How to Choose a Pediatrician

There is so much to think about and so many choices to make during your pregnancy, that choosing a pediatrician seems too far away to pay much attention to. It will be one of the most important decisions you make. You spend a lot of time, especially in the first 2 years with your pediatrician with 10 well-child checks and usually plenty of shorter sick visits, and lots of phonecalls. You are really choosing a practice to take care of you and your child, becuase a large part of what a pediatrician does is educate and guide parents. I suggest making prenatal appointments with several practices to help you find a practice which matches your needs best. Many practices will arrange these appointments as a courtesy, some will bill for them. As importantly is to talk with as many friends as possible (or read a local blog) about their experiences with their own practice. Other Moms will know the reality of how a practice is run and how the needs of them and their child are met. Many practices have websites where you can get a lot of this information. Here are some things to think about.

1. Personality - You will get a sense for the personality of the doctors, nurses and culture of the practice from your visit and from talking with your friends. Try to get a sense if this personality matches with yours. For example, some practices are large, high tech and efficient, others are smaller and more intimate. More importantly, some doctors work-up every complaint and others take a watch-and see approach when they think it's prudent. For this, you have to figure out what you and your partner would feel most comfortable with, and it may be a different choice than some of your firends make.
2. Proximity - all else being equal, finding a practice which is close to your home makes a big difference. It is no small feat just getting out the house on time with a new baby, and being close by to the pediatrician makes all the difference. As your child gets older and starts picking up colds, ear infections, and the like, you will be grateful your doc is close by.
3. Training - You can probably find this information out on line before you go. I research the medical school and residency program and appropriate board certification for all doctors I go to. If the pediatrician has been to a good medical school and trained in a large academic medical center, it's a good sign. If they were trained abroad or at a smaller institution, they still might be very good, but I would rely heavily on personal recomendations when considering that doctor. Also make sure your choice is Board Certified by the American Board of Pediatrics. For these boards one has to complete a 3 year acccredited US residency program, pass a 2 day exam, and maintain certification with annual continuing medical education, an additional board exam every 10 years, and a good record in practice. This should be a deal-breaker if they are not board certified.
4. Other providers in the practice - In most practices you will see the other providers in the practice when your doctor is not there. Inquire about their training as well, and ask about Nurse Practioners and PAs. If possible, I personally prefer practices with all MDs. The training and experience is simply more extensive.
5. Insurance - as with any doctor, inquire about insurance and reimbursement, fees for missed appointments etc. With so many visits a year, make sure you are covered!
6. Office hours/Call/appt structure - Find out the regular office hours and weekend hours. Are you able to make an appointment with the doctor of your choosing (schedule permitting) or is it run like a clinic where it's firstcome first-served?
7. After hours - Who covers the call after hours. Some practices have only their own docs cover the call at night and weekends. Others share the call with other practices, so your own doctors may not be calling you back. Still some practices, hire a nursing answering center to field calls. Ask where their patients go for urgent care after hours and does the practice get a note from that place (urgent care or ER) the next day to document what happpened at that visits. This is important for continuity of care.
8. Nursing phone line - If you have a question during regular hours, is there a nurses line to answer questions or do you have to wait until lunch hour or the evening to have questions answered? Do you have acccess to your doctor on the phone?
9. Hospital Priveleges - find out which hospital the doctors admit their patients? Will your doctor come see your baby once they are born in the hospital? Do they take care of their own patients (increasingly rare) or do hospitalists take care of their patients for them? If the latter, are they in-touch with the hospital about your child's care and for follow-up?

So, this is a lot information to absorb and sort through. You will get a feel for most of this from the websites and your friends before you visit and there may only be one or two practices which fit your needs and pass your personal benchmarks. So by the time you visit, you may have only a few questions left. Allow the pediatrician to describe the practice to you and you'll get a great feel for the practice. What you really want is a well trained team who is going to take care of you and your baby and be your advocate and cheer-leader. Quite simple, actually!