Choosing a child's doctor

Choosing a doctor for your child can be challenging. Here are some points to consider while you're making the decision.


Types of doctors
After medical school, pediatricians complete three years in a pediatric residency, where they learn how to care for babies, children and adolescents. Pediatricians have the most experience with pediatric patients. They're trained to care for serious pediatric ailments, as well as answer routine new parent questions, such as "How can I get my baby to stay awake during the day and sleep during the night, instead of vice versa?"
Like pediatricians, family physicians complete three years of specialty training beyond medical school. Family physicians address the health needs of an entire family -- including newborns, children, teens, adults, pregnant women and the elderly -- with a focus on prevention.

Training in family medicine covers all major areas of medicine, including pediatrics, internal medicine, psychiatry, obstetrics and gynecology. Family physicians learn to handle most common medical issues and consult specialists when necessary. If your child develops a complex medical problem, for example, the family physician may make a referral to a pediatrician or a pediatric subspecialist, such as an allergist.


Board certification
After the residency training, a doctor can become board certified in a particular area. There are currently 24 approved specialties, including pediatrics and family medicine. To receive certification approved by the American Board of Medical Specialists, the doctor must earn a doctor of medicine (M.D.) or a doctor of osteopathy (D.O.) degree from an accredited school of medicine and complete three to seven years of specialty training in an accredited residency program that meets the approval of the Accreditation Council for Graduate Medical Education.
Individual performance evaluations from the residency training director or the chief of service in the hospital where the specialist practices may be required. Most specialty boards require that the doctor's license be free of restrictions. Finally, the doctor must pass a written exam given by the specialty board. Fifteen of the 24 specialty boards also require an oral exam. Sometimes, full-time work within the specialty field -- often two years -- is required before the exam can be taken.

After completing these requirements, the doctor is awarded the title of diplomate and becomes a board-certified specialist. Many specialties now require periodic exams and recertification. Specialists who want to subspecialize in a particular field follow a similar procedure after completing a fellowship in the subspecialty area.


Other providers
Physician assistants (PAs) are educated in medical programs accredited by the Commission on Accreditation of Allied Health Education Programs. The average PA program takes about two years to complete, including classroom and lab instruction and clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, emergency medicine and geriatric medicine. Physician assistants practice under the supervision of a physician.
Most states also recognize nurse practitioners, or registered nurses who've completed further training in a particular field, such as pediatrics. This education is usually completed through a college or university, where the person earns a master's degree in nursing. Requirements for doctor supervision of nurse practitioners vary from state to state. In some states nurse practitioners are allowed to practice independently, although in most states they work in collaboration with doctors.


Personal preferences
It's important to consider your personal preferences. Would you prefer a male or female doctor? One who works alone or in a group practice? How much experience would you like the doctor to have? If your child has a specific medical condition, would you prefer someone who has a special interest or expertise in the condition?

Rapport
Having confidence in your child's doctor is important. To be able to communicate openly, you must feel comfortable with him or her.
It may be helpful to interview potential doctors to learn about their views, special medical interests and character. Ask in advance if there will be a charge for this type of meeting and how much time the doctor can set aside. You may want to take notes during the interview.

While you're there, meet the office staff. Find out if they're friendly and helpful. Make sure the office setting is clean. Ask about separate waiting areas for sick patients.


Philosophy
Consider how the doctor feels about topics important to you, such as breastfeeding, circumcision and nutrition. Ask his or her opinion on antibiotics and other medications, preventive medicine and immunizations. Also discuss any particular concerns or conditions related to your child. Look for a doctor who:
listens to patients and parents and acknowledges their problems and concerns
encourages questions and takes them seriously
provides answers and explanations in easily understandable terms
takes careful medical histories and does thorough physical exams
prescribes medications and treatments carefully
tries to solve underlying problems and considers the child's development

Other considerations
Is the doctor's office in a convenient location? Are pharmacy, lab, X-ray and parking facilities nearby? What are the office hours? What about evening or weekend hours? When is the best time to call with questions? Are calls answered between patient visits, at the end of the day or during daily phone-in times? When the doctor isn't available, who handles the calls?

Hospital affiliation
Find out where the doctor admits patients for hospitalization. Is the hospital close to your home? Does the hospital routinely care for children? As the name implies, children's hospitals specialize in the care of children. Staff members are familiar with the special needs of children, and each hospital department is equipped and operated with children in mind.

Emergencies
You'll also want to know emergency and after-hours procedures. Are backup doctors available or on-call? If so, are they on staff or hired as consultants? Make sure you're comfortable with the doctor's policies and availability.

Referrals
Ask friends, co-workers, neighbors or others who share your medical philosophy for recommendations. Check with doctors and nurses at pediatric hospitals in the area. You may also want to consult local medical societies, physician referral services and medical specialty directories.