And Doctor Makes Four

How to find a pediatrician who can meet the baby’s needs—and yours

CHOOSING A PEDIATRICIAN isn’t child’s play. This is the person, after all, you are entrusting with your son or daughter’s health—the doctor you will spend years turning to for advice, guidance and middle-of-the-night reassurance.

In order to choose a pediatrician, you first have to understand what pediatricians do and how they differ from other kinds of doctors. Although like other physicians they spend four years in medical school, pediatricians do an additional three-year residency solely in pediatrics—three years of supervised training where they acquire the skills to treat a broad range of childhood diseases and illnesses. What really separates pediatricians from other kinds of doctors, though, is the number of patients they see and the time they spend educating those patients—and more importantly, the patients’ families.

In the past 20 years, the job of a pediatrician has been complicated by insurance companies. “We see more patients in the course of a day now, because demand is greater, and the basic reimbursement is less for a pediatric patient than an adult patient,” says Richard Walls, a La Jolla pediatrician. The insurance industry has a bias, he says, believing that taking care of a child is easier than taking care of an adult. Lower reimbursement for care, plus high demand, means pediatricians simply can’t spend as much time with patients as they did in the old days. “When I first started in 1982, a full day was seeing 24 patients,” says Walls. “Now, just to keep even financially, you have to see 24 in half a day.”

Yet parents are demanding more time than ever before. “The parents I see are more proactive and anxious than previous generations,” says Walls. “There is an incredible amount of confusion because of the Internet and the amount of misinformation out there.” But he is a bit of a dinosaur, spending most of his time talking to patients and answering parent questions, rather than distributing handouts that explain various vaccines or describe the different developmental stages of childhood. “I much prefer to sit and talk to the family,” he says. Walls estimates 90 percent of his time is spent educating parents, which has always been the central role of pediatricians.

That dual role—doctor and adviser—means it’s essential for parents to feel comfortable with the pediatrician they choose and find one who agrees with them philosophically. If you don’t believe in vaccinating, for example, you need a pediatrician who will hear your concerns, not chastise you.

“The key question to ask is: Do you feel comfortable talking to this doctor?” says Marvin Zaguli, a San Diego pediatrician. To determine that, Zaguli recommends scheduling a prenatal visit toward the end of pregnancy, to test the waters. “You sit down and talk to the doctor, and it gives you a chance to see if you click with this person,” he says. If you will occasionally see other doctors in the practice, you may need to meet them as well, to make sure you feel comfortable with all of them.

Both Zaguli and Walls suggest soliciting pediatrician recommendations from friends, family and coworkers first. You can also ask your obstetrician to recommend someone. Once you meet with the pediatrician, be sure to ask about office hours and his or her individual availability. Will you be able to see him or her for well-child and sick visits, or do you have to take whoever is available in the group practice? Find out what kind of after-hours coverage is provided. Many practices have a number on weekends and evenings where panicked parents can call for advice.

“A parent’s perception of what is an emergency isn’t always a true emergency,” says Zaguli. “A 101-degree fever doesn’t always require a trip to the emergency room, so parents need someone to talk to first.”

It’s also important to make sure the pediatrician you choose is someone who is keeping up with new treatments, discoveries and standards of care, says Nancy Shiau, a pediatrician in La Mesa. A good way to check is to ask if the doctor is board-certified.

“To be board-certified, you have to take a national test on core competencies and recertify every seven years,” she says. “You want your doctor to be on the cutting edge of medicine.”

That’s because pediatrics is constantly evolving. The way doctors treat children, and the health threats children face, have changed substantially. Shiau points to the reduced use of antibiotics in an effort to stop antibiotic-resistant strains of bacteria from developing, and how prevention of sudden infant death syndrome has changed. Doctors now advise putting a baby to sleep on its back, rather than its stomach or side.

“We are also more focused than we used to be on safety—car seats, seat belts, home childproofing,” says Shiau. But one of the biggest health issues pediatricians treat now is obesity, something they saw very little of 20 years ago. “It’s a huge problem,” says Walls, “simply because we have an extraordinary number of inactive children.”

For parents who wonder when their child will be too old to see a pediatrician, Shiau says a child is never too old—pediatricians are trained to treat children of all ages, from newborns up until they are adults. “With teens, obviously, you ask different questions than you do a 4-year-old,” she says. “But as soon a child is old enough, we try to interact with the patient, not just the parent.”

When Walls sees an adolescent, he often asks the parent to leave the room so he and his patient can speak in confidence. “From adolescence on, I want that child to know I’m their primary advocate,” he says. “If there’s ever an issue they are reluctant to discuss with their parents, they can talk to me.”

And that’s why it’s so important to feel comfortable with your choice. When it comes to caring and rearing kids, your pediatrician is part of the team, says Zaguli, and should share your views. “You need to feel comfortable sharing ideas with this person,” he says, “because this is someone you’re going to have a long-term working relationship with.”

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