Choosing a pediatrician is both harder and easier than it sounds. If you already have a child and you're happy with your kid's doctor, you're all set. If your friends and family have a pediatrician or pediatric practice that satisfies them, great... assuming they're taking new patients. For many new parents, though, it's not quite so simple.
In our case, my wife and I each have family all over the place and none with children living nearby. We don't know too many people in our neighborhood with kids - I suspect that'll change soon enough - but, in the meantime, we're more or less on our own in terms of finding a pediatrician.
I should mention here that my wife is the only child of a career soldier who retired at the rank of sergeant major after 26 years of military service. He has a natural inclination towards compulsive organization, a habit the Army did little to correct and much to encourage. And my wife is very much her father's daughter.
One of her first actions was to track down a the names of doctors at the pediatric practice affiliated with her OB and put together a list. Making a list may sound like a lot of work but in this case, it saved us a lot running back and forth for information. It was made easier in our case because we asked the nurse teaching our childbirth class if she had any recommendations. This list became the base of our search.
She printed out the list, noted where they went to medical school, conducted - although, if you know any doctors, you'll probably agree that "endured" is the better word - their residency training, and how long they had been in practice. Once the list was complied, we went over it together. And this where my biases crept into play.
I don't care about my doctor's ethnicity, religion, gender, or sexual orientation. I don't care about those things in my kid's doctor, either. What I do care about is where my doctor went to medical school and where they did their residency training. This may be due to conversations I've had with a former girlfriend - herself a doctor - who never a met a student from a Caribbean medical school who was remotely competent or interactions I've had over the years with friends and classmates who've gone into medical practice. I don't know. What I do know is, I want a doctor who trained in the United States or, failing that, Great Britain or Western Europe. What I don't want is someone who attended medical school in the Caribbean. I'll get into why in a minute.
Say what you will about the present state of the American health care system - and there is a lot to say about it - I would still argue that the United States as a whole consistently produces the best doctors anywhere. I want to stress the words "as a whole." I have no doubt that European, Asian, and Indian medical schools produce some outstanding physicians. In most cases, however, the level of resources available to train doctors is far higher in the U.S. than elsewhere. The result is that, knowing nothing about else about my child's potential caregiver, I'm more comfortable with a U.S.-trained physician than one who was educated overseas. In places like, say, the Caribbean.
Many American students have over the years gone to medical schools in the Caribbean. Despite their idyllic locations, however, places like Ross University and St. George University have lower admissions standards than their U.S. counterparts and lack an academic medical center at which medical students can train. This, to me, is a major strike against them.
Students at these schools typically spend their first two years studying basic science, just like their American counterparts. For their third and fourth years, however, they are scattered to the four winds, sent to hospitals around the U.S. and U.K. in largely piecemeal fashion to get their clinical training while American students typically stay in the same area, rotating through their home medical center and nearby hospital affiliates.
Academic medical centers in the U.S. see a huge variety of cases and have eight- or nine-figure research budgets, giving medical students an exhaustive - in every sense of the word - range of learning experiences. These hospitals typically don't teach students from foreign medical schools, including those based in the Caribbean, concentrating instead on teaching students affiliated with their own medical education programs. Foreign students are consequently forced to take on clinical rotations at hospitals with fewer resources for training and don't see the range of cases that students at a major medical center would encounter. The result is that Caribbean medical students tend to receive a lower quality of basic clinical training, which hampers their ability to land a high-quality residency.
In fact, when it comes time to find a residency, graduates of foreign medical schools are at a distinct disadvantage. Highly competitive specialties tend to have few or no foreign medical graduates at all, with those spots going to the cream of the U.S. crop. Unfair? Perhaps. But medical education is as much about opportunity as anything else. A med school graduate from Harvard or Columbia, or even the University of Arkansas, will have had many more opportunities to engage in a wide range of clinical experiences than a graduate of a school in the Caribbean.
I'll be the first to admit that Caribbean medical schools might not be getting a fair hearing. But as long as recruiters from those schools continue to recruit applicants who couldn't get into American medical schools, they're going to be stuck with a reputation as second-rate, a reputation that will limit their training opportunities and count against them when medical residency directors rank their wish lists of applicants.
The long and short of it, then, is that my wife and I wanted an American-trained pediatrician. Personally, despite everything I've written above, I'd be willing to overlook a Caribbean medical degree if the doctor in question had done his or her residency at a reputable medical center in the U.S. A top-flight residency can make up for most deficiencies in earlier medical training and I'd be comforted knowing that Dr. X passed a rigorous training program. As it happened, though, that was a non-issue.
In fact, most of the pediatricians in our area were educated and did their residencies either in our state or a neighboring state. This isn't surprising. While a neurosurgery or dermatology practice may have a roster of physicians from the best medical schools and residencies in the country, pediatrics is one of the least glamorous - and lowest-paying - medical specialties. And where a Park Avenue or Beverly Hills pediatric group might boast a collection of Johns Hopkins or Stanford M.D.s, this is not the norm in most parts of the country. And that's fine.
Training standards at major academic medical centers are high enough to reassure me that the doctor I choose will be competent to handle 99% of whatever afflicts my child. For the other 1%, I can always see a specialist (assuming my insurance agrees to cover the costs, but that's another post). So as long as the pediatricians we were considering had done their training at a major university hospital, we would be happy.
We narrowed our list down to a small handful of candidates at the local pediatric practice, all educated at state university medical schools, all with residencies within driving distance of our home. Unfortunately, some of the factors we might have used to winnow the list further didn't apply.
All had the FAAP designation following their names, meaning that as Fellows of the American Academy of Pediatrics they were committed undergo regular training to update their skills and knowledge base. So the lack of that couldn't be used to narrow the list.
We asked our OB, herself the mother of 3 school-age kids, if she had any recommendations or reservations, and were told that she'd be comfortable with any of the doctors in that practice. So that didn't help, either.
I also skipped over two doctors who were in their sixties, although it didn't matter much to my wife. While there's a lot to be said for decades of clinical experience, my wife and I didn't want to be in the position of looking for a new doctor again in five years because our current pediatrician retired. We want to build a stable, long-term relationship with someone who knows our child and I thought that an older doctor might call it a career before Junior called it a childhood.
My wife then picked up the phone and tried to schedule brief appointments to meet with the two doctors left on the list. One was available, the other couldn't commit to a time right away. So my wife met with doctor #1, a 40-something man with an approachable demeanor, and came away impressed.
A short while later, she met with doctor #2, who was the head of the practice. Saying that your kid's doctor is the chief of pediatrics at X Hospital may impress at cocktail parties - and if it does, that's kind of sad - but the head of a practice isn't always the best doctor. It's usually the doctor most willing to take on the administrative workload involved in managing the practice, often in return for a larger piece of the practice's income or a reduced clinical or overnight call load. All that paper shuffling takes time away from patient care and I didn't want my kid to have to compete with paperwork for his or her doctor's time.
Like I said, choosing a pediatrician is both harder and easier than it sounds. If you're stuck in the "harder" end of things, there are many good resources available to help. Start by asking your obstetrician or perhaps your primary care doctor for referrals. If you don't have a regular OB or if you prefer to look online, you can warm up at Parents Magazine or Baby Resource. An excellent list of questions for your prospective pediatrician comes from Children's Hospital in Boston. And if you're not happy with the referrals you've gotten locally, you can try the referral service run by the American Academy of Pediatrics.
My wife and I were lucky in that our local pediatricians met our requirements and were available to take new patients. For some, it might be this easy. Others may have a tougher time. The most important point is to not rush into this decision. This is your kid's life on the line. Do your homework and take your time. It's as much for your health as your child's.
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