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Discussion Starter · #1 ·
We're starting to think about who will be our baby's physician once she's here. DH and I both see a nurse practitioner at a family care clinic associated with the big hospital here in town. I think she's great - she's really laid back and has done right by both of us over the couple of years we've been to her. I think she takes baby + child patients, and I'm inclined to have our baby see her as a primary HCP. DH is thinking maybe it's better to have an MD, either family practice or pediatrics, just because they have a bit more training. I feel like there probably isn't any problem that a NP would miss and an MD would catch in our baby, and if anything serious comes up, the NP can refer us to a specialist just as well as an MD can.

What do you ladies think about family practice nurse practitioner vs family practice MD vs pediatric MD? Is there any advantage to getting an MD or a pediatric specialist that I'm not thinking of?
 

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we have a family practice physician that we use for our entire family. If dh adn I had been seeing a family practice nurse then we would have gone with that. In my opinion if you are comfortable with her treating the 2 of you then why wouldn't she be good enough for your baby. For us it was very important we all went to the same person. That has actually been beneficial as dh has developed some health issues that are hereditary and our dr can monitor the kids easier just bcs he knows all of the issues personally.
 

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We had a family nurse practitioner before we moved out of state, and she was my favorite of all our providers, by far! And she was *ecstatic* about getting to see a newborn baby - it was such a treat for her since most people tend to take babies to pediatricians, so she showered extra love on our little guy! I found she was very attentive with my older kids, too. We never had any issues come up while we saw her, but I was perfectly comfortable with her ability as a health care provider. In my opinion, she was probably a little *more* careful to be thorough than the average Ped would be, simply because she wasn't seeing the same thing day in and day out, you know?
 

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We use a ped. A bunch of the FPs in our area don't take kids or at least infants (maybe it's not viable for them to stock vaccines, I don't know) and my PCP is an internal/cardiology practice, so there's no real advantage to an FP for me. There's an NP at the ped's office but I like the fact that there is a ped available if it's something more complicated. I'm not sure NPs can practice independently here; I haven't seen any, though at a clinic I'd assume there are MDs somewhere?

There is a level of problems that an NP can't handle but which don't require a specialist. It's up to you whether you think you're likely to encounter those.
 

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We are planning to a use a Family Practitioner (though he's new and my other kids have their first appt in the end of June, so we'll see what we think. My midwives highly recommend him). I think think that NPs can be great too. I wouldn't have a problem with seeing a NP for a healthy kid. Neither of my children have ever required anything much in the way of care.

You can usually have a quick interview with potential HCP. You might want to ask how the NP would handle common problems in early infancy- like jaundice (with 25% of newborns get. and 100% of my children so far). Ask her what she would refer you out for... the main thing is that any generalist is able to know when to transfer your care. Even a ped will refer to specialists as needed.

If you have a child who ends up needing a fair bit of care, then the situation is obviously different.

On the other hand, we're pretty relaxed, and our 2yo has only been once to the pediatric practice (it was an NP that she saw). There are a variety of reasons for this that include laziness, lack of health insurance and a major move, but also, after watching what they ped actually does, I didn't feel a lot of urgency to get all those checkups when its obvious to me that my child is thriving and healthy. I am ready to take her to a doctor, start immunizations, etc, and have at this point just been waiting until we had insurance for her, which took many, many months, and two separate attempts to get (its active as of June 1st, yay!)
 

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In my view, a ped is a mid-level specialist, and I see no need to take a normal, healthy baby to a specialist.

Assuming he is healthy, our babe will see our midwives for the first six weeks. Then he will see our NP/family doc team, same as the rest of us.

I have some fairly complex medical needs myself (multiple autoimmune chronic illnesses), but I still find that the primary care I get from the NP/family doc team is the best primary care I've ever had. Which is really saying something, given how much time I have spent in medical appointments over my life so far. (And it's a 15 minute walk from our house and appointments always run on time, which is way more than I can say for any other medical professional I have ever seen.)
 

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Discussion Starter · #7 ·
Thanks for all the perspectives!

I definitely plan to interview my NP and any other potential HCP before we pick one. I want to ask about attitudes toward /familiarity with delayed vax (definitely delaying the hepatitis jab and possibly others), breastfeeding, and attachment parenting especially regarding sleep. I will also ask how the NP feels her level of care compares to that of an MD, and if there's anything she wouldn't be comfortable with that the family practice MDs in the same office would handle.

Is there anything else you all would ask potential HCPs?
 

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I would ask how their team handles consultations. I.e., if she needs to consult with an MD, does that mean you might need to come in for another appointment, or do they try to handle it right then and there?

For what it's worth, I don't usually bother asking about parenting issues (i.e., sleep, attachment parenting) as I don't consider those to be primarily medical issues. Though I've never had a care provider who gave me a hard time about co-sleeping, breastfeeding, etc. If I had, I might feel differently and it might go on my list of questions. I also don't ask about vaxes, as we vax fully and on schedule. (ETA: I know it's common on MDC to delay/avoid. I choose differently, obviously, but I support everyone's right to make their own choices. I only bring it up because it really changes the dynamic of looking for a care provider, so it means my input may be less relevant here. In other words, the fact that our family is strongly pro-vax makes everything else like co-sleeping, breastfeeding, etc. less of a big deal in discussions with HCPs.)
 

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I too would not advise discussing sleeping arrangements with the HCP, or even particularly about "attachment parenting". As Pi said, sleep (and even more so other AP practices) really is not a medical issue (unless sleep becomes a serious problem, and many peds are not going to know any more about that anyway). I would ask them about alternative vax schedules if you want to delay or vaccinate selectively. Perhaps you might want to get into how they support breastfeeding (like, do they refer to an LC if a baby is not gaining weight? when do they recommend supplementation? You might want to ask in a slightly sneaky way too, where you don't tip your hand about what you think about these things ahead of time, esp as many peds and PCP actually don't know a heck of a lot about BFing anyway.) IME most HCPs assume that you will not actually exclusively BF for very long. Remember that its something like 30% of babies are still EBF at 6m? So they operate under the norm that most babies are not EBF.

I mentioned jaundice in my earlier post b/c I wish I'd known more about jaundice w/ #1. I didn't know it could be treated at home, or, NOT treated if not severe. I think DS was way overtreated for mild, normal jaundice that would have resolved itself. Its important to me subsequently to have docs who are knowledgeable about it. So, knowing their perspective on treating those common newborn things is maybe useful?

For me also discussing HB, simply b/c that is our plan, and I want a HCP who is okay with that, and willing to coordinate with our MWs if the baby does need more care (As with Pi, my plan is that a healthy baby will also be only seen by my MWs for the first month or so, but that I will trust them to refer me to the Dr or at least consult with him if they think there is any reason to).
 

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I'm an RN in a primary care pediatric office and a soon to be NP (not primary care though, psych specialty). So, my perspective on this is definitely from a pro-nurse perspective and based on what I see in my particular practice, but fwiw, I have a few thoughts.

In the group I work with there are MDs and NPs, all primary care peds practitioners. The NPs both have more years of experience of than the most junior MD (though he's great too and has the most up to date knowledge in some areas), and the years of academic training (3-4 post-college for NPs and 7 for the MDs) get washed out, IMO, by the exposure to real clinical situations over the years. The NPs consult with MDs as needed while the patient is in the office (no need to come back), and this usually is only needed when there is a new fairly complex or serious diagnosis (e.g., presumed strep throat turns out to be an abcess that needs to be drained) or the provider ends up seeing someone they normally wouldn't (e.g., we have one MD who sees most of the kids with complex special needs but if she's not able to one day, one of the NPs may see the patient but check in with the doc briefly mid-visit). The MDs all pull one another into an appointment from time to time and do bring in the NPs and RNs depending on the issue too (breastfeeding and sleep problems being common examples). I think every group practice probably has their own particular ways of collaborating internally, but as long as your NP is working in a group practice, it is pretty much inevitable that collaboration will be part of the practice, and most good providers welcome and seek out the opportunity.

Finding out how off hours care is handled is important for babies, I think. What's the on-call system (who will you speak with at midnight when baby has croup)? Can you be seen after hours or on weekends if needed, or is it straight to the ER? Because it's what I do most, I also think knowing how phone calls are handled could be helpful. I'd estimate that for at least a substantial minority (maybe 25%?) of our patients, they speak to a nurse on the phone more often than they're seen in the office. So, knowing who takes calls, how soon they can typically get back to you, and what issues can be handled over the phone (we do a lot of breastfeeding trouble shooting, advising on home care for common viral illnesses, first aid guidance, case management, and a good chunk of mental health and behavioral counseling and coordination over the phone) could be helpful.

All in all though, I think it is about knowing if you trust your child's provider and can work with them even if there are some areas of difference in perspective. A family NP or MD can be a wonderful choice for a baby and child's care too. Lots of family NPs I know absolutely love seeing kids and many got the family NP vs peds only training primarily to be more marketable. So, go with your gut.
 

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We have an FP whom we love, and only really see for the well child stuff. But we also love his physicians assistant and his NPs are equally great. The hours are perfect, and include Sat. and Sun. mornings. They are always available on call, so I have no complaints about that.

Sometimes, such as when Pascal had roseola, they did not diagnose the illness by name, but were absolutely right about how to treat it (I found out what it was from a friend whose 4 kids all had it) and when I told the np what it turned out to be she said, "Oh yes, that sounds just like roseola." So I wasn't completely impressed in the Grey's Anatomy sense with the specific diagnosis, but the treatment and the approach they had was just right, so who cares?
 

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I absolutely love our family practitioner and his team, they are all wonderful (some of you may recall how awesome they have been to me
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) so we will be taking our baby boy there too. Unless of course he needs specialty care, which is as of yet not known. Having a doctor you trust and are not afraid to go to with your concerns is so very important... You should never feel like "they will think I'm one of those hysterical, overly concerned first-time mothers" or "I can't possibly call them again", or "if they figure out I co-sleep, I will get so much flack". I have a friend who actually got told by the receptionist at her pedi's office:"Aren't you getting tired of calling here?!" and consequentially brushed off when she wanted an appointment for her son.
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What if the kid gets something very serious, but his mom is afraid to call the doctor because she's been told off before?

By the same token, I'm a big proponent of "knowledge is power" so whatever I feel is wrong with one of my kids, I will read up on it, and when a doctor gives me a diagnosis, I research both it and the treatment options presented. I may love my doc, but I am pretty vigilant about not just accepting everything I'm told or - handed.
 

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Quote:
Originally Posted by mingus View Post

Finding out how off hours care is handled is important for babies, I think. What's the on-call system (who will you speak with at midnight when baby has croup)? Can you be seen after hours or on weekends if needed, or is it straight to the ER?
This is an EXCELLENT point. Our place has 24 hour on-call coverage by one of the family docs (not necessarily yours, but someone) and also reserves 4 hours every day for same day appointments (though again, you may not see your usual NP or doc.) They also do house calls when really necessary. These policies definitely came in handy with DS once when he went from pretty sick to very ill the evening of Dec 23 at 18 months old. I was able to get through and talk to the doctor on call within half an hour, and then met him at the clinic the next morning. (He also offered to do a house call that same night, but after discussing it, I felt much more at ease to get through the night.) Being able to avoid the ER in that situation was an enormous relief to us, and may have helped DS bounce back faster, as we could keep him happier and more well-rested at home.
 

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We have no idea at this point. We've actually been looking for a new dr for ds (when we switched insurance in January his old ped doesn't accept his new insurance). So that's my goal this summer- find a new dr that will see ds and the new baby. I hate this part of parenting!
 
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