Pediatrician vs Family Practice Doctor: Update #70

[magnificent_baby]

That's a hard decision. I like a pede for my kids because I think they are more attuned to finding weird and unusual things, specific to kids. Also they see more of what's "going around" n that population and I would think more likely to prescribe safe dosages of medications. Perhaps even being more up to date with current best practice for pediatrics through the AAP. 

 

On the other hand, there are many benefits to having a GP know your whole family. I think they are more laid back and more receptive to your opinion/input (our pede tends to jump the gun when finding abnormals, but that's okay with me, I'd rather be safe than sorry). 

 

Ultimately, I chose a pede because ours has can see his own patients at the local children's hospital. 

 

[fairfarmhand]

We love our Family Practice Doctor.

 

They've seen my kids since they were babies.

[Rachel]

Wow, jealous of the people who have pediatricians with extended hours! Ours is NOT open weekend/nights. But I do have a pediatric urge care just down the street, staffed by pediatricians, that is open evenings and weekends.

Ours isn't open for regular appointments evenings and weekends, you have to go through the on call nurse, but I've never had trouble getting my kids in when needed even at weird times.

 

They do have later appointments for parents who work and do Saturday clinics for flu shots or athletic physicals a few times a year.

[Katy]

The only reason you might need a pediatrician is if your kiddo gets a serious and rare infection that your family doctor isn't familiar with and is afraid to treat.  In that case, the family doctor will refer you to a pediatrician, possibly for liability reasons, possibly because the family doctor will want you to be seen by someone with privileges at a certain hospital (a children's hospital, for example).

 

Other than that rare, probably never occurring instance, there is NO reason you wouldn't get better care from a family doctor or nurse practitioner.   There is a lot to be said for knowing the whole family and trusting the parents, and IME that is much more likely to happen with a family practice than in a pediatrician's office.  Also, IME, family doctors are more amenable to delaying vaccines and listening to parental instincts in general. Also, if you choose a DO, they can crack your back like a chiropractor, but you only have the one copay.  IME DO's are less certain of their own expertise, so if something weird happens and you don't respond to treatment they way they expect, they are more likely to do extra research that will be extremely helpful to you than an MD - who, IME, is just likely to get frustrated with refractory patients.

[Tap]

It really depends on the doctor.  My kids see a doctor who does about 50/50 peds/adults.  My family goes to a clinic that every doctor is both a pediatrician and an internal medicine doctor.  The entire practice (8 or so doctors) sees both demographics. Some doctors also have a specialty, like elderly patients, so while they see all ages, they have more patients in the older group.  I feel 100% confident in my kids doctor, because pediatrics is what he does about half of his day.  I would feel less confident if the doctor only saw 1 or 2 pediatric patients each day.  Since those doctors have a special interest in aging patients, most of their continuing education and personal research/interests are not in keeping with current pediatric issues.  There are some doctors who are amazing no matter what the age, and if you have one of those doctors....hold on to them, they are getting harder and harder to find. 

 

Our brains really are 'use it or lose it' with knowledge, but years of experience can really seem to refine the 'gut instinct' in medical care.  I personally would be more likely to see a 40yo MD who sees both age groups, than to go to a 30yo recent grad who does pediatrics only.

 

If I had a baby/toddler with a major health issue or even one who is not hitting typical milestones, I would definitely want a pediatrician.  If the child only has the normal occasional illness and  vaccinations, then I wouldn't hesitate to see a doctor who sees both kids and adults.

 

 

 

 

[Peach]

Our kids see a pediatrician that we absolutely love. However, he is in the same practice/office with GPs and internal medicine docs. Our oldest (the one with epilepsy) just turned 18 and I hate to think of moving him on. The good thing is, though, that once he does the GP is about 5 feet from the ped's office :)

[Guest]

I don't think a lot of doctors will do four children at once, because if you cancel last minute, that's a lot of open spots. I schedule 2, 2, and 1 for the doctor, with 3 and 2 for the dentist, and 2, 2, and 2 (myself and one child) at the eye doctor.

Ours will but I demand it and never cancel. Like, never. They know this and make an exception for us. If we did cancel we would be charged a hefty fine against our accounts but it's a non issue.

[ktgrok]

Hmm. We've never had a real issue, other than orthopedic stuff. Or when the teen broke his back. But we saw specialists then anyway. I actually really do like our pediatrician, but it's such a long wait to see him now, as so many people also like him a lot. Like, a long time to schedule an appt (forget about same day with him, for that you see the nurse), but also an hour wait or longer once you are there. With no separate waiting room for well kids. I feel like we get sick every time we go. 

[OH_Homeschooler]

One unexpected benefit to switching the kids to the family practice is just how excited everyone at the office is to see kids. The older patients love it, and I think the doctors and nurses enjoy a break from serious older people problems. I don't know if this makes sense, but it just makes me happy to take them to the doctor and to see some old lady's face light up. 

[ktgrok]

One unexpected benefit to switching the kids to the family practice is just how excited everyone at the office is to see kids. The older patients love it, and I think the doctors and nurses enjoy a break from serious older people problems. I don't know if this makes sense, but it just makes me happy to take them to the doctor and to see some old lady's face light up. 

 

That makes total sense. When I get my pregnancy ultrasounds I go to a general imaging center, rather than the hospital or an OB/GYN office, and it is a similar thing. I get all sorts of attention and they are so happy to be doing a baby ultrasound instead of say, a 90 year old man's testicals or whatever. 

[trulycrabby]

Our pediatrician is wonderful and has treated both our boys since birth. DS23 aged out of the practice several years ago, and he has said several times he wished he could go back to Dr. Z. If she were a family practice doc, we would all go see her, so my opinion is if you find a special doctor, pediatrician or family practice, then stay with her/him.

 

On the other hand, the pediatricians I know seem to know what particular bug is circulating in the pediatric community, so they can test and treat easily. A family practice doctor may not be quite as familiar since she primarily sees and treats adults. Circulating bugs can differ between age groups because they often live and work in different environments, and their immune systems are different because adults may have already had childhood illnesses.

Edited June 30, 2016 by trulycrabby

[Caroline]

One more thing to love about our pediatrician--they are seeing us today even though I forgot the insurance cards. I had mine, but not the kids'. No questions asked. Phew!

[dirty ethel rackham]

After having several pediatricians that were unsatisfactory, we switched to a family practice doc and haven't looked back.  We have received much better care since we went with the family practice model.  I even made my husband switch from the internist who was prescription happy for a non-existent cholesterol problem.

 

Pediatrician issues we had:

• Claimed to be supportive of breastfeeding, but blamed every "child issue" on breastfeeding and pushed weaning or supplementing.  Your baby cries?  Wean.  Your baby has an ear infection?  Wean.  Your baby has diaper blow outs?  Wean.  Your baby isn't sleeping through the night?  Wean.  Your baby cries when the doctor comes into the room during those stranger anxiety years?  Wean.  Your 14 month old baby stopped eating food?  Wean.  What?  My kid is not a fern ... he doesn't live on air.  She missed some tooth decay that caused the food strike. 
• Condescending toward parents.  We just don't know shit.  Even when we come armed with AAP recommendations printed out.
• Claimed to be a parenting expert when I know that her training did not include parenting advice.  Claimed I was spoiling my baby.
• Told me that my baby was too fat and that I had to stop feeding him too often (was nursing on demand.) 
• Pushed early solids only due to the fact that I had a larger baby, despite AAPs recommendations against such practices.
• Pushed antibiotics for every "ear looks red" situation until parent pointed out that ear drums can get red from crying.  I think she was the cause of my oldest's bowel problems from all those unnecessary antibiotics.
• Staff was rude to me and my baby. 
• Refused to "allow" me to take an antibiotic for mastitis and nurse because it might get into the breastmilk, but pushed augmentin on that same child a month later for the imaginary ear infection.  At least I was smart enough to have an LC look up the med in Hale's and determine that it was safe to take while nursing.
• Sent me to the hospital with kid who was getting sicker, but didn't send orders to the hospital and we ended up in the ER cooling our heels for hours instead of getting the IV started and admitting him.  And then yelled at me for not telling them what to do. 
• Kicked us out as patients because we didn't come in often enough (did all well visits and a few sick visits) and they wanted to reduce their patient load from our insurance carrier. 

Family practice experience

• Listens to me and treats me as a partner in health care decisions (using TRUE informed consent rather then bullying me into accepting their decision as an order to be followed.)
• Listens to the whole story and hears what is going on in the family rather than only what that patient was there for at that moment.
• Treats screenings as an opportunity for conversations and problem solving rather than a tool to beat parents over the head with.
• Considers nursing mothers and babies as a dyad and makes treatment decisions (i.e mastitis) with that relationship in mind.
• Wasn't too lazy to look up medications in Hale's rather than advise "pump and dump" as the default.
• Correctly identified ds' bowel disorder and referred out appropriately.  This was dismissed by the pediatrician.
• Took over my thyroid treatment when I had to leave an endocrinologist due to poor treatment (told it was all in my head and I needed a shrink rather than waste her time) and I had trouble getting into someone else, which would have left a long gap where I was unmedicated and not able to complete a sentence.  Did complete thyroid panel instead of just TSH and noticed my conversion problem that the endocrinologist missed.
• Compassionate care when I had a miscarriage.  The OB refused to see me because I hadn't yet had my initial visit for that pregnancy.  FP followed up several times in the following weeks to make sure that I wasn't having any health issues from the the miscarriage (infection, incomplete expelling of POC) as well as checking up on my mental well-being.
• If I can't get in to the the doc (not frequent), I can always get in to see the nurse practitioners, who are excellent.  They also conferred with the doctor if there was any question about my treatment. 
• Basically does evidence-based care rather than "what they were taught by their precepting docs." 
• ETA:  has admitting priviledges at our local hospital and does newborn checks at the hospital if listed as the physician of record. 

 

 

 

 

Edited June 30, 2016 by dirty ethel rackham

[TranquilMind]

I asked the same of our pediatrician, and his answer was that ped docs specialize in a particular age group's issues. We adore him, and my oldest (19) is sadly looking for an internist although they're fine with him continuing there until he's 21. The reality is that almost all of the good internists and all of the family doctors here have waiting lists.

 

I'd go with your gut and who you feel is best.

This is true. It is hard to get in with the good family practitioners (never used an internist). Mine has not taken new clients for 20+ years. But my kids and their kids someday can continue with him so long as he is in practice. Another plus for a family doctor.

[Alice]

Well, as a pediatrician, I'm obviously biased. :) In reality, I think it depends on the individual doctor more than FP vs. Peds. 

 

We have had a family practice physician since I was pregnant with our eldest, so 21 years.  We'd be lost without her, she has seen us through so much.

She is  board certified in both internal medicine and pediatrics.

 

If someone is board certified in internal medicine and pediatrics,they are probably Med-Peds and not family practice. Family Practice is a 3 year residency and someone would be boarded in family practice. There is also a residency that is Med-Peds which is 4 years and afterwards you can be boarded in both  internal medicine and pediatrics. 

 

Our dentist will only schedule 2 family members on the same day because they've been stung when larger groups all cancel.

 

 

Ours will but I demand it and never cancel. Like, never. They know this and make an exception for us. If we did cancel we would be charged a hefty fine against our accounts but it's a non issue.

 

 

We generally won't see more than 2 siblings for well-checks because it does cause a huge issue if people no-show or cancel last minute. We schedule 20 min for physicals so if 3 kids in a family don't come, that's an hour where the doctor has an empty schedule. In our office, it's also somewhat harder on the nurses as they get the kids ready (height, weight, vision, blood pressure) and to do that for three or four at once disrupts the flow. Ideally each doctor usually has three patients in rooms...one being put back in the room by a nurse, one that the doctor is seeing and one that is getting shots or about to leave. But when the nurse has to get more than 2 kids ready at once or has to give shots to 3-4 kids, it is harder. 

 

I will see more than 2 kids in a family together if I know the patients well and know they won't no-show. Having three kids myself, I understand why it's easier for families. And then if needed I will help the nurses do all the pre-visit tasks to help with the flow. 

[Lanny]

IMO your oldest DC can go to the Family Practice Doctor, with no issues.  I would prefer to see the younger ones, and the one on the way, go to a Pediatrician.  Especially, the one on the way.  Nobody can be an expert on everything. Even among Pediatricians, when our first Pediatrician moved from Colombia, back to California, after working here on a temporary contract for 5 years, we tried several other Pediatricians, but never found one we trusted like him. For us, that was a huge loss.  He was in the O.R. when DD was delivered by a necessary C section, he received and examined DD in the O.R.,  and he gave me his home phone number then. Newborns and Infants/Toddlers frequently have special needs that Pediatricians have far more experience dealing with. As your DC get older, I would feel more comfortable with them going to the Family Practice Doctor. Disclaimer: On my resume, I had the word "Generalist".  That signifies that I was not an "expert" at any one thing,  but could do many things on a project.  IMO, a Family Practice M.D. is a Generalist.  Usually, that will be fine, but it may not always be what you need from a doctor.  Take care of yourself and the baby on the way!

[SKL]

My preference is family doc / chiropractor.  Annoyingly, my HMO stopped allowing that, which is one reason we mostly go to the chiropractor.

 

I find I get more personalized service at a family practice, and they are much more likely to listen to me and my kids.

[wintermom]

family practice is the normal model here in Canada, people don't generally go to a ped unless they are refered. 

 

Actually, it really depends where you are in Canada. Every province has a different health care system, different shortages (or not) of doctors, etc. In our area, there is a huge shortage of GPs, and there are many families who don't have one at all. They have to go to ER or clinics in order to see a doctor.  Pediatricians cannot refuse care to new-borns, so this is how I got a doctor for my dc. They all were able to get the same pediatrician. When things opened up a little, we were all able to get the same GP.

[Rachel]

Hmm. We've never had a real issue, other than orthopedic stuff. Or when the teen broke his back. But we saw specialists then anyway. I actually really do like our pediatrician, but it's such a long wait to see him now, as so many people also like him a lot. Like, a long time to schedule an appt (forget about same day with him, for that you see the nurse), but also an hour wait or longer once you are there. With no separate waiting room for well kids. I feel like we get sick every time we go.

In this case I would probably switch. There is something to be said for your time and for the ability to be seen when needed.

[ktgrok]

So, thought I would update. The visit went well. The ANRP was very thorough, took her time, and we had almost zero wait in the waiting room. She was at least as thorough as our normal pediatrician's office if not more so. HOWEVER, they don't carry combination vaccines, which may be a deal breaker for me. I don't do combos when it is the first time they are getting a vaccine, or at least not multiples, but do prefer them for vaccines they have already had, to minimize how many times they get stuck. So may go back to our regular pediatrician's office after all. Or find a closer one. 

[Bluegoat]

Actually, it really depends where you are in Canada. Every province has a different health care system, different shortages (or not) of doctors, etc. In our area, there is a huge shortage of GPs, and there are many families who don't have one at all. They have to go to ER or clinics in order to see a doctor.  Pediatricians cannot refuse care to new-borns, so this is how I got a doctor for my dc. They all were able to get the same pediatrician. When things opened up a little, we were all able to get the same GP.

 

Yes, there are places in my provice wheer a specialist is more common for particular situations - in a small town with a hospital, the OBs may need to see low risk people as well in order to have enough patients, for example - if they took only high risk  they would not be able to work full time, or have enough doctors to cover shifts. 

 

 

If you live up North, you are likely to be a NP.

 

But I think the concept for model of care still is much more centered on family practice being the ideal, that is modified due to circumstances, which is not quite the same as in the US. 

Edited July 5, 2016 by Bluegoat

[kiana]

So, thought I would update. The visit went well. The ANRP was very thorough, took her time, and we had almost zero wait in the waiting room. She was at least as thorough as our normal pediatrician's office if not more so. HOWEVER, they don't carry combination vaccines, which may be a deal breaker for me. I don't do combos when it is the first time they are getting a vaccine, or at least not multiples, but do prefer them for vaccines they have already had, to minimize how many times they get stuck. So may go back to our regular pediatrician's office after all. Or find a closer one. 

 

If you really like them and the only deal-breaker is the no combination vaccines, is there something like a county health clinic or pharmacy where you could do the vaccines only? 

[Bluegoat]

If you really like them and the only deal-breaker is the no combination vaccines, is there something like a county health clinic or pharmacy where you could do the vaccines only? 

 

Another possibility might be, buy the vaccine at the pharmacy and take it to the office for your visit.

[ktgrok]

I actually asked about other options, and she made it sound like that vaccine can only be purchased in bulk, which is why they don't carry it. I also felt a bit more pressured regarding vaccines, now that I've had time to think about it, which I didn't like. She was fair, not mean, but...I think I prefer the pediatrician's office in the end. Just will have to be proactive about scheduling way ahead to try to get the first after lunch or first in the morning appointments to minimize wait time some. (still a wait, not sure why, but it's better then). And bring their tablets to play on. 

 

And keep using the pediatric urgent care down the street, which actually has a shorter wait time, for sick visits. 

[kroe1]

When I was just a wee graduate student, standing in a busy pediatric ER, the pediatric emergency physician was treating a child in respiratory distress. He was teaching the residents how to read the pneumonia infiltrate on the xray and barking orders to the nurse to start the antibiotics. I looked over at the child who was gasping for breath, breathing faster than I knew was possible. One of the residents was obviously very uncomfortable. He was shifting back and forth. He looked like he was about to vomit. He meekly raised his hand. He told the pediatric emergency physician that he was reading the xray incorrectly. He said the child was in congestive heart failure and did not have pneumonia. He said the child needed other medicine, and not the antibiotics.

 

Turns out, the resident who saved the child was a family medicine resident. He knew what the child had because it is an adult problem, but very rare in children. From that day forward, I have always taken my kids to family medicine doctors. I am sure similar stories can go both ways, but that was the one I saw with my own eyes.