Choosing a Doctor

How to choose a fellowship-trained orthopedic specialist for your child or teen athlete 

There are tremendous advances taking place in medicine today, but in order to benefit from them, the healthcare consumer must take an active role. The best healthcare will not find you; you have to seek it out.

First, the healthcare consumer needs to understand that today’s medical field is divided into very narrow specialty categories. Twenty years ago, the specialty of orthopedic surgery addressed a variety of problems including knee, foot, hip, shoulder, hand and spine. 

While an orthopedic surgeon in a small rural town may still address all these problems, most orthopedic surgeons today in larger cities specialize in only one of those areas, like knee, or shoulder, or hip.

Because children and teens have growth plates, they need special care otherwise they may have permanent complications — like having one limb shorter than the other as they mature into adults. Consequently, the specialty of Pediatric Orthopedics was created several decades ago. 

If your teen or child has had an orthopedic injury, it can definitely be worth the trip to a major city like Fort Worth for an evaluation by a pediatric orthopedic surgeon who is trained specifically in the care of orthopedic problems for the teen athlete and child.

About using your health insurance plan as a guide

Most people are surprised to learn that their health insurance provides little help in finding the best specialist within a specific niche. Offering a preferred provider directory of specialists gives no real indicator of quality. Inclusion in a PPO directory typically only means that the physician has agreed to accept a discounted rate for payment from the insurance company. 

In this sense, “preferred provider” simply means that the insurance company would “prefer” you to see doctors who have agreed to accept a discount. These discounts can be steep, depending upon the health insurance plan. With mature industries, consumers expect to pay more for higher quality. For example, Lexus and Mercedes Benz are not the same price as Ford or Chevrolet.

Under this current scenario, healthcare consumers are left on their own to search for a top healthcare provider. It is their responsibility to research the best center of excellence for treatment of a complex health problem.

How to find a super-specialist

There are many ways to identify the best specialist within a given area.  The Internet can provide a wealth of helpful information. The educated consumer can locate information on a doctor’s education, training, clinic and area of specialization.  

Fellowship training, the highest level of training in the United States, is perhaps the best indicator that the physician has invested an additional year in a specific area of specialization.  

Board certification is another criteria that indicates a physician has met the competency standards within an area of specialization, as judged by the specialty board. Board certification typically requires that a physician has been in practice for several years since graduating from medical school and has passed a rigorous written and oral exam. Younger physicians, however, may be in the process of obtaining board certification by fulfilling the various criteria of time in practice, etc. These physicians are called "board eligible."

Using the Internet for information

Be a good patient

To be a good patient, you must comply with the physician’s recommendations and prescriptions. Too many times, it’s natural to want a magic pill or miracle surgery to provide an easy route back to activity. However, you should always view surgery as the last card to be played, after all nonsurgical options are explored. For nonsurgical treatment alternatives to work, the patient must often follow physician and therapist prescriptions, which may include a commitment to therapy. 

Some physicians refuse to see Medicare or Medicaid patients because it almost amounts to working for free, as these government payors sometimes reimburse physicians 25% or what other patients pay. Consider the reaction a person would get if they stopped by Starbucks and expected a grande latte and three 50% on the counter.  

Worse, the paperwork and reporting required by Medicare and Medicaid can be onerous for the physician, and can intrude on the care provided as the government can restrict treatments that the physician may feel are beneficial to the patient, but the government won’t pay for them. Not surprisingly, the number of physicians who accept Medicare or Medicaid patients continues to shrink. 

Those physicians who do accept these patients often do so because they want to care for those in need regardless of the compensation. But at some point, the ability to stay in business and pay for office staff, office space and insurance can be overwhelming to the private practice physician.  One certainly doesn’t see Starbucks accepting 50 cents for a $5 coffee.

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