How to look for a good Primary Care Physician (PCP), and no price transparency...

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fatFIRE
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How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by fatFIRE » Wed May 13, 2020 3:52 pm

Healthcare prices is ridiculously untransparent in this country, Ok, I knew that. But it's a different thing when you are actually shopping.

Anyway... I need to get a Primary Care Physician (PCP) ASAP... and I never had a PCP before. I don't like doctors and have stopped seeing them since 2013. But I need a PCP to manage ongoing health conditions.

Non-Financial Aspect
- How do you rate/rank a doctor? I'm totally clueless!
- Is one PCP specialty better than the other? General Medicine vs Internal Medicine perhaps? Assume that the patient has a short lifespan, and everyone in his family dies of cancer, stroke, heart attack, kidney failure, liver failure, etc...
- Do you go for a certain threshold of experience by looking at the doctor's graduation dates? Do you consider the quality of their medical school? What med school rankings do you use?
- Are there any certifications you expect the PCP to have or must have, besides a MD of course?

Financial Aspect
- I'm on a HDHP/HSA plan, so I have to pay for everything. There is no information on pricing on how much a doctor's visit would cost. There is no Amazon for healthcare... it's so sad. How then do you figure out which PCP to choose?
- Do you consider a Direct Pay arrangement, as opposed to traditional insurance arrangement? My understanding in Direct Pay is that you pay the doctor directly (cut out insurance middle man), and fees are transparent and upfront, sometimes there is also a subscription to get better access to the doctor. I found this quite interesting, and I'm wondering if these payments would count towards the deductible (so you file your own paperwork with the insurance company)?
Last edited by fatFIRE on Wed May 13, 2020 3:59 pm, edited 2 times in total.

123
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by 123 » Wed May 13, 2020 3:58 pm

You can ask people you know, relatives, friends, neighbors, for recommendations as a starter. In many cases PCP's practice as a group so even though you may identify one as your PCP it's quite possible that you will see others in the practice depending on who is available. Look to identify physicians near you and in many states you can look up information about their medical licenses such as what school of medicine they graduated from, year of graduation, and where they served their residency from a state licensing website. Some states will also indicate disciplinary action against the physician if applicable. Even online information, like Yelp.com, can be helpful in some areas.

The initial visist with a physician is normally longer (and likely more expensive) than a "regular" visit because of the need to go over your medical history.

Some urgent care centers will serve as PCPs. In many you will actually visit with a physician in person, but in some, like those in some Safeway stores, you visit with the physician via video conference and a nurse does any examination necessary that the physician directs. They can direct you to other service providers if things like lab tests or xrays are necessary. Urgent care centers will often provide general fee information over the phone.

Perhaps you should consider returning to your physician from 2013.
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Kennedy » Wed May 13, 2020 5:26 pm

If you have a specific health issue, see an Internal Medicine boarded physician to start. He/she can refer you to a specialist for things they can't handle.

When trying to select a doctor, I look on their website (or even your state medical board) and see where they did their residency. A doctor coming out of a "good" residency program has my vote over a no-name institution. Where they did medical school is less important to me. I am familiar with the quality of many of the programs, but you might not be. In that case, you would be better off by asking people who they use and if they're happy with their care. You can join a website called "Nextdoor," members of which live in your community. You could ask there and see who people like.

I try to pick people who have been practicing for ten years or more. I want someone who has been around the block and has seen everything.

Personally, I would skip concierge medicine arrangements and just pick someone contracted with my insurance company. If you don't, many insurance companies do not have out-of-network benefits (non-contracted provider), and if they do, they do not help too much with your deductible, for the most part. Since you said you have health issues, you may end up meeting your deductible so this matters.

If you use a doctor in your insurance network (go to insurance website and see if they're in-network), your cost will be the negotiated rate established by the insurance company and provider. I don't think there will be too much difference provider to provider for the same specialty.

Oh, and be aware that if you select a physician who works for a big teaching hospital, they may pawn your visit off on a "fellow" or a resident, which is not ok to me personally. If you need a procedure, insist that the attending physician do it or at least is right there to guide the doc in training. Further, if you select a doc at such a facility, you will end up being billed by the physician and also by the facility, which is way more expensive than otherwise.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by decapod10 » Wed May 13, 2020 5:27 pm

fatFIRE wrote:
Wed May 13, 2020 3:52 pm
Healthcare prices is ridiculously untransparent in this country, Ok, I knew that. But it's a different thing when you are actually shopping.

Anyway... I need to get a Primary Care Physician (PCP) ASAP... and I never had a PCP before. I don't like doctors and have stopped seeing them since 2013. But I need a PCP to manage ongoing health conditions.

Non-Financial Aspect
- How do you rate/rank a doctor? I'm totally clueless!
It's virtually impossible, since patients really don't have a good way of knowing whether a doctor is good or not, even other doctors probably don't even know. You can get recommendations from other people, at least you can probably judge bedside manner that way and get an idea if your doctor is someone you would get along with.

- Is one PCP specialty better than the other? General Medicine vs Internal Medicine perhaps? Assume that the patient has a short lifespan, and everyone in his family dies of cancer, stroke, heart attack, kidney failure, liver failure, etc...

"General Medicine" isn't really a thing. For Primary Care doctors, it's usually either Internal Medicine or Family Practice. Given the requirements, you probably want Internal Medicine.

- Do you go for a certain threshold of experience by looking at the doctor's graduation dates? Do you consider the quality of their medical school? What med school rankings do you use?

Again difficult to say. The most important part of a doctor's training in my opinion is the residency program they attended (if we are talking about Primary Care doctors). Unfortunately there's no easy way to rank residency programs, since there are many good residency programs that non-physicians have never heard of since they may not be attached to a famous school. Though usually if a residency program is attached to a good medical school, it's probably a good one. Experience can be a double-edged sword IMO, there are good and bad aspects to older vs younger doctors, and of course generalizations could be wildly inaccurate for any particular doctor.

- Are there any certifications you expect the PCP to have or must have, besides a MD of course?

Board certification (American Board of Internal Medicine, or ABIM)

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by junior » Wed May 13, 2020 5:38 pm

I would think there should be a negotiated rate on your HDHP plan so as long as the doctor is on your plan theres no point comparing prices.that's how it works on mine.

In my limited experience as a patient for many ongoing conditions the PCP will just refer you to a specialist so it doesn't necessarily matter how "good" the PCP is. I can't speak to anyone else's experience though.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Sgal8713 » Wed May 13, 2020 5:50 pm

From a physician perspective (Internal Med, practicing as a Hospitalist)... I think the most important aspect is how well you trust and get along with the doc. IE the first impression should go a long way. There are many fantastic physicians that went to smaller, less well known residencies. If you are picking your neurosurgeon, get a high-level residency; PCP, get one with which you feel comfortable. Family/friend recs go a long way.

There are two degrees and two residency paths. The degrees are MD and DO which have some slight differences, but dont matter much by the end of residency. The two residencies are Family Medicine (FM) and Internal Medicine (IM). I also dont think this matters much with PCP. IM gets more exposure to specialties (cards, nephro, GI). FM has more clinic focus during training. Also largely a toss up. Experience is a double-edge sword as above. Fresh out, less experience but more up to date knowledge. Long-in-the-tooth, seen everything but may not know most up to date treatments.

Lastly I would avoid walk-in as PCP. Their focus is speed and more speed. You will more likely see extenders (NP/PA) and not the doctor. They are also less likely to have finished a residency. Make sure the doctor has an active ABIM or ABFM certification.

TL;DR. Find a PCP near where you live that you can stand and will actually go see and follow what they recommend. Avoid the walk-ins for a PCP. Make sure they are board certified.

Dicast
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Dicast » Wed May 13, 2020 6:26 pm

If you know any doctors in your area you should ask who they see. I generally find that the doctor who doctors doctors to be the best doctor.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by blammo » Wed May 13, 2020 6:30 pm

I am an MD. I personally see a family physician, but many recommend internists. I agree that your relationship with the physician is very important.

There are a couple of factors one should consider. There is data to show some predictive factors that impact the quality of a doctor. For one, the medical and residency program an MD attends matter. Doctors who graduate from more "prestigious" programs (think Harvard, Penn, Wash U, Northwestern, UCSF, UCLA, Michigan, Case Western, Cleveland Clinic, many others) have higher ratings and lower malpractice claims. Additionally, the doctors who adhere to current recommendations the closest are actually those 5-10 years out from residency graduation. This finding goes against the common recommendation to go to a practitioner who has been in practice a long time. The longer an MD has been out of training, the more likely he or she will not be up to date with current evidence-based guidelines.

I am a surgeon, so my recommendation for folks who need a surgeon is to go to someone who does lots of whatever you need, as they will be good at it. For a PCP, I personally chose someone who trained at a reputable program and was a couple of years out from finishing training.

b

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by TexasPE » Wed May 13, 2020 6:57 pm

Ask a nurse for a recommendation - they see many doctors 'in action' and can network with other nurses they know. (I'm married to one :D )
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by BogleFanGal » Wed May 13, 2020 7:08 pm

Sgal8713 wrote:
Wed May 13, 2020 5:50 pm
From a physician perspective (Internal Med, practicing as a Hospitalist)... I think the most important aspect is how well you trust and get along with the doc. IE the first impression should go a long way. There are many fantastic physicians that went to smaller, less well known residencies. If you are picking your neurosurgeon, get a high-level residency; PCP, get one with which you feel comfortable. Family/friend recs go a long way.

There are two degrees and two residency paths. The degrees are MD and DO which have some slight differences, but dont matter much by the end of residency. The two residencies are Family Medicine (FM) and Internal Medicine (IM). I also dont think this matters much with PCP. IM gets more exposure to specialties (cards, nephro, GI). FM has more clinic focus during training. Also largely a toss up. Experience is a double-edge sword as above. Fresh out, less experience but more up to date knowledge. Long-in-the-tooth, seen everything but may not know most up to date treatments.

Lastly I would avoid walk-in as PCP. Their focus is speed and more speed. You will more likely see extenders (NP/PA) and not the doctor. They are also less likely to have finished a residency. Make sure the doctor has an active ABIM or ABFM certification.

TL;DR. Find a PCP near where you live that you can stand and will actually go see and follow what they recommend. Avoid the walk-ins for a PCP. Make sure they are board certified.
great post - thank you. Good info. My PCP is a DO...i was always wondering if that had any bearing vs MD
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by climber2020 » Wed May 13, 2020 7:08 pm

fatFIRE wrote:
Wed May 13, 2020 3:52 pm
- Are there any certifications you expect the PCP to have or must have, besides a MD of course?
Someone mentioned board certification. A few thoughts about that.

All good physicians are board certified, but not all board certified physicians are good. All it means is that the doctor paid a lot of money to take a test that contains minutia that is barely related to actual patient care, passed the test, and continues to pay money each year to jump through a bunch of hoops to maintain the certification. That's it.

I took and passed this test the first year out of training, and it is by far the most useless thing that I have to deal with in my profession. I wish they'd burn it to the ground, but it's too late for that now.

Just be aware that a physician can be board certified and still be a terrible doctor.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by oldfort » Wed May 13, 2020 7:13 pm

Lay person, but in my opinion

1) Look for a MD. I would trust a MD over a nurse practitioner or physicians assistant as a PCP.
2) Look for a US med school and residency.
3) Look for someone board certified.
4) If they meet all the above, the rest may not matter much. In any major city, your PCP is likely to refer you to a specialist for any particularly complex issues.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by decapod10 » Wed May 13, 2020 7:34 pm

BogleFanGal wrote:
Wed May 13, 2020 7:08 pm
Sgal8713 wrote:
Wed May 13, 2020 5:50 pm
From a physician perspective (Internal Med, practicing as a Hospitalist)... I think the most important aspect is how well you trust and get along with the doc. IE the first impression should go a long way. There are many fantastic physicians that went to smaller, less well known residencies. If you are picking your neurosurgeon, get a high-level residency; PCP, get one with which you feel comfortable. Family/friend recs go a long way.

There are two degrees and two residency paths. The degrees are MD and DO which have some slight differences, but dont matter much by the end of residency. The two residencies are Family Medicine (FM) and Internal Medicine (IM). I also dont think this matters much with PCP. IM gets more exposure to specialties (cards, nephro, GI). FM has more clinic focus during training. Also largely a toss up. Experience is a double-edge sword as above. Fresh out, less experience but more up to date knowledge. Long-in-the-tooth, seen everything but may not know most up to date treatments.

Lastly I would avoid walk-in as PCP. Their focus is speed and more speed. You will more likely see extenders (NP/PA) and not the doctor. They are also less likely to have finished a residency. Make sure the doctor has an active ABIM or ABFM certification.

TL;DR. Find a PCP near where you live that you can stand and will actually go see and follow what they recommend. Avoid the walk-ins for a PCP. Make sure they are board certified.
great post - thank you. Good info. My PCP is a DO...i was always wondering if that had any bearing vs MD
Officially, DO and MD have different types of schooling. I can't claim to know much about DO training, but I believe OMT (osteopathic manipulative treatment) is part of it, which is why they are sometimes called "osteopathic" doctors. However, both DO and MDs can go to the same residency programs, though generally speaking it is more difficult for DO graduates to match in more competitive programs and competitive specialties. Once DO and MDs go to a residency program however, their training is identical at that point, and as I mentioned most of the "learning to be a doctor" comes in residency rather than medical school. So functionally, if you have a doctor with a DO degree who attended a traditional Internal Medicine residency, their practice will probably not be significantly different than an MD who attended the same Internal Medicine residency.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Sgal8713 » Wed May 13, 2020 7:46 pm

decapod10 wrote:
Wed May 13, 2020 7:34 pm
BogleFanGal wrote:
Wed May 13, 2020 7:08 pm
Sgal8713 wrote:
Wed May 13, 2020 5:50 pm
From a physician perspective (Internal Med, practicing as a Hospitalist)... I think the most important aspect is how well you trust and get along with the doc. IE the first impression should go a long way. There are many fantastic physicians that went to smaller, less well known residencies. If you are picking your neurosurgeon, get a high-level residency; PCP, get one with which you feel comfortable. Family/friend recs go a long way.

There are two degrees and two residency paths. The degrees are MD and DO which have some slight differences, but dont matter much by the end of residency. The two residencies are Family Medicine (FM) and Internal Medicine (IM). I also dont think this matters much with PCP. IM gets more exposure to specialties (cards, nephro, GI). FM has more clinic focus during training. Also largely a toss up. Experience is a double-edge sword as above. Fresh out, less experience but more up to date knowledge. Long-in-the-tooth, seen everything but may not know most up to date treatments.

Lastly I would avoid walk-in as PCP. Their focus is speed and more speed. You will more likely see extenders (NP/PA) and not the doctor. They are also less likely to have finished a residency. Make sure the doctor has an active ABIM or ABFM certification.

TL;DR. Find a PCP near where you live that you can stand and will actually go see and follow what they recommend. Avoid the walk-ins for a PCP. Make sure they are board certified.
great post - thank you. Good info. My PCP is a DO...i was always wondering if that had any bearing vs MD
Officially, DO and MD have different types of schooling. I can't claim to know much about DO training, but I believe OMT (osteopathic manipulative treatment) is part of it, which is why they are sometimes called "osteopathic" doctors. However, both DO and MDs can go to the same residency programs, though generally speaking it is more difficult for DO graduates to match in more competitive programs and competitive specialties. Once DO and MDs go to a residency program however, their training is identical at that point, and as I mentioned most of the "learning to be a doctor" comes in residency rather than medical school. So functionally, if you have a doctor with a DO degree who attended a traditional Internal Medicine residency, their practice will probably not be significantly different than an MD who attended the same Internal Medicine residency.
Yes there are some training differences during medical school. OMT is specific for DO (Doctor of Osteopathy for those keeping record). All of that comes out in a wash during residency IMO. Very few DO that I know do any OMT at this point. I certainly agree with above on needing a US residency and that all good doctors have board cert, not all board cert are good doctors.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Sgal8713 » Wed May 13, 2020 7:50 pm

As far as the price transparency... good luck. Usually the doctors dont even know what they charge for X, Y, or Z. Commonly yearly physicals are free under insurance plan and then paying someone in network is cheaper than out of network and from there, who knows... well beyond the allowances on this forum.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Carter3 » Wed May 13, 2020 8:06 pm

blammo wrote:
Wed May 13, 2020 6:30 pm
I am an MD. I personally see a family physician, but many recommend internists. I agree that your relationship with the physician is very important.

There are a couple of factors one should consider. There is data to show some predictive factors that impact the quality of a doctor. For one, the medical and residency program an MD attends matter. Doctors who graduate from more "prestigious" programs (think Harvard, Penn, Wash U, Northwestern, UCSF, UCLA, Michigan, Case Western, Cleveland Clinic, many others) have higher ratings and lower malpractice claims. Additionally, the doctors who adhere to current recommendations the closest are actually those 5-10 years out from residency graduation. This finding goes against the common recommendation to go to a practitioner who has been in practice a long time. The longer an MD has been out of training, the more likely he or she will not be up to date with current evidence-based guidelines.

I am a surgeon, so my recommendation for folks who need a surgeon is to go to someone who does lots of whatever you need, as they will be good at it. For a PCP, I personally chose someone who trained at a reputable program and was a couple of years out from finishing training.

b
^This. Although I think residency matters most. Medical school matters nil.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Turkishcoffee » Wed May 13, 2020 8:09 pm

Look for a board certified MD/DO with a good residency. It absolutely doesn’t matter which school they went to, residency counts a lot.

Ask around for someone who has good communication and diagnostic skills and is a caring person. Personally, I don’t care if it is a family medicine or internist, but I don’t like family practice physicians who treat kids, as I think pediatricians do that better, so one who focuses on adult medicine is good.

Word of mouth is good. “Best of” docs usually only means they are well connected or refer a lot to other specialists who in turn, name them. Not always the best gauge.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by eye.surgeon » Wed May 13, 2020 8:11 pm

fatFIRE wrote:
Wed May 13, 2020 3:52 pm
- I'm on a HDHP/HSA plan, so I have to pay for everything. There is no information on pricing on how much a doctor's visit would cost. There is no Amazon for healthcare... it's so sad. How then do you figure out which PCP to choose?
You don't appear to understand how your health plan works. A HSA is a type of health insurance. You are not paying for everything. Rates are set by your insurance company, not your doctor. It doesn't matter which doctor you see, the rates are the same. You're paying a greatly reduced negotiated fee for service compared to someone with no insurance, and if you hit your high deductible you're paying even less. Your insurance company has already negotiated the price for you.
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by averagedude » Wed May 13, 2020 9:21 pm

This is a very good question and I am looking forward to the answers. It seems to me that the "best doctors" have a large client base which means they have less time to spend with each customer. Me personally, I would rather have a doctor that has time to spend on my current concerns that may be less knowledgeable, than a doctor that is intelligent, but doesn't take the time to fully explain my concerns or is just trying to fit in the next patient's appointment. Me personally, a doctor that is easily accessible, cares about and explains my concerns, and will follow through on my future healthcare needs is the kind of healthcare professional that I would want to deal with. I could care less about how many years of education attainment that they have had. In my experience, follow through of doctors today is very poor.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by oldfort » Wed May 13, 2020 9:24 pm

If you can find out if there's a history of malpractice claims, this may allow you to weed out the worst doctors from consideration.

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fatFIRE
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by fatFIRE » Wed May 13, 2020 9:34 pm

This is great information. Thanks A LOT!!! I wouldn't have thought about it but intermediate-level of experience now makes sense, good balance between enough experience and up-to-date with latest practices/research!

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Marylander1 » Wed May 13, 2020 9:40 pm

You're looking not just for a good doctor, but a good system including their staff and appointment availability. Talk to your life-savvy friends who are medically similar to you (especially type of medical conditions and any medically-significant activities like marathon running, rugby, or performing on-stage with tigers) for their recommendations. If you're in an area served by checkbook.org, they have a good ratings system; you'd need to subscribe but finding a good doctor is easily worth a $28 subscription.

Do not look at glossy magazines with "Top 100 doctors in the city!" full of smiling posed photos, as those seem to be just advertisements.

Yelp, Google ratings, and purely crowdsourced doctor-rating websites are of dubious value, largely because patients with negative experiences are far more likely to post, and some patients generate their own negative experiences. But if there are 15 reviews all complaining that a physician always runs late for their appointments, it's probably true.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by txbabe » Wed May 13, 2020 9:47 pm

I am a physician. For your situation - I would recc an Internist - someone who completed a residency in Internal Medicine. Medical not that important but I would always prefer a US one - but I have known some great doctors from international schools. I would look for Board Certification - yes I get that it is just a test but there are people that fail it and never get certified. This is a big red flag. Internet ratings don't mean very much - people get angry when you won't give them xanax and give you a one start. Your mother will go on and give you 5 stars. Pretty worthless.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Cubicle » Wed May 13, 2020 10:45 pm

Personally my best primary doctors have come from visiting multiple until I found one I didn't dislike. I never gave credence to medical school, residency, boarding, research, etc... How reasonable, logical, friendly, & receptive are you when I'm sitting/standing in front of you? When I throw out stupid things, how do you react? Condescending, inquisitive, dismissive?

I have no idea where my current primary doctor went to school, residency, when, if he is boarded. I have zero complaints.
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by eye.surgeon » Wed May 13, 2020 10:50 pm

FYI people, the "best doctors" awards are literally bought and paid for advertisements. I get calls regularly informing me I've won my local best doctor award and for only $200 to cover processing and shipping they will send me my plaque. My partner paid for a best doctor cover feature in an in-flight magazine. It literally means nothing.
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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by FI4LIFE » Thu May 14, 2020 4:35 am

I would treat it like a home repair contractor. Get three recommendations then interview them and ask about pricing and decide which you like.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by Katietsu » Thu May 14, 2020 5:29 am

Spend some time learning how your insurance works. You may be paying for “everything” initially but usually at the rate negotiated by the insurance company as long as you use an in network provider. Even more importantly than the doctor being in network is to make sure any laboratory work or imaging is in network. A $100 blood test could be $1000 if out of network. Also, for my insurance, out of network care does not count towards the deductible or OOP maximum except to a very tiny extent. So, even with a HDHP plan, how you access healthcare can mean a big difference in your cost.

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Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by InMyDreams » Thu May 14, 2020 10:44 am

fatFIRE wrote:
Wed May 13, 2020 3:52 pm
Healthcare prices is ridiculously untransparent in this country,
The best price transparency that I've heard of is Direct Primary Care. It will not count towards your deductible. I do not use one, but have thought about it - I'm happy with my current PCP, tho she's out of network for me now.

Anyway, if you search bogleheads forum for it, you will find at least a couple of threads about it. Here's a website for finding DPC physician:
https://mapper.dpcfrontier.com/

rich126
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Joined: Thu Mar 01, 2018 4:56 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by rich126 » Thu May 14, 2020 11:25 am

Anyway... I need to get a Primary Care Physician (PCP) ASAP... and I never had a PCP before. I don't like doctors and have stopped seeing them since 2013. But I need a PCP to manage ongoing health conditions.
I also don't like going to doctors and was fortunate to avoid doctors (other than dental/eye) from college through my mid 30s w/o any damage but that is not a smart idea. Early testing can detect things early and many things can be resolved when detected early. I'm now in my 50s and do a pretty good job staying regular with my doctors.

I've had friends, friends of friends that:
1. Found out they have stage 4 colon cancer in their latter 50s and had never had a colonoscopy
2. Passed away due to a variety of things that were treatable but he wouldn't see a doctor
3. One guy was very lucky that while waiting in a hospital for his wife he saw a brochure where they were testing smokers for lung cancer. He was a smoker and decided to take the test. Turned out he had cancer but it was like Stage 1 where the doctor said "We never catch it this early since there aren't usually any symptoms". He was treated and is fine now.

Don't wait until you are in the emergency room to realize you should have been on BP medicine or have other treatments. Sometimes it ends up being too late.

And if you don't like the doctor, you can always find another one.

nobleMemo
Posts: 8
Joined: Wed Dec 14, 2016 11:12 am

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by nobleMemo » Thu May 14, 2020 11:49 am

Doctor here, for what it's worth.
fatFIRE wrote:
Wed May 13, 2020 3:52 pm
How do you rate/rank a doctor? I'm totally clueless!
You don't.
fatFIRE wrote:
Wed May 13, 2020 3:52 pm
Is one PCP specialty better than the other? General Medicine vs Internal Medicine perhaps? Assume that the patient has a short lifespan, and everyone in his family dies of cancer, stroke, heart attack, kidney failure, liver failure, etc...
You will want a person board certified in either Internal Medicine or Family Medicine. The difference in training is the latter have to learn pediatrics/obstetrics/adult internal medicine in a 3 year residency while the former learn just adult internal medicine. Both can be great. I personally see an internist.
fatFIRE wrote:
Wed May 13, 2020 3:52 pm
Do you go for a certain threshold of experience by looking at the doctor's graduation dates? Do you consider the quality of their medical school? What med school rankings do you use?
This is a difficult question to answer. The longer out you are from residency the more experienced you are, by definition. However, unless you are a very self-motivated person you are more likely to not know the most recent standards of care, which are tested on the board certification examination at the end of the three year residency. Maintenance of certification may help a bit with this. Who knows. It's a touchy subject in the medicine world.

Medical school location doesn't matter at all. If you're going to go by anything by way of certification/training it should be the residency. Unfortunately for you, being a non-physician, you have absolutely no idea (1) which places are considered great training programs (Flashy names you know when looking at undergraduate colleges do not necessarily have great IM programs) (2) whether they were great when the doc you're looking at trained there (3) whether it is a primary care focused program (I say this because some of the "best" IM programs are very hospitalist/fellowship focused - meaning most people go on to specialize in heme/onc, cardiology, GI, etc...).

I probably wouldn't worry about it. Unlike law, our training is highly regulated. The product may seem variable, but is actually quite consistent.
fatFIRE wrote:
Wed May 13, 2020 3:52 pm
Are there any certifications you expect the PCP to have or must have, besides a MD of course?
Just make sure they completed a residency in IM or family medicine. I personally wouldn't see a doc who isn't currently board certified (up-to-date) in their specialty.

As for the other questions, I'll leave it up to other people who can speak on those things without having a stroke out of shear anger at the stupidity of how our healthcare system is funded.

I think a non-doctor has the best shot of finding a great IM/FM doctor by using the same strategy a doctor would use, though I expect with lower success. Ask a doctor you know who they go to. People in this thread have mentioned how nice a doctor is, etc.. etc... That's important. You don't want a mean doctor. At the same time, I know a few doctors who are absolutely beloved by their patients because they have charismatic personalities but truth be told they are trash doctors.

Only downside to this strategy is that most of the truly "best" PCPs will already be completely full up on patients, with the exception of the young ones.

rjbraun
Posts: 1603
Joined: Sun Sep 09, 2012 8:22 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by rjbraun » Thu May 14, 2020 3:47 pm

Have skimmed most of the replies, which seem to offer good insights.

Not an MD myself, but feel fortunate to have had good health and overall positive experiences with medical providers. Arguably, it may be harder for me to assess medical care as with good health maybe I have fewer opportunities to really put the care to a test? I don' t know.

I do like my current PCP quite a bit, whom I have seen for the past several years. I was surprised when I learned at a recent telemedicine appointment that he had "downsized" his office in the past several weeks, due to covid-19, as I understand things.

Now, it's just him and a couple of doctor-partners and a couple of receptionists, apparently. Was surprised to hear of that development, but, on reflection, I guess it's somewhat understandable. People are staying home for the most part and reluctant to seek medical attention for all but extreme cases, so I guess that leaves GPs in a tough spot.

Fwiw, this was/is a "young practice" with a sports medicine orientation and patient group that seems to skew relatively young and active. Similarly, the doctors have been practicing for about 15 or so years, so presumably kind of the "sweet spot" in terms of experience.

This Washington Post article seems to highlight some of the issues independent medical offices face currently (hope that the paywall doesn't prevent access):

https://www.washingtonpost.com/health/s ... story.html

sawhorse
Posts: 3560
Joined: Sun Mar 01, 2015 7:05 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by sawhorse » Fri May 15, 2020 3:08 pm

nobleMemo wrote:
Thu May 14, 2020 11:49 am
You will want a person board certified in either Internal Medicine or Family Medicine. The difference in training is the latter have to learn pediatrics/obstetrics/adult internal medicine in a 3 year residency while the former learn just adult internal medicine. Both can be great. I personally see an internist.
How much training do physicians in Internal Medicine and Family Medicine get in psychiatry and dermatology? Those two specialities tend to have major waiting lists, so people may have to rely on their primary care physician to handle those problems.

nobleMemo
Posts: 8
Joined: Wed Dec 14, 2016 11:12 am

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by nobleMemo » Fri May 15, 2020 3:12 pm

sawhorse wrote:
Fri May 15, 2020 3:08 pm
How much training do physicians in Internal Medicine and Family Medicine get in psychiatry and dermatology? Those two specialities tend to have major waiting lists, so people may have to rely on their primary care physician to handle those problems.
Not enough. I would advise just waiting for the real deal.

sawhorse
Posts: 3560
Joined: Sun Mar 01, 2015 7:05 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by sawhorse » Fri May 15, 2020 7:43 pm

nobleMemo wrote:
Fri May 15, 2020 3:12 pm
sawhorse wrote:
Fri May 15, 2020 3:08 pm
How much training do physicians in Internal Medicine and Family Medicine get in psychiatry and dermatology? Those two specialities tend to have major waiting lists, so people may have to rely on their primary care physician to handle those problems.
Not enough. I would advise just waiting for the real deal.
Sometimes that isn't an option. This is especially true in dermatology offices because a lot of dermatologists have shifted their practice to cosmetic procedures. When I had to find a dermatologist a few years back, I was told it was a 6 month wait. Out of curiosity, I called the offices back asking what the wait time would be for Juvederm. The answers ranged from "come in this afternoon" to 4 days.

decapod10
Posts: 656
Joined: Thu Dec 28, 2017 6:46 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by decapod10 » Fri May 15, 2020 8:34 pm

sawhorse wrote:
Fri May 15, 2020 3:08 pm
nobleMemo wrote:
Thu May 14, 2020 11:49 am
You will want a person board certified in either Internal Medicine or Family Medicine. The difference in training is the latter have to learn pediatrics/obstetrics/adult internal medicine in a 3 year residency while the former learn just adult internal medicine. Both can be great. I personally see an internist.
How much training do physicians in Internal Medicine and Family Medicine get in psychiatry and dermatology? Those two specialities tend to have major waiting lists, so people may have to rely on their primary care physician to handle those problems.
I would say almost no dedicated training in Psychiatry and Dermatology (probably more training in Dermatology than Psychiatry), though if it's something very common and uncomplicated a PCP can manage it, like depression or eczema or something of that nature.

In integrated medical systems however, things like Dermatology can be handled virtually, where the PCP will take a picture and send it to the Dermatologist along with their physical exam findings.

toofache32
Posts: 2056
Joined: Sun Mar 04, 2012 6:30 pm

Re: How to look for a good Primary Care Physician (PCP), and no price transparency...

Post by toofache32 » Fri May 15, 2020 8:37 pm

eye.surgeon wrote:
Wed May 13, 2020 10:50 pm
FYI people, the "best doctors" awards are literally bought and paid for advertisements. I get calls regularly informing me I've won my local best doctor award and for only $200 to cover processing and shipping they will send me my plaque. My partner paid for a best doctor cover feature in an in-flight magazine. It literally means nothing.
This is true. My partner bought one too.

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