Your choices of physicians are the most important decisions you make in determining the quality of medical care you will receive. Physicians initiate diagnostic procedures, devise treatment plans, guide patients through care decisions, prescribe medications, authorize hospital admissions, refer to other physicians and other providers, and in general are at the center of patients’ health care experiences. You need to select, and build a relationship with, a good primary care physician—a family practitioner, an internist, a pediatrician (for children), or a geriatrician—and, working with that physician, you need to play an active role in physician selection when there is a need for specialists.

Sources of Info on Doctor Quality

Checkbooks provide several types of information to help you choose the best doctors:

Ratings from Patients

For areas where we publish Consumers' Checkbook magazine—the Boston, Chicago, Philadelphia, San Francisco-Oakland-San Jose, Seattle-Tacoma, Twin Cities, and Washington, DC, areas—our Ratings Tables provide ratings of primary care physicians, based on our surveys of patients. For both primary care physicians and many types of specialists, patients are the best source of information on many aspects of quality, including how well physicians listen, explain things, help patients coordinate care among other physicians and health care providers, and make themselves accessible for appointments and advice. These aspects of care are critical to prevention, to accurate diagnoses, and to a patient’s ability and motivation to do his or her part in carrying out a plan of care. Click here for further information on our surveys of patients.

Recommendations from Doctors

Another valuable source for insight on a physician’s performance is the judgments of his or her peers. It is these judgments that patients depend upon when a physician makes a referral.

To identify many of the primary care physicians and specialists rated highest by their peers, we regularly send surveys to all actively practicing physicians in the 53 largest metropolitan areas in the U.S. and ask them to tell us which one or two specialists in each of 38 different specialty fields they “would consider most desirable for care of a loved one.” In our Ratings Tables we indicate in the column “Top Rated by Other Doctors” the physicians who were mentioned by a sufficient number of other physicians in their area to meet our cutoff criteria. We also report the number of times the physician was mentioned by other physicians in our survey. Because of the nature of the survey, physicians in some specialties with large numbers of practitioners who could be mentioned, such as internal medicine, are unlikely to be mentioned more than a few times, while physicians in specialties with only a few practitioners—cardiac surgeons, for example—may get a large number of mentions. Accordingly, in some specialties we have listed doctors mentioned as few as three times; in other specialties, the cutoff was much higher. Click here for further discussion of our surveys of physicians.

Ratings of Doctors for Surgical Outcomes

Choosing the best surgeon can reduce your chances of death, complications, or other bad outcomes. Our SurgeonRatings.org website, based on analyses of data on more than five million surgeries done in hospital by more than 50,000 surgeons, shows you which surgeons' patients Checkbook found had the lowest (or highest) rates of deaths, prolonged lengths of stay (indicating likely complications), or need to be readmitted to hospital, after our risk-adjustments for patient characteristics.

Health Insurance Plan Provider Directories

Most health insurance plans post physician directories online. The better ones list information such as specialty, medical school and year of graduation, hospital affiliations, biographical info, and treatment philosophy. Some forward-looking plans use medical claims data and other data sources to check whether doctors consistently follow evidence-based clinical guidelines, identify doctors who fail to perform recommended procedures (such as eye exams and hemoglobin tests for diabetics), and perform inappropriate or unnecessary procedures.

Research Grant Awards

One way to identify specialists who have the most cutting-edge knowledge of your medical condition is to seek out those who receive a lot of funding for research on it. For example, use the National Institutes of Health (NIH) awards search tool to see which research and teaching hospitals received the most funding for various conditions. Then check those hospitals’ websites to see which specialists work there. For example, choose “NCI” or “National Cancer Institute” (or whatever institute is related to your medical problem) in the dropdown menu of the “Institute/Center” field. Then scroll down and click the “Funding” column head twice to sort from largest to smallest funding to see which ones received the most funding.

Hospital Affiliation and Medical School Faculty

Another way to find a good specialist is to ask a top-quality hospital for names of its affiliated physicians. Start at Checkbook.org, where subscribers have free access to our national ratings of more than 4,800 acute care hospitals in the U.S., to find top-rated hospitals. Then call or visit the websites of those hospitals to find which of their doctors specialize in your condition. Good prospects are teaching hospitals, where you can specifically request doctors who have teaching responsibilities. A surprisingly large number of doctors teach—often spending two or three hours per week on clinical work with medical students and interns—while maintaining their own practices. A teaching position can ensure that a doctor is regularly exposed to new developments and questions from medical students and residents.

Board Certification

Board certification means that a physician has completed at least three to eight years of post-medical school training in his or her specialty, has passed a difficult exam in that field, and has fulfilled other requirements of a specialty board. Most doctors must continue to meet educational and other requirements, and take tests every six to 10 years (depending on the specialty) to maintain their certification.

You can find board-certified doctors by searching the online provider directories of the American Board of Medical Specialties and the American Osteopathic Association’s Doctors of Osteopathic Medicine. Our ratings of physicians also report on board certification.

You may as well select doctors who are board certified. But because about 89 percent of physicians in the U.S. are board certified, know that it’s overall not a very discriminating measure of quality.

What to Ask When Shopping for a Top Doc

Once you’ve created your short list of high-quality doctors, seek answers to further questions; we’ve listed several below, which you can ask the office manager or doctor or answer yourself by first-hand observation when you schedule and attend your first office visit.

Is this doctor accepting new patients?

Does this doctor accept your healthcare insurance?

If so, office staff are usually able to help confirm whether the procedures or treatments your doctor prescribes are covered, determine your copayment, and file claims directly before they send you a bill for any portion not paid by your insurer.

Usually, going outside your plan’s network of providers results in higher deductibles, lower reimbursement by your insurer, and lower coverage levels, costing you more money. Of course, if the doctor you want is out-of-network, the higher cost and inconvenience may be worth it.

Some doctors no longer affiliate with any insurance plans, and about one-third of primary care doctors don’t accept Medicare or Medicaid, or cap the number of patients with those types of coverage. For our ratings of primary care doctors, we indicate whether doctors accept Medicare. We gathered that info from the doctors’ office staff and Medicare’s “Physician Compare” website.

For primary care doctors, is there an annual or monthly fee to join the practice? If so, what do you get for it?

An increasing number of primary care doctors charge their patients monthly or annual fees to access care at their practices. At some of these practices (sometimes referred to as “concierge” or “boutique” practices), these payments, which can run as high as $1,000 to $2,000 a year, buy VIP access to premium care, increased time with doctors, same- or next-day appointments, or even house calls

Doctors who charge these fees argue that they allow them to reduce their number of patients and provide more personalized attention. In some cases that may be true, but in many cases these arrangements seem like another way to squeeze patients for more money.

If you’re considering one of these practices, ask what you get for the extra cost. With many it covers an annual physical and a comprehensive wellness plan (coaching, nutrition advice, etc.). At some practices, it covers comprehensive diagnostic tests that insurance doesn’t usually pay for when done as part of annual checkups.

The extra revenue from these fees lets these practices limit the number of patients in their practice, which in theory means they can spend more time with each patient and provide more “personalized medicine.” With still others, these fees just help the practice offset overhead costs (or simply generate extra revenue).

Your health insurance plan won’t reimburse you for these fees (although a flexible savings account plan might).

How far in advance do you have to book a routine appointment, and is that wait acceptable to you?

For primary care doctors, how quickly can you get an appointment if you are sick or need urgent care?

Are the office location and parking/public transportation options tolerable?

Does the doctor offer a patient portal?

Since standard email is often considered not secure enough to protect patient privacy, most doctors are reluctant to communicate with you that way. Some doctors instead use patient portals for online communications. The best portals allow you to send secure messages and questions to your doctor’s office and also let you make appointments, pay your bill, and access your electronic medical records.

With which hospitals does the doctor have a relationship?

It’s an important question to ask of both specialists and primary care doctors.

For surgery, hospital affiliation will tell you where you’ll have your procedure. Preferably, choose a surgeon who works at a top-rated hospital.

For a primary care doctor, hospital affiliation will tell you whether he or she can help coordinate or oversee your care at facilities where you are most likely to be admitted, based on their proximity to your home. However, keep in mind that “hospitalists”—hospital staff physicians—have taken over most of these responsibilities.