The Modern Odyssey: How do I find a ‘good doctor’?
Recently a good friend texted me: “I feel dumb asking this, but how do I find a good doctor near me?” It’s a pretty common question for me these days because a) I’m a physician, b) I turned 40 last year and many of my friends are at similar life stages, and c) I’m in health technology — and often trying to fix these types of mundane but incredibly persistent problems in healthcare.
Whenever I get this question, my answer is unfortunately pretty consistent: “You’re not dumb, there’s literally NO simple answer.” And naturally, being me, I launch into a whole big thing to this seemingly innocuous question (yes, I’m that guy). Something along the lines of…
It depends on what you mean by “good”? If you’re looking for soft skills like being non-judgemental, a good listener, attentive, or courteous, unfortunately, those qualitative characteristics are not captured anywhere. Basically the only characteristics you can truly ‘know’ about a doctor before meeting them is typically A) where they went to school and did their training and (rarely) B) how long they’ve been practicing (I say rarely because IF you assume that experience is a factor in ‘good’, most profiles don’t actually show dates associated with their training). Also, if you found a doctor who went to med school and residency at OU 10 years ago, what does that really tell you?
Even if you have identified the perfect doctor profile, you’re likely to find that either A) they’re not accepting any new patients (if they’re perfect for you, they’re probably perfect for thousands of patients just like you, especially in a big city) or B) their earliest appointment availability is in 2-3 months from now… yes for primary care.
Assuming you’re a pretty healthy adult, without any major common conditions (e.g., hypertension, diabetes or heart disease), looking for prevention / wellness / longevity knowledge or services, then A) good for you! And B) good luck. 99.9999% of care (and medical training) in the US is exclusively focused on sick care, namely treatments for illness, injury or disease. I asked my primary care doc about the latest research on Intermittent Fasting or Rapamycin for longevity (again, yes that guy), and he smiled politely, patted me on the shoulder and said, “you’re in good health, just keep doing what you’re doing”.
After the uninvited lecture, I typically apologize and then try to point them in the right direction:
Ask friends similar to you in your area if they have a doctor they like, and pursue that doctor. Seriously, in 2023, that is my advice and, YES, it is a serious indictment on the entire state of healthcare and technology, but that’s where we are. I wish there was a better answer, but since there’s not, the reality is there’s a good chance that A) your friends are a lot like you, B) that a person they like is someone you’d like and C) that doctor is willing to take on referrals from friends and family of current patients, even if they’re not accepting new patients overall. Sad, but this is your best bet.
Google. Or, if there are major health systems in your area, check their website(s). The tough part of either option is A) doctor’s information is rarely 100% accurate on the web, even when you’re looking on a health system website (health systems can have a half dozen different directories that are maintained with post it notes and duct tape). Phone numbers, addresses, etc. can be severely outdated. B) Google and websites typically don’t tell you if the doctor is accepting new patients or when the next available new patient appointment is. You have to call to find out, which is super annoying. IF you find a website that has appointment availability listed, stick with it — that’ll cut the time invested in your search down substantially.
NOTE: If you’re a health system reading this… WE CAN HELP. Fixing this is the lowest hanging fruit to help you climb out of a terrible financial year(s).If you’re willing to pay more, there are a few additional options available to you in major markets:
One Medical – In major cities with a One Medical office, you can pay $200 to become a member. You can read the website for the latest benefits, but in general, with a membership-based clinic, you’re paying for access. There should be fancier pillows in the waiting room, same/next day appointment options, and virtual/chat visits available to you.
NOTE: One Medical is now owned by Amazon. This could be great, or this could be creepy. No one knows, but JFYI because you might start to see this ‘integrate’ with a broader Amazon offering. Most likely that’ll be something trivial like Amazon Prime members get 5% off an annual membership.Forward – The idea behind Forward is a more proactive approach to health — that’s the idea. Having tried this first hand, I can tell you it’s far more of a modest improvement on technology (i.e., during your virtual visit, the patient gets a live diagram of some EMR highlights). Genetic testing is no longer included, but in clinic labs, at home vitals and few other perks are. I’d be hard pressed to defend this against critics who say that there’s little evidence that this model will improve your health, but if you’re actually considering their $150/mo all-in price tag, then you’re probably like me and enjoy throwing money at a problem that’s really about motivation, consistency and habit forming.
Parsley – I’ve experienced this model personally, and although it was not for me, patients who have a favorable view of “root cause medicine” (I believe synonymous with the newly forming field of “Functional Medicine”), then it might be right for you. Just be ready to make some serious lifestyle changes to address the high rates of inflammation that you’re very likely to see in your first comprehensive lab set.
NOTE: the website claims pretty ubiquitously that Parsley is NOT intended to replace your PCP (which tells you this is squarely in a ‘luxury’ category of care).Any other local ‘Concierge’ practice, many aggregated at MDVIP. These vary greatly, but if you’re in a big city or suburb, there’s a good chance you can find one. They range from a few hundred to several thousand dollars a year.
By the way, if you’re interested in these new age models, many if not most fall under the moniker of “Direct Primary Care”. Instead of explaining what that means, XPC already did a great write-up.
Lastly on this topic, a several additional observations for the super nerds on this topic (welcome, make a name tag, and sign up for the newsletter):
Quality and outcomes are basically unknowable, especially in primary care. I’ve spent 10+ years as an expert in this industry, and there’s literally no making sense of any of it. We (the healthcare industrial complex) have absolutely refuted or obfuscated ANY meaningful definition of quality, so we need to move on. Every legacy provider, new care model or startup claims they’re the best at quality, and where they’re not, their patients are sicker. IMHO, we’ve lost ALL credibility in any objective or standardized measures and I’ve never met a doctor who will accept any measure that rates them poorly.
Several companies have tried to make some meaningful directories / guides / navigators by utilizing volume data (i.e., which doctor has done the most X procedures or for doctor X, how much of their practice is Y procedure?) including formerly Vitals and now Ribbon, but I’ve not seen anyone successfully translate this into a useful tool for the public.
On ratings and reviews:
Little known secret: if you’re looking at them on a big health system website, they’re cherry picked and all the negative ones have likely been protested out. Quickly check and see if you see ANY that are 4.0 or under. If not, I wouldn’t put much stock in them.
Google reviews can be helpful, but like most things (plumbers, roofers, etc.), you’d need dozens before they started establishing a meaningful pattern that I would trust. If I see 3 stars with 4 reviews, I can’t tell you what that means.
Why not start with doctors who take your insurance? Well, for most of the big carriers (Blue Cross/Blue Shield, United, Cigna, Aetna — commonly knowns as BUCAs), I’m assuming:
Their websites and provider searches have terrible user experience
Their provider network data is typically not the best, and when you search there you get even less information than Google, and half the time you call, it’s wrong. YES, this is anecdotal, so don’t come at me if you work at one of these places, but 90% of consumers would agree with me
IF you have one of the big carrier plans, most docs will accept it. Again, NOT universally true, but for me personally, not worth starting with or checking against my insurance carrier’s terrible website.
Time is a HUGE factor… finding a ‘good’ doctor is kind of like finding the right partner. But unlike dating, there’s no ‘speed dating’ option (nor would market dynamics ever really create one). If you wanted to try to meet 10 different doctors, it would probably take you several hours online and on the phone booking the appointments, some significant time off work, and like several months to complete. Realistically, very few people are going to do that, at least not in one sitting. So my advice is the same to single friends: just don’t settle. If your current doctor is ‘meh’, you don’t need to break up with them immediately or try a new one every month. But, ask around, be on the lookout, and commit to trying a new one next time you make an appointment.
“Good” is obviously subjective, but I find that when people ask me for a “good” doctor, they typically mean 1 of 2 things:
One that they’ll like and/or that will like them. In other words, one where they can build a long-lasting relationship with trust at its foundation. No judgment on this definition — I think we’d all like a primary care doctor we feel comfortable with and that we can trust. When it comes to surgeons, I suspect we’d all be willing to trade some soft skills for more experience, expertise and/or outcomes.
A few people really mean a doctor who’s knowledgeable about some specific topic, or experienced with a specific type of patient and the issues they commonly deal with. This can mean a lot of things, like an athlete, LGBTQ issues, longevity/anti-aging research, or some sort of rare disease that affects every other primary care need. This sort of categorization should exist, but I just don’t think there’s enough supply (of doctors in the market) to meaningfully warrant it.
In conclusion, I believe finding a good doctor is…
Going to be a life skill. Unfortunately, there are several compounding reasons why we’re only going to see an increasing shortage of primary care doctors. One not mentioned in the linked article is that we’re simply not making enough new ones — although there have been attempts made to increase the number of MDs produced in the US every year (thanks @SunnyJhaMD for the link here). That’s a topic for another post, but for now, my point is that even when you’ve found a doctor, there’s little guarantee that they’ll be your doctor for life.
Going to change dramatically in 10-20 years. Assuming the US does not dramatically increase the number of residency spots, then either one of two things will happen, or a combination of them:
The majority of primary care in the US will not be delivered by physicians. Instead, we’ll need to see dramatic increases in roles like Nurse Practitioners (NPs) and Physicians Assistants (PAs). Some (I) would argue that this is already happening, a good thing and should continue with enthusiasm.
ChatGPT (or some sibling / equivalent) will start to encroach on basic primary care. There’s little doubt in my mind that the major difficulty of Primary Care is not the knowledge required to figure out the diagnosis or the treatment, it’s dealing with patients. So I suspect that when low cost technology can reasonably account for the answers to “what should I do to treat X?”, then we might see the role of PCP be handled with someone trained in motivational interviewing + Dr. ChatBot. The major resistance will come from Doctors claiming it’s unsafe, and citing that dangerous care is worse than no care (i.e., the playbook to deny virtual health before COVID). Hopefully this time around, we’ll move past that argument quickly.
Have thoughts? Disagree? Let me know what I got right, wrong or in the middle.
