Affordable Care Act
Choosing Your Doctor (Primary Care Physician)
Updated on November 20, 2019
What is a Primary Care Physician?
In the past people relied on family doctors for everything from broken bones and the common cold to the delivery of babies. Family practitioners knew the medical history of the entire family because they treated both the children and the parents.
Today many doctors are specialists, focusing on the care of specific bodily systems. But general practitioners, internal medicine doctors and family medicine doctors are still carrying on the tradition of the old family doctors.
Many health insurance plans today – especially HMO (Health Maintenance Organization) plans require members to choose a primary care physician (often called a PCP). Since major provisions of the Affordable Care Act (also known as “Obamacare”) were first rolled out in 2014, the popularity of HMO-style plans has increased. As a result, more and more consumers are choosing primary care doctors and getting at least a little taste of the old family medicine model.
A primary care doctor under an HMO plan will typically be your first point of contact for all your health issues. When you need care from a specialist physician, your primary care physician will generally refer you to specialists within your health insurance plan’s provider network.
What kinds of plans typically require members to choose primary care physicians?
Consumers covered under any type of health insurance plan may select a primary doctor as their main point of contact for all medical care. But only people enrolled in Health Maintenance Organization (HMO) plans are typically required to officially designate a specific doctor as their primary care physician.
People enrolled in Preferred Provider Organization (PPO) plans , POS (Point of Service) plans, or EPO (Exclusive Provider Organization) plans typically are not required to officially designate a primary care physician.
Since 2014 the popularity of HMO-style plans has increased significantly, while the popularity of PPO-style plans has decreased. This means that more and more Americans are being required to choose primary care doctors.
Which doctors qualify as primary care physicians?
There are many specialties in medicine, but typically only four qualify as PCPs. These include:
- Family practice or general practice doctors: A family or general practitioner is qualified to care for the entire family. Family or general practitioners can be board-certified and have training in a variety of subjects including Obstetrics and Gynecology, Pediatrics, Internal Medicine, or Psychiatry. Doctors of this sort were more common in years past but can still be found to treat the entire family.
- Internal medicine doctors: An internist can diagnose and treat disease with medicine. An internist is not a surgeon. There are several sub-specialties an internist can have. Some may specialize in a particular organ, like the lungs or the kidneys; or a particular disease, like diabetes; or a particular age group, like the elderly.
- Pediatrics: A pediatrician specializes in the overall well-being of children. Most pediatricians treat children from birth until adolescence or about 14 years old. Pediatricians can have sub-specialties such as surgery or pediatric cardiology. Pediatricians only serve as primary care doctors for children.
How do you find a primary care physician?
Choosing a doctor can be challenging. You might not want to just pick a name out of the phone book. If your insurance plan requires you to choose a PCP, however, you may want to take time to research your options. Here are some ideas to get you started:
- Your health insurance plan. Your health insurance plan may keep an online list of network primary care doctors who are accepting new patients. Choosing a PCP is often the first step in seeking treatment under an HMO plan. PCPs will handle any referrals to specialists you need.
- Personal referrals. People often ask their friends, families, and co-workers for referrals to primary care physicians. If someone you respect and trust has a positive experience with a doctor, it’s possible you may like that particular physician.
- Referrals from your current physician. If you are moving to a new area, you could ask your current physician to help you find a PCP in your new neighborhood, assuming you’re still going to be covered under the same health insurance plan.
- Hospital access. It is common for hospitals to offer a referral service that can provide you with the names of staff doctors who meet certain criteria you may be seeking, such as specialty, gender, experience, and location.
Why should you choose a primary care physician?
Don’t wait until you get sick to choose a PCP. Primary care physicians typically prefer to see their patients regularly and look for symptoms a patient may not notice.
For example, a routine health exam may uncover conditions such as high blood pressure or even hormonal imbalances due to glandular problems. Health problems like these can go unnoticed by the patient for years and could result in serious chronic health issues. Annual exams may help your PCP guide you toward healthy lifestyle habits that may decrease the likelihood that you’ll need expensive specialty care.
Developing a relationship with your primary care physician can help keep illnesses at bay. Remember the old adage: An ounce of prevention is worth a pound of cure.
To ensure that you have the right coverage before seeing a doctor, let us help to find the right health plan for you. Enter your zip code where requested on this page to see a personalized health insurance quote.