Tips for choosing a primary care provider

What’s a primary care provider (PCP)? One way you can think about them is as the captain of your healthcare ship. In the American healthcare system, they’re the first line of defense. A PCP can help you assess any new or changing healthcare needs. Then, they can often treat those needs themselves. And they also make an informed and valued opinion should you need to pursue care from a specialist.

A primary care provider tells you where you are with your health today. Typically specializing in internal medicine or family medicine, they make recommendations, give you advice, and address any potential risks. Best of all, they're a reliable resource. When common conditions arise, they can help treat you. And when things are more complicated, they can steer you towards more advanced levels of care when appropriate.

By working closely with you over a long period of time, you can build a real and meaningful relationship with your PCP. And this relationship gives your PCP the opportunity to gain a strong understanding of your health, risks, and needs.

Do I need a primary care provider?

Depending on the kind of health insurance plan you have, you might need a primary care provider before you can access any kind of specialty care, like dermatology or gastroenterology. If you have an HMO or POS plan, you will need a referral from your PCP to see other providers. The exception to this, typically, is for a gynecologist for well-woman care.

Does your plan not require you to see a primary care provider for a referral to a specialist? It's still the smartest idea to have one. A PCP is there to provide a long-view on your health through annual check-ups. There, they'll perform  basic tests and labs. This allows them to effectively track your health and help you course-correct should anything seem out of sorts. 

Your PCP should also be your first phone call when you wake up sick. Your primary care provider can see you for a sick visit with only a PCP copay. (And this is typically much less than an urgent care copay). A sick day doesn't have to stop you in your tracks. Your PCP can get you back on your feet quickly and with minimum damage to your wallet.

What does a primary care provider do?

Your primary care provider is your first point-of-contact in the medical care system. This person will diagnose and treat any common healthcare problem you may have. But that’s not all. Your PCP will also see you for an annual well check-up, make sure you’re up-to-date on and administer any necessary vaccines, and conduct routine diagnostic screenings. They’ll also help advise and guide you in developing and maintaining a healthy lifestyle. And if you need a referral to go see a specialist, your PCP will be able to provide that too. Essentially, your primary care provider is your partner in health and wellness.

What are the different types of primary care doctors?

The first major distinction in primary care providers is the age of the patient. Under 18? Then you should be seeing a pediatrician. A pediatrician is just a primary care provider who focuses on babies, children, and teens.

Over 18? Then you have a few choices to make.

The Affordable Care Act recognizes the unique benefits offered by a range of professional providers. Depending on your state regulations and the policies of your health plan, you may have some choices. Different places may let you choose between a number of different kinds of providers. A nurse practitioner (NP), physician’s assistant (PA), doctor of osteopathy (DO), naturopathic doctor (ND) and a physician (MD) are all choices you may have.

What type of doctor should I choose for primary care?

If your primary care provider is a physician, you can choose between a family medicine doctor, an internist, or a geriatrician. A family medicine doctor can care for entire families, including children. An internist focuses on general adult health. And a geriatrician specializes in elder health. 

A family practice doctor might be a good choice for someone who wants one doctor to see them and their children both. But an internal medicine doctor or general practitioner (GP) might make more sense for others and their health needs. An obstetrician-gynecologist might also qualify as a primary care provider. Remember, though, that it is best to see your ob-gyn for your reproductive and sexual health-related care. Your internist is best to equipped to assess the other parts of your health. 

Each person in our family can have their own primary care provider. So take the time to research and find the individual doctor who is the best fit for you.

What should I consider when choosing a primary care provider?

Practical factors: Location, hours, communication, training

You will likely want to start with the big picture when looking for the right doctor. Choose a doctor who is board-certified in internal medicine or family medicine. Also make sure they're in good standing with the state board of health.

Next, you’ll want to think practically. Is the new doctor’s office in a location that is convenient for you to get to? Do they offer office hours that are conducive to your schedule? Do they offer online communication tools? What is their system for scheduling both sick and well appointments? Do you feel comfortable with the office staff and are they helpful in addressing any scheduling needs or other requests? You may also want to review additional credentials, like where a doctor went to medical school. You can also look for any additional board certifications they have and any expertise in managing any conditions you have.

Personality and philosophy match

Then, you’ll want to think on perhaps the most important factor: Personality.

When choosing a primary care provider, you want to make sure it’s someone you will feel comfortable with long-term. You might want to ask for a referral from a friend, family member, or coworker to start. If you are seeing another kind of doctor you already know and trust, ask them too.

Many providers will let you schedule short, no-cost interviews, to meet them. At this time you can get a better idea of their health care philosophy (ie, their perspective on medical interventions, preventative care, and communication style). Then, you can assess if this aligns with your own attitudes and outlook. Meeting someone in person is a great way to see if they're a good match. 

You should always feel comfortable with your primary care provider. Pick someone you believe you can talk openly with about your health, and who you believe can be a good advocate and partner.

What’s the difference between an in-network and out-of-network provider?

An in-network provider has contracted with your insurance company to provide care at a certain negotiated rate for its members. In other words, just like with any other kind of healthcare, if you see a primary care provider who is in-network for your insurance plan, it will be much less expensive than seeing someone who is out-of-network. Again, if someone is out-of-network, then there is no special, discounted negotiated rate in place, and you’ll have to pay the full “retail” amount for your care.

Don’t forget that just because a provider takes a certain name-brand of insurance doesn’t mean they’re necessarily in-network on your plan. There are lots of different kinds of plans and provider networks for those plans with any given insurance carrier, so be sure to double check before you make that first appointment.

How do I find an in-network primary care provider?

All health insurance plans maintain a list of in-network providers, along with their specialties, addresses, and whether or not they are currently accepting new patients. If you’ve signed up for health insurance through HealthSherpa, you can find these tools in your Consumer Dashboard. If you signed up for health insurance another way, the easiest way to locate this list is on your plan’s website. From there, you should be able to locate a link that will bring you to a list of providers. If you have trouble finding this information online, you can also call your health insurance’s customer service number. Then, you can check to see if various providers are in-network. You can also ask for the names and phone numbers for in-network providers that are located close to you.

Once you’ve found an in-network primary care provider, you’ll want to contact that provider’s office to confirm that they are accepting new patients. And then, go ahead and schedule your first annual wellness check-up appointment! It’s never too soon or too late to find a primary care provider and build a relationship to best manage your health.

What if I want to change my primary care provider?

In almost all situations, it shouldn’t be any problem to change your primary care provider if you decide for some reason that you need to make a switch. If you are still on the same plan and can find another provider who is in-network on that plan, you should be able to do so fairly seamlessly. Most insurance plans have an online portal where you can manage your plan information and account. You might already be paying your monthly premiums through this online portal, but you can use this space to research, find, and select a new primary care provider too. If you have trouble finding this online or don’t have access to a computer, a phone call to your insurance plan’s customer service line will connect you with someone who can help you identify a new provider and make the switch.

How often should I see my primary care doctor?

There are three main categories of times you should be seeing your PCP: for an annual check-up, when you've personally experienced a change in your life or health, and when you've learned of any changes in your family's medical history. In addition, you should certainly always seek out your primary care doctor when you're sick,too!

Annual exam

As a baseline rule, you should plan on seeing your primary care doctor once a year for an annual well check-up. This will allow your provider to see if there have been any major changes to your health in the past year, run any needed lab tests to see any variance in certain results, and get a working understanding of the continued progress of your health. Seeing your primary care doctor on an annual basis also allows you the chance to not only build a relationship with your provider, but have a built-in annual opportunity to voice any concerns you have about your health. And thanks to the Affordable Care Act, your annual wellness check-up is zero-cost. 

Life change

You would also want to see your primary care provider if certain things in your life have changed. For example, if you’ve had unprotected sex with a new partner, you might want to visit your primary care provider for an STI check. Or, if you spot a mole that you hadn’t noticed before, your primary care provider would make for the best first place to go. If you’ve developed any new symptoms or conditions that are getting worse or not changing since you last saw your PCP, certainly don’t hesitate to schedule an appointment to see them to check-in. That’s literally what they are there for!

Family medical history

Also don’t hesitate to reach out to your PCP if you’ve had any new developments in your family’s medical history you’re concerned about, or if there were any conditions or potential conditions identified at your last check-up that you have new concerns about. And if you have a chronic condition, experts recommend seeing your PCP more than once a year, too, so you can be best monitored and cared for.

Conclusion

Your primary care provider is an essential team member in working towards your healthiest you. By maintaining a long-term relationship with a provider who can give a big picture perspective on your health and its progress, a PCP can help guide you to keep making the best choices to live your most healthy life.