Sticking with the same doctor year in and year out is usually a smart way to boost your chances of getting the best medical care. That’s especially true for your primary care doctor.

But doctors retire, move, or sometimes turn out to be not so great in listening to your concerns. And so you have to search for a new provider.

The internet beckons.

You can find a ton of stuff online about medical providers you might want to consider. But how reliable is it?

And what is the role of off-line, old school, real life recommendations? As we’ll see in this newsletter, those matter — a lot.

Academic credentials, membership in specialty societies, patient endorsements, even videos where a practitioner introduces herself and describes her philosophy of care — all these can be valuable to a patient looking for a good fit.

For business-savvy hospitals, a major marketing tactic loads all this and more data onto their website. Big hospitals and academic medical centers usually will double-check their staff doctors’ credentialing and practice areas. But that varies a lot among institutions.

Patients can do their own checking with independent credentialing organizations. Three key organizations have online ways for patients to check specialty credentials:

American Board of Medical Specialties (ABMS)
American Board of Physician Specialties (ABPS)
American Osteopathic Association (AOA)

More resources for independent searching include websites from the federal government, that post vital qualitative and quantitative data and even ratings of hospitals, med centers, and nursing homes.

Hospital ratings also come from the likes of U.S. News, the Leapfrog Group, and the Lown Institute.

The online world has a bunch of apps to help patients with their MD hunting. The old saw about caveat emptor — let the buyer beware — still applies.

These apps include Vitals, Healthgrades, and Zocdoc. They cooperate with doctors to help patients search for them based on characteristics such as their medical specialty and whether they are nearby.

These services, which provide credentialing and other information on doctors (such as their gender, age, and languages they speak), may offer assistance for patients to make an initial appointment for care.

These searchable databases also seek to help consumers with what has been a major stumbling block in finding doctors – what insurance the practitioners will accept and if they are “in network.”

With most Americans getting their coverage through their employers, companies and insurers have sought to curb medical costs by negotiating with doctors and hospitals for preferred rates – captured in so-called in-network care. Insurers have further created “narrow networks,” limiting patient choices to further contain costs.

Insurers have largely stopped mailing directories of doctors, hospitals, and other medical providers that are in their networks. Instead, they, too, offer patients online search portals to scour for doctors and specialists, typically by geography. The insurer sites also provide a range of information about doctors and their backgrounds and capacities.

A giant coverage provider, by the way, offers its own publicly searchable doctor, hospital, and nursing home database. If you are 65 and older and have Medicare as your main health insurance the federal government’s search site for medical services and providers may be a good option. But if you’ve found a provider that appeals to you and she doesn’t appear in the Medicare site’s rolls, call and check with her. Doctors gripe about Medicare’s paperwork, regulations, and low reimbursement rates, and so they go in and out of the program.

Of course, everyone wants to avoid bad doctors. But how do you find out who they are? It’s not always easy.

Each state regulates its own doctors by issuing practice licenses that each doctor must hold to legally lay hands on any patient. These licensing boards are usually dominated by practitioners in the same field, and sometimes they look out more for their colleagues than for the safety of patients.

Decades of news investigations have shown that states’ medical boards too often fall down on their jobs.

HBO satirist John Oliver in a recent segment of his show assailed the official inaction on this issue.

Medical boards, as the deep digs into their doings have shown, should be aggressive in ferreting out bad doctors. They should demand that clinicians and hospitals report to them all significant incidents of doctor misbehavior and patient harm, including deaths due to malpractice.

In reality, and perhaps in fear for their own jobs and liability, too many doctors and hospitals fail to be candid, especially with regulators and the public. They hush up mistakes and negligence and they deal with bad doctors by pushing them out the door, often on unsuspecting institutions in other places.

With the rise of various technologies, it would seem simple for states to communicate well with each other and with federal regulators. The goal should be to safeguard the public and rid medicine of what studies have shown is a small minority of bad practitioners (notably doctors with not one or two but multiple malpractice settlements or judgments)

Tthe feds operate the National Practitioner Data Bank, which is supposed to be a gold-standard source of information on doctors – especially problem doctors with licensing suspensions, revocations and malpractice and other cases of patient harms. The NPDB, though, relies on states, doctors, hospitals, and others to report this vital data. News investigations say this is done in lax fashion.

Here’s the other poke in the public eye: This information is not accessible by the public, even though taxpayers fund it as they do state medical boards and their sluggish oversight.

In response to constant criticism about the current system, a group that represents state medical boards has created a public site for patients to make limited queries about the license standing of doctors nationwide.

Patients in the DMV – the District of Columbia, Maryland, and Virginia – will find more robust information about regulators’ oversight of doctors on sites operated by the respective states’ medical boards.

The mission of finding good doctors involves more than just clicking around the net. Patients must make this process work for them with common sense, good judgment, and in-person experience (the kids call this IRL: in real life).

A quest for good doctors ought to start with recommendations from trusted, known sources, including loved ones, savvy friends, and knowledgeable folks, maybe like other doctors.

What weight should patients give to a ubiquitous aspect of the online world – customer ratings? Consumers have become familiar with these as applied to merchants, merchandise, restaurants, and a whole lot more. Why not doctors?

Well, medical care is more complex than whether a sweater fits or a burger has a big enough tomato. Doctor reviews can offer savvy patients key insights about the office staff, clinician personality, billing practices, and more. But what elements covered in online reviews will make or break decisions for patients seeking medical care?

That requires personal judgment and real experience with a practitioner, right? Consumers have learned to look at both raves and rants on sites like Yelp, maybe looking for middle consensus. Doctors bristle at negative reviews and, as might be expected in cyber world, problems have arisen with fake or astroturf postings.

It is vital for patients to determine for themselves whether a given doctor and practice works well – or not. This includes whether the office is welcoming, the staff are helpful, and the appointments process is convenient.

It is crucial for patients to know that their doctor, in general, keeps to schedule (emergencies happen), listens well, has a sound bedside manner (no lecturing, shaming, or gaslighting), and is clear and understandable. The doctor’s day may be out of control. But is she calm and patient? Or does he seem harried, cold, and distant?

If you have questions, does your doctor answer them, fully and helpfully? Does he have a professional answer if asked directly about his experience in treating your problem or condition (this is five-star information with specialists – e.g. how many surgeries of this kind have you done in a recent period?) Is she responsive to concerns you may have about the cost of medical services or prescription drugs? Does he order a lot (too many) tests or procedures, especially if they seem redundant (they may have been ordered by another doctor that is treating you)? Does she seem to you to have good relationships with staff and other doctors (e.g. through referrals)?

Most important of all: How do you, as the patient, feel about the quality and safety of your medical care? Are you healthier? Getting better? Or worse? Do you have any inkling that your doctor is doing anything harmful or shady? Did you suffer what you think is inappropriate pain or injury due to your MD’s treatment? Does any aspect of gynecological care seem discomforting our out of line? Does your doctor’s care seem in accord with what was given to your friends or loved ones with similar conditions?

Here’s the bottom line: Doctors aren’t infallible. Most of them are solid, compassionate, caring pros. But we must feel comfortable with them and trust the medical care they give to us. If you lose faith in the quality, safety, affordability, and accessibility of your doctors and the care they give to you, don’t wait. Find new ones. The internet offers options previously unavailable for searching, and they can be helpful if used wisely.

With the soaring complexity and expense of medicine these days, experts say that patients should make sure they have a primary care doctor, such as a family physician or internist.

This caregiver – often now part of a team, perhaps with physician assistants or nurse practitioners – can deal with many of patients’ lesser and routine medical needs.

They can treat common respiratory infections and allergies, as well as patching up cuts and other injuries. They can ensure patients get their needed vaccinations and checkups.

Regular care with them could be a key way to keep patients out of the ordeal of getting what can be one of the most expensive kind of care — treatment in an emergency department. Primary doctors can be vital monitors over time about your health and well-being, getting to know you and your loved ones in a deepening and important fashion.

As one published study found about the role of primary care doctors:

“[Researchers] found that adults with primary care were significantly more likely to fill more prescriptions and to have a routine preventive visit in the past year. They were also significantly more likely to receive more high-value care such as cancer screenings, including colorectal cancer screening and mammography.”

Primary care doctors can be valuable “quarterbacks” in coordinating care, recommending specialists when needed and helping to oversee how multiple clinicians treat patients with difficult, complicated, and chronic conditions.

Patients may turn to specialists (like cardiologists or oncologists) for their primary care needs. This can work, particularly if treatment for a chronic condition falls primarily in a specialty area. It also may be a bit of medical overkill, with highly credentialed caregivers dealing with issues that others with less education or training could handle as well — and likely at lower cost and perhaps with greater scheduling convenience.

By the way, the rise of stand-alone treatment facilities — urgent care and surgical centers, some under the roofs of familiar retail drug stores — can be helpful and convenient. But patients should remember that these facilities typically do not provide the sustained, long-term medical care that allows doctors to see important trends in individuals’ health and well-being.

This country faces a significant shortfall of doctors – and patients are starting to feel the crunch. There are longer waits for appointments, and in swaths of the nation medical care is getting downright hard to find.

In the next dozen or so years, according to medical educators, the physician shortage will amount to almost 90,000 clinicians. That is less than some glum forecasts calculated, but this is a looming public health problem that will not be easily resolved.

It takes a long time and a pile of money and other resources to train doctors. That leaves aspirants with not only demanding years of toil but also debts that stack up to hundreds of thousands of dollars.

While there is great need for primary care physicians (see the other sidebar), young doctors may find that their debt and desire for a more comfortable life leads them to more lucrative specialties. Many doctors prefer to live and practice in cities, rather than in exurban or rural areas where they may struggle with lower compensation, higher caseloads, and fewer and less than state-of-the-art facilities.

The coronavirus pandemic, with its shocking surge in abusive and even violent conduct against doctors and nurses (still persisting, by the way), has only worsened the looming shortages of health care personnel, experts say.

To further complicate the growing MD shortage, significant numbers of clinicians are boomers – a giant generation whose retirements are reshaping U.S. society.

Experts have proposed an array of steps the country could take to increase the doctor supply without undermining the quality and safety of U.S. medical care. These include greater investment in medical education, notably in easing the financial burdens of students and increasing the opportunities for them in medical schools, internships, and residencies. Reformers want big reductions in the blizzard of medical paperwork, increases in the employment of useful technologies (including telehealth?). They hope for major changes in doctor compensation, especially so primary care is more rewarding and all MDs battle less with federal reimbursement programs like Medicare and Medicaid.

Doctors, critics say, also must pull in the sharp elbows they throw as advocates try to improve the scope of others’ “practicing up to one’s credentials.” This is a mindset that better recognizes that PAs and highly trained nurses could handle more routine medical care, freeing doctors to focus on diagnoses and treatments that require their deep education, training, and experience. Doctors themselves would, in this approach, also better coordinate their care, with primary physicians helping to shepherd patients through a thicket of specialists.

Patients, in a new era, also would be pushed to think about medical care and their doctors and treatment in a different way. The focus would be on healthier living and prevention of disease, notably chronic conditions like obesity, diabetes, heart disease, and cancer that crush so many people now.