a problem. If there's an issue where the 6 minute difference is important you should be calling 911 anyway. On a related note, I've realized that both during labor and delivery and with a newborn there are few circumstances where minutes matter (although hours might).

The separate sick/well waiting rooms aren't an issue in my opinion. Our pediatrician only has one waiting room, but if a kid is sick they get them out of the waiting room and into an exam room ASAP to wait there (we've gone back within 10 seconds for example).

Even if your child is perfectly healthy, you will likely have a lot of questions in the first month. I'd probably go with whoever you'd be more comfortable calling a lot during that time to ask questions, even if there're just "hey, this is happening, is it normal?" If you're anything like us you'll be doing that a lot and want to talk to someone who takes your questions seriously so you won't feel guilty about calling.

If you have more detailed questions feel free to memail me.
posted by unix at 7:23 AM on January 5, 2018 [2 favorites]

To me the most important thing has been "How quickly can we be seen if our child is sick"?

I'm not sure if that's exactly answered in your bulletpoints. I would want to know a) how likely is it to see my pediatrician for a same day appt, b) how likely it is to see ANYONE same day, and c) what happens in a semi-emergency?

For example in our old practice (we just moved), it was a) 95%, b) 100%, c) immediately put through to OUR doctor's nurse who answered questions and triaged where we needed to go asap.
posted by freezer cake at 9:44 AM on January 5, 2018 [1 favorite]

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