Identifying and Choosing a Doctor in USA

The methods for identification and choosing of a physician or a doctor in USA are enlisted below:

a) Insurance Plans: Many health insurance plans especially HMO's (Health Management Organizations), have a list of selected physicians whose services are covered or paid for under the plan. Thus, the patient or the policyholder is provided with a list of physicians or doctors whom he or she may consult, and in majority of the cases, if is made mandatory by the Insurance company to choose from that particular list only. It must be noted that not all health insurance plans will reimburse a policyholder for any doctor or physician whose name is not on the list and such a medical professional may be selected by the patient himself/herself. If an individual is covered under a Managed Care Plan, it is always recommended to have a look at the list of doctors included under that healthcare insurance plan.

b) Medical Societies: Like any organized industry in an economy, medical professionals including doctors have their umbrella organizations. Such medical professionals, corporate, institutions, hospitals, healthcare service providers etc are affiliated to such umbrella organizations for varied reasons – for keeping in touch with up-to-date and latest trends in the industry, increased business prospects and wider accessibility to the markets. The principle physicians' group in U.S.A. is the American Medical Association (AMA). The AMA offers a definition of the various types of medical specialties and importantly, displays a physicians' referral or listing, by specialty according to region-wise or state-wise classification in the United States. An individual or a policyholder can check on the training and board certification of such medical professionals. This website lists doctors who are members of AMA as well as those who are not the members. Most medical specialties have their own organizations, viz. the American Academy of Pediatrics. A physician may choose to join his or her specific organization based on medical specialty instead of joining the AMA. It is a good idea to choose a physician is a member to any one of these organizations of repute.

c) Asking family members, friends, well-wishers, neighbours and co-workers: Like anything else, it must be noted that networking, creating contacts and building relationships is a valuable tool, which can come handy at anytime in our lives. It is always recommended to ask friends and acquaintances for their feedback regarding healthcare facilities, products and services before the need arises. Most people are rather passionate about their doctors and will not hesitate to sing their praises or could suggest avoiding them based on their personal experiences.

d) Ask doctors or other health professionals or healthcare organizations: The feedback pertaining to the services provided by doctors or medical professionals can be enquired from other doctors, hospital nurses, hospitals, healthcare service providers, professional bodies etc for gaining a better insight regarding the doctors to be chosen or selected by an individual or the policyholder for his/her medical treatment.

e) Local Hospitals: Many hospitals have doctor referral services including other health-related services. They can serve as a useful resource for deriving further relevant information as desired by the individual and can be contacted by telephone, fax or email. However, it must be borne in mind that such services usually do not possess information regarding the quality of healthcare services provided by such doctors and instead, may simply refer the individual or the policyholder to other doctors or the staff of that hospital. It is advisable to verify the telephone directory for the appropriate telephone number for the hospital or to refer the Yellow-pages for getting such information.

f) Walk-in Clinics: Such facilities can be availed especially in cases if the concerned individual does not have a regular physician for medical consultations and subsequent follow-ups. There is a broad-spectrum measurement regarding the quality of medical or healthcare services provided by such Walk-in clinics which can range from excellent to barely adequate or poor services. Many physicians spend their additional time by providing service to such clinics by providing healthcare facilities, but the quality of services may be dismal in nature. Such facilities do provide "same day" service, but at the same time, the individual may be required to wait for several hours to seek medical consultation.

g) Telephone Directory: The yellow pages contain a listing of physicians or doctors under the section "Physicians" and this is further categorized based on their specialties.

Note: It is recommended to prepare a list of potential doctors to be incorporated under his/her Health Insurance plan and always verify or check regarding their quality via independent sources.

Necessity for Selection of a Medical Professional/Doctor

The medical professional or the doctor will be an individual’s partner in healthcare, hence it becomes essential to choose the doctors carefully from amongst the doctors available under the plan.

In certain Managed Care Health Insurance Plans, an individual will generally be restricted to choosing from only certain doctors available under the plan. In some other health insurance plans, certain doctors may be "preferred" over other medical professionals which means they are part of the network plan. The individual will pay less if the services of chosen or selected doctors are utilized for healthcare management. While purchasing a health policy cover, it is always recommended to ask for a list of medical professionals, doctors, specialists, hospitals, nursing homes and other healthcare providers available under that particular plan. An individual can ask doctors known to him/her, medical societies, friends, family members and co-workers to recommend doctors or specialists to be incorporated under the plan. An individual can also contact hospitals and referral services for knowing more details about the doctors practicing in that area. Once an individual collects or chooses the names of competent medical practitioners who are of interest to him/her, it is always advisable to make sure that such medical professionals are accepting new patients. Such individuals should also verify for information regarding their doctor’s practical experience and reputation in the market. More importantly, the concerned individual should check and verify regarding the Quality of healthcare services provided under the plan.

It is recommended to check for basic information about the list of doctors in the Directory of Medical Specialists available at the local library. This reference contains up-to-date professional and biographic information regarding the practicing physicians. Also recommended is to make usage of "DoctorFinder," which is the American Medical Association's free service on the Internet for deriving information about the physicians.

In addition to the above details, it is better to know whether the concerned doctor is board certified or not. Though the doctors have license to practice medicine, it must be noted that only some medical professionals are board certified. By this, it can be established that the doctor has completed several years of training in a specialty and thereafter passed the qualifying exams. For such details, an individual should visit the website of the American Board of Medical Specialties or call them at 800-776-2378 for deriving more information.

In addition, it is important to know whether any case of complaint or negligence has been registered or disciplinary action initiated against that particular doctor. The State Medical Licensing Board should be consulted for knowing more details regarding this aspect. An individual must also take into consideration as to whether any complaints have been registered with State Department of Insurance regarding reimbursement of claims.

Once an individual narrows down his/her search to a few handful doctors, he/she may want to get appointments with such medical professionals or doctors so as to get acquainted with them Before going for an acquaintance visit, it is always better to ask whether any charge would be levied for such acquaintance visits. Such sort of acquaintance appointments gives an individual a golden opportunity to interview the doctors and gather information whether they possess relevant experience regarding any health conditions he/she may be suffering from or of interest to him/her including the outcome of such medical cases.

Primary care doctors are trained to serve as family physician or main doctor for an individual over the long-term. Such primary care doctors provide the desired medical and health care for an individual, help him/her to remain healthy and assist in management of healthcare aspects for any individual. The primary care doctor can refer such an individual to specialists for specialized treatments and expert opinion, if required by such individuals or policyholders.

What to Expect

Any doctor or physician who does consultation practice as well as specialized practice, should have the designation of MD. In normal practice, a doctor will have a registered nurse (RN) assisting him/her and will perform minor procedures such as recording weight, checking the patient’s temperature, pulse, blood-pressure, drawing blood from veins, dispensing of medicines, assistance in surgical procedures, maintaining medical records and case-sheets and doing dressings for wounds. Some medical practices, particularly group practices where several doctors share the same staff and suite of clinics, may also involve a nurse practitioner who is licensed to perform tasks not normally permitted of an RN (Registered Nurse). These may include simple diagnosis and the writing of some prescriptions. Nursing professionals provide a valuable service, are highly skilled and can reduce some of a physician#$#s workload to a great extent. However, if an individual feels that a nurse or nurse practitioner has not met your requirements, do not hesitate to insist on seeing the doctor or speaking with him/her especially if the concerned individual is making inquires over the phone.

Practicing medicine in the U.S. has become departmentalized i.e. practice of medicine is categorized according to various departments or based on specialties. Although family physicians or general practitioners still exist, many patients eschew these in favor of a more specialized physician in their respective fields. For example, if an individual is suffering from some skin ailments, he/she can consult a dermatologist; if an individual’s feet ache, a podiatrist can be consulted; if a bone is fractured, an orthopedic surgeon can be consulted. Women can approach gynecologists for their ailments, children can be approach pediatricians etc. As a medical condition becomes more specific or serious, a referral from a primary care physician, such as an internist (internal medicine) or a family physician to a more specialized one (i.e. an Otorhinolaryngolist, or "ENT physician") is likely to be required, especially by some Healthcare Insurance plans. But for general check-ups or "wellness visits," or for treatment of basic, minor or localized problems, an individual must choose a doctor or a physician of his/her own choice.

It is important to note that not all the medical professionals or doctors accept new patients. A common reason for majority of the medical professionals is on account of excessive work-load. Incase, if a physician is accepting or seeing new patients, he or she may be required to conduct a thorough examination as a pre-requisite and should definitely include a consultation to discuss with the patient regarding his or her general health, general condition and any related health problems. While going into the details of the patient's medical history, presenting symptoms, past medical history of the patient, family history, personal history etc aspects needs to be taken into consideration. Accordingly, most medical professionals charge a higher consultation fee for first time visits and the fees are relatively lower for each of the subsequent or follow-up visits. In practice, it may be noticed that many doctors are "booked" weeks in advance and hence, taking an appointment is of utmost importance for any patient who wants to seek medical opinion of the concerned physician. Unless and until the patient or the policyholder is suffering from a significant or emergency medical problem where immediate medical attention is required, do not expect to be able to visit the doctor within one or two days. The scheduling of the patient’s appointment depends upon the work-load of the concerned physician as well on his/her availability. For this purpose, it is always a good practice to line up or keep an appointment with the concerned doctor well in advance to deal with any emergency medical situation. Nowadays, many doctors run behind their daily proposed schedule, on account of various reasons. Hence, it is always advisable for the customers to have patience till their chance or turn comes for seeing or visiting a doctor for seeking medical advice.

When visiting a physician for seeking medical advice, an individual will always be encountered with a query whether he/she possesses Health Insurance cover.In normal practice, the doctor#$#s clinic/hospital staff will file the Insurance claim on the patient’s behalf. Incase, if the concerned hospital does not assist an individual in filing insurance claims, the concerned policyholder can approach his/her Insurance agent and get the information regarding the procedure for filing claims, incase if it is done individually. It is important for any policyholder to note that most laboratory tests, consultation fees and/or medical bills are billed separately for convenience purposes. For filing such claims, the doctor's staff or the Insurance agent can guide the concerned policyholder regarding filing of documents. Occasionally, an Insurance plan may refuse to pay for a laboratory test or a medicine recommended by his/her physician, in which case, the concerned individual will be responsible for payment of the cost for that procedure. It is possible to contest such decisions delivered by the Insurance company and an individual’s doctor or physician can assist and co-operate with the concerned policyholder regarding this aspect. If an individual does not possess a Health Insurance cover, such an individual will be solely responsible for making the payment of incurred medical expenses to the concerned doctor including laboratory tests or procedures. Most of the doctors' clinics require payment to be made at the time of the visit, but there are several occasions when such clinics will be willing to bill an individual through the mail. If the incurred medical expenses as part of the treatment are high, on account of ongoing medical treatment or due to an expensive procedure, most medical professionals or hospitals or healthcare service providers would be willing to co-operate and work out a payment plan, for the benefit of the customer. The same is true if you incur the services of a hospital. All such healthcare providers accept major credit cards as well as personal cheques.