Choosing a new- or a first- gynecologist can be very stressful for women. This health care provider consults us in some of the most intimate arenas of our health, sexuality, and well-being. Even for those of us who enjoy good health, we rely upon our Ob-gyn’s to see us through some of our most emotional transitions: contraception, conception, childbirth, PMS, and menopause. For those of us in health crises, it is often the Ob-gyn to whom we turn: when our periods are late, when our pregnancies are complicated, when our systems malfunction, when we have an abnormal Pap smear, or when we find a dreaded breast lump. Yet most of us spend more time choosing a hair stylist than choosing a gynecologist! Many of us rely more on luck than strategy to identify this critically important health care partner. Dr. Donnica discusses the different ways to identify the best gynecologist for you.
“Your relationship with your gynecologist is one of the most intimate professional relationships you may have. While this relationship will take time to nurture, you should have a feeling even on the first visit that this is a person you will be able to trust with your most private or serious concerns.”
Your obstetrician-gynecologist (“Ob-gyn”) may be the most important health care partner you ever have. Gynecologists (“gyn’s”) are physicians (MD’s or DO’s) who specialize in treating women’s reproductive health problems; obstetricians (“OB’s”) provide prenatal care and deliver babies; Ob-Gyn’s do all of the above. Some gyn’s also provide general primary medical care as well. Whether or not you are permitted to choose a gyn as your primary care provider (PCP), may depend on the health plan to which you subscribe and state in which you live, and may have relatively little to do with that physician’s particular background or experience.
Because gyn’s play such an important role in your health and well being–and because they play such a central role in one of the most private aspects of your life–finding the right one may take some initiative, time, and planning. Yet most women spend more time planning a one-week vacation than selecting a gynecologist! By far the most frequent medically-related question I am asked relates to choosing an Ob-gyn. Most women who inquire simply ask me to recommend someone for them. While this seems like a relatively simple question, the variables involved go far beyond identifying someone who is competent, compassionate, well-trained, and conveniently located. Regrettably, financial factors are often the first to be considered in choosing an Ob-gyn. Location and other logistical factors are also clearly important. Increasingly, sub-specialization is also a consideration. There is no standard or even straightforward way to identify the Ob-gyn who is best for you. Hopefully, these tips will help!
When Should a Woman See a Gynecologist?
- Annually after age 18 or after becoming sexually active, whichever is first.
- When considering becoming pregnant for a preconception counseling visit.
- As early as possible in a pregnancy.
- When you have any unusual signs or symptoms in your breasts, vagina, lower abdomen, urinary system, period or PMS problems, hormonal concerns, need for contraception, etc.
How Do I Choose a Gynecologist? Take Dr. Donnica’s DecisionnaireT.
All women do not have the same needs from their Ob-gyn, nor do most women have the same needs from their Ob-gyn throughout their lives. Answer all of the following questions for yourself to create a check-list of your individual needs. This will help you choose the most appropriate gyn for you, now. Remember that your needs may change over time and you may have to review this process.
Do you have any limitations or guidelines for Ob-gyn selection or referral from your insurance carrier?
How important is “bedside manner” or personality to you? If this is very important, you may want to consider asking a potential Ob-gyn to meet you for an informational interview or “get-to-know-you” visit. Feeling comfortable with this person is paramount.
Is the doctor’s gender important to you?
Race, age, religion, and other commonalities may also be (or seem) important to you. Some women feel more comfortable with doctors who are more like them; other women feel differently. Remember, however, that while sharing values is nice, feeling like you and your values are valued is much more important.
How important are logistical concerns?
Consider how far you’re willing to travel, whether you want your gynecologist to be closer to your home or office, whether you will need to get there by public transportation, whether you need someone with evening or weekend hours, etc.
How important are the gyn’s affiliations to you?
Some women prefer having a gyn who is based at an academic health science center or a hospital; some prefer gyn’s with private practices; some women are limited to the Ob-gyn’s listed in their managed care plan manuals. Generalizations about the quality of care or qualifications of gyn’s solely on these credentials is inappropriate, however, and often irrelevant.
Are you planning to get pregnant?
If so, you may want someone who practices obstetrics (provides prenatal care and delivers babies). If this goal is far in the future, this may not be relevant now, but be aware that you would have to switch to an OB once you became pregnant.
If you are pregnant:
do you need an OB trained in high-risk pregnancies? Common reasons to consult a specialist in maternal fetal medicine include having multiples (e.g. twins, triplets), having had a serious medical problem (from diabetes to high blood pressure to certain surgeries), having had previous miscarriages, or if your mother was given DES (diethylstilbesterol) in her pregnancy. Choosing an OB requires all of the same questions as choosing a gyn when you’re not pregnant, but some additional criteria may take precedence such as:
- Where do you want to deliver? Many OB’s deliver at more than one hospital; it’s important to identify an OB who delivers at the hospital of your choice. How far the hospital is from your home (in time more than in miles!) may take precedence over any other factors!
- Do you have specific concerns about your needs for the hospital? Things to consider are whether you have limitations from your insurance carrier, whether you want/need an Intensive Care Nursery, whether you want/need 24 hour in-hospital anesthesia coverage, whether you want/need 24 hour in-hospital neonatology experts, whether you want a birthing room, whether you want a midwife to deliver your baby and an OB to supervise, the hospital’s policies on visitors, the hospital’s policies on the baby staying with the mom (or not), whether you want a circumcision performed on your son in the hospital, or whether you want a sterilization procedure after delivery.
- Do you like all the members of the OB’s group? Will you have the opportunity to meet all the OB’s in the practice? Remember that you may not deliver when “your” OB is on duty. Even solo practitioners generally have cross coverage systems.
- If you have had difficulty getting pregnant, you may want to consult a sub-specialist in infertility called a “reproductive endocrinologist”. These are gyn’s who have extra training, experience, and further board certification. There is a difference between a gyn who has done a fellowship in Reproductive Endocrinology and Infertility versus a generally trained gyn who has a special interest in infertility. If you are being evaluated by your regular OB/Gyn for infertility, you should ask at what point they would refer you to an infertility sub-specialist. Generally this should happen within 6–12 months of treatment with your OB/Gyn depending upon the particulars of your history, diagnosis, insurance coverage, and age. Particular concerns in choosing an infertility specialist include many of the same factors as choosing any gyn, as already discussed. Some unique considerations for infertility specialists include:
- Questions about in vitro fertilization (IVF) treatment: ask the doctor’s specific success rate for patients who have had similar circumstances to yours.
- Questions about cost: don’t be embarrassed to discuss this frankly. Many costs related to infertility treatments are not covered by insurance, and this can be very expensive. Many specialists who perform IVF have financial counselors on staff to assist couples proactively in this regard. Make sure that the prices you are quoted include all the details; find out what your insurance will cover before initiating treatment. Remember that prices for IVF are often quoted per treatment cycle ; most couples require more than one treatment cycle to achieve a pregnancy.
- Questions about convenience: As with obstetrics, there are often many tests involved; convenience may be a concern. You should ask whether blood tests and ultrasounds, for example, can be performed at the office or if you will have to travel to another location for them. Many treatments depend upon happening on a particular day of your cycle; ask if the doctor’s practice has staff and technicians seven days a weekand during holidays.
If you (or your mother or your sister) have had a gynecologic cancer (e.g. ovarian, cervical, or endometrial cancer), you may want a sub-specialist called a gynecologic oncologist (“Gyn Onc”) to provide your routine gyn care. Alternately, you may want to choose a gyn who has had additional training in your particular kind of cancer, or one who has a good working relationship with a gyn onc with whom you’re comfortable.
If you are sure (or at least pretty sure) that you do not want to become pregnant again, you may want to choose a gynecologist who no longer practices obstetrics. In some cases, these gynecologists are able to have more predictable office hours schedules and may be able to focus more on non-obstetric gynecologic or general women’s health issues.