How should you choose a doctor or hospital? It’s a question many find themselves facing after a troubling diagnosis, moving to a new city or simply attempting to get a new primary care physician.
Like a lot of health care questions, the answer is complicated, said David Cutler, an economist who studies health policy at Harvard University.
“It's a little bit like saying, ‘Tell me what's the best car that I should buy,’” said Cutler. “Well, it depends.”
The same way someone in the car market might prioritize safety over speed, or the number of people it fits over fuel consumption, choosing a doctor or hospital is not a one-size-fits-all process.
But there are a few factors everyone should consider, said Cutler.
Quality
Top of mind for people choosing a doctor is finding someone who knows what they’re doing. That becomes more important the more complex a particular condition or procedure might be.
Research shows that for surgeries, repetition is a key factor in determining success. Typically, the more a physician does a surgery — especially those that are not routine — the better the outcome.
Especially for one-time procedures, Cutler recommends researching which hospital is the expert in the field. The difference in experience between the closest hospital and the one five miles further could be significant.
“Probably the biggest mistake … is people are unwilling to travel very far,” said Cutler.
The Centers for Medicare and Medicaid have a website, Medicare.gov, that allows for users to search for hospitals or providers. By clicking on a provider’s name, you can see how often they performed a procedure. The data, taken from Medicare patients, is not reflective of the full caseload but can give potential patients an idea of their experience.
Searching for specific hospitals on the Medicare.gov site shows key quality metrics, such as the number of hospital-acquired infections and rates of complications that led to death after surgery. If a hospital is doing much poorer than national standards, it should be a red flag.
Hospital size
Larger hospitals often offer better access to technology and top specialists. One study looking at patients who called 911 from the same neighborhoods did better when the ambulance took them to large teaching hospitals. At the one-year mark, they were 20% more likely to be alive.
“If I had to choose, I’d definitely be choosing to go to a teaching hospital,” said Joseph Doyle, health economist at MIT Sloane School of Management and one of the study’s authors.
Larger hospitals have better technology, see more cases and have more staff and specialists on hand. They may be more crowded, but seeing more patients can help health providers refine their skills.
“Volume is one reason why you’d want to go to a larger, fancier hospital,” said Doyle, pointing out that every team member, from the nurses to the physician assistants to the surgeons, has seen more cases, giving them the ability to fall into a rhythm during procedures. “We know there is learning by doing, either individually or in a group.”
Hospital quality rankings from groups like Leapfrog, which assigns letter grades to hospitals, can be useful. Many hospitals aggressively advertise their top rankings, but these ratings don’t always tell the full story.
“I would be skeptical in general if I’m driving along and see a billboard that says we’re No. 1 in this kind of care, because they may just be treating healthier patients to begin with,” said Doyle.
Trust
Despite the technology a large teaching hospital can provide, patient-doctor relationships and trust are also crucial, especially for primary care. Some patients may feel that can be harder to establish at a teaching hospital, where it’s likely you’ll be seen by a string of medical residents completing their training.
Finding someone you click with is about more than just a good conversation at your check-up. It can also save your life, according to research.
One study that randomly assigned 1,300 Black patients to get a check-up from doctors of different races found that Black men who saw Black doctors were more likely to receive preventative care like vaccinations or blood draws.
Women also benefit from seeing women doctors. Several studies have repeatedly shown better outcomes for female patients who have female doctors. In one analysis of 580,000 heart attack cases over 19 years, 13.3% of female patients treated by males died vs. 12% treated by females. The percentage difference sounds small, but amounts to hundreds of more deaths per year. Men in the study also benefited when they had a female doctor.
While it can be easier to measure technical quality, a doctor’s compassion and humanity, or how they make patients feel, is difficult to quantify, said Mark Diana, associate dean of health sciences at University of West Florida and former Tulane professor who studies hospital quality.
“That feeling of confidence and trust that you have in somebody — did they treat you with dignity and respect — that kind of thing makes as big a difference as anything else, said Diana.
Even experts have trouble sifting through the top doctor claims, recommendations and data. Diana went through the process of weighing where to go last year during his own health scare.
“It was overwhelming,” he said. "And I'm someone who knows this field.”
Ultimately, Diana turned to patient advocacy groups to get firsthand accounts of various doctors' experience and bedside manner for his cancer surgery.
Referrals from a trusted physician, friends or patient advocacy groups can give just as much weight to choosing a doctor or hospital. Beyond quality metrics, they can give you an idea of what the daily logistics are like: how long the appointment wait time might be, what the nurses are like, and whether it’s easy to get in touch with a doctor. Diana was blown away when his surgeon gave him his personal cellphone number.
"It was patients who'd gone through the experience that really sort of helped me think about it," he said.
Not everyone has a large selection of doctors and hospitals to choose from. Insurance often narrows the pool of providers, and distance can determine whether a patient can go to repeat appointments. But insurance networks are getting broader, said Diana, and large metropolitan areas offer a lot of choices.