DQOTD: Finding doctors (specialists)?

[Midpack]

In the MegaCorp days, insurance required we go thru our (gatekeeper) PCP for everything, and they recommended specialists. So that seemed normal to me for 40+ years.

Now that we’re in the Medicare system (A/B & Plan G, not Advantage if that matters), I gather that’s not true? We’re happy with our PCP, but she seems to be a little reluctant to recommend specialists - except those in her medical group limited to eight distinct specialties. Maybe I’m bothering her by asking?

Under Medicare, do “we” just find specialist/doctors on our own? I think I need an orthopedist…knee issues.

 

[braumeister]

In the MegaCorp days, insurance required we go thru our (gatekeeper) GP for everything, and they recommended specialists. So that seemed normal to me for 40+ years.

Now that we’re in the Medicare system, I gather that’s not true? We’re happy with our GP, but she seems to be a little reluctant to recommend specialists - except those in her medical group which has eight distinct specialties. Maybe I’m bothering her by asking?

Under Medicare, do “we” just find specialist/doctors on our own? I think I need an orthopedist…knee issues.

I think either way is fine.
I was always happy with the specialists my GP recommended, but I've also been happy with those I found myself. Try to get recommendations from friends and neighbors, use online ratings like Healthgrades and similar sites. Usually if someone is a disaster it will quickly become apparent, but most physicians are good in my experience.

 

[ShokWaveRider]

From my experience, as long as they take Medicare, you are golden. Just make sure you have a good Supplement Part G. (AARP). Although all bets are off with Medicare Advantage, you may then need the gatekeeper.

 

[Ian S]

Yes, you can do your own research and find your own specialist. When I lived in Phoenix, I generally got good advice from my GP but his was an independent practice which is getting rare now.

When I needed my first shoulder surgery, I went with his suggestion but got a second opinion on my own via advice from a physical therapist I know and who had helped me previously and running the choice by my next door neighbor MD.

 

[Silver]

Physicians who practice within a group that has specialists are expected to refer only within that group. Otherwise, they are referring to competitors, which few in any industry would sanction doing. Even if you want a referral to a specialty that your PCP's group does not have, there may be a hesitancy to suggest anyone because of referral patterns.

Referral patterns within our healthcare system are extremely important to every medical practice, and they are developed in lots of ways. They are often (not always) very political, so physicians may tread lightly because they never want to disrupt current referral patterns that are coming their way.

Best way to know who to call may be to ask friends who have had similar health issues, or ask them to ask around on your behalf. If they were happy, there is a better chance you may be also happy.

 

[OldShooter]

We are in a concierge medicine program now so it is a little different for us, but we always ask our PCP for a specific name when a referral is needed. Sometimes he is a little hesitant but our program is imbedded in a large system with 3K doctors, so he does know a lot about the good ones. "If you were recommending a specialist to your daughter, who would you recommend?" breaks the ice a little bit. Naturally he knows doctors in the system best, so that is a bit limiting.

Prior to the current program we were on our own. Our local city magazine publishes a "Super Doctor" list every year based on surveys of docs and nurses. (Patient surveys are IMO worthless. At best they are bedside manner popularity contests.) From the super doc list then we start looking up credentials. From that effort, selection is often surprisingly easy.This process found me the doc that did my cataract surgery:

… is an ophthalmologist with subspecialty training in corneal, cataract, and refractive surgery. She was born in Boston and grew up in Annapolis, MD, where she was the valedictorian of her high school class. She attended Cornell University as an undergraduate, graduating summa cum laude in mathematics with distinction in all subjects (top 5% of her class). She was inducted into the Phi Beta Kappa, Phi Kappa Phi, and Mortar Board National Honor Societies.
She was selected as a Presidential Scholar and received several research awards. Dr. … completed her doctor of medicine degree at Johns Hopkins University School of Medicine, graduating first in her class. She received a Dean’s Award and Lange Medical Student Award each year of medical school. She also received the Franklin Paine Mall Prize in anatomy, Hewlett-Packard Top Medical Graduate Award, and the Janet M. Glasgow Memorial Award. She was elected into the Alpha Omega Alpha Honor Society and won research awards as well as the prestigious William Stewart Halsted Award in surgery. She completed four years of cardiac surgery residency at Johns Hopkins before changing specialties to ophthalmology. At Johns Hopkins, she also completed a two-year immunology research fellowship, being supported by an American Heart Association Fellowship Award and Stetler Research Award.
For her ophthalmology residency, Dr. … attended Massachusetts Eye and Ear Infirmary, Harvard Medical School. She then received a HEED Ophthalmic Foundation Scholarship to complete subspecialty fellowship training in cornea, external disease, refractive surgery, and glaucoma. She ranked in the 99th percentile on her Ophthalmology Board examinations.
She is also an adjunct assistant clinical professor at the University of ... . She is a member of the State Academy of Ophthalmology, American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), Refractive Surgery Interest Group and the International Society of Refractive Surgery.
​

I like resumes like that one.

 

[W2R]

In the MegaCorp days, insurance required we go thru our (gatekeeper) GP for everything, and they recommended specialists. So that seemed normal to me for 40+ years.

Now that we’re in the Medicare system (A/B & Plan G, not Advantage if that matters), I gather that’s not true? We’re happy with our GP, but she seems to be a little reluctant to recommend specialists - except those in her medical group limited to eight distinct specialties. Maybe I’m bothering her by asking?

Under Medicare, do “we” just find specialist/doctors on our own? I think I need an orthopedist…knee issues.

Sorry you are having knee issues!

My primary care physician (PCP) just WILL not recommend anybody and never has. Don't know why but that's how he is. He is an internist/endocrinologist, and not in a group.

When I needed to see an orthopedic surgeon about my knee, I didn't even tell my PCP that I was going to do it. I just searched for a good orthopedic surgeon with lots of knee surgeries under his belt, on the staff of the best hospital here (which is just 1-2 miles from my home). Then I made the appointment on the phone. The surgeon's office staff got my Medicare+supplement info on the phone so I knew they would take Medicare. Then when I saw the surgeon, he said that although he had done a lot of knees, he was more the "shoulder guy" of his orthopedic group and due to the multiple problems with my knee he felt unsure if he should be the one doing the surgery. So he hooked me up with their "knee guy", a highly qualified and experienced surgeon who had an even more stellar knee surgery background. The knee guy fit me into his schedule ASAP so a week or two later I had my knee replaced.

That's how it worked for me! The next time I saw my PCP after getting him to sign the permission forms, was in the hospital after the total knee replacement surgery - - the hospital had asked me on a form who I went to, and they notified him, and he visited me in the hospital and helped with my blood sugar during that first day after surgery.

(I am Type 2 diabetic and my blood sugar kind of spiked insanely high due to the surgery for a little while, so he appeared out of nowhere and gave me the only insulin injection of my entire life... what a great PCP!)

When I checked out of the hospital, they told me I owed $0.00 which made me happy. Medicare paid most of it and my supplement paid the rest.

 

[PageTwo]

I recently had a situation where the specialist (or his assistant, really) refused to even discuss setting up an appointment without my GP's referral. That was without even asking any questions about insurance or even my name. Very strange, her tone was even a bit condescending, as in "your GP can probably fix whatever you have, Dr. XYZ works on bigger and better things". Oh well. While I have gone to specialists before via my GP's referral, I have also booked directly so maybe that hospital's policies have changed.

 

[braumeister]

The first GP I had when I moved here had made friends with a lot of specialists during his residency, and many of them had come to the same city. So when he was asked for a referral, he automatically recommended someone he knew from that group. It worked very well for me; they were all wonderful.

Our local city magazine publishes a "Super Doctor" list every year based on surveys of docs and nurses.

We have the same kind of thing here, and it's a great starting point when you need to find a specialist.

 

[Midpack]

Physicians who practice within a group that has specialists are expected to refer only within that group. Otherwise, they are referring to competitors, which few in any industry would sanction doing. Even if you want a referral to a specialty that your PCP's group does not have, there may be a hesitancy to suggest anyone because of referral patterns.

Referral patterns within our healthcare system are extremely important to every medical practice, and they are developed in lots of ways. They are often (not always) very political, so physicians may tread lightly because they never want to disrupt current referral patterns that are coming their way.

Best way to know who to call may be to ask friends who have had similar health issues, or ask them to ask around on your behalf. If they were happy, there is a better chance you may be also happy.

Thanks. I am perfectly OK with finding my own specialists thru personal referrals and online reviews (yes, I know they can be paid fake ones). Just after years of YOU MUST go to your in network PCP for EVERYTHING unless it's an emergency, I never found my own specialist for over 40 years. All good, just checking the rules for Medicare.


Thanks for ALL the replies, much appreciated.

 

[Scratchy]

For a knee replacement I'd seek a surgeon who specializes in knees. If there is none near you, it may be worth traveling to the nearest center where there is one.

If you have access, an excellent source to identify a good knee surgeon would be a person who in a professional capacity works with orthopedic surgeons such as
-another orthopedist
-physical therapist
-radiologist
-anesthesiologist

Asking one of your health care providers may or may not not identify the best orthopedist as they may be influenced by business arrangements.

Asking a friend also may not identify the best physician. As a physician, I have observed a poor correlation between the professional competence of a physician and their patients' opinion of them. It is still worth asking friends, because some experiences, especially those at the extremes, speak for themselves. But, hear what is said critically.

Best wishes for a good recovery!

Edit: somehow I assumed surgery was needed. Upon rereading your post, that's not clear at all. The above advice to seek a knee specialist applies more if surgery is being considered. For a first visit, a knee specialist would be good but is certainly not necessary. If you get physical therapy, that may be a good opportunity to befriend your therapist and get a recommendation for an orthopedic surgeon if surgery is needed.

 

[braumeister]

I think I need an orthopedist…knee issues.

One final comment.

Years ago I had horrible knee issues that turned out to be chondromalacia patella (runner's knee). I saw three different orthopedists who all gave me the same answer: stop running.

Finally I found a wonderful podiatrist who fitted me with custom orthotics and my knee problem disappeared like magic the first day I wore them. Seriously, it seemed like magic to me. So my comment is simply to explore all possible avenues of relief.

 

[OldShooter]

... online reviews (yes, I know they can be paid fake ones). ...

... It is still worth asking friends, because some experiences, especially those at the extremes, speak for themselves. But, hear what is said critically. ...

I am very skeptical of patients' evaluations of docs, even ignoring the problem of fakes. In most cases patients are not qualified to have a valid technical opinion of the docs' expertise, so really all they can evaluate is bedside manner and the outcome of their particular interaction. I'll take a technically skilled and intellectually strong jerk any day. I am not trying to select a friend.

 

[Aerides]

If I don't have a strong recommendation from a friend/family, then I do the online thing:

Look who is in my plan locally that does the thing I think I want/need
Look at their reviews in google
Check out their bio, the facility - yes I want somewhere that looks nice that isn't too much of a drive, etc.

'll take a technically skilled and intellectually strong jerk any day. I am not trying to select a friend.

If I'm looking for someone to do surgery, and all that comes with it, I need someone with a decent personality. I want to feel comfortable asking questions, know they are listening to me, and that they don't want to just rush out of the room. If things get more complex, and you need to depend on that doc for more than you expected, you don't want someone who makes your skin crawl. Medicine isn't always just transactional.

 

[braumeister]

If I'm looking for someone to do surgery, and all that comes with it, I need someone with a decent personality. I want to feel comfortable asking questions, know they are listening to me, and that they don't want to just rush out of the room. If things get more complex, and you need to depend on that doc for more than you expected, you don't want someone who makes your skin crawl. Medicine isn't always just transactional.

Very well said!

 

[Midpack]

One final comment.

Years ago I had horrible knee issues that turned out to be chondromalacia patella (runner's knee). I saw three different orthopedists who all gave me the same answer: stop running.

Finally I found a wonderful podiatrist who fitted me with custom orthotics and my knee problem disappeared like magic the first day I wore them. Seriously, it seemed like magic to me. So my comment is simply to explore all possible avenues of relief.

Apologies if TMI.

Week in and week out I was walking 6 miles a couple times a week (golf), and 3-4 miles every other day with no problems at all. I quit running decades ago, but I decided to try augmenting my walks with a little running - run a block, walk a block, and repeat for much of the walk. Did it for a couple weeks. Then one day I walked 6 miles playing golf, didn't slip/fall/twist or any incident and felt fine after, but woke up the next day almost unable to stand it hurt so much? Didn't walk or play golf for about 10 days, lots of rest, ice, elevation and then slowly went back to golf with a riding cart, and walking 2 miles a day. After 4 weeks the knee felt pretty good, but not 100%. So I walked 6 miles playing golf again, seemed fine, even told DW when I got home that I might be OK again. Started to ache as the evening went on, and then I woke up the next day again almost unable to stand. That was a week ago, and I'm back to no golf or walking, and the knee seems to be recovering REALLY slow if at all. I'm afraid attempting to run again was a REALLY BAD idea...

I have to figure out what's going on, the other knee which has done the exact same work, is fine...

 

[braumeister]

I have to figure out what's going on, the other knee which has done the exact same work, is fine...

Certainly you have a bit of detective work in store.
FWIW, my problem was only in one knee as well.

 

[RetireeRobert]

. We’re happy with our GP, but she seems to be a little reluctant to recommend specialists - except those in her medical group limited to eight distinct specialties. Maybe I’m bothering her by asking?

.

Maybe you also need a different GP. One that isn't "bothered" by her patients asking for help with referrals?

 

[Huston55]

My experience is similar to most of the posts above. Medicare became my primary insurance late last year, and Tricare is now my secondary insurance. So, I'm pretty free to select who I want. My process for finding specialists is:

- Referrals from my PCP (a concierge Doc who I happily pay to see because she's top notch, very caring & has always had my back in even the worst of situations)

- Referrals from knowledgeable friends, especially those in the medical field

- Top Doc ratings for our area

- Further online research of a short list

I also have knee problems (from a college injury), and found my Orthopedic Surgeon through a PCP referral. He also did a knee replacement for a close friend about my age and it was very successful. The Ortho is highly rated, very experienced and, for a surgeon, somewhat reluctant to do a knee replacement, even though my knee has no medial meniscus and severe osteoarthritis. I've seen him three times in the past 5 yrs and, each time when I confirm that I can still walk the golf course, go on moderate level (but long) hikes, and other physical stuff with moderate pain after taking two Aleve, he says, "I don't recommend surgery now for you." The most invasive treatment he's done is a cortisone shot, which worked wonders. He's part of a sports medicine practice here in the SF Bay Area so, I'd suggest investigating such practices in your area.

 

[audreyh1]

Some specialists won’t see you without a referral, so you may need your PCP to do one. Otherwise you can go direct.

 

[youbet]

Some specialists won’t see you without a referral, so you may need your PCP to do one. Otherwise you can go direct.

Yep, I've run into that. My cardio-physiologist didn't actually require a referral. But he did require that I have a PCP and his office checked to be sure.

 

[MrsHaloFIRE]

Agree!

Maybe you also need a different GP.

 

[harllee]

Midpack, I can't remember where in NC you are but in my area the orthopedic doctors with Duke are known to be the best. My DH just had knee replacement done by Dr Scott Dr Kelly at Duke in Durham and was very pleased. Everybody we know who has had knee replacement went to Dr Kelly. DH did not have to have a referral to see Dr Kelly but it took about 6 weeks for an appointment. Maybe you just need to ask around among your friends and see who the best knee person in your area is.

 

[MrsHaloFIRE]

agree if Duke is an option, go there first. My baby niece somehow FLIPPED a toe bone and no one in their part of the state would even touch it. Ortho surgeons were like ew yuck, I wouldnt touch that on my own child. Find someone better than me. Well they eventually ended up at Duke with a sh*t hot young female surgeon that was like Im gonna fix that thing on Friday. Flipped it back without opening it up. Put a huge temporary pin in it. Knew there was a little brother on scene so made the cast exceptionally long for safety. She was brave enough and good enough to do it. Duke also did my sister's hip surgery revision after a local guy screwed it up royally the first time. That guy does the basketball players.

 

[CRLLS]

I have found that sometimes a Dr. or other medical professional will not give any recommendations at all. If they do, they usually give me 2 or 3. I have found that when I reword the question to" If you were deeding this (fill in the blank) who would you got to?" I get a single, great answer. YMMV.