Chapter 5: Finding the Best Primary Care and Medical Specialists

Appendix

Other Legal Issues to Consider

Because each state licenses its doctors to practice, you can go online to the state medical board in your state¹ and look up the potential doctor. You may also find information concerning any disciplinary issues. The Federation of State Medical Boards itself makes available² additional doctor information pertaining to disciplinary sanctions, education, medical specialty, and practice locations. Regarding malpractice claims, the National Practitioner Data Bank is an electronic information repository created by Congress³ that contains information on medical malpractice payments and certain adverse actions related to healthcare practitioners, entities, providers, and suppliers. Organizations authorized to access these reports use them to make licensing, credentialing, privileging, or employment decisions. However, the reports are confidential and not available to the public. Nonetheless, you may see the information reflected in the state medical board record for the doctor. There are additional ways suggested to research malpractice suits and disciplinary actions.⁴ For example, do an online search by entering “Dr. Joseph Smith” (be sure to put those quotation marks around the name to keep that phrase intact) and then additional identifiers, such as the words malpractice or lawsuit or sanction or problem or whatever you choose.

Does Your Doctor Participate in Your Insurance Plan?

Your doctor’s participation can be determined on several websites, often along with other important information.

If you have Medicare as your primary insurance and you are looking for a doctor who participates in Medicare, you want to go to a special Medicare site called “Physician Compare.”⁵ All doctors listed on this site are enrolled in Medicare. On this site you can find valuable additional information such as:

• Medicare assignment status (whether accepts or not)
• Office addresses where the professional sees patients
• Primary and secondary specialties including American Board of Medical Specialties (ABMS) board certification
• Medical school education and residency information
• Hospital affiliation
• Whether the individual or group participates in select Centers for Medicare and Medicaid Services (CMS) quality programs
• Gender

If you have Medicaid, these are state-run programs so you must go onto your state-specific site to confirm what potential doctors participate in that healthcare coverage.

If you have UnitedHealthcare, you can use their “Find a Doctor” site⁶ to see if your prospective doctor participates in your plan.

If you have Anthem as your insurer, you can use their “Find a Doctor” site ⁷ to check if your doctor participates in it.

If your insurance is with Humana, you can use their “Physician Finder” site⁸ to see if your doctor is listed as participating in their networks. You can also check a doctor’s specialty, whether the doctor is accepting new patients, and what languages are spoken by his or her office staff.

If your health insurer is Aetna, use their “Find a Doctor, Dentist or Hospital that Accepts Your Plan.” ⁹

If your carrier is Cigna, there are at least two sites depending on whether your plan is through employers or school¹⁰ or whether you bought it on your own or through a state or federal insurance marketplace.¹¹

The above health insurers are the major ones in the country. However, there are certainly other very reputable plans. Go to their website, look for how to find a doctor, and then see if your prospective doctor participates in your plan.

Different Mental Health Professionals

A psychiatrist is a physician who, after completing four years of medical school, trains for about four additional years at a psychiatric residency training program. The curriculum includes biological, psychological, sociological, and cultural bases for various psychiatric disorders; the theories and practice of different psychotherapies (insight oriented, supportive, cognitive-behavioral, interpersonal, family, and others), and the judicious use of psychiatric medications. Because he or she has a medical background, the psychiatrist is knowledgeable about how a medical illness can present as a psychiatric disorder and contribute to psychiatric symptoms. And because the psychiatrist has specialized training in the use and side effects of psychiatric medications, he or she can prescribe these medications, usually in combination with psychotherapy, to treat various psychiatric illnesses (such as mood and anxiety disorders, schizophrenia, behavioral problems of dementia, and addiction).

Many, but not all, psychiatrists take a special examination under the auspices of the American Board of Psychiatry and Neurology to become board certified in general psychiatry. Some psychiatrists, following successful completion of a four-year residency, elect to train for an additional year or more to become proficient in a formally recognized subspecialty area. There are other skilled areas that do not have formal ABMS board certification such as expertise in providing psychoanalysis, family therapy, or group therapy. Most specialists take an additional examination, where available, to become board certified in that subspecialty. Board-certified psychiatrists with a subspecialty, and other subspecialty physicians, are expected to become recertified in that subspecialty by passing an examination every ten years or so in order to maintain their board-certified status.

Concerning clinical psychologists, there are many recognized specialties and proficiencies in professional psychology.¹² Programs and internships are accredited by the American Psychological Association (APA).¹³ According to the APA, doctoral graduate programs occur in clinical, counseling, and school psychology. The primary professional degrees offered are the PhD (Doctor of Philosophy) and PsyD (Doctor of Psychology). Most doctoral degrees take five to seven years to complete. In addition, the trainee must pass a comprehensive exam and write and defend a dissertation. In order to practice as a psychologist in clinical, counseling, or school psychology, the trainee will also have to complete a one-year internship as part of the doctoral study in their area of practice. Some universities and professional schools offer a PsyD degree in lieu of the traditional research PhD or EdD degree. PsyD degrees, with their emphasis on clinical psychology, are designed for students who want to do clinical work.¹⁴

An advanced degree in clinical psychology (PsyD) typically includes a Master and Doctoral level program that is completed in four years followed by a one-year approved internship.

With regard to Social Work training, the National Association of Social Workers (NASW) indicates that a social worker must have a degree in social work from a college or university program accredited by the Council on Social Work Education. The undergraduate degree is the bachelor of social work (BSW). Graduate degrees include the master of social work (MSW) and the doctorate in social work (DSW) or PhD. Note that an MSW degree is required in order to be able to provide therapy. Degree programs involve classroom study as well as practical field experience. The bachelor’s degree prepares graduates for generalist entry-level work, while the master’s degree is for more advanced clinical practice. A DSW or PhD is useful for doing research or teaching at the university level.¹⁵ Social workers with MSW credentials work in many areas such as mental health clinics and outpatient facilities as well as in private practice, where their typical services are indicated by the NASW.¹⁶

A psychotherapist may have a background in psychology, sociology, nursing, education, or other fields and special training in the theories and practice of various psychotherapies (somewhat like the training of psychiatrists), but they have little to no medical training. To practice psychotherapy, therapists need to be licensed in the state where they practice.

In contrast to psychiatrists, psychologists are not licensed to prescribe psychiatric medication except in certain states where they undergo special training and need to pass an examination.