Awaiting the birth of a baby is an exciting time, and a busy
one. Along with considering baby names and buying a crib,
choosing the right health care provider should be on your to-do
list, too.
Your Options
When it comes to medical care for kids, there are three types of
qualified providers: pediatricians, family physicians, and
pediatric nurse practitioners.
Pediatricians
Pediatrics is the medical specialty fully focused on the
physical, emotional, and social health of children from birth
through adolescence. The primary focus of pediatrics is on
preventive health care.
Pediatricians complete 4 years of medical school, followed by 3
years of pediatric residency. To become board certified, a
pediatrician must pass a written examination given by the American
Board of Pediatrics. Pediatricians must recertify by taking
examinations every 7 years. This means pediatricians keep current
on changes in children's health care. Pediatricians also must
take a certain number of continuing medical education (CME) courses
each year to be eligible for license renewal in the state in
which they practice.
Some pediatricians have additional training in a subspecialty
area such as cardiology, critical care or emergency medicine, or
hematology. These specialists usually have 3 years of additional
training after their residency to be board certified in their
subspecialty.
Family Physicians
Family physicians must complete 3 years of residency after
medical school. Family medicine residents train in pediatrics and
several other areas such as internal medicine, orthopedics, and
obstetrics and gynecology. They usually spend several months
training in each area. Afterwards, they're eligible to take the
certifying examination of the American Board of Family Medicine.
They're also required to earn CME credits and take periodic
recertification exams.
Because they train in many areas, family physicians are
qualified to care for patients of all ages. This means your child
would be able to see the same doctor from birth through adulthood.
It also means that all members of your family can receive their
primary care from the same doctor. A family physician will know the
medical histories of all family members and may also be more aware
of the emotional and social issues within your family.
When seeking a family physician, be sure to ask about age
policies - some see only a few kids or don't see children
younger than a certain age.
Pediatric Nurse Practitioner
Another type of child health care provider is the pediatric
nurse practitioner
(PNP). These professionals generally have earned a master's
degree in nursing and have special training in obtaining medical
histories, performing physical examinations on children, making
medical diagnoses, and providing counseling and treatment. Like
pediatricians, PNPs may specialize in a particular area, such as
neurology or endocrinology. PNPs work closely with doctors in
hospitals, clinics, and private practices.
Some parents may be hesitant to have their child receive care
from a PNP, possibly worrying that the PNP is less extensively
trained in children's health care. These feelings are largely
unwarranted. The presence of PNPs in the practice can have many
advantages. Parents often find that PNPs spend more time with them
than doctors discussing health and child care issues. Plus, if a
PNP encounters a more complex medical problem, he or she is trained
to consult the doctor. Still, if you want to see only the doctor or
feel the doctor should be consulted after the PNP has seen your
child, most practices will honor your request.
When and How to Start Looking
Your search for a health care provider should begin well before
your baby's due date. Babies often come early and you'll
want to be sure you've found a health professional whose
style and personality work with your own.
A good time to begin your search is about 3 months before the
baby is expected. If you're in a managed health care plan, your
choice of participating doctors who provide primary care for
children may be limited, so be sure to check the plan's online
list (paper lists get outdated quickly).
If you have questions about whether a provider participates in
your plan or if you're interested in a doctor who isn't on
the list, call the health plan directly. Also call if your child
has any special medical needs that would require an out-of-network
doctor.
Once you know the limits of your health plan, compile a list of
candidates from people you trust - your relatives, friends,
neighbors, and coworkers who share your parenting philosophies.
Your doctor, obstetrician, or
nurse-midwife
can also be a good source for recommendations.
If you've recently moved to a new area, you may not have
personal or social connections established to ask for referrals. In
this case, you may want to contact area hospitals or medical
schools for recommendations or ask the pediatric residents or
nurses where they take their kids.
You also can request a list of board-certified pediatricians
from the American Academy of Pediatrics (AAP) and board-certified
family physicians from the American Academy of Family Physicians
(AAFP). Local hospital "nurse line" referral services,
the local medical society office, medical directories in public
libraries, and the yellow pages also can be helpful.
Once you have some recommendations, check them out more
thoroughly. In each state, a medical board investigates complaints
against doctors and may take disciplinary action, ranging from
citing a doctor for non-payment of certain administrative fees to
suspending or revoking his or her license for criminal
behavior.
Disciplinary action is rare but fortunately very easy for
parents to uncover. In most states, the information is public and
is posted by state medical boards on their websites.
Now you're ready to begin the interview process. Considering
that this doctor will be the first to treat your baby, you'll
want to be sure that you're comfortable with the doctor's
personality, office staff, location, and environment. A prenatal
appointment is an excellent opportunity for parents to ask
questions and get acquainted with the office staff.
During the interview, you should find out how the practice works
by addressing these topics:
- What are the office hours? Flexibility of the doctor's
schedule may be a concern, especially if you work outside the
home; you may prefer a doctor who offers weekend and evening
hours.
- Is this a solo or group practice? If it's a solo practice
and your doctor is not available on weekends or evenings, what
are the coverage arrangements? If it's a group practice, ask
about the qualifications of the other doctors in the office. Who
will see your child if your doctor is on vacation or otherwise
unavailable?
- Does a PNP work in the office? How does he or she fit into
the practice arrangement?
- Which hospitals is your doctor affiliated with? Will your
doctor come to the hospital when you deliver to examine the baby?
If your baby needs to be hospitalized, who will provide care
there?
- How does the office handle phone inquiries during and after
hours? Are special times set aside for parents to call in with
questions or is there an open advice line (usually staffed by a
"phone nurse") during working hours? How are
after-hours calls handled? How quickly can you expect a call back
from the doctor on call after you've contacted the answering
service? Are after-hours calls routed to a
"nurse-on-call" system? This is a service that employs
a staff of nurses to give parents advice about how to handle most
common childhood illnesses. If your child's illness is
thought to be serious, the nurse will transfer the call to your
child's doctor or a covering physician, or advise you to go
directly to the emergency room. Otherwise, a record of the call
will be relayed to your doctor the next day.
- Is email an option for communicating with your doctor?
- Will the doctor handle emergencies or will your child be
referred to an emergency room or urgent care center? Are these
facilities equipped to handle pediatric emergencies?
- Are
lab tests
done in the office? Most offices can perform basic tests, such as
complete blood counts, urine testing, and rapid strep tests
rather than send samples out to a laboratory.
- What are the payment policies? This is especially important
if you do not have prepaid health coverage. What are the fees for
services? Must they be paid in full at the time of the visit or
can payment plans be arranged?
- What are the policies regarding referrals to specialists in
the event your child needs additional care? Is the doctor
financially penalized by your health plan for referring patients
to specialists, and if so, will this influence the doctor's
referral practices? If you are in a health management
organization (HMO), it's important to ask how your doctor
handles out-of-network referrals.
Making a question checklist will help you organize your thoughts
and be thorough during the interview. Some doctors offer group
classes for expectant parents to learn about the practice and
discuss newborn care, while others offer one-on-one interviews.
Many insurance companies encourage these prenatal appointments
or classes and will cover any cost involved; however, be sure to
check with the doctor's office and your health plan first to
avoid surprises.
What the Doctor's Office Should Be Like
The interview is a great time to observe office procedures.
Check out the reception area; how many patients are waiting?
More than a handful may mean overbooking or it could mean the
doctor is spending extra time with a patient who needs it. Is there
a place where sick kids can be separated from those in for a well
visit? Is the area clean and child-friendly? Is the staff polite
and considerate to patients in the waiting room and to people on
the phone?
While you're waiting, talk to other parents to determine
whether they're satisfied with the care. Is their child
comfortable with the doctor? Do the parents feel confident the
doctor is thorough and competent? The overall atmosphere in the
waiting area will give you a good idea what the practice is
like.
The Doctor's Personality
Another important aspect of the interview is getting a feel for
the doctor's personality. Does he or she see parents as
partners in a child's care? Is he or she patient and willing to
explain things carefully? Do you get the impression the
doctor would be supportive if you requested a second opinion?
Are the doctor's age and gender important issues to you?
Good communication between a doctor and parent is essential to
building a good working relationship. Is the doctor is a good
listener who seems responsive to your concerns? Are you comfortable
asking questions or do you feel intimidated?
You also should be sure that your parenting style matches your
doctor's in the important issues. How does the doctor feel
about circumcision? Breastfeeding? Alternative or integrative
medicines or techniques? Use of antibiotics and other medications?
Does the doctor focus on preventive care, including
immunizations
, child safety, and nutrition? Philosophical issues might not seem
important before the birth but if you consider that this doctor may
see your child for years to come, agreement on larger issues
becomes more significant.
Although you may feel overwhelmed with preparing for your
baby's arrival, imagine how you'll feel after the baby is
born. Choosing the right health care provider will help you feel
confident your baby will be well cared for throughout childhood and
beyond, and will ease some of the anxiety all
new parents
experience.
Reviewed by:
Steven Dowshen, MD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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