Primary Care Checklist: 10 Things to Look for in a PCP
Categories: Clinical Insights, For Members
Primary care physicians (PCPs) are at the forefront of patient advocacy and care coordination. They are best positioned to help their patients navigate an increasingly complex health care system and get on the road to better health. Studies have consistently demonstrated the health and cost benefits associated with partnering with high-quality PCPs. They provide continuity of care for all ages and genders, and can generally manage the majority of health concerns most people experience. PCPs focus on preventive health at the family and community levels, and they help coordinate care when specialty needs arise. Establishing a relationship with a high-quality PCP is invaluable for keeping you well and reducing health care costs.
“Often patients choose and remain with a doctor because he or she is warm and engaging, an excellent diagnostician or highly accessible.”1 — Wall Street Journal
Experts agree that finding and establishing a relationship with a quality PCP is essential to short- and long-term health. But what should you look for when choosing a PCP?
Here are 10 factors to consider when selecting a PCP:
- Board certification. At a minimum, PCPs should hold the appropriate licensing and board certification in the area of medicine they practice. While this cannot assure patient-physician compatibility, it does at least guarantee a degree of competency. For PCPs, important board certifications to check for include Family Medicine (treats both adults and children), Internal Medicine (treats adults), and Pediatrics (treats children). You can confirm PCP credentials at www.certificationmatters.org.
- Hospital system affiliation. Some PCPs remain affiliated with hospital systems, though this is becoming less common. If they do have an affiliation, consider whether the system is well-regarded and whether it has the facilities and diagnostic equipment you desire. The system’s website can also be a source of information about PCPs. Most hospital system and private practice websites list physician bios containing earned academic degrees and qualifications. It’s worth asking how inpatient care, if needed, is managed. Does the physician admit and follow his or her own patients? If not, how is care in the hospital coordinated with the office?
- Insurance. Generally speaking, care from a PCP is very cost-efficient. However, it is important to determine if the physician is an in-network provider on your plan. Practitioners outside the network typically cost more out-of-pocket, and fees paid may not count toward deductibles.
- Physician expertise. PCPs are educated and trained to manage a broad spectrum of health conditions. However, some physicians have areas of focus within their practice. You may want to ask if the physician is accustomed to treating ailments common to your stage of life. You may also want to consider the role gender might play in the level of transparency you can comfortably provide the physician. Would you be as honest with a female doctor as a male?
- Location. Is the doctor’s office conveniently located? Is it near other routinely visited medical providers? Having a primary care physician who is geographically accessible to you is important, though in some parts of the country this is more difficult due to nationwide shortages in PCP supply. The idea is to be able to get to your physician as a “first option” for your health care needs.
- Recommendations. Nothing can replace a one-on-one conversation, but reading about the experiences and impressions of other patients can provide assurances that a doctor is at least respectful, attentive and helpful. Recommendations from friends and family – like-minded people who share common values – also carry a high value. Other resources, such as the Physician Quality Map, illustrate the density of quality physicians by region to help you make informed health care decisions.
- Access. Having access to care is key to helping you manage your health. Some questions to consider include: Does the office offer reasonable appointment access for follow-up care, and good access for acute care? How are acute or same-day needs handled by the office? What options does the office provide for getting information (is there a nurse line or some other method for getting questions answered?)
- Office hours. Are the practice’s hours convenient for your schedule and family? Does the office offer early morning or evening appointments before and after standard business hours? How does the office handle needs that arise after operating hours?
- Patient care portal. Does the practice offer an online patient portal? These web-based applications can provide online scheduling, appointment reminders, refill requests, test results and messaging capabilities to communicate with office staff, nurses, and schedulers. Some PCP offices are starting to offer “virtual visits” through the portal or other telemedicine tools. It is worth asking if the office you are considering provides this or plans to in the future.
- Rapport. Importantly, once you meet with the doctor and the office staff, do you feel at ease and capable of being honest with the doctor? The time and communication you share with your PCP are vital to establishing trust, and trust is key to a therapeutic relationship with your doctor. Rapport is a highly individual experience, but discomfort or embarrassment can seriously inhibit the patient-physician dynamic and reduce a doctor’s ability to render effective treatment.
These questions will help you find a PCP who is best matched to you and your family’s needs and preferences. From there, scheduling visits with physicians will help you to further assess the interpersonal compatibility of the patient-physician relationship before making a final decision. Whatever your choice, understanding the value and benefits of building a long-term relationship with a PCP will likely help you experience better health and financial outcomes.
- “How to Pick a Primary-Care Doctor,” The Wall Street Journal, February 24, 2014