Many doctors specialize in specific parts of the body and specific health
care conditions. You will most likely need such doctors at various times
in your life. But there is one type of doctor you need right now and throughout
your life: a primary care physiciansometimes referred to as a personal
This doctor should be familiar with your medical history, your family relationships,
and other factors that can help in diagnosing and treating the physical
and emotional causes of health problems. You will rely on this doctor to
coordinate your care throughout the healthcare system.
Your primary care doctor should be an internist, family practitioner, pediatrician
(for children), or general practitioneror perhaps an obstetrician/gynecologist
(for women) or a geriatric specialist. If you belong to an HMO, you wont
be allowed to get your primary medical care from any other specialty. But
even if you have the option, its inadvisable to rely on a narrower specialistfor
example, a surgeonfor primary care because specialists may see cures for
your problems in the procedures they performsurgery, perhaps, where drug
therapy would suffice.
Our Ratings Tables give ratings of area physicians collected in our
surveys of consumers. Our survey asked consumers (primarily CHECKBOOK and
Consumer Reports subscribers) to rate their experiences with doctors they
had recently used on several aspects of care and service
Listening to/communicating with you
Personal manner (courtesy, respect, sensitivity, friendliness)
Spending enough time with you
Seeking your input in making decisions
Coordinating your care
Giving prevention/self-help advice
Thoroughness, carefulness, and apparent competence
Arranging to see you quickly when you request an appointment
Giving timely, helpful advice by phone or email
Keeping down office waiting time
Ratings on all of these questions are reported on our Ratings Tables.
These questions are not just about pleasantness or comfort; they go to
the heart of quality medical care. For example, research has shown that
patients who get care from doctors who listen and communicate well tend
to receive more accurate diagnoses, respond better to treatment, and recover
more quickly. Certainly, it is hard for a doctor to make a good diagnosis
or a good treatment plan without listening to what is bothering you and
hearing about any impediments you might have to self care. And you are
more likely to do your part in carefor example, taking medicine and making
lifestyle changesif the doctor has successfully communicated what is expected
of you, why it is important, and what effects you can expect to experience.
We have reported what percentage of respondents rated each physician as
very good or excellent (as opposed to poor, fair, or good) on
each question. We have reported results for all of the physicians for whom
we received at least 10 ratings on our customer surveys.
Many physicians were rated very good or excellent for overall quality
by more than 95 percent of their surveyed patients. But some other doctors
received such favorable ratings from fewer than 70 percent of their surveyed
By clicking on the names of physicians, you can also see the comments surveyed
patients submitted with their ratings. Most commenters heap praise upon
their committed, caring physicians. But some describe doctors who tend
to frustrate their patients more often than they solve their problems
Cannot recommend. Has zero bedside manner, spends most of the time with
you staring at a laptop typing. Seems in a great hurry to move on to the
One of the rudest doctors we have ever seen. He was condescending and
didnt want to listeneven to answers to questions he asked.
Seems totally uninterested in patient.
When asking him questions, he doesnt answer most of them and tells you
to go elsewhere. He always seems to be in a hurry.
Probably a competent doctor, but she runs the worst office in the area.
They are consistently rude, arrogant, and unhelpful. Customer service is
completely foreign to her and her staff.
Doesnt return phone calls; takes up to a week to refill prescriptions;
doesnt seem to know muchalways referring to specialists.
Practice is completely overbooked. Can NEVER get in... Staff is way too
busy. Feels like a big factory.
While many of the doctors listed on our Ratings Tables are good candidates,
keep in mind that often the number of raters is small and that any of these
doctors might have scored substantially higher or lower with a larger number
of respondents. Also keep in mind that the survey responses are inherently
subjective. Because the doctor-patient relationship is very personal, a
physician our respondents liked may not be right for you. (Other limitations
on our customer survey results and other research methods are discussed
In addition to finding out how patients rate doctors, you can also consider
another CHECKBOOK resource: our list of the areas Top Doctors. To compile that list, we asked all practicing
physicians in the Bay Area to name one or two physicians in each of 38
specialty fields whom they would consider most desirable for care of a
loved one. Our list of Top Doctors includes physicians recommended most
often in that survey, and our Ratings Tables for primary carecare physicians
indicates which doctors also made our Top Doctors list.
While patient feedback and recommendations by physician peers provide valuable
insight on physicians, other types of information are also important. In
particular, you will want wherever possible to have direct clinical measures
of physician quality. There is good reason to be concerned. Evidence shows
that many doctors dont consistently perform the basic procedures that
have been demonstrated to produce the best medical results, and that many
doctors routinely do unnecessary and risky procedures or perform appropriate
For example, in an article published a few years ago in the New England
Journal of Medicine, researchers reported that patients participating in
a large-scale study received 54.9 percent of recommended appropriate care.
The researchers concluded that the deficits we have identified in adherence
to recommended processes for basic care pose serious threats to the health
of the American public.
Unfortunately, it has for many years been difficult or impossible to find
out whether doctors you are considering have better or worse clinical-care
track records than what these studies often found. We are concerned that
Medicare, the federal program that has a major influence on physician practice
and possesses extensive claims-payment data and the leverage to get more
data, has been too slow in using its leverage to improve individual physician
practicesincluding sharing information on individual physician performance
Under the Affordable Care Act, as passed in 2010, the Department of Health
and Human Services (HHS) is charged with creating a PhysicianCompare
website (www.medicare.gov/find-a-doctor) with much information on the
quality of physicians. Such a website could include information on physician
qualifications, whether physicians follow evidence-based clinical guidelines,
whether they achieve good patient outcomes, how they are rated by patients,
and other dimensions of quality. But HHS so far has provided very little
useful information on this website. And it is not clear that HHS is sufficiently
committed to, even in the future, reporting a broad range of quality measures
at the individual doctor level, as opposed to the medical group or clinic
leveleven though most patients want to know about individual physicians
and there is big variation from clinician to clinician within clinics and
medical groups on many measures.
Some forward-looking health plans are using data they have to check whether
doctors consistently comply with evidence-based clinical guidelines. They
are analyzing data from medical claims and other sources for each doctor
and identifying doctors who fail to perform recommended procedures (such
as eye exams and hemoglobin tests for diabetics), or who perform inappropriate
or unnecessary procedures. But because most plans have as members only
a limited number of each doctors patients, sample sizes for such assessments
are often small. Also, anyone attempting to use claims data to judge physicians
in this way encounters difficulties, such as problems knowing whether a
doctor who did not perform a test had a good clinical reason for not doing
the test in a particular case, or whether the doctor knew that the test
had been performed elsewhere (for instance, in a clinic or hospital).
There are also independent programs that enable physicians to seek recognition
for quality of their practices.
The National Committee for Quality Assurance (NCQA) (www.ncqa.org)
has a program that recognizes doctors who participate in patient-centered
medical homes (PCMH). This is an innovative program for improving primary
care. A PCMH is a health-care setting that facilitates partnerships between
individual patients and their personal physicians and, when appropriate,
the patients families. Care is facilitated by information technology,
information exchange, and other means to ensure that patients get the indicated
care when and where they need and want it in a culturally and linguistically
NCQA also has programs in which doctors voluntarily agree to have their
practices reviewed and seek to be recognized for consistent high quality
care of certain conditionsdiabetes, heart/stroke, and back painand also
for practice connections (having practices that use up-to-date information
and systems to enhance patient care). For example, the diabetes recognition
program checks how well doctors do with patients blood pressure control
and with giving smoking cessation advice.
Similarly, Bridges to Excellence (BTE) (www.hci3.org) has recognition
programs intended to identify clinicians who deliver high-value care to
patients with specific chronic conditions. Recognitions cover all major
chronic conditions, such as diabetes care, cardiac care, spine care, chronic
obstructive pulmonary disease, congestive heart failure, asthma, and major
BTE also has a physician office system recognition program to identify
practices that have implemented systematic office processes to reduce errors
and increase quality. The program includes three levels of recognition.
It assesses, for example, the use of evidence-based standards of care;
the provision of educational resources to patients; the use of electronic
systems to maintain patient records, provide decision support, enter orders
for prescriptions and lab tests, and provide patient reminders; and the
use of electronic systems that can automatically send, receive, and integrate
data such as lab results and medical histories from other organizations
Various other lists provide names and addresses and, in some cases, other
information about doctors.
For example, the American Medical Associations (AMA) DoctorFinder
(www.ama-assn.org) allows you to search by specialty and location; it
offers information on training, hospital affiliations, specialties, and
board certification for AMA membersbut only name, primary specialty, board
certification information, city, and zip code for the many physicians who
are not AMA members. At the American Board of Medical Specialties website
(www.abms.org), you can check whether individual physicians are board
Most health insurance plans post physician directories online, often accessible
to both members and non-members. The better directories list specialties,
medical school and year of graduation, hospital affiliation, and other
facts. Some even identify physicians who have been recognized for adherence
to evidence-based care guidelines or provide patient-survey results, usually
for only a limited number of physicians or medical groups, or based on
a small number of survey responses.
Another option is to check with a top-quality hospital for names of physicians
affiliated with it. In our Hospital Guide section, CHECKBOOK subscribers
have free access to our national ratings of over 4,000 acute-care hospitals
in the U.S. You can check to see which doctors are affiliated with top
hospitals by calling hospitals or, for most hospitals, checking the hospitals
websites. Good sources of prospects are teaching hospitals, where you can
ask specifically for doctors who have teaching responsibilities. Although
the full-time faculty at a local medical school may include only a handful
of primary care physicians, a surprisingly large number of doctors teachoften
putting in two or three hours per week in clinical work with medical students
and internswhile maintaining their own practices. Doctors who teach part-time
at local medical schools are excellent prospects, as are doctors who teach
at large community hospitals.
Once you have identified potential candidates, you may want to get answers
to some questions about each. Some of these questions can be answered by
checking various sources listed above; others will require a call to the
doctors office; and still others will require asking other patients or
meetingor usingthe doctor.
Does the doctor work as a personal, or family, doctor on a primary care
basis? For children, for adults, or both?
Is the doctor accepting new patientsspecifically patients from your health
At what hospitals does the doctor admit patients? You do well to have a
doctor who can admit patients to one or more top-rated hospitals (go to
our Hospital Guide section for our ratings of area hospitals for inpatient
care). There is a good chance that you will be admitted to one of these
hospitals if you need hospitalizationeven if you are admitted by a specialist.
Your primary care doctor is likely to refer you to specialists who practice
at the same hospitals he or she uses.
Does the doctor use an electronic health record system? Will the doctor
use the system to record your health history information and recall this
health history at each encounter with you? Will the doctor enter lab service
orders, x-ray orders, and/or prescription orders into the system; will
these orders be communicated directly to labs and pharmacies for you; and
will the results of tests be communicated back to the physician and electronically
entered into your personal record? Does the health record system automatically
ask the doctor questions; check for possible drug interaction problems;
and suggest tests, diagnoses, or treatments? Does the system automatically
issue alerts about abnormal tests, the need to follow up on referrals,
and other recommended procedures? Will it issue reminders to patients?
There is reason to believe that implementation and use of electronic health
record systems represent some of the greatest opportunities for improvements
in medical care. But the Centers for Disease Control and Prevention (CDC)
estimates that at this time only about one-third of doctors offices use
electronic health records systems that meet the criteria for a basic
system. Even in offices that have robust systems, there is great concern
that many doctors use only a fraction of the features the systems offer.
Is the doctor board certified in his or her specialty? Board certified
means that the doctor has taken at least two to six years of post-medical
school training and has passed a difficult exam. And while a well-recommended
doctor who is not board certified may serve you admirably, it makes sense
to seek out certification. Our Ratings Tables show board certification
status for each physician, according to the American Board of Medical
Specialties at the time we checked. The American Osteopathic Association
(AOA) declined to grant us permission to provide board certification
information for physicians on our list who have osteopathic medicine degrees
Where did the doctor take his or her residency? Hospitals where doctors
take advanced post-medical school trainingcalled a residencythat have
recognizable university ties usually provide good instructionfor instance,
Duke University Hospital or Stanford University Medical Center. But the
absence of a university connection in the name of the hospital doesnt
necessarily mean the hospital doesnt have one.
What medical school did the doctor attend? Virtually all medical schools
in the U.S. are acknowledged to be of relatively high quality. Medical
schools in some other countries such as Canada, the U.K., Switzerland,
and Belgium are of comparable quality. So give special consideration to
doctors trained in the U.S. or one of these countries. But remember that
most experts think the site of a physicians residency is more relevant
than the medical school attended.
When did the doctor graduate from medical school? This tells you roughly
the doctors age. You may prefer a doctor who has many years of practical
experience and has seen firsthand a vast range of medical problems. Or
you might want a younger doctor unlikely to retire soon. A recent graduate
might also have more up-to-date training, although many older doctors keep
current by teaching, engaging in hospital activities, and participating
in continuing education programs.
Does the doctor have teaching responsibilities at a hospital? If you found
the doctor through a hospital referral service, you may already have this
answer. Its important because a teaching position reflects respect from
colleagues and also ensures that the doctor is regularly exposed to new
developments and questions from medical students and residents.
Does the doctor practice in a group or alone? Doctors who share an office
may share ideas and maintain informal standards of quality. They may also
be able to operate more efficiently by sharing costly equipment and specialized
staff. Finally, if the group includes doctors with different specialties,
referrals are convenient and your medical record can comprehensively incorporate
all the specialists comments. On the other hand, in a multi-specialty
group, the groups doctors might not be as flexible as you would like in
referring you outside the group to the very best specialist for a particular
What are the doctors hours? Many doctors schedule weekend or evening hours
to accommodate patients work schedules.
How does the doctor cover emergencies on nights and weekends? Be wary of
a doctor who does not have an arrangement with at least one other doctor
to share on call duties. Where will you turn when the doctor is out of
town, ill, or at a meeting?
Does the doctor give regular patients advice over the phone? Does the doctor
answer questions by email? Is there a charge for such advice? Phone and
email advice can be a great conveniencea partial substitute for the house
calls most doctors no longer make. With malpractice liability looming over
them, doctors are careful about giving such advice in questionable cases,
but most doctors give some advice over the phone, and some are now using
email. Very few charge for such advice, as long as patients come in for
office visits occasionally and dont call or email often.
What is the usual wait to get an appointment for a non-emergency medical
problem? For a full physical exam?
Will the doctor deal with your insurance carrier? You save time if your
doctor bills your insurance company directly. Also, doctors who dont have
relationships with your insurance company may charge higher fees than the
insurance company will pay, leaving you to pick up the difference. And
your insurance company might expect you to pay a higher percentage of the
covered fees than you would pay for care from plan-affiliated doctors.
If you have Medicare, it is important to find out whether the doctor participates
What is the charge to you for a routine follow-up office visit? For a routine
follow-up hospital visit? For a typical general physical exam? The answers
will give you a sense of the doctors charges for other services also,
and of how the charges relate to your health plans payment rules.
How convenient is the doctors office? Is there public transportation?
What lab, x-ray, and machine diagnostic tests can be done in the doctors
own office? Its convenient to have all these diagnostic services performed
in one place. But be aware that doctors who provide these services have
a financial incentive for prescribing them, possibly leading to more such
tests than necessary.
When you have gathered all the information you can from calls to physicians
offices, conversations with friends, and other sources, consider a visit
to the physician who looks best. A visit just to meet a doctor should be
inexpensive or free. But some consumers find this kind of meeting awkward,
a feeling some doctors share. A considerably more expensive alternative
is to schedule a physical exam.
If you do not feel its immediately necessary to establish a relationship
with a doctor, keep your notes on the doctors you have checked and call
your first choice when a medical problem arises.
If you are not satisfied with your first meeting, or any subsequent encounter,
look for someone else and have copies of your records sent there (you have
a right to your records). But avoid hopping from doctor to doctor. An established
relationship with a doctor you like and trust is a healthful asset.
CHECKBOOK has for many years surveyed patients about their experience of
care with their physiciansand published the survey results at the individual
physician level. We believe the information you get on individual doctors,
based on these surveys, is much better than what you will find at the proliferating
websites where anyone can go to rate doctors. But it can be better. And
we want to make this type of information available to consumers and doctors
throughout the U.S., not only in the seven major metropolitan areas where
we publish CHECKBOOK.
So we launched pilot projects in four metropolitan areasDenver, Kansas
City, Memphis, and New York City (Manhattan)to survey patients about their
doctors using a questionnaire and survey procedure developed and tested
by the U.S. Agency for Healthcare Research and Quality and endorsed by
the National Quality Forum.
Five major health plan organizations agreed with us about the importance
of making this type of information available to consumers, and that it
makes sense for health plans to collaborate on such surveys, rather than
having each plan waste money and survey-respondent time by conducting separate
surveys about the same doctors.
Aetna, Blue Cross and Blue Shield of Kansas City, BlueCross BlueShield
of Tennessee, CIGNA HealthCare, and UnitedHealthcare cooperated with us
to identifyfor hundreds of physicians in each of the four pilot metropolitan
areasplan members who had visited these physicians in the previous 12
months (while strictly protecting the confidentiality of plan members).
We surveyed these patients, and made public each physicians scores. The
scores are available free at www.checkbook.org/patientcentral.
We hope these pilot projects will inspire health plans, medical groups,
government policymakers, and others to work together toward conducting
similar surveys and reporting patient evaluations of individual physicians
throughout the U.S.