9 Steps to Take After You Get a Specialist Referral (2024)

Don’t just take someone else’s word on who’s right for you.

Whether you receive a referral from your primary care physician or the name of a favorite specialist from one of your friends, it can be easy to simply trust that other person’s judgment. But the fact is, not all specialists are equal when it comes to experience in the specific type of care you need. After you receive a referral, take these important steps to decide if a specialist is the right match for you--or find a different one who is.

1. Confirm if the specialist is in-network for your insurance.

Start with the basics: Does the specialist accept your insurance? Ensure your coverage before making an appointment and clarify what your out-of-pocket costs will be so you don’t get caught off-guard when your bill is due. In some cases, you may decide it’s worth going out-of-network to see a particular specialist. Again, research your expected costs upfront and weigh the risks and benefits of receiving out-of-network care.

2. Check the specialist’s board certifications.

While board certification is not required of doctors, it reflects a level of achievement and knowledge within a specialty. Doctors who are board-certified have undergone extended training specific to their specialty, and they have passed an additional exam beyond their medical education and state licensing. You can search on the American Board of Medical Specialties website to find a specific doctor’s current board certifications. The listings on MyHealthMatch also include board certifications on each doctor profile.

3. Look up any professional sanctions or malpractice settlements.

There can be multiple reasons why a physician may have been sanctioned by a state board or have chosen to settle a malpractice lawsuit, and the presence of these issues does not necessarily indicate the quality of care you will receive. That said, you have a right to know the full picture of a physician’s history. MyHealthMatch will indicate a report of any such incidents under the Records Check column. For more details about a specific doctor, you can contact your state medical board through the Federation of State Medical Boards website.

4. Find out the specialist’s frequency of treatment for your specific condition or procedure.

Studies have shown that specialists who perform a treatment more frequently have lower rates of complications and more successful outcomes. Even within a specialty, a doctor may have a particular area of expertise. For example, one orthopedic surgeon may have a higher number of knee surgeries, while a different orthopedic surgeon is an expert on hip replacement. That’s why the Match Scores on MyHealthMatch include a calculation for procedure and condition treatment volume. In fact, it’s the primary factor in determining a doctor’s Match Score.

5. Learn about the quality of the specialist’s affiliated hospitals.

Finding a high-quality specialist is only half the equation. If you’re undergoing an inpatient procedure or treatment, the quality of the hospital where you receive care plays a significant role in your risk of complications or even death. By choosing a specialist affiliated with a 3-star (performs as expected) or 5-star (performs better than expected) hospital, you can help reduce this risk and improve your likelihood of a successful outcome.

6. Consider your own personal preferences.

Ultimately, you need to feel comfortable with the physician you choose. Depending on the specialty, you may prefer a doctor of a certain gender. Age may also be a factor for you. For a specific surgery, you may choose an older surgeon with years of experience in that procedure. If you have a chronic condition, you may opt for a younger specialist who will oversee your treatment for years to come. Finally, location can be a critical consideration, particularly if you depend on public transportation or have limited mobility.

8. Make a list of questions for your appointment.

Be ready with your medical history, including your current medications, and organize your list of questions. This can include asking about a doctor’s experience with your particular treatment, his or her care philosophy, knowledge of available treatment options, and the quality of his or her affiliated hospitals. Along with the information itself, pay attention to the doctor’s communication style. Does the specialist take time to listen to your questions and concerns? Does he or she explain information in a way you can understand? Being able to have an open and honest conversation is an essential element in your overall relationship with a specialist.

7. Schedule an appointment.

Once you have selected a specialist, schedule an appointment. This process itself can be an indicator of whether the doctor is a good fit. Were you able to get in quickly, or do you have to wait three months for an appointment? At the physician’s office, were you happy with how the nurses and staff members treated you? Depending on the type of care you need, you may be interacting with this team for several months or even years. Make sure the experience is as comfortable and accommodating as you’d like it to be.

9. Be ready to seek a second opinion.

It may take a few appointments before you find a specialist who is right for you. Even if you like the first specialist you choose, it can be helpful to seek out a second opinion, particularly for a serious condition or significant procedure. Up to 88% of second opinions initially result in a different diagnosis, according to a 2017 study from Mayo Clinic. Keep in mind: Asking for a second opinion is not an insult to the first doctor, and you should not hesitate for fear of offending anyone. A good specialist will welcome any additional input from other doctors, with a primary goal of finding you the most effective care.