What to Expect the First Year (9 page)

Before you settle on a partnership practice, ask whether or not scheduling checkups with your doctor of choice will be an option. If not, and if you discover you (or your baby) prefer one to the other, you may spend half of the visits with Baby Doctor Not-So-Right. Of course, even if you get your choice for checkups, sick kids are usually seen based on doctor availability.

The group practice.
If two are good, will three or more be better? In some ways probably yes—in others, possibly no. A group is more likely to be able to provide 24-hour coverage by doctors in the practice, but less likely to ensure close doctor-patient relationships—again, unless you can schedule the same doctor or two for regular checkups (most practices offer this option). The more physicians a child will be exposed to on well-child and sick-call visits, the longer it may take to feel comfortable with each one, though this will be much less of a problem if all the doctors score high on warmth, caring, and baby charm. Also a factor here: The more doctors, the more opinions and advice—sometimes a perk, sometimes a potential problem.

A combined practice.
Any of the above types of practices may include one or more highly trained and skilled pediatric practitioners who aren't pediatricians. Pediatric nurse practitioners (PNP) are the equivalent of the nurse-midwife in the obstetrician's office—they hold a BSN or RN with additional training (generally at the master's degree level) in pediatrics. Pediatric physician's assistants (PA), who work under the supervision of a physician, spend 2 years training at an accredited program after completing college. A PNP or PA usually handles well-baby checkups and often the treatment of minor illnesses as well, consulting with physician colleagues as needed. Problems beyond the scope of a PNP or a PA are referred to one of the doctors in the office. Like a midwife, a PNP or PA will frequently spend more time on each visit—which means more time for questions and answers (something you'll really appreciate as a new parent). Having them on your baby's health care team will also help keep costs and wait times down. Concerned that you'll have less confidence in the care your baby receives from a PNP or PA? You probably don't have to be. Studies have shown that nurse practitioners and physician's assistants are, on average, at least as successful as, and sometimes more successful than, physicians at diagnosing and treating minor illnesses. Another welcome addition to any pediatric practice if you'll be breastfeeding: a certified lactation consultant on staff.

Once you've narrowed your field to the right type of practice, it's time to get serious in your search for Baby Doctor Right—and the right doctor usually comes with the right recommendations. Here's where to look for those referrals:

Your obstetrician or midwife.
Happy with the prenatal care you're getting? Then you'll likely be just as happy with a pediatric practitioner suggested by your ob or midwife. After all, doctors usually refer patients to other doctors with similar styles and philosophies. Not a fan of your prenatal provider? Look elsewhere for a recommendation.

An obstetric or pediatric nurse, a doula, or a lactation consultant.
These professionals get an insider's perspective on doctors, so tap into any you know who work with pediatricians, in either an office or a hospital setting. You're likely to get a pretty accurate—and honest—assessment of the care they provide.

Parents.
No one can tell you more about a doctor's bedside (or exam table–side) manner than satisfied (or dissatisfied) patients—or, in this case, parents of patients. So ask parents you know—especially those you know who are like-minded when it comes to hot button topics that matter a lot to you, such as breastfeeding, nutrition, alternative therapies, or attachment parenting.

Online medical directories.
The American Medical Association website's
DoctorFinder.com
provides basic professional information, such as credentials, specialty, location, and training, on the majority of licensed physicians in the United States. Medical websites often offer searchable doctor directories, as do most professional associations for medical specialties, such as the American Academy of Pediatrics (
healthychildren.org
). Just remember that these directories give you only names, not ratings or information on a doctor's quality of care.

Referral services.
Some hospitals, medical groups, and entrepreneurs have set up referral services to supply the names of doctors in specific specialties. You probably won't get a good read on personality, practice style, or philosophies on parenting practices from these kinds of services, but they will provide information on where doctors you're considering have hospital privileges, as well as on specialties, training, and board certification. Such services will also be able to tell you whether the doctor you have in mind has been sued for malpractice.

There are also plenty of online lists, referral sites, and user generated ratings for local doctors. Just type your city's name and “pediatrician” in a search engine and you'll get plenty of hits. Or, check out reviewing websites. One caveat when reading reviews on rating websites: You don't know the reviewers (or any potential beef they might have with a particular provider), so it's hard to get a true sense of who the doctor is and what his or her expertise, quality of care, and personality is really like. Plus, many of these sites contain inaccuracies (from where the doctor trained to what types of insurance the office accepts)—so be prepared to confirm details through your own research, too.

La Leche League.
If breastfeeding is a priority, your local La Leche chapter (
lllusa.org
) can supply you with names of pediatricians who can offer you the support and know-how you'll need. Some pediatricians have certified lactation consultants on staff.

Health insurance provider.
Your HMO or health insurance provider will likely give you a list of physicians available to you under your insurance plan—which may narrow down the field quite a bit if you're not prepared to go out of network.

So you have a list of names—and now you're ready for the next steps: narrowing it down to an even shorter short list, and scheduling consultation appointments with the finalists, if possible. Some doctors charge for these visits, others don't. Either way, a late-pregnancy meet-and-greet will help you feel confident that you've found that special someone (or group of someones)—the doctor (or doctors) who's right for you and your baby-to-be.

Here are some key factors to consider:

Hospital affiliation.
It's a definite plus if the doctor you choose is affiliated with a nearby hospital that has a good reputation for pediatric care. That way, he or she can provide or coordinate care if your little one ever has to be hospitalized or receive emergency treatment. Also a perk: If that doctor has privileges at the hospital where you are planning to deliver, he or she can check your baby out before discharge. But affiliation should definitely not be a deal breaker for an otherwise top-notch
candidate. A staff pediatrician can perform the hospital exam and arrange for discharge, and you can take your baby to see the chosen doctor after you've checked out.

Credentials.
A must-have for any doctor you're considering for your baby's care: a residency in pediatrics or family medicine and board certification by either the American Board of Pediatrics (ABP) or the American Board of Family Practice (ABFP).

Office location.
Lugging a size-42 belly with you everywhere you go may seem like heavy lifting now, but it's traveling light compared with what you'll be toting after delivery. Going the distance will require more planning than just hopping behind the wheel of your car or onto a bus or subway. And the farther you have to go, especially in nasty weather, the more complicated every outing will become, including those trips to the doctor. Factor in an illness or injury, and a nearby office isn't just convenient—it can mean faster care for your little bundle. Your favorite candidate by far isn't the closest one? Baby Doctor Right may be worth the trip.

Office hours.
Working 9 to 5? Then you'll probably prefer a doctor who offers some early morning, evening, or weekend hours.

Office atmosphere.
You'll get your first impression of a doctor's office before you've even stepped inside. When you called for an appointment, were you treated to a voice that was eager to help or one that can't be bothered? Remember, you'll be on that line often as a new parent—phone friendliness matters, and compassion counts. You'll gain more insight when you step up to the front desk of the doctor's office. Is the front desk staff warm and welcoming, or frosty and brusque? Are little patients (and their parents) treated patiently? Or with equal parts annoyance and exasperation? Read between those lines—and you'll learn volumes.

Office decor.
A baby doctor needs more than a couple of magazines on the table and a few tasteful prints on the wall to make the right design statement in the waiting room. On your consult visit, look for features that will make long waits less painful for both you and your expected: a fish tank, a comfortable play area, a selection of clean, well-maintained toys and books appropriate for a range of ages, low chairs or other sitting space designed for little bodies. Walls painted in bold colors and child-friendly patterns (orange kangaroos and yellow tigers rather than understated earth tones) and bright pictures also score comfort points with the smaller set. A welcome addition in the family doctor's office: separate waiting areas for adults only and adults with children, as well as separate entrances for well visits and sick visits.

Waiting time.
A 45-minute wait when you're pacing with a fussy infant or trying to distract a restless toddler with yet another picture book can be a trying experience for everyone. If you're running on a tight schedule yourself, an inconveniently long wait may also be a logistical nightmare. Keep in mind, though, that squirmy babies and sick kids are (and should be) given priority over consults with expectant parents—so don't judge the average waiting time by how long you're kept waiting. Instead poll the parents in the waiting room (and ask how much of the waiting generally goes on in the exam room, too—since that wait can be the hardest of all).

A long average wait can be a sign of an inefficiently run office, of overbooking, or of a doctor's having more patients than he or she can handle.
But it can also mean that the doctor or doctors in the office spend more time with their patients (or answering parent questions) than allotted—something you're likely to appreciate more during the exam than during the wait. It can also mean that it's office policy to squeeze in sick kids (or phone calls with worried parents) even when there's no room in the schedule—something you're sure to value when your child is the one who's sick or you're the parent who's worried.

House calls.
Yes, a few pediatricians and family practitioners still make them, though often at a premium cost. Most of the time, however, house calls aren't only unnecessary, they aren't best for baby. At the office, a doctor can use equipment and perform tests that can't be stashed in a little black bag. Still, situations may come up when a house call may be just what the doctor ordered—say, when your preschooler is home from preschool with a bad stomach bug, baby's down with a high fever and a chesty cough, and you're on duty at home alone … in a snowstorm.

Call-ins.
There will be times (probably more than you'll want to count in that first year) when questions and concerns come up, and you just don't feel comfortable waiting for an answer or some reassurance until baby's next scheduled visit. Enter the phone call—or in more and more practices, email or text. Different offices handle parent calls differently, so be sure to ask about this very important protocol. One approach is the call-in hour: A particular time is set aside each day for the doctor to field calls and/or texts or emails—which means you're pretty much assured of getting the advice you need, if you call at the designated time. Other offices use a call-back system—the doctor (or PA or PNP) will call back to answer questions when there's a free moment between patients or at the very end of the day (questions are usually screened and prioritized by the staff). This approach may work better than a call-in hour if you suspect you'll be the type of parent who can't confine concerns to between 7 and 8 in the morning or 11 and noon, or can't contemplate waiting until tomorrow's call hour for relief from today's worries. Still other pediatric offices use on-call nurses to answer common questions and dispense advice, passing only urgent or complicated medical issues to the doctor. Nurses can also “triage” the situation, helping a parent decide whether the baby should be brought in for an office visit and how soon. This system usually yields a prompter response (and faster relief for parental stress).