Finding a good doctor is important regardless of what type of health plan you have, provided your plan allows a choice of physicians. In a health maintenance organization, or HMO, you will be limited in your choice of physicians. In a preferred provider organization, or PPO, certain physicians will be "preferred," meaning that the cost of using such physicians will be lower than using an out-of-network physician. In an indemnity plan, you may choose any physician you wish. You will want to ask several questions in evaluating a physician, but where can you find the answers to such questions?
For example, you may want to know whether your physician is board certified. Other things being equal, choose a board-certified physician. Board certification requires several years of post-medical school training in a specialty, as well as passing an examination. What training did the physician receive? You may want to review what medical school a physician attended, and date of graduation (to determine how many years’ experience the physician has). It could also be useful to determine whether a physician has been subject to any disciplinary actions.
Insurers and health care plans have long had access to such information, which they use in a sophisticated "credentialing" process to evaluate physicians. Now individual consumers are beginning to have access to such information via the Internet, courtesy of state licensing boards (and in some cases state legislators). For example, if you live in one of the sixteen participating states (Arizona, California, Colorado, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, Texas and Vermont) you might first visit "DocFinder" at http://www.docboard.org. The web site is maintained by Administrators in Medicine (AIM), the Association of State Medical Board Executive Directors. I entered the name of my primary care physician in the Texas database and the results screen contained a wealth of useful information, including license status, number, and type (e.g. MD), address, date of birth, original license date, license expiration date, education, and specialty. The screen also indicated that no information was on file as to any disciplinary actions, at least as of the date the database was created or modified (the screen contains a note that information is accurate as of October 27, 1998).
I then visited the "CertifiedDoctor Verification Service" maintained by the American Board of Medical Specialties (ABMS) at http://www.certifieddoctor.org. The site contains all physicians certified by an ABMS member board, and allows anyone to verify the board certification status, location by city and state, and specialty of physicians certified by any of the 24 member boards of ABMS. I again entered the name of my Texas primary care physician, and the screen confirmed that my physician’s certificates include "Family Practice." The site contains a good description of the board certification process, and the training required for certification in a specialty or subspecialty. The site also allows one to search by geographic area and specialty for a board certified physician through the "CertifiedDoctor Locator Service," but the site makes clear that listings are of those physicians who have subscribed to be listed in the service, not all certified physicians as contained in the verification service.
In the future, even more profiles of physicians and other health care providers should be available on the Internet, since several states are considering legislation mandating consumer access to such information. According the Health Policy Tracking Service, at least 17 states have introduced legislation in 1999 to either create new provider profile laws or amend existing provider profile statutes.