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Select Your Doctor

There are great advances taking place in medicine today. 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.

While the United States offers the highest standard of healthcare in the world, a vast treatment variation still exists based on the doctor you see. The doctor you choose will determine the quality of care you will receive. Here is an outline of how to find your way through the healthcare system and select the best doctor for you.

The Age of Specialized Medicine

It is important for the healthcare consumer to understand that today's medical field is divided into very narrow specialty categories. Decades ago, the specialty of orthopedic surgery addressed a variety of problems including knee, foot, hip, shoulder, hand and spine. Today, most orthopedic surgeons in larger cities specialize in only one of those areas. It would then make sense for the educated healthcare consumer with a knee problem to seek out an orthopedic surgeon with a knee specialty. This increases the likelihood that the surgeon will be more proficient in surgery and will use the most advanced surgical techniques available for knees. In the spine field, spine surgery is performed by neurosurgeons and orthopedic surgeons who specialize in spine. Also, in the field of spine, it's common knowledge that the best spine care is found in spine centers that include a team of specialists.

Neurosurgeons and orthopedic surgeons may specialize in spine surgery, and include other spine specialists like physical medicine doctors, anesthesiologists, neurologists and physical therapists who focus on the nonsurgical relief of back and neck pain symptoms.

Advice from your health insurance plan

Health insurance companies, surprisingly, offer little help in finding the best specialist within a specific niche. A preferred provider directory does not indicate quality of specialists. Typically, PPO directory physician listings only show that the physician has agreed to accept a discounted rate for payment from the insurance company. In a nutshell, "preferred provider" basically means that the insurance company would "prefer" you to see doctors who have agreed to accept a discount.

In most industries, market demand and the highest quality product typically demands the highest price.

Similarly, increasing nationwide trend is that the "super specialists" are less inclined to accept discounted reimbursement from some health plans. Due to their reputation and excellent outcomes these specialists and their Centers of Excellence will often have full schedules and do not need to discount their services to attract patients. As a result, they are electing not to participate in PPO plans, while other physicians may rely on discounted services to attract patients.

PPO plans usually have out-of-network benefits that allow patients to see a physician not listed in the PPO directory. On average, the person may pay an increased percent of the bill and a higher deductible. After weighing the options and what ifs, the more sensible approach in the end may be to visit an out-of-network specialist and access the most current technology. That's because, a spine center of excellence may in fact tell you that you that surgery is not even necessary -- consequently saving the patient money as well as the risks and pain of a needless surgery.

An emerging well-known fact is that traditional healthcare plans have historically done a poor job of creating panels of physicians based on quality care. Accordingly, numerous employers are seeking out centers of excellence for the treatment of complex problems like cancer, heart disease, neuroscience, organ transplants, joint implants and spine problems. The healthcare insurance industry is evolving to adapt to the demands of the patient, who interestingly enough, may be the most unheard person in the mix. But it will take time.

Specialists in Medicine

Why do the best Centers of Excellence cost so much? Specialists invest in superior technology for their offices, including highly trained physician assistants and a modern clinic facility with multiple capabilities. Patient convenience and satisfaction is the goal. Part of the trouble related to PPO panel discounting is that it penalizes the specialist. When participating in a PPO panel, the highest level specialist who has a great deal invested; years of training, fellowships and top continuing education courses in the latest procedures must accept the same level of payment as a non-specialist who has less invested in training, support staff and clinic facilities. Centers of Excellence also invest thousands of dollars in patient education tools to improve care, and prevent re-injury.

For these reasons, health insurance plans are not prepared to direct consumers to the highest quality physicians. Healthcare directors know that the best physicians and specialists will save money, as their outcomes are superior in addition to the fact that they provide less risky minimally invasive surgery options. While directors may explore ways to quietly promote centers of excellence for complicated conditions, they are also apprehensive with possible litigation from other physicians that may develop if they openly favor one center over other physicians.

Currently, healthcare consumers are alone in their search for a top healthcare provider. It remains their responsibility to research the best center of excellence for treatment of a complicated health condition.

Locating your specialist

There are multiple ways to recognize the best specialist in a given area. Make an effort to consult a family practice doctor who addresses your general healthcare needs. Typically, this "primary care" physician will be familiar with the best specialists within a specific region. Moreover, as this primary care physician may have referred patients to the specialist before, they may have witnessed actual post surgical outcomes. Obviously, If outcomes are unsuccessful, the primary doctor will not refer other patients.

Possible disadvantages to this approach may exist however. This referral process hands over the selection process to someone else. It is also known that some physicians routinely refer to other physicians, or in the hope of mutual referrals. The educated healthcare consumer would be wise to enlist secondary options in the effort to identify the best possible specialists and clinics within a given specialty.

The Internet can be a very effective tool. The prospective patient can locate information on a doctor's education, training, clinic and area of specialization.

How to identify competence

Identify where the physician has trained. Many times, a large or more prestigious institution signifies that the physician was exposed to more demanding cases, which may point to higher proficiency in their chosen specialty. Fellowship training is the highest level of training in the United States and indicates that the physician has invested an additional year in a specific area.

Board certification is another sign of a physician's skill and ability within an area of specialization, as judged by the specialty board. This certification normally requires that a physician has been in practice for several years since graduating from medical school and has passed a difficult written and oral exam. A younger physician may be "board eligible", meaning they are in the process of fulfilling the various criteria of time in practice, etc.

Using the Internet for information

While visiting a physician's own Internet site, note if the physician takes a multidisciplinary approach to his specialty. A characteristic of the best specialists is to place a variety of complementary services under one roof for the ease of the patient. This center of excellence approach may be all encompassing, specialized therapists in addition to an internal diagnostic center with X-ray, MRI and treatment suites. Allowing the patient to visit one "center of excellence".

Pair the individual Internet site searches with a review of trustworthy national sites that provide overall information about a specialty. These sites should list all of the treatment options for a given problem. Next, compare this impartial, unbiased list with the recommendations provided by a specific clinic's Internet site.

The societies responsible for board certification usually provide a non-biased listing of the board-certified physicians in your area. Scam 'pay a fee' Internet sites listing doctors as "an expert" in a specialty are a dime a dozen. In actuality, the only impartial sites are those related to the specialty boards of the American Medical Association such as the American Academy of Orthopedic Surgeons (AAOS) or the American Academy of Neurological Surgeons (AANS).

You may need to travel

An emerging trend is for the best specialists to develop Centers of Excellence that focus on certain problems such as cancer, neuroscience, spine problems, diabetes, asthma, etc. Since the cost of developing these centers is high, they exist normally in larger cities. Therefore, be prepared to travel for the best treatment for your complex medical condition.

The physician visit

In a given niche, the best specialists will typically provide all the suitable nonsurgical and surgical treatment options for your problem, including pros and cons of each approach. Occasionally, treatment by observation may be necessary. Be aware if your doctor is unwilling to answer questions about your diagnosis or treatment. Consult another doctor.

Be a good patient

In the end, once you have found the best doctor for you, the rest is in your hands. It is important to abide by the physician's recommendations. It is human nature to want a magic pill or miracle surgery to relieve pain and return to activity. Yet, you should always view surgery as the last card to be played; after all nonsurgical options are explored.

In order for nonsurgical treatment alternatives to help, the patient must often follow physician and therapist prescriptions, which may also encompass physical therapy. Strengthening exercises that rebuild supporting muscles may be utilized for spine and joint problems. While this may be uncharted territory for many people, it is essential if you are to give nonsurgical options an opportunity to heal.




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Numerous patients have shared their life-changing experiences with the physicians at Black Hills Neurosurgery & Spine. Read more.

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