How to Find the Best Doctor
An Interview with John Connolly, Ed.D. President and CEO of Castle Connolly Medical Ltd. America’s Trusted Source for Identifying Top Doctors The Best in American Medicine
You can get information on a doctor’s credentials from the doctor, from the Medical Affairs Office of the doctor’s hospital, or from your health plan if a doctor is in the network. You can check on a physician’s board certification from the American Board of Medical Specialties on www.abms.org, or the Federation of State Medical Boards, www.fsmb.org.
What are some guidelines for choosing an appropriate specialist?
Choosing the correct specialist to treat a particular medical problem is often a matter of finding a top doctor in a specific medical specialty who is board certified in that specialty. For example, for a problem with your vision, you would seek an ophthalmologist; a skin problem would require a dermatologist; and a broken bone would necessitate an orthopedic surgeon. However, in some cases the type of specialist needed may be more complex. For example, back surgery may be performed by an orthopedic surgeon or a neurosurgeon. In some cases, several specialists with expertise in different areas of medicine may be involved in treating one patient’s health problem. For example, a person with diabetes might need an endocrinologist, a cardiologist and an ophthalmologist. In other situations, doctors trained in different specialties may use varied approaches or differing therapies to manage a disease or condition.
For prostate cancer, a patient could be treated by a urologist for surgery, a medical oncologist for chemotherapy and a radiotherapist for radiation therapy. All approaches could be successful, or one might be preferable to another, depending on the circumstances. My best advice is to thoroughly explore all your options before making a final choice.
What is the role of your primary care physician?
The first and most important person to look to for guidance is your primary care physician. He/she will assess your medical condition, determine the appropriate type of specialist to recommend and perhaps refer you to a specific doctor or doctors. Be sure to ask for several recommendations, if possible, to provide you with some choice among specialists.
However, there may be times when you are searching for the very top physician not limited to your area. In those cases, visit www.castleconnolly.com.
How can you evaluate the qualifications of a physician?
Education: Your review of your prospective doctor’s education and training should begin with medical school. A degree from a highly selective undergraduate college or university will help an aspiring doctor gain admission to a medical school, but once there, all students are peers. American medical schools are highly standardized in terms of basic quality. The Liaison Committee for Medical Education (LCME) accredits all U.S. medical schools that grant medical degrees (MDs) and osteopathic degrees (DOs). Most also are accredited by the appropriate state agency, if one exists, and by regional accrediting agencies. Most doctors practicing in the U.S. are graduates of U.S. medical schools, but there are also foreign nationals who graduated from foreign schools and U.S. nationals who graduated from foreign schools. Foreign medical schools vary greatly in quality and produce good doctors and poor doctors. Foreign medical graduates must pass the same exam taken by U.S. graduates for licensure, but the failure rate for foreign graduates is significantly higher.
Residency: Most doctors practicing today have at least three years of postgraduate training (following the MD or DO) in an approved residency program. This is a requirement for board (specialty) certification. Without undertaking extensive and detailed research on every residency program, the best assessment you can make of a doctor’s residency program is to see if it took place in a large medical center whose name you recognize. The more prestigious institutions tend to attract the best medical students, sometimes regardless of the quality of the individual residency program.
Board Certification: With an MD or DO degree and a license, an individual may practice in any medical specialty with or without additional training. For example, doctors with a license but no special training may call themselves cardiologists, pediatricians or gynecologists. This is why board certification is such an important factor. The American Board of Medical Specialties (ABMS) recognizes 25 specialties and more than 90 subspecialties. Eighteen boards certify in 106 specialties under the aegis of the American Osteopathic Association (AOA). Doctors who have qualified for such specialization are called board certified; they have completed an approved residency and passed the board’s exam. While many doctors who are not board certified do call themselves “specialists,” board certification is the best standard by which to measure competence and training. While board certification alone does not guarantee competence, it is a standard that reflects successful completion of an appropriate training program.
Board Eligibility: Many doctors who have been more recently trained are waiting to take the boards. They are sometimes described as “board eligible.” Board eligible means that the doctor has completed an approved residency and is qualified to sit for the related board’s exam.
The description “board eligible” should not be viewed as a genuine qualification, especially if a doctor has been out of medical school long enough to have taken the certification exam. To the boards, a doctor is either board certified or not.
Furthermore, most of the specialty boards permit unlimited attempts to pass the exam and, in some cases, doctors who have failed the exam twice or even ten times continue to call themselves board eligible.
Recertification: A relatively new focus of the specialty boards is the area of recertification. Until recently, board certification lasted for an unlimited time. Now, almost all the boards have put time limits on the certification period. For example, in Internal Medicine and Anesthesiology, the time limit is ten years; in Family Practice, six, and under some circumstances, seven years. These more stringent standards reflect an increasing emphasis on recertification by both the medical boards and state agencies responsible for licensing doctors. Many states also have a continuing medical education requirement for doctors.
Fellowships: The purpose of a fellowship is to provide advanced training in the clinical techniques and research of a particular specialty. Fellowships usually, but not always, are designed to lead to board certification in a subspecialty such as cardiology, which is a subspecialty of internal medicine. In the U.S. fellowship programs fall into two categories: approved and unapproved. Approved fellowships are those that are approved by the appropriate medical specialty board (e.g., the American Board of Radiology) and lead to subspecialty certificates. Fellowship programs that are unapproved are often in the same areas of training as those that are approved,but they do not lead to subspecialty certificates. To check that a fellowship is approved, call the hospital where the training took place or the medical board for that specialty. Some physicians may have completed more than one fellowship and may be boarded in two or more subspecialties, and some physicians may pursue fellowship training and subspecialty certification, but then choose to practice in their primary field of certification.
Hospital Appointment: Most doctors are on the medical staff of one or more hospitals and are known as “attending.” If a doctor does not have admitting privileges or is not on the attending staff of a hospital, you may want to find out why.
It can be very difficult to ascertain whether or not the lack of hospital appointment is for a good reason. If you need care in a hospital, the lack of an appointment means that another doctor will have to oversee your care. In some specialties, such as dermatology and psychiatry, doctors may conduct their entire practice in the office and a hospital appointment is not as essential. The best hospitals are highly selective, so a degree of screening has been done for you; the best doctors practice at the best hospitals. If you are having a surgical procedure and are concerned about the doctor’s experience, call the Medical Affairs office at the hospital to see if he/she is authorized to perform that procedure in that hospital. To learn about a hospital’s accreditation, visit www.JCAHO.com,www.hospitalcompare.com, www.usnews.com, www.whynotthebest.org,www.leapfroggroup.org
Medical School Faculty Appointment: Many doctors have appointments on the faculties of medical schools. A straight academic rank (i.e. “professor of surgery,” without clinical in the title) usually means that the individual is engaged full-time in medical school research, teaching activities and patient care. The title “clinical professor of surgery” usually indicates a less direct involvement in medical school activities such as teaching and research. Doctors who are full-time academicians may be in the forefront of new techniques and research, but they are not necessarily better doctors. When you are seeking a subspecialist, a doctor’s relationship to a medical school becomes more meaningful since medical school faculties tend to be made up of subspecialists.
Medical Society Membership: Most medical society memberships range from being selective to some that virtually any doctor can join. Membership in many prestigious societies is based on research and publication or on leadership in the field, and may have little to do with direct patient care.
Memberships may be less than helpful in discerning whether a doctor can deliver the excellent clinical care you require.
Experience: Experience is difficult to assess. In most cases, an older doctor has more experience; on the other hand, a younger doctor has been more recently immersed in the challenge of medical school, residency, or even a fellowship, and may be the most up-to-date. If a doctor is board certified, you may assume that assures at least a minimal amount of experience, but since it could be as little as a year, check the date of graduation from medical school or completion of residency to know precisely how long a doctor has been in practice. The more a doctor performs a procedure, the better he/she becomes at it, which is why it is important to ask a doctor about his or her experience with the procedure that you need. The one type of experience you should specifically want to know about is that dealing with any special procedure, particularly a surgical one that has recently been developed and introduced into practice. Practice may not lead to perfection, but it does improve skills and enhance the probability of success.
In some cases, relatively young doctors have recently completed residency or fellowship training under recognized leaders who have developed new approaches or techniques for dealing with a particular problem. They may have learned the new techniques from their mentors and may be far ahead of the field (and ahead of more senior and distinguished colleagues) in using those approaches. So age and experience should be considered along with other factors when choosing a physician.
Professional Reputation: There are doctors who meet every professional standard on paper, but who are simply not good doctors or may not be the right doctor for you. There are also doctors who are outstanding leaders in their fields because of research or professional activities but who are not particularly strong, or perhaps even active, in patient care. It is important to distinguish that kind of professional reputation from a reputation as a competent, caring doctor in delivering patient care, or in the case of this site, as an outstanding practitioner in a given specialty.
How does chemistry fit into the doctor-patient relationship?
Chemistry is an element of the doctor-patient relationship that cannot be overlooked. A doctor’s “bedside manner” is of major importance in a long-term relationship, such as one you would have with your primary care physician. It may be of less importance when you see a specialist only once or twice. It is vital that there is a sense of mutual trust and respect between patient and doctor. In general, patients prefer doctors who listen, demonstrate concern, are responsive to patient needs and spend sufficient time with them. You should feel you can be open, trusting and responsive to your physician and that your relationship will be a positive one. Otherwise, find another doctor, since not doing so could adversely affect your care.
What is the overriding message you offer to consumers?
Always seek the best healthcare. Look for the best-trained doctors, not those who simply can do the job. Be certain that the physicians who care for you are trained appropriately and are qualified to provide the care you require. When it comes to healthcare no one wants second best.
About Castle Connolly Medical Ltd.: The doctors included in Castle Connolly’s Top Doctor listings were selected after peer nomination, extensive research and careful review and screening by our doctor- directed research team. Doctors do not and can not pay to be listed as a Castle Connolly Top Doctor. The listings of top doctors are updated annually. In addition to their books and sites, Castle Connolly offers an individualized service called the Doctor Patient Advisor, providing one-on-one consultations to individuals who have serious or complex medical problems, or anyone who feels he/she needs assistance finding the right doctor for any purpose. Patients or their family members can speak with a nurse practitioner and/or a doctor regarding their condition. To aid in finding a doctor, Castle Connolly identifies two to three top specialist doctors, based on the medical condition, patient needs AND the patient’s specific preferences regarding geographic location, hospital affiliation, gender, age, etc.www.americastopdoctors.com