Pediatrician vs family doctor.

[Nu_mama]

We have had a change in insurance and will be basing medical care out of a new primary clinic. I am trying to decide if I should have DC see a pediatrician or perhaps choose a family doctor that sees all of us and perhaps gets a better view of whole family issues. Any thoughts on this? FWIW we don't have any history of medical issues or special needs and tend to see the doc only at well visits. (thankfully!)

[brittone2]

Not to be dismissive, but I really think it depends on the doc.

We used a family practice doc for all of us when we were living in another state, and we adored him. He was good, he was thorough, he knew far more about BFing and so forth than most of the peds I've dealt with through the years, etc. He regularly ran behind schedule...substantially...but at the same time, he never rushed you out of the office. If we had a newborn and we were nursing at the end of an appt, he'd say take as long as you need, no worries, etc. He ran a BFing support class staffed by a IBCLC in his office for pregnant/new moms. Everyone I know who had kids who saw him really loved his bedside manner and his knowledge, and his interaction with the kids was far superior to most peds we've dealt with as well. We've had board certified peds who didn't seem to be especially knowledgeable (or up to date on the current recommendations) with respect to topics like BFing, carseat use, etc. And while yes, their overall medical expertise is extremely important, I think peds have an obligation to at least be up to date on BFing and carseat info, for example, since that is something all of their patients are dealing with. eta: our family practice doc is also an assistant professor at a large university medical center, so I believe that responsibility helps keep him up to date

So very much a YMMV situation, IME.

eta: one downside is that IME, a family practice doc is unlikely to have sick/well waiting rooms, which can be an issue with kids, especially young ones. With our infants, we generally had a first of the day appt and we'd both go (one parent would stay with the older kids in the car). Sometimes when they were really itty bitty we'd have one parent go in and wait and then call cell, etc. when it was time to go in (then other parent would come in with baby and other parent would sit with older kids in the car) out of an abundance of caution.

[belovedgandp]

I am in the process of a similar switch. My kids are no longer super young then throw in insurance changes and staffing changes at the pediatrician's office and it was time for a switch.

My youngest is almost 3 and I like the idea of having someone for the whole family. I always liked my ped and adored her nurse, but the office staff wasn't great. Our ped only works part time and others in the office were great, but they have turned over and I needed to switch.

[Nu_mama]

Not to be dismissive, but I really think it depends on the doc.

We used a family practice doc for all of us when we were living in another state, and we adored him. He was good, he was thorough, he knew far more about BFing and so forth than most of the peds I've dealt with through the years, etc. He regularly ran behind schedule...substantially...but at the same time, he never rushed you out of the office. If we had a newborn and we were nursing at the end of an appt, he'd say take as long as you need, no worries, etc. He ran a BFing support class staffed by a IBCLC in his office for pregnant/new moms. Everyone I know who had kids who saw him really loved his bedside manner and his knowledge, and his interaction with the kids was far superior to most peds we've dealt with as well. We've had board certified peds who didn't seem to be especially knowledgeable (or up to date on the current recommendations) with respect to topics like BFing, carseat use, etc. And while yes, their overall medical expertise is extremely important, I think peds have an obligation to at least be up to date on BFing and carseat info, for example, since that is something all of their patients are dealing with.

So very much a YMMV situation, IME.

Right, it feels so hit or miss. Add that to the fact that we are not familiar with any of these docs and it is so hard to find out about them. We don't have any word of mouth referrals for this clinic so I feel like I am choosing blindly.

[brittone2]

Right, it feels so hit or miss. Add that to the fact that we are not familiar with any of these docs and it is so hard to find out about them. We don't have any word of mouth referrals for this clinic so I feel like I am choosing blindly.
I think it unfortunately can end up being a hit or miss situation whether it is a ped or a family practice doc if you aren't going by word of mouth. I guess what I'm saying is that I would not rule out using a FP doc solely because they are FP and not a peds doc.

I hate switching care providers and find it very stressful, so I totally understand where you are coming from. I was soooo happy to have found the FP doc that we adored, and then was so sad when we moved.

[Nu_mama]

Thanks, brittone. I think my inclination is to go with a family doc, at least for me and the kids. DH can make his own choice. There is one that I am drawn to based on her bio, but who really knows. I appreciate the input.

[Gena]

We have a med-peds and find this to be the best of both worlds. A med-peds is a doctor who is board certified both in pediatrics and in adult internal medicine. They have a longer training time than family medicine practitioners and they train on pediatric and adult medicine in equal amounts.

I like that our doctor is a pediatrician who is fully trained in childhood diseases and conditions and has privileges at the local Children's Hospital. Because my son has several complex conditions, this is very important to us. At the same time, our doctor is fully trained in adult medicine, and is the primary care provider for DH and myself. This allows him to know us as individuals and as a family. It's very convenient for us all to have the same primary doctor.

[sste]

Well, I will qualify this greatly by saying it all depends on the individual doctor -- I would take an awesome family practice doctor over a mediocre pedi any day. There also tend to be more family practice docs that have an alternative/holistic angle to their practice as compared to board certified pedis if that matters to you.

It may also matter if you live in a rural area and you have limited access to pedis or internists.

All of this being said, we know tons of doctors and nurses and I can't think of any that send their kids to family practice doctors over pedis. I am sure there are some out there (and in those cases I am sure it is based on the particular wonderful family practice doc). But when you look at what medical insiders do in areas with decent medical choice they generally go for a diligent and highly rec. pedi (or internist for an adult) over a family practice doc.

There are a number of reasons for this. Even the most devoted doctor is going to be extremely hard-pressed to keep up- - this is a problem in pediatrics and internal medicine in general and then when you have a doctor that is supposed to know pediatrics AND internal medicine, it becomes even harder. So, *without knowing anything about the particular doctors being compared* the knowledge base might not be as deep. This won't be a big deal when everyone is healthy but might be if you are relying on that doctor to spot an issue or stay on top of an inpatient hospitalization of your family member. Second, family practice training programs have a higher range of quality variation - - more so than pediatrics programs. This happens I think because some of them are in rural areas with limited medical resources - - it would not be an issue if the family practice doc trained at a major training center and certainly some small programs are good too. Again, I am not trying to insult family practice doctors or training but just to point out the items you want to look into.

Anyway, I would ask around, particularly among friends who work in the nursing and medical field, see who you get good recs for and focus on that rather than "family practice" v. "pedi" per se.
HTH. :)

ETA: Med-peds as Gina mentions have excellent training. I am in a metro area and we have several med-ped friends - - what we have seen in these cases is that over time they generally either become all peds or all adult or they become "mostly peds" and do an afternoon or clinic day of adult or vice versa. Again, alot of it is the stress of keeping up in so many areas and also they often find they prefer kids or adults. If I was a healthy adult, no family history issues, I would def. consider something like Gina describes though - - it sounds to me like that doctor is "more peds" and linked into a phenomenal healthcare system where he can consult with specialists, refer, informally ask questions. All of those things take strain off the knowledge base issue.

[marymoo86]

I was not happy with our peds practice and move my 2yo to my DH's family practice doctor. I have been very happy with the switch. The practice is more in line with my values and parental philosophy so it is more of a team approach rather than continuing to battle wills with the doctor.

I would also see if there are any local forums that could advise on good/bad docs or peds in your area.

SSTE - we posted at the same time but the alternative/holistic approach was the exact reason I ended up moving DD.

[Nu_mama]

Great to see all of these replies. I am looking for a someone who takes a holistic approach, for sure. Even though my instinct was to go with the family dr, I just got off the phone with scheduling and made an appt for both DC with a ped. The scheduling person spent about 15 minutes talking through some of the docs with me and one reason I elected to go with the ped was she said he will only do so many well child checks per day and requires an extra 15 minutes beyond regular time slots so he can spend that time with each patient/family. On its face, that says a lot to me. The upside of my insurance is that we don't have to designate a doc, just the primary clinic- so if we don't mesh we'll with this doc I will try another next time. Again, it has been really helpful to see others talk this through.

[pb&j]

We switched to a family practice doc a couple of years ago, after getting very frustrated with our ped and peds practice. The family doc is in solo practice and she has been WONDERFUL. She sees lots of kids, and is well-connected to other peds and specialists in town. I come from a medical family and am very picky about my MD's!

[LBW]

I moved all of my boys to my doctor, who is a family practitioner, a year or so ago for many reasons. I love that I can take care of any issues the boys and I are having all with one appointment.

[AnnieW625]

I grew up going to a family practice doctor, I never once saw a pediatrician. I didn't know any different, but when I had DD1 we were in So Cal and the trend here is that kids see pediatricians until they are 18 yrs. old so that is all my kids have ever seen because initially no here I knew of had kids who went to a family practice physician. Then we switched to Kaiser which is very very strict about keeping children with pediatrics until they are 18 (you even have to go to separate urgent care for pediatrics). I never really had any issues with the pediatrics dept. at Kaiser so I was happy there, but now that we have switched to Anthem Blue Cross I am wondering if we should all just look for a family practice group (there is one that is recommended here, and I know one of the drs. wives) to keep things simple or if we will continue to do the peds. thing for the kids and the internal med./family practice for ourselves.

If anyone is in the general LB/NW OC area please feel free to send me a PM if you go to a family practice group (sorry for the mini hijack).

[MommyAllison]

We switched the kids to our FP when DS was around 18 months, after our ped became impossible to get in with (week+ wait for a sick appt), and we were happy. Our FP is great, very thorough and will go the extra mile to tease out a problem, but I don't think he sees many young children, as he had the checklist in front of him the whole time for well checks. Our previous ped saw so many well checks that she never referred to the checklist, just moved naturally through the exam, kwim?

We did switch to a new pedi just before Dd2 was born, partly because I wanted someone more specialized for the newborn/infant stage, and partly because our new ped does house calls. Our FP is part of a three doctor practice, and the waiting room is always full of people, and I didn't want to take a new baby and 2 bigger kids to well checks all winter long and end up sick each time from the exposure. House calls are amazing!

[redhookmom]

I am guessing that teen would not be that crazy about going to a ped office? So going to a FP now might head those problems off.

[amldaley]

I struggled with this decsion, too. We also see a pediatric pulminologist and so I asked her what she recommended. She broke it down for me in terms of training and convinced me to keep the girls with a pediatrician.

[BabbyO]

I've only scanned replies, so if I'm repeating this, please forgive me. Do you like your current doctors? If the change is due to insurance...perhaps you can just simply ask your current doctors.

"Hey, unfortunately we have to make a change here due to our insurance coverage. Do you know any of the docs at XYZ clinic and can you recommend anyone?" Often doctors, even from different clinics know each other.

My best recommendation for a pediatrician came from my OB. He just said, "Based on what I know of you as a patient, I think Dr. Z would be great for you/your kids....if you'd prefer to go to this closer clinic Dr. B would be a great choice."

He was right on the money. We see other docs (it is a group practice) when the kids are sick and my two favorites are the ones he recommended.

[acmom]

I agree with PPs points about considering the differences in training between a pedi/internist and a family practice dr. We have several drs in our family (including pediatric specialists, adult specialists, and general pediatricians) and they all strongly recommend seeing internists and pediatricians over family practice simply due to the fact that their training and continuing education is more specific. Family practice drs. have more to keep current on, given that they cover adult medicine, pediatrics, as well as sometimes ob/gyn and/or sports medicine. That is just a lot of information to keep current on (and their training is often the same # of years as Peds or internal medicine, but they have to cover so much more in that time.).

Obviously as PPs have also said, a lot can depend on the individual dr and what is available in your area...there are many wonderful family practice drs as well as not so hot Peds or internists.

I'm sure you will find someone who is a good fit for your DC and family!

[cleo27]

We were very happy with our family practice doc. Her approach is very holistic and she is a DO. When we found out we were expecting, we discussed it with her and opted to have DD see her as well. We have never regretted this decision.

[pb&j]

I am guessing that teen would not be that crazy about going to a ped office? So going to a FP now might head those problems off.

Our former pedi practice, before we switched to our Family Med doc, has and Adolescent Center. I have friends who kept going there well into their 20's!

[queenmama]

I am guessing that teen would not be that crazy about going to a ped office? So going to a FP now might head those problems off.

My 12yo has been to his pedi since birth and has never said anything about feeling awkward going there. :)

I do think it's good that pedis are focused on children's health, but you have to find the right fit for your family.

Lara

[LizLemon]

Well, I will qualify this greatly by saying it all depends on the individual doctor -- I would take an awesome family practice doctor over a mediocre pedi any day. There also tend to be more family practice docs that have an alternative/holistic angle to their practice as compared to board certified pedis if that matters to you.

It may also matter if you live in a rural area and you have limited access to pedis or internists.

All of this being said, we know tons of doctors and nurses and I can't think of any that send their kids to family practice doctors over pedis. I am sure there are some out there (and in those cases I am sure it is based on the particular wonderful family practice doc). But when you look at what medical insiders do in areas with decent medical choice they generally go for a diligent and highly rec. pedi (or internist for an adult) over a family practice doc.

There are a number of reasons for this. Even the most devoted doctor is going to be extremely hard-pressed to keep up- - this is a problem in pediatrics and internal medicine in general and then when you have a doctor that is supposed to know pediatrics AND internal medicine, it becomes even harder. So, *without knowing anything about the particular doctors being compared* the knowledge base might not be as deep. This won't be a big deal when everyone is healthy but might be if you are relying on that doctor to spot an issue or stay on top of an inpatient hospitalization of your family member. Second, family practice training programs have a higher range of quality variation - - more so than pediatrics programs. This happens I think because some of them are in rural areas with limited medical resources - - it would not be an issue if the family practice doc trained at a major training center and certainly some small programs are good too. Again, I am not trying to insult family practice doctors or training but just to point out the items you want to look into.

Anyway, I would ask around, particularly among friends who work in the nursing and medical field, see who you get good recs for and focus on that rather than "family practice" v. "pedi" per se.
HTH. :)

ETA: Med-peds as Gina mentions have excellent training. I am in a metro area and we have several med-ped friends - - what we have seen in these cases is that over time they generally either become all peds or all adult or they become "mostly peds" and do an afternoon or clinic day of adult or vice versa. Again, alot of it is the stress of keeping up in so many areas and also they often find they prefer kids or adults. If I was a healthy adult, no family history issues, I would def. consider something like Gina describes though - - it sounds to me like that doctor is "more peds" and linked into a phenomenal healthcare system where he can consult with specialists, refer, informally ask questions. All of those things take strain off the knowledge base issue.

:yeahthat:

This is exactly what I was going to post. Not to be snobby, but I could never imagine sending my child to a FP unless it was a very bizarre situation, for exactly the reasons sste mentioned. I'm not sure if any other posters here have medical backgrounds, but I am surprised at the high FP rate. Not what I was expecting!

[Zansu]

:yeahthat:

<snip> Not to be snobby, but I could never imagine sending my child to a FP unless it was a very bizarre situation <snip>

Funny, because I would never have a ped treat my kids unless they had a specialized illness that required ongoing care.

[essnce629]

Every time I've moved (3 times) I've specifically searched out a practitioner that was supportive of non-mainstream parenting practices and a more holistic approach. 2 out of those 3 times my pick ended up being a family doctor and not a pediatrician. They seem to be a little more open-minded and it's great that they can see the whole family. Our current practitioner is a family doctor who is a DO. The best way I've been able to find a like minded doctor is by searching on the MDC boards, by finding a natural parenting board specific to the city I'm in, and getting recommendations from those at local LLL meetings or other local non-mainstream parenting type meetings.

I can count on one hand the amount of times I've actually taken my kids to the doctor for being sick over the past 9 years. Mostly it's just once a year for a well-child visit or school physical. I'm fine with a family doctor for that! Only once did I ever need to take DS1 to the doctor to be prescribed something. Two years ago he got an eyelid infection and was prescribed his first dose of antibiotics. DS2 has never been prescribed anything.

[crl]

I have always gone ped. I mentioned family practice to my mom once when I was having a hard time finding a ped (ds was six by then and dd wasn't born yet); she's a nurse; and she was pretty clear that she would personally strongly prefer a ped. I know from working for a dermatologist that keeping up with even a relatively narrow field was a time suck. (She subscribed to various publications that I was responsibe for filing for her and she attended regular sessions at a nearby medical school with other practicing dermatologists where they presented their difficult cases.). I can't imagine trying to manage a full patient load and keeping up with the much broader fields of adult and child general practice.

If choices were limited and the family practice doctor was great and the ped bad, of course, I'd go family practice. But as a general proposition I would always go
Ped.

Catherine

ETA. For those that have healthy kids so are content with family practice, that's awesome and I totally hope that continues. But you can't predict when your kid might suddenly need treatment. Ds is pretty darn healthy and never been to the ER at age nine. Dd is nearly three and she's been to the ER once with pneumonia and to the ER and then admitted once with a bug bite near her eye that got horribly swollen and they were afraid she had MRSA. Both times our ped was invaluable in either care before the ER or after the fact. I am sure many family practice doctors would also be wonderful, but I would never bank on my kids staying healthy in choosing a doctor for them because you just never know.

[AnnieW625]

ETA. For those that have healthy kids so are content with family practice, that's awesome and I totally hope that continues. But you can't predict when your kid might suddenly need treatment. Ds is pretty darn healthy and never been to the ER at age nine. Dd is nearly three and she's been to the ER once with pneumonia and to the ER and then admitted once with a bug bite near her eye that got horribly swollen and they were afraid she had MRSA. Both times our ped was invaluable in either care before the ER or after the fact. I am sure many family practice doctors would also be wonderful, but I would never bank on my kids staying healthy in choosing a doctor for them because you just never know.

See I knew nothing different. If I needed to go the doctor I went and saw a doctor in our family practice clinic. 99% of the time it was my normal doctor, but at the time I wasn't living in a city with a general population 600,000+ people, it was about 30K at that time so there were nice little gaurantees like that. I had UTI issues they were concerned were kidney related when I was less than 5 and later hearing issues when I was 5-8 and he either treated me or referred me out to a specialist. My doctor went to our same church so we knew him outside of the practice, his kids were a bit older than us (his youngest was a classmate of DH's in school) and there was just something about the care we got from him that was okay, he just got it. I was mad when he went to Kaiser when I was 12 or 13. I begged my parents to switch insurance, but they wouldn't, the Kaiser hospital was 30 miles away. When my brother was between the age of 12 and 15 he ended up in the ER two or three times (our clinic was just starting an urgent care, and it shared the same facility as the ER for a while), once via ambulance (he hit a patch of black ice on his bike riding to school and skidded and fell off--to this day he doesn't remember it) and he still got good care, but it was routine care.

Now with all of that said my kids have only ever been to a pediatrician. I would like to eventually get them into a family practice situation, but my DD1 needs a warm and cuddly environment health care wise so I am 99% sure I am going to send her a specific pediatric group because it is a warm and cuddly environment.

[LizLemon]

I have always gone ped. I mentioned family practice to my mom once when I was having a hard time finding a ped (ds was six by then and dd wasn't born yet); she's a nurse; and she was pretty clear that she would personally strongly prefer a ped. I know from working for a dermatologist that keeping up with even a relatively narrow field was a time suck. (She subscribed to various publications that I was responsibe for filing for her and she attended regular sessions at a nearby medical school with other practicing dermatologists where they presented their difficult cases.). I can't imagine trying to manage a ful
patient load and keeping up with the much broader fields of adult and child general practice.

If choices were limited and the family practice doctor was great and the ped bad, of course, I'd go family practice. But as a general proposition I would always go
Ped.

Catherine

ETA. For those that have healthy kids so are content with family practice, that's awesome and I totally hope that continues. But you can't predict when your kid might suddenly need treatment. Ds is pretty darn healthy and never been to the ER at age nine. Dd is nearly three and she's been to the ER once with pneumonia and to the ER and then admitted once with a bug bite near her eye that got horribly swollen and they were afraid she had MRSA. Both times our ped was invaluable in either care before the ER or after the fact. I am sure many family practice doctors would also be wonderful, but I would never bank on my kids staying healthy in choosing a doctor for them because you just never know.
:yeahthat:
There is so much new information coming out all the time, that it is hard to stay current in one field. A family practice doctor is dividing his journal reading time (and required CME time) between both adult and pediatric medicine. Most FPs I know see far more adults than kids, so I wouldn't be surprised if their study time reflected that. That is certainly no guarantee that any pediatrician will be better than any FP. Any field can have dinosaurs that don't stay current and practice much as they did in residency.

[justlearning]

I moved all of my boys to my doctor, who is a family practitioner, a year or so ago for many reasons. I love that I can take care of any issues the boys and I are having all with one appointment.

I assume that you mean at one visit, where you book back-to-back appointments for your kids and yourself.

My DH is a family practice doctor and one pet peeve of his is when an adult patient comes in for an appointment and then asks him to examine his/her child at the end (trying to avoid having to pay separately for the child). In order to prescribe meds, etc. (and to bill for his time), he needs to have the child booked as a separate appointment and have the chart pulled for the child. It's understandable that many patients are tempted to try to squeeze more of out their visit (getting more "bang for their buck"), but it's not fair to the doctor to do so.

Again, I assume that the PP doesn't do this--I just am using this opportunity for a little PSA. :)

ETA that to answer the OP's question, I don't really have a preference but happen to like a pediatrician that we know and take my boys to him (just for well child visits).

[LizLemon]

I assume that you mean at one visit, where you book back-to-back appointments for your kids and yourself.

My DH is a family practice doctor and one pet peeve of his is when an adult patient comes in for an appointment and then asks him to examine his/her child at the end (trying to avoid having to pay separately for the child). In order to prescribe meds, etc. (and to bill for his time), he needs to have the child booked as a separate appointment and have the chart pulled for the child. It's understandable that many patients are tempted to try to squeeze more of out their visit (getting more "bang for their buck"), but it's not fair to the doctor to do so.

Again, I assume that the PP doesn't do this--I just am using this opportunity for a little PSA. :)

ETA that to answer the OP's question, I don't really have a preference but happen to like a pediatrician that we know and take my boys to him (just for well child visits).
Aww that's nice for your to put in a PSA for your DH, and also on behalf of his patients who could be kept waiting by such "bargain shoppers."