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Choosing a pediatrician for your unborn baby

Deciding on a pediatrician for your unborn baby is like trying to find the house you want to live in for the next 10 to 20 years, sight unseen, from online listings. It is an incredibly important decision, but how can you possibly know what will fit your needs from an online listing, especially when you don’t even know what your needs may be?

First, you should begin researching pediatricians in your area when you are in your second trimester. That will give you enough time to consider the available options in your area, meet with practices, and assess what’s most important to you.

Here are the top five factors to consider when deciding on the best healthcare provider for your most precious person:

Location and access - Location is critical for obvious reasons but may be especially important if you need early morning appointments before work or your partner wants to meet you at the office for a check-up during the workday. Access to appointments can be a little more complicated. This goes beyond office hours. Don’t get me wrong, business hours are important, but you also need to ask, ‘What happens if my child is sick on a weekend or holiday? Who will I talk to if I call when the office is closed?’ Also find out if your child will have all their check-ups scheduled with the same provider, as well as who they will see when they are sick. If you are told they are scheduled with your doctor unless they are full, ask how often they are full. Also do they block same-day appointments with your provider? I’ve heard many patients complain over the years that they loved their doctor or provider but were never able to book appointments with them.

Size of the practice - There is no right or wrong for practice size. This is purely about your individual preference and what fits your family’s needs. Are you looking for a large practice to be able to get an appointment on the exact date and time you may need? (Many of these appointments would not likely be with the provider you choose, but day and timing may be more important to you.) Large practices may offer a walk-in hour first thing in the morning for sick patients. These visits are usually intended for a new concern that can be addressed quickly and are staffed by nurse practitioners or on a rotating basis with physicians. You will not likely see your child’s doctor, but the convenience of a quick appointment first thing in the morning may be ideal for you. Larger practices often have evening and weekend hours, so think about your logistical needs and how the practice fits with those needs. A small practice may provide more personalized care, with benefits like more consistency with the provider you see; the nurses and staff knowing your family and child, and a more intimate feeling.

Appointment Logistics - Almost all pediatricians and most family medicine physicians follow a well-child or check-up schedule recommended by the American Academy of Pediatrics, AAP. The AAP sets standards for pediatric care, based on appropriate screening, health recommendations, and the current science on children’s medical care. The first visit should be scheduled within 24-

72 hours of going home from the hospital or from birth if the baby is not seen by a pediatric provider after birth. Your baby may be seen within a few days to two weeks of this first appointment, depending on your needs. The AAP then recommends well-visits at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. Beginning at three years, children should be seen at least annually. You can find the APP well visit schedule and screening recommendations here. It’s important to ask how much time a practice allots for a well-visit and a sick visit. Due to insurance reimbursement, some practices allow a limited number of concerns to be addressed at a well-visit and may ask you to return at another time to address specific concerns.

Asking about the type of support the practice offers is important. This may include lactation support for new breastfeeding mothers, nurses to talk with during office hours for smaller concerns, or an option for a telehealth visit, if medically appropriate. Some practices limit the number of caregivers that can be at an appointment at one time, some require in-person visits for all concerns, and others will communicate over a patient portal where you have access to your child’s chart with lab results and immunizations accessible when you need them. It is difficult to understand what your communication needs may be in the future but knowing what the options are will help you make a more informed decision.

Cost, Insurance & Networks - Cost of healthcare with and without insurance is difficult to predict and even more difficult to understand. If you intend to use your health insurance for your child’s medical care, you can ask prospective practices if they take your insurance or ask your insurance if there are practices that are in-network if required by your plan. The Affordable Care Act mandates that all routine well-child visits are covered by health insurance. There still may be additional costs at a well-visit that are not covered under your plan, however. If you have a high-deductible plan, the well-visits should be covered, but cost can vary greatly for a sick visit depending on the tests run or needs of your child. For example, strep throat tests in some offices bill at less than $25, while others may be as much as $125 depending on the type of test used and your health insurance plan. I recommend trying to understand your health insurance plan, what is covered, and not being afraid to ask the practice you choose how much a particular test or visit will cost.

Networks among medical practices are also important to be aware of. Even if your health insurance allows you to choose any specialist or hospital for higher level care, if your physician’s practice belongs to a particular network or organization, this may dictate where your physician can refer your child for specialty care if needed.

Lastly, it is important to know that there are practices that do not participate with health insurance companies. One advantage could be that costs are pre-determined – especially with all-inclusive membership Direct Primary Care practices.

Philosophy of provider & the practice - Most important, is to find a provider you trust. This is not blind trust, but it is a leap of faith. For instance, as a pediatric specialist, there is no way I can know if my GYN is suggesting up-to-date, evidence-base recommendations for my care, so I need to have a level of trust with my provider that they follow the science, they are thoughtful about

how those broad or narrow recommendations fit into my care plan, and they treat me as an individual, not a number. Some of this fit may be based on personality and some may be based on logistics. But ultimately, there needs to be a relationship based on trust, as there is nothing more important than entrusting your child’s health and well-being to someone.

By Dr. Kelly Parker-Mello

Tailored Pediatric Medicine

Portsmouth, NH

This blog is for informational and educational purposes only and is not intended as personal medical advice.

Always seek treatment recommendations from your healthcare provider.

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