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.
When it comes to medical care for kids, there are three types of qualified providers: pediatricians, family physicians, and pediatric nurse practitioners.
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. To keep current on changes in children's health care, pediatricians must recertify by taking examinations every 7 years. They 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 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. Afterward, 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
A pediatric nurse practitioner (PNP) has earned a master's degree in nursing and can take medical histories, perform physical examinations on children, make medical diagnoses, write prescriptions, and provide 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 might hesitate to choose 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.
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 someone 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, consider contacting 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 nonpayment 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 asking:
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? Does the practice use an electronic medical record, that may make it easier to transfer your child's health information, fill out forms, and schedule appointments? Does the practice have its own website that provides helpful advice and access to reliable health educational material, or may allow you to directly view your child's test results?
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.
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.