Association Between Physician Online Rating and Quality of Care

Assessing extremely negative online patient reviews and complaints of musculoskeletal oncology surgeons in the United States: a retrospective analysis

INTRODUCTION

Physician-review websites (PRWs) are commonly used by patients while searching for a surgeon. There is no current literature investigating the factors that contribute to online one-star reviews of musculoskeletal oncology surgeons. This retrospective study aims to identify these factors to determine areas of care affecting patient's subjective reviews.

METHODS

Patient ratings and comments regarding musculoskeletal oncology surgeons from the Musculoskeletal Tumor Society (MSTS) were collected from Vitals.com. One-star reviews with comments were then classified as either operative or nonoperative. These complaints were then further classified based on content including wait time, uncontrolled pain, time spent with the physician, surgical outcomes, medical staff/institutional complaints, and bedside manner.

RESULTS

A total of 169 reviews (375 complaints) from 181 physicians were included. Of these complaints, 198 were from patients in the operative category while 177 were from patients in the nonoperative category. Bedside manner was the most common complaint. Operative patients reported higher instances of uncontrolled pain in their reviews, whereas nonoperative patients more frequently cited wait time. No significant difference in the complaints that mentioned the amount of time spent with the physician, bedside manner, a disagreement with the plan, or the medical staff or institution was found.

CONCLUSION

Online one-star reviews of musculoskeletal oncology surgeons on Vitals.com referenced both surgical and non-surgical aspects of patient encounters, with bedside manner being the most popular complaint overall. Surgical patients were more likely to complain of uncontrolled pain whereas non-operative patients were more likely to complain of wait time.

TYPE OF STUDY

Outcomes 2c.

The majority of negative online otolaryngology reviews are non-clinical

OBJECTIVE

To characterize extremely negative online reviews of Otolaryngologists in the United States.

METHODS

A search for reviews was performed on Yelp.com using the keyword "Otolaryngologist" in four major urban cities in the United States. On a five-star scale, one-star reviews were isolated, classified as clinical or non-clinical complaints, and further subcategorized. Chi-square analysis was used to determine differences in complaint types between patients reporting surgery and those who did not.

RESULTS

From the 7653 reviews that were surveyed, 375 one-star reviews met the inclusion criteria and were used in the analysis. These negative reviews yielded 808 total complaints, 25 % were clinical, and 75 % were non-clinical. The most common clinical complaints were a lack of diagnosis, disagreement with the treatment plan and misdiagnosis, whereas the most common non-clinical complaints included poor physician bedside manner, cost, and unprofessional staff. Fifty-two (14 %) patients reported having surgery. The difference in the number of complaints by patients reporting surgery and patients not reporting surgery was statistically significant (P < .05) for almost all subcategories.

CONCLUSION

The most common complaints in negative reviews of Otolaryngologists on Yelp are non-clinical, primarily centered around the professionalism of the physician and staff. This work offers insights into patient satisfaction within Otolaryngology. Considerations should be given to these results as a means for improvement in patient experiences.

Application of sentiment and word frequency analysis of physician review sites to evaluate refractive surgery care

Background

Online physician reviews increase transparency in health care, helping patients make informed decisions about their provider. Language processing techniques can quantify this data and allow providers to better understand patients' experiences, perspectives, and priorities. The objective of this study was to assess patient satisfaction and understand the aspects of care that are valued by patients seeking refractive care using sentiment and word frequency analysis.

Methods

Written reviews and Star ratings for members of the Refractive Surgery Alliance Society practicing in the United States were collected from Healthgrades, a popular physician rating website. Surgeons with at least one written review were included in the study. Reviews were scored from -1 (most negative) to +1 (most positive) using Valence Aware Dictionary sEntiment Reasoner (VADER). Reviews were stratified by demographic characteristics, namely gender, region, and years in practice. Word frequency analysis was applied to find the most common words and phrases.

Results

A total of 254 specialists and 3104 reviews were analyzed, with an average of 4.4/5 stars and mean 48 ratings each. Most physicians had positive reviews (96%, average VADER ​= ​0.69). Younger physicians (<20 years since residency) had significantly higher Stars rating than senior peers (>20 years) (P ​< ​0.001). A similar trend was observed in VADER score (0.71 vs 0.69), although not statistically significant (P ​= ​0.06). No statistical differences were observed between Stars rating and VADER score by gender (P ​= ​0.66, P ​= ​0.83) or by geographical region (P ​= ​0.74, P ​= ​0.07). "Staff" (n ​= ​1269), "professional" (n ​= ​631), "office" (n ​= ​523), "questions" (n ​= ​424), and "friendly" (n ​= ​386) were frequently used in reviews, along with phrases such as "the staff" (n ​= ​273) and "my questions" (n ​= ​174). "Surgery" (n ​= ​719), "staff" (n ​= ​576), "procedure" (n ​= ​251), "experience" (n ​= ​243), and "professional" (n ​= ​240) were the most common words in positive reviews, while "surgery" (n ​= ​147), "office" (n ​= ​86), "staff" (n ​= ​54), "time" (n ​= ​47), and "insurance" (n ​= ​28) were the most commonly used in negative reviews.

Conclusions

Both the average Stars and VADER sentiment score suggest a high satisfaction among refractive patients. Word frequency analysis revealed that patients value non-clinical aspects of care, including interactions with staff, insurance coverage, and wait-times, suggesting that improving non-clinical factors could enhance patient satisfaction with refractive surgery.

Online ratings and narrative comments of American Head and Neck Society surgeons

BACKGROUND

We analyzed online rating scores and comments of head and neck surgeons to understand factors that contribute to higher ratings.

METHODS

Numerical ratings and comments for American Head and Neck Society physicians were extracted from Healthgrades, Vitals, RateMDs, and Yelp, with narrative comments categorized based on content. Physician practice location, education, and residency training were also compiled.

RESULTS

Patient ratings were significantly higher with supportive staff and affable physician demeanor but showed significant drops with longer wait times and difficulties scheduling appointments or follow-ups. Physician education and postgraduate training did not significantly affect ratings.

CONCLUSION

Online ratings and comments correlated to modifiable factors in clinical practice and may be informative in understanding patient needs.

Effect of Negative Online Reviews and Physician Responses on Health Consumers' Choice: Experimental Study

BACKGROUND

The COVID-19 pandemic has highlighted the importance of online medical services. Although some researchers have investigated how numerical ratings affect consumer choice, limited studies have focused on the effect of negative reviews that most concern physicians.

OBJECTIVE

This study aimed to investigate how negative review features, including proportion (low/high), claim type (evaluative/factual), and physician response (absence/presence), influence consumers' physician evaluation process under conditions in which a physician's overall rating is high.

METHODS

Using a 2×2×2 between-subject decision-controlled experiment, this study examined participants' judgment on physicians with different textual reviews. Collected data were analyzed using the t test and partial least squares-structural equation modeling.

RESULTS

Negative reviews decreased consumers' physician selection intention. The negative review proportion (β=-0.371, P<.001) and claim type (β=-0.343, P<.001) had a greater effect on consumers' physician selection intention compared to the physician response (β=0.194, P<.001). A high negative review proportion, factual negative reviews, and the absence of a physician response significantly reduced consumers' physician selection intention compared to their counterparts. Consumers' locus attributions on the negative reviews affected their evaluation process. Physician attribution mediated the effects of review proportion (β=-0.150, P<.001), review claim type (β=-0.068, P=.01), and physician response (β=0.167, P<.001) on consumer choice. Reviewer attribution also mediated the effects of review proportion (β=-0.071, P<.001), review claim type (β=-0.025, P=.01), and physician response (β=0.096, P<.001) on consumer choice. The moderating effects of the physician response on the relationship between review proportion and physician attribution (β=-0.185, P<.001), review proportion and reviewer attribution (β=-0.110, P<.001), claim type and physician attribution (β=-0.123, P=.003), and claim type and reviewer attribution (β=-0.074, P=.04) were all significant.

CONCLUSIONS

Negative review features and the physician response significantly influence consumer choice through the causal attribution to physicians and reviewers. Physician attribution has a greater effect on consumers' physician selection intention than reviewer attribution does. The presence of a physician response decreases the influence of negative reviews through direct and moderating effects. We propose some practical implications for physicians, health care providers, and online medical service platforms.

The quality of telemedicine consultations for sexually transmitted infections in China

The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed. However, the quality of STI care provided by telemedicine platforms remains unknown. After systemically identifying the universe of DTC telemedicine platforms providing on-demand consultations in China in 2019, we evaluated their quality using the method of unannounced standardized patients (SPs). SPs presented routine cases of syphilis and herpes. Of the 110 SP visits conducted, physicians made a correct diagnosis in 44.5% (95% CI: 35.1% to 54.0%) of SP visits, and correctly managed 10.9% (95% CI: 5.0% to 16.8%). Low rates of correct management were primarily attributable to the failure of physicians to refer patients for STI testing. Controlling for other factors, videoconference (vs SMS-based) consultation mode and the availability of public physician ratings were associated with higher-quality care. Our findings suggest a need for further research on the causal determinants of care quality on DTC telemedicine platforms and effective policy approaches to promote their potential to expand access to STI care in developing countries while limiting potential unintended consequences for patients.

Assessing reviews of academic oral and maxillofacial surgeons within the US on Healthgrades

PURPOSE

The purpose of the following study was to explore the patient feedback on academic oral and maxillofacial surgeons (OMSs) practicing in the United States (US) using the physician rating website (PRW) Healthgrades.com.

METHODS

We conducted a retrospective cohort study on academic OMSs in the US using data from Healthgrades.com. Predictor variables included OMS characteristics or rating characteristics. The primary outcome variable was overall rating. Linear regression was used to determine independent predictors of overall rating.

RESULTS

The final study sample consisted of 309 academic OMSs (mean age, 56.4 years; males, 86.4%). Age group was significantly associated with overall rating (p = 0.034). Dual-degree OMSs had a higher mean overall rating than single-degree OMSs (4.26 vs. 3.98, p = 0.012). The number of ratings was also significantly associated with overall rating (p = 0.019). Upon controlling for all other variables, merely age group was independently associated with overall rating. Specifically, OMSs aged 41-55 years were associated with a higher overall rating (+0.96, p = 0.022) relative to OMSs aged >70 years.

CONCLUSIONS

The OPRs on Healthgrades.com for academic OMSs within the US are generally positive. Age was the only independent predictor for overall rating - younger OMSs (aged 41-55 years) were independently associated with a higher overall rating relative to older OMSs (aged >70 years). The new generation of younger OMSs is likely to be aware of PRWs and their implications in the growing world of online exposure.

An Analysis of Negative One-star Patient Reviews and Complaints for Pediatric Orthopaedic Surgeons throughout the United States: A Retrospective Study

OBJECTIVE

Patients commonly use physician review websites when choosing a surgeon for an elective procedure. Although data exist regarding other orthopaedic specialties, no study has investigated one-star reviews for pediatric orthopaedic surgeons. The goal of this retrospective study was to classify the factors contributing to one-star reviews of pediatric orthopaedic surgeons to identify which areas contribute to lower patient satisfaction.

METHODS

Patient ratings on a 5-star system and comments about pediatric orthopaedic surgeons were collected from the state with the most physicians registered in the "Pediatric Orthopaedic Society of North American" database for each of the 9 geographical regions of the United States as defined by the Association of American Medical Colleges. One-star reviews that included comments were classified as either surgical or nonsurgical. These comments were then further classified based on their content.

RESULTS

Three hundred fifty-four one-star reviews with 700 complaints were included in this study. Of these complaints, 481 (68.7%) were from nonsurgical patients and 219 (31.3%) were from surgical patients. Nonsurgical patients were significantly more likely to reference the amount of time spent with the physician (12.9% to 6.6%, P = 0.026), wait time (11.9% to 0.0%, P < 0.001), and bedside manner (41.2% to 22.8%, P < 0.001). Patients who said they had undergone a surgical procedure in their one-star review were significantly more likely to reference a disagreement with the physician's decision or plan (35.3% to 17.5%, P < 0.001), and uncontrolled pain (21.6% to 5.2%, P < 0.001). There was no significant difference in the comments that referenced medical staff or institutional complaints between surgical and nonsurgical patients (13.8% to 11.4%, P = 0.424).

CONCLUSION

Most one-star reviews of pediatric orthopaedic surgeons referenced interpersonal skills and other nonclinical aspects of a clinical encounter, with bedside manner being the most frequent complaint. Patients who had undergone surgical procedures were less likely to leave a one-star review, but if they did, their comment was usually about a disagreement with the physician's plan.

CLINICAL RELEVANCE

Prognostic studies III.

Are online reviews of assisted living communities associated with patient-centered outcomes?

BACKGROUND

Existing literature on online reviews of healthcare providers generally portrays online reviews as a useful way to disseminate information on quality. However, it remains unknown whether online reviews for assisted living (AL) communities reflect AL care quality. This study examined the association between AL online review ratings and residents' home time, a patient-centered outcome.

METHODS

Medicare beneficiaries who entered AL communities in 2018 were identified. The main outcome is resident home time in the year following AL admission, calculated as the percentage of time spent at home (i.e., not in institutional care setting) per day being alive. Additional outcomes are the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score (ranging 1-5) and rating status (no-rating, low-rating, and high-rating) were generated using Google reviews. Linear regression models and propensity score weighting were used to examine the association between online reviews and outcomes. The study sample included 59,831 residents in 12,143 ALs.

RESULTS

Residents were predominately older (average 81.2 years), non-Hispanic White (90.4%), and female (62.9%), with 17% being dually eligible for Medicare and Medicaid. From 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' risk-adjusted home time by 0.33 percentage points (p < 0.001). Compared with residents in ALs without ratings, residents in high-rated ALs (average rating ≥4.4) had a 0.64 pp (p < 0.001) increase in home time.

CONCLUSIONS

Higher online rating scores were positively associated with residents' home time, while the absence of ratings was associated with reduced home time. Our results suggest that online reviews may be a quality signal with respect to home time.

The Credibility of Physician Rating Websites: A Systematic Literature Review

OBJECTIVES

Increasingly, the credibility of online reviews is drawing critical attention due to the lack of control mechanisms, the constant debate about fake reviews and, last but not least, current developments in the field of artificial intelligence. For this reason, the aim of this study was to examine the extent to which assessments recorded on physician rating websites (PRWs) are credible, based on a comparison to other evaluation criteria.

METHODS

Referring to the PRISMA guidelines, a comprehensive literature search was conducted across different scientific databases. Data were synthesized by comparing individual statistical outcomes, objectives and conclusions.

RESULTS

The chosen search strategy led to a database of 36,755 studies of which 28 were ultimately included in the systematic review. The literature review yielded mixed results regarding the credibility of PRWs. While seven publications supported the credibility of PRWs, six publications found no correlation between PRWs and alternative datasets. 15 studies reported mixed results.

CONCLUSIONS

This study has shown that ratings on PRWs seem to be credible when relying primarily on patients' perception. However, these portals seem inadequate to represent alternative comparative values such as the medical quality of physicians. For health policy makers our results show that decisions based on patients' perceptions may be well supported by data from PRWs. For all other decisions, however, PRWs do not seem to contain sufficiently useful data.

Setting goal difficulty in monetary incentives to physicians: evidence from an online health knowledge-sharing platform

Purpose

Prior studies on the impact of incentives on physicians’ online participation mainly focused on different incentives while ignoring the difficulty of setting monetary incentives efficiently. Based on goal-setting theory, the current research examines the relationship between incentives with goals of varying difficulty and professional health knowledge sharing (PHKS) in online health knowledge-sharing platforms (OHKSPs).

Design/methodology/approach

Four field experiments with different monetary incentives were conducted by one of China’s largest OHKSPs, with whom the researchers cooperated in data collection. Monthly panel data on 10,584 physicians were collected from September 2018 to December 2019. There were 9,376 physicians in the treatment group and 1,208 in the control group. The authors used a difference-in-difference (DID) model to explore the research question based on the same control group and the Chow test with seemingly unrelated estimation (sureg) to compare regression coefficients between four groups. Several robustness checks were performed to validate the main results, including a relative time model, multiple falsification tests and a DID estimation using the propensity score matching method.

Findings

The results show that the monetary incentive significantly positively affected the volume of physicians’ PHKS directly with negative spillover to the duration of physicians’ PHKS. Moreover, the positive effect of incentives with higher difficulty on the volume of physicians’ PHKS was significantly smaller than that of incentives with low difficulty. Finally, professional title had a positive moderating effect on the volume of goal difficulty setting and did not significantly moderate the effect on the duration of physicians’ PHKS.

Research limitations/implications

Some limitations of this study are: firstly, because the field experiments were enterprise benefit oriented, the treatment and control groups were not balanced. Secondly, the experiments for different incentive measures were relatively similar, making it challenging to validate a causal effect. Finally, more consideration should be given to the strategy for setting hierarchical incentives in future research.

Originality/value

The research indicates that monetary incentives have a bilateral effect on PHKS, i.e. a positive direct effect on the volume of physicians’ contributions and a negative spillover effect on the duration of physicians’ PHKS. The professional titles of physicians also moderate such bilateral switches of PHKS. Furthermore, when a physician’s energy is limited, the goal difficulty setting of the incentive mechanism tends to be low. The more difficult the incentives are, the more inefficient the effects on physicians’ PHKS will be.

The Impact of Social Influence on the Intention to Use Physician Rating Websites: Moderated Mediation Analysis Using a Mixed Methods Approach

BACKGROUND

Physician rating websites (PRWs) have become increasingly important in the cross-section between health and digitalization. Social influence plays a crucial role in human behavior in many domains of life, as can be demonstrated by the increase in high-profile influential individuals such as social media influencers (SMIs). Particularly in the health-specific environment, the opinion of family and friends has a significant influence on health-related decisions. However, so far, there has been little discussion about the role of social influence as an antecedent of behavioral intention to use PRWs.

OBJECTIVE

On the basis of theories of social psychology and technology acceptance and theories from the economic perspective, this study aimed to evaluate the impact of social influence on the behavioral intention to use PRWs.

METHODS

We conducted 2 studies by applying a mixed methods approach including a total of 712 participants from the Austrian population. The impact of social influence on the behavioral intention to use PRWs was investigated through linear regression and mediation and moderated mediation analysis using the PROCESS macro 4.0 in SPSS 27 (IBM Corp).

RESULTS

The 2 studies show similar results. In study 1, an experiment, no direct effect of social influence on the behavioral intention to use PRWs could be detected. However, an indirect effect of social influence on the behavioral intention to use PRWs via credibility (b=0.572; P=.005) and performance expectancy (b=0.340; P<.001) could be confirmed. The results of study 2, a cross-sectional study, demonstrate that social influence seems to have a direct impact on the behavioral intention to use PRWs (b=0.410; P<.001). However, when calculating the proposed mediation model, it becomes clear that this impact may partly be explained through the 2 mediator variables-credibility (b=0.208; P<.001) and performance expectancy (b=0.312; P<.001). In contrast to the observed direct and indirect effect, neither demographic nor psychographic variables have a significant moderating impact on the influencing chain in study 2.

CONCLUSIONS

This study provides an indication that social influence has at least an indirect impact on the behavioral intention to use PRWs. It was observed that this impact is exerted through credibility and performance expectancy. According to the findings of both studies, social influence has the potential to boost the use of PRWs. As a result, these web-based networks might be a promising future interface between health care and digitalization, allowing health care practitioners to gain a beneficial external impact while also learning from feedback. Social influence nowadays is not just limited to friends and family but can also be exerted by SMIs in the domain of PRW use. Thus, from a marketing perspective, PRW providers could think of collaborating with SMIs, and our results could contribute to stimulating discussion in this vein.

A Theory of Information Compression: When Judgments Are Costly

A Theory of Information Compression: When Judgments Are Costly

How useful to tourists are thousands of reviews of different five-star hotels in a city on a travel website when the mean rating is 4.5, and all the five-star hotels score around the mean? How insightful are reviews of physicians on a physician review website to potential patients when the ratings cluster tightly around an average for all physicians? Are there costs to the physicians, the patients, and to society as a whole? When all the students at a university score “A” grades on most courses, are there consequences for the university, the students, and potential employers? This paper calls the “clustering around a mean” phenomenon “information compression” and the systems in which it occurs (e.g., universities, students, employers) “judgment networks.” When there is extensive information compression in a system, measures such as ratings or grades have little value for decision makers. When all five-star hotels in a city score an average of 4.5 does it really matter which one a traveler chooses? The paper introduces a way of measuring information compression. It also suggests ways for organizations to overcome the negative consequences of information compression for themselves and their various stakeholders.

Should Doctors Open Online Consultation Services? An Empirical Investigation of Their Impact on Offline Appointments

Online healthcare portals have become prevalent worldwide in recent years. One common form of healthcare portal is the online consultation website, which provides a bridge between patients and doctors and reduces patients’ time and cost when seeking healthcare services. Another form is the healthcare service appointment website, which facilitates offline visits for patients. Though nominally separate, the behaviors of the users (including patients and doctors) on these two types of websites could be related to each other. In particular, how does opening online consultation services impact the offline appointments of doctors? Although this is an important question for healthcare portals, doctors, and policy makers, it has not been rigorously examined in the literature. We examine the overall impact of opening online consultation services on offline appointments and show that the number of offline appointments for doctors increases after opening online consultation services. Given that online consultation is a new but important way to connect patients and doctors, our findings provide useful implications for all the stakeholders—doctors, patients, hospitals, and policy makers—regarding how to integrate online and offline channels in the healthcare context.

Investigating the effect of service feedback and physician popularity on physician demand in the virtual healthcare environment

Purpose

This study examines how service feedback and physician popularity affect physician demand in the context of virtual healthcare environment. Based on the signaling theory, the critical factor of environment uncertainty (i.e. disease risk) and its impact on physician demand is also investigated. Further, the research on the endogeneity of online reviews in healthcare is also examined in the current study.

Design/methodology/approach

A secondary data econometric analysis using 3-wave data sets of 823 physicians obtained from two PRWs (Healthgrades and Vitals) was conducted. The analysis was run using the difference-in-difference method to consider physician and website-specific effects.

Findings

The study's findings indicate that physician popularity has a stronger positive effect on physician demand compared with service feedback. Improving popularity leads to a relative increase in the number of appointments, which in turn enhance physician demand. Further, the impact of physician popularity on physician demand is positively mitigated by the disease risk.

Originality/value

The authors' research contributes to a better understanding of the signaling transmission mechanism in the online healthcare environment. Further, the findings provide practical implications for key stakeholders into how an efficient feedback and popularity mechanism can be built to enhance physician service outcomes in order to maximize the financial efficiency of physicians.

Patient Satisfaction Scores Are a Poor Metric of Orthopedic Care

Patient satisfaction scores are a popular metric used to evaluate orthopedic care. There is little consistency with how satisfaction is described in the orthopedic literature. Online physician reviews are a growing trend that directly and indirectly affect a surgeon's reputation. There is little correlation of higher satisfaction with improved surgical outcomes, so rating surgical care may be misguided and possibly dangerous. Patient satisfaction is an important part of the patient-centered care model, so rating systems should directly reflect quality. More research is needed to determine the relationship between patient satisfaction and the delivery of quality care. [Orthopedics. 2022;45(3):e127-e133.].

Physician Gender, Patient Risk, and Web-Based Reviews: Longitudinal Study of the Relationship Between Physicians' Gender and Their Web-Based Reviews

Background

Web-based reviews of physicians have become exceedingly popular among health care consumers since the early 2010s. A factor that can potentially influence these reviews is the gender of the physician, because the physician’s gender has been found to influence patient-physician communication. Our study is among the first to conduct a rigorous longitudinal analysis to study the effects of the gender of physicians on their reviews, after accounting for several important clinical factors, including patient risk, physician specialty, and temporal factors, using time fixed effects. In addition, this study is among the first to study the possible gender bias in web-based reviews using statewide data from Alabama, a predominantly rural state with high Medicaid and Medicare use.

Objective

This study conducts a longitudinal empirical investigation of the relationship between physician gender and their web-based reviews using data across the state of Alabama, after accounting for patient risk and temporal effects.

Methods

We created a unique data set by combining data from web-based physician reviews from the popular physician review website, RateMDs, and clinical data from the Center for Medicare and Medicaid Services for the state of Alabama. We used longitudinal econometric specifications to conduct an econometric analysis, while controlling for several important clinical and review characteristics across four rating dimensions (helpfulness, knowledge, staff, and punctuality). The overall rating and these four rating dimensions from RateMDs were used as the dependent variables, and physician gender was the key explanatory variable in our panel regression models.

Results

The panel used to conduct the main econometric analysis included 1093 physicians. After controlling for several clinical and review factors, the physician random effects specifications showed that male physicians receive better web-based ratings than female physicians. Coefficients and corresponding SEs and P values of the binary variable GenderFemale (1 for female physicians and 0 otherwise) with different rating variables as outcomes were as follows: OverallRating (coefficient –0.194, SE 0.060; P=.001), HelpfulnessRating (coefficient –0.221, SE 0.069; P=.001), KnowledgeRating (coefficient –0.230, SE 0.065; P<.001), StaffRating (coefficient –0.123, SE 0.062; P=.049), and PunctualityRating (coefficient –0.200, SE 0.067; P=.003). The negative coefficients indicate a bias toward male physicians versus female physicians for aforementioned rating variables.

Conclusions

This study found that female physicians receive lower web-based ratings than male physicians even after accounting for several clinical characteristics associated with the physicians and temporal effects. Although the magnitude of the coefficients of GenderFemale was relatively small, they were statistically significant. This study provides support to the findings on gender bias in the existing health care literature. We contribute to the existing literature by conducting a study using data across the state of Alabama and using a longitudinal econometric analysis, along with incorporating important clinical and review controls associated with the physicians.

Choosing a Provider: What Factors Matter Most to Consumers and Patients?

Enhancing consumer and patient choice has been proposed as a means to improve care quality and reduce health-related costs. Choosing a medical provider is one of the most critical and often complex decisions patients make about their health care. We investigated the perceived importance of factors patients may consider when selecting a practitioner and if rated importance of the factors varies with their characteristics and prior experiences with different types of clinicians (physicians, physician assistants, and nurse practitioners). Participants most often identified medical license, certification, and whether the provider accepts the patients’ health insurance as important, while provider type, others’ recommendations, and online reviews were among the least important. We found wide-ranging differences based on patient characteristics. Prior experience with providers was also a strong determinant of patterns of factors patients considered valuable. Policy-makers, health systems, insurers, and providers need to take into account that patients rely on a range of factors that vary based on their distinct needs, backgrounds, and previous experiences—requiring tailored information to make more informed decisions.

Impacts of physician promotion on the online healthcare community: Using a difference-in-difference approach

In this study, we use a difference-in-difference approach to explore how physician promotion, the advancement of a physician's offline reputation, affects patient behavior toward physicians in online healthcare communities; this allows us to explore how patients interpret the signals created by physician promotion. The study sample was collected from over 140,000 physician online profiles after 25 months of continuous observation, with 280 physicians who were promoted at month 13 as the treatment group and a control group obtained by propensity score matching. Our results show that a physician's promotion causes more patients to choose that physician, makes patients willing to give more psychological rewards, and makes them tend to give that physician a higher online rating. This implies that patient behavior is susceptible to the signal of physician promotion because the quality of the physician is unlikely to have changed significantly in the short term. These findings extend prior research on reputation in online communities and have crucial implications for theory and practice.

Comparing the Impact of Online Ratings and Report Cards on Patient Choice of Cardiac Surgeon: Large Observational Study

Background

Patients may use two information sources about a health care provider’s quality: online physician reviews, which are written by patients to reflect their subjective experience, and report cards, which are based on objective health outcomes.

Objective

The aim of this study was to examine the impact of online ratings on patient choice of cardiac surgeon compared to that of report cards.

Methods

We obtained ratings from a leading physician review platform, Vitals; report card scores from Pennsylvania Cardiac Surgery Reports; and information about patients’ choices of surgeons from inpatient records on coronary artery bypass graft (CABG) surgeries done in Pennsylvania from 2008 to 2017. We scraped all reviews posted on Vitals for surgeons who performed CABG surgeries in Pennsylvania during our study period. We linked the average overall rating and the most recent report card score at the time of a patient’s surgery to the patient’s record based on the surgeon’s name, focusing on fee-for-service patients to avoid impacts of insurance networks on patient choices. We used random coefficient logit models with surgeon fixed effects to examine the impact of receiving a high online rating and a high report card score on patient choice of surgeon for CABG surgeries.

Results

We found that a high online rating had positive and significant effects on patient utility, with limited variation in preferences across individuals, while the impact of a high report card score on patient choice was trivial and insignificant. About 70.13% of patients considered no information on Vitals better than a low rating; the corresponding figure was 26.66% for report card scores. The findings were robust to alternative choice set definitions and were not explained by surgeon attrition, referral effect, or admission status. Our results also show that the interaction effect of rating information and a time trend was positive and significant for online ratings, but small and insignificant for report cards.

Conclusions

A patient’s choice of surgeon is affected by both types of rating information; however, over the past decade, online ratings have become more influential, while the effect of report cards has remained trivial. Our findings call for information provision strategies that incorporate the advantages of both online ratings and report cards.

Correlation between social media utilization by academic neurosurgery departments and higher online patient ratings

OBJECTIVE

Patients increasingly utilize online physician review websites (PRWs) and social media to inform healthcare-related decisions. This provides neurosurgeons with opportunities for increased patient engagement. And despite the growing use of social media among neurosurgeons, the relationship between social media utilization and online reviews remains unknown. The goal of this study was to characterize the relationship between social media utilization and PRW ratings across academic neurosurgery departments.

METHODS

Social media accounts (Twitter, Facebook, YouTube, Instagram) of academic neurosurgery departments were identified. Online reviews for individual faculty were obtained from Healthgrades, Vitals, WebMD, and Google. Reviews were aggregated to identify the total number of reviews per department, to generate a composite departmental rating, and to calculate a summed departmental score. US News & World Report (USNWR) and Doximity rankings were recorded for each department. Social media utilization by individual neurosurgeons and associated ratings were investigated within the departments with the highest social media utilization.

RESULTS

Seventy-eight percent of academic neurosurgery departments utilized social media. The most prevalent platform was YouTube (49.1%), followed by Twitter (46.5%), Facebook (38.6%), and Instagram (16.7%). Higher patient ratings on PRWs were associated with the utilization of YouTube (p = 0.048) or Twitter (p = 0.02). The number of social media platforms utilized demonstrated a significant, positive correlation with patient ratings (p = 0.006) and summed patient ratings (p = 0.048). Although USNWR (p = 0.02) and Doximity (p = 0.0008) rankings correlated with patient ratings, only the number of social media platforms utilized remained a significant predictor of patient ratings on multivariate analysis (p = 0.0001). Thirty-one percent of academic neurosurgeons from departments with high social media utilization were active on social media. The most prevalent social media platform among individual neurosurgeons was Twitter (27.4%), followed by Instagram (8.4%), Facebook (4.9%), and YouTube (2.2%). Higher summed patient scores were associated with individual neurosurgeon utilization of YouTube (p = 0.04), Facebook (p < 0.0001), and Instagram (p = 0.01). Increased social media utilization among neurosurgeons was correlated with a greater number of patient reviews (p = 0.006) and higher summed patient scores (p = 0.003). On multivariate analysis, only Facebook use remained a significant predictor of the number of patient reviews received (p = 0.002) and summed patient satisfaction scores (p < 0.001).

CONCLUSIONS

An increased social media presence is associated with higher ratings on PRWs. As neurosurgeons continue to expand their online presence, they should be aware of the possible impact of social media on online patient reviews.

Patient Experience Surveys Reveal Gender-Biased Descriptions of Their Care Providers

Patient experience surveys (PES) are collected by healthcare systems as a surrogate marker of quality and published unedited online for the purpose of transparency, but these surveys may reflect gender biases directed toward healthcare providers. This retrospective study evaluated PES at a single university hospital between July 2016 and June 2018. Surveys were stratified by overall provider rating and self-identified provider gender. Adjectives from free-text survey comments were extracted using natural language processing techniques and applied to a statistical machine learning model to identify descriptors predictive of provider gender. 109,994 surveys were collected, 17,395 contained free-text comments describing 687 unique providers. The mean overall rating between male (8.84, n = 8558) and female (8.80, n = 8837) providers did not differ (p = 0.149). However, highly-rated male providers were more often described for their agentic qualities using adjectives such as "informative," "forthright," "superior," and "utmost" (OR 1.48, p < 0.01)-whereas highly-rated female providers were more often described by their communal qualities through adjectives such as "empathetic," "sweet," "warm," "attentive," and "approachable" (OR 2.11, p < 0.0001). PES may contain gender stereotypes, raising questions about their impact on physicians and their validity as a quality metric which must be balanced with the need for unedited transparency. Future prospective studies are needed to further characterize this trend across geographically and racially diverse healthcare providers.

Psychiatry in the Digital Age: A Blessing or a Curse?

Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.

The impact of social media presence, age, and patient reported wait times on physician review websites for sports medicine surgeons

BACKGROUND

When choosing physicians, patients often review options online via physician review websites, which may influence decisions on providers.

PURPOSE

The purpose of this study is to investigate the impacts of social media usage, age, and patient reported wait times on online ratings for three popular review websites.

STUDY DESIGN

Cross-sectional study.

METHODS

The American Orthopaedic Society for Sports Medicine database was used to extract demographic information for all listed sports medicine surgeons in Florida. Overall ratings, number of ratings and comments, and patient reported wait-times were recorded from three leading review websites (Healthgrades.com, Vitals.com, Google.com). Professionally focused SM accounts were searched for each physician on Facebook.com, Twitter.com, Instagram, and LinkedIn.com.

RESULTS

102 orthopaedic sports medicine surgeons were included. At least one form of social media was used by 62.4% of our cohort. Those with social media had higher overall online physician ratings out of 5.00 across all review websites (Google:4.65vs4.44, p = 0.05; Healthgrades:4.41vs4.15, p = 0.03; Vitals:4.43vs4.14, p = 0.01). In bivariate analysis, older age was associated with lower ratings on Health Grades (Absolute difference (AD) -0.26, p < 0.0001), and social media was linked to higher ratings (Google: AD 0.21, p = 0.05; Healthgrades: AD 0.26, p = 0.03; Vitals: AD 0.29, p = 0.008). Longer wait times were associated with lower ratings in a dose-dependent manner in both bivariate and multivariable analysis.

CONCLUSIONS

Social media use among sports medicine surgeons correlated with higher overall physician ratings. Potentially, younger surgeons increase social media use because of a heightened concern for online image, whereas older surgeons may have less value in using online platforms to capitalize on an online presence. Older age and increased patient reported wait times in office had a negative correlation with online reviews, which highlights that factors beyond the surgeon's skill sets can influence overall ratings.

Building a Multidisciplinary Academic Surgical Gender-affirmation Program: Lessons Learned

Background:

Every day, we see more patients present to hospitals and clinics seeking gender-affirmation care to ameliorate the symptoms of gender dysphoria. However, to provide a multidisciplinary approach, it is important to offer an integrated clinical program that provides mental health assessment, endocrine therapy, physical therapy, research, and the full spectrum of surgical services devoted to transgender patients. This article describes our experience on building a specialized, multidisciplinary, academic state-of-the-art gender-affirmation program.

Methods:

Herein, we describe the main and critical components on how to build a multidisciplinary academic gender-affirmation program. We share our lessons learned from this experience and describe how to overcome some of the obstacles during the process.

Results:

Building a multidisciplinary academic gender-affirmation program requires an invested team, as each and every member is essential for feedback, referrals, and to improve patient’s experience. Institutional support is essential and by far the most important component to overcome some of the obstacles during the process. Having all team members working under the same institution provides all the critical components needed to improve outcomes and patient satisfaction. In addition, the collection of prospective data with a well-structured research team will provide information needed to improve clinical services and standardize clinical protocols, while leaving space for innovation.

Conclusions:

This article describes the steps and experience needed to build a multidisciplinary holistic academic gender-affirmation program. We provide our lessons learned during the process that will help guide those who intend to start an academic gender-affirmation program.

Analysis of Online Urologist Ratings: Are Rating Differences Associated With Subspecialty?

Patients are increasingly using online rating websites to obtain information about physicians and to provide feedback. We performed an analysis of urologist online ratings, with specific focus on the relationship between overall rating and urologist subspecialty. We conducted an analysis of urologist ratings on Healthgrades.com. Ratings were sampled across 4 US geographical regions, with focus across 3 practice types (large and small private practice, academic) and 7 urologic subspecialties. Statistical analysis was performed to assess for differences among subgroup ratings. Data were analyzed for 954 urologists with a mean age of 53 (±10) years. The median overall urologist rating was 4.0 [3.4-4.7]. Providers in an academic practice type or robotics/oncology subspecialty had statistically significantly higher ratings when compared to other practice settings or subspecialties (P < 0.001). All other comparisons between practice types, specialties, regions, and sexes failed to demonstrate statistically significant differences. In our study of online urologist ratings, robotics/oncology subspecialty and academic practice setting were associated with higher overall ratings. Further study is needed to assess reasons underlying this difference.

Correlation of Online Physician Rating Subscores and Association With Overall Satisfaction: Observational Study of 212,933 Providers

BACKGROUND

Online physician rating websites commonly ask consumers to rate providers across multiple physician-based (eg, spending sufficient time, listening) and office-based (eg, appointment scheduling, friendliness) subdimensions of care in addition to overall satisfaction. However, it is unclear if consumers can differentiate between the various rated subdimensions of physicians. It is also unclear how each subdimension is related to overall satisfaction.

OBJECTIVE

The objectives of our study were to determine the correlation of physician-based and office-based subdimensions of care and the association of each with overall satisfaction.

METHODS

We sampled 212,933 providers from the Healthgrades website and calculated average provider metrics for overall satisfaction (likelihood to recommend doctor), physician-based subdimensions (trust in physician, ability to explain, ability to listen and answer questions, and spending adequate time), and office-based subdimensions (ease of scheduling, office environment, staff friendliness, and wait time). We used Spearman rank correlation to assess correlation between subdimension ratings. Factor analysis was used to identify potential latent factors predicting overall satisfaction. Univariate and multivariable linear regression were performed to assess the effect of physician and office-based factors on overall satisfaction.

RESULTS

Physician-based metrics were highly correlated with each other (r=.95 to .98, P<.001), as were office-based metrics (r=.84 to .88, P<.001). Correlations between physician-based and office-based ratings were less robust (r=.79 to .81, P<.001). Factor analysis identified two factors, clearly distinguishing between physician-based metrics (factor loading = 0.84 to 0.88) and office-based metrics (factor loading = 0.76 to 0.84). In multivariable linear regression analysis, the composite factor representing physician-based metrics (0.65, 95% CI 0.65 to 0.65) was more strongly associated with overall satisfaction than the factor representing office-based metrics (0.42, 95% CI 0.42 to 0.42). These factors eclipsed other demographic variables in predicting overall satisfaction.

CONCLUSIONS

Consumers do not differentiate between commonly assessed subdimensions of physician-based care or subdimensions of office-based care, but composite factors representing these broader categories are associated with overall satisfaction. These findings argue for a simpler ratings system based on two metrics: one addressing physician-based aspects of care and another addressing office-based aspects of care.

Academic Rhinologists' Online Rating and Perception, Scholarly Productivity, and Industry Payments

INTRODUCTION

The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.

METHODS

Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.

RESULTS

A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender (p = 0.58), geographic quartile (p = 0.48), social media presence (p = 0.41), or attending top-ranked medical school (p = 0.86) or residency programs (p = 0.89). Years of practice negatively correlated with RS (R = -0.22, p<0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively (p = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (p<0.01) and H-index (p = 0.02).

CONCLUSION

Academic rhinologists' online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.

Radiation Oncologist Perceptions and Utilization of Digital Patient Assessment Platforms

BACKGROUND

Patient engagement is increasing in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, data remains insufficient regarding how these evaluations impact radiation oncologists.

OBJECTIVES

The purpose of this study was to assess radiation oncologists worldwide on their awareness and noted effects of digital patient assessment platforms.

METHODS

An electronic survey was delivered to 6,199 members of the American Society of Radiation Oncology. Subjects were radiation oncologists practicing throughout the world. The survey consisted of 14 questions focused on demographics, practice details, patient volume, institutional utilization of patient reviews, and perceptions of radiation oncologists on health care reviews provided by patients.

RESULTS

There were 447 responses from practicing radiation oncologists in total, 321 (72%) of which are in the US. Most respondents (228; 51%) either agreed or strongly agreed that patients consider online reviews when deciding which physician to visit. Of all respondents, 188 (42%) reported that their institution checks their online feedback, whereas 157 (36%) and 99 (22%) respectively reported not knowing, or to their knowledge their institution does not check their online feedback. Respondents who saw more than the average number of consults per week were significantly more likely to receive negative feedback (P = 0.005). Forty-five percent of respondents agreed or strongly agreed that online virtual assessment tools contribute to physician burnout. Respondents (100; 22%) who received inappropriate or misdirected feedback were significantly more likely to report that virtual reviews contribute to burnout (P = 0.001).

CONCLUSIONS

Radiation oncologists need to be aware that self-reported patient assessments are a data point in the quality of a physician and health care establishment. To best ensure appropriate feedback of a physician's capabilities as a doctor, leadership and employee alignment for patient experience are now more important than ever.

Factors Associated With the Actual Behavior and Intention of Rating Physicians on Physician Rating Websites: Cross-Sectional Study

BACKGROUND

Although online physician rating information is popular among Chinese health consumers, the limited number of reviews greatly hampers the effective usage of this information. To date, little has been discussed on the variables that influence online physician rating from the users' perspective.

OBJECTIVE

This study aims to investigate the factors associated with the actual behavior and intention of generating online physician rating information in urban China.

METHODS

A web-based cross-sectional survey was conducted, and the valid responses of 1371 Chinese health consumers were recorded. Using a pilot interview, we analyzed the effects of demographics, health variables, cognitive variables, and technology-related variables on online physician rating information generation. Binary multivariate logistic regression, multiple linear regression, one-way analysis of variance analyses, and independent samples t test were performed to analyze the rating behavior and the intentions of the health consumers. The survey instrument was designed based on the existing literature and the pilot interview.

RESULTS

In this survey, 56.7% (778/1371) of the responders used online physician rating information, and 20.9% (287/1371) of the responders rated the physicians on the physician rating website at least once (posters). The actual physician rating behavior was mainly predicted by health-related factors and was significantly associated with seeking web-based physician information (odds ratio [OR] 5.548, 95% CI 3.072-10.017; P<.001), usage of web-based physician service (OR 2.771, 95% CI 1.979-3.879; P<.001), health information-seeking ability (OR 1.138, 95% CI 0.993-1.304; P=.04), serious disease development (OR 2.699, 95% CI 1.889-3.856; P<.001), good medical experience (OR 2.149, 95% CI 1.473-3.135; P<.001), altruism (OR 0.612, 95% CI 0.483-0.774; P<.001), self-efficacy (OR 1.453, 95% CI 1.182-1.787; P<.001), and trust in online physician rating information (OR 1.315, 95% CI 1.089-1.586; P=.004). Some factors influencing the intentions of the posters and nonposters rating the physicians were different, and the rating intention was mainly determined by cognitive and health-related factors. For posters, seeking web-based physician information (β=.486; P=.007), using web-based medical service (β=.420; P=.002), ability to seek health information (β=.193; P=.002), rating habits (β=.105; P=.02), altruism (β=.414; P<.001), self-efficacy (β=.102; P=.06), trust (β=.351; P<.001), and perceived ease of use (β=.275; P<.001) served as significant predictors of the rating intention. For nonposters, ability to seek health information (β=.077; P=.003), chronic disease development (β=.092; P=.06), bad medical experience (β=.047; P=.02), rating habits (β=.085; P<.001), altruism (β=.411; P<.001), self-efficacy (β=.171; P<.001), trust (β=.252; P<.001), and perceived usefulness of rating physicians (β=.109; P<.001) were significantly associated with the rating intention.

CONCLUSIONS

We showed that different factors affected the physician rating behavior and rating intention. Health-related variables influenced the physician rating behavior, while cognitive variables were critical in the rating intentions. We have proposed some practical implications for physician rating websites and physicians to promote online physician rating information generation.

Understanding Physicians’ Online-Offline Behavior Dynamics: An Empirical Study

Online healthcare platforms allow physicians and patients to communicate in a timely manner. Yet little is known about how physicians’ online and offline activities affect each other and, consequently, the healthcare system. We collected data from both online and offline channels to study physicians’ online-offline behavior dynamics. We find that physicians’ online activities can lead to a higher service quantity in offline channels, whereas offline activities may reduce physicians’ online services because of resource constraints. We also find that the more offline patients that physicians serve, the more articles the physicians will likely share in online healthcare platforms. These findings are of great importance to practitioners and policy makers. Our work provides evidence that online healthcare platforms supplement offline services and thus lessen the concern that physicians’ participation in online healthcare platforms will negatively influence offline healthcare services. Our findings also indicate the need for the improvement of online-offline coordination and better system design.

Association Between Web-Based Physician Ratings and Physician Disciplinary Convictions: Retrospective Observational Study

BACKGROUND

Physician rating websites are commonly used by the public, yet the relationship between web-based physician ratings and health care quality is not well understood.

OBJECTIVE

The objective of our study was to use physician disciplinary convictions as an extreme marker for poor physician quality and to investigate whether disciplined physicians have lower ratings than nondisciplined matched controls.

METHODS

This was a retrospective national observational study of all disciplined physicians in Canada (751 physicians, 2000 to 2013). We searched ratings (2005-2015) from the country's leading online physician rating website for this group, and for 751 matched controls according to gender, specialty, practice years, and location. We compared overall ratings (out of a score of 5) as well as mean ratings by the type of misconduct. We also compared ratings for each type of misconduct and punishment.

RESULTS

There were 62.7% (471/751) of convicted and disciplined physicians (cases) with web-based ratings and 64.6% (485/751) of nondisciplined physicians (controls) with ratings. Of 312 matched case-control pairs, disciplined physicians were rated lower than controls overall (3.62 vs 4.00; P<.001). Disciplined physicians had lower ratings for all types of misconduct and punishment-except for physicians disciplined for sexual offenses (n=90 pairs; 3.83 vs 3.86; P=.81). Sexual misconduct was the only category in which mean ratings for physicians were higher than those for other disciplined physicians (3.63 vs 3.35; P=.003).

CONCLUSIONS

Physicians convicted for disciplinary misconduct generally had lower web-based ratings. Physicians convicted of sexual misconduct did not have lower ratings and were rated higher than other disciplined physicians. These findings may have future implications for the identification of physicians providing poor-quality care.

Influence of Health Literacy on Effects of Patient Rating Websites: Survey Study Using a Hypothetical Situation and Fictitious Doctors

Background

Physician rating websites (PRWs) are a device people use actively and passively, although their objective capabilities are insufficient when it comes to judging the medical performance and qualification of physicians. PRWs are an innovation born of the potential of the Internet and boosted very much by the longstanding policy of improving and encouraging patient participation in medical decision-making. A mismatch is feared between patient motivations to participate and their capabilities of doing so well. Awareness of such a mismatch might contribute to some skepticism of patient-written physician reviews on PRWs.

Objective

We intend to test whether health literacy is able to dampen the effects that a patient-written review of a physician’s performance might have on physician choice.

Methods

An experiment was conducted within a survey interview. Participants were put into a fictitious decision situation in which they had to choose between two physicians on the basis of their profiles on a PRW. One of the physician profiles contained the experimental stimulus in the form of a friendly and a critical written review. The dependent variable was physician choice. An attitude differential, trust differential, and two measures of health literacy, the newest vital sign as an example of a performance-based measure and eHealth Literacy Scale as an example of a perception-based measure, were tested for roles as intermediary variables. Analysis traced the influence of the review tendency on the dependent variables and a possible moderating effect of health literacy on these influences.

Results

Reviews of a physician’s competence and medical skill affected participant choice of a physician. High health literacy dampened these effects only in the case of the perception-based measure and only for the negative review. Correspondingly, the effect of the review tendency appeared to be stronger for the positive review. Attitudes and trust only affected physician choice when included as covariants, considerably increasing the variance explained by regression models.

Conclusions

Findings sustain physician worries that even one negative PRW review can affect patient choice and damage doctors’ reputations. Hopes that health literacy might raise awareness of the poor basis of physician reviews and ratings given by patients have some foundation.

Online ratings of spinal deformity surgeons: analysis of 634 surgeons

STUDY DESIGN

Observational study.

OBJECTIVE

To evaluate the online ratings of spine deformity surgeons and variables that may affect online ratings Physician review websites (PRW) continue to be an emerging trend in the US across all specialties. Previous literature with smaller sample sizes revealed that most spine surgeons are rated on at least on PRW. To date, the online ratings of spinal deformity surgeons have not been evaluated.

MATERIALS AND METHODS

A review of the 2017 Scoliosis Research Society (SRS) Fellowship directory for active fellows and candidate members yielded 634 active members. Online ratings from five PRWs were recorded and scaled from 0 to 100. Using SPSS, one-way analysis of variance was used to compare differences between multiple groups. A t test was used to compare differences between two groups. Significance was set at p < 0.05.

RESULTS

Most surgeons (98.7%) were rated on at least one PRW. Surgeons in academic or hospital practice had higher ratings than those in private practice (83.4 vs. 78.8, and 83.7 vs. 78.8, p < 0.001). Surgeons with 0-5-year experience had higher ratings than more experienced surgeons (p < 0.001). However, surgeons in practice for 0-5 years also had fewer reviews than their more experienced colleagues (p < 0.05). We found no differences in ratings based on sex, specialty, or region. The largest differences in ratings between high and poorly rated spine surgeons was in areas pertaining to the doctor-patient relationship (answering questions, time spent with the patient).

CONCLUSION

The majority (98.7%) of SRS surgeons are rated on at least one PRW. SRS surgeons in practice between 0 and 5 years have higher ratings than more experienced surgeons, but were rated by fewer patients than their more experienced counterparts. Higher ratings were associated with variables pertaining to the patient-doctor relationship.

LEVEL OF EVIDENCE

IV.

The Impact of Online Health Information on Patient Health Behaviours and Making Decisions Concerning Health

The number of Internet users searching for health-related issues increases significantly every year. The aim of this study was to investigate whether and how the information about health and disease obtained from the Internet by patients influenced them and how different e-health services can affect the patients' choice of the doctor. The research was based on a national survey conducted among 1000 Polish adults. The study was carried out with the use of the computer-assisted telephone interviews (CATI). The study showed that e-health facilities are increasingly affecting the patient's choice of doctor. Among the highest rated factors, the possibility of setting the date of appointment online and practice's own website were indicated. Information on health and disease obtained from the Internet influenced respondents in many areas. Almost half of health Internet users (HI-users) wanted to change their diet and increase healthy physical activity under the influence of health information obtained online. Regarding health decision making, health information obtained from the Internet caused 45% of HI-users to make an appointment to see a doctor, and 40% of them had questions concerning diagnosis and treatment. Information on health and disease obtained from the Internet undoubtedly affects patient behaviour and health decisions they make.

Patients' Online Perception and Ratings of Neurotologists

OBJECTIVES

To assess and characterize patients' online ratings and comments of neurotologists and determine factors that correlate with higher ratings.

METHODS

All the American Neurotology Society members were queried on Healthgrades, Vitals, RateMDs, Yelp, and Google from March to June 2018. All ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and for positive/negative aspect.

RESULTS

Of the 560 American Neurotology Society members, 465 (83%) were rated on at least one online platform. Of those rated, 420 (90%) were on Healthgrades, 392 (84%) on Vitals, 283 (61%) on RateMDs, 232 (50%) on Google, and 56 (12%) on Yelp. Across all platforms, the average overall rating was 4.06 ± 0.68 (range: 1.00-5.00). There were significant positive correlations between overall rating and specific ratings (p < 0.01) on individual topics. Moreover, categorizing 5,317 narrative comments elicited the majority to be related to perceived physician bedside manner and clinical outcome. Although the number of positive comments outnumbered the negative ones, only the negative comments correlated (negatively) with the overall score (p < 0.01). Attending a top 25- or 50-medical schools or residency programs did not correlate with their rating.

CONCLUSIONS

Online ratings and comments for neurotologists are highly dependent on patient perceptions of physician competence, caring bedside manner, and office management. Minimizing the number of negative comments, especially regarding perceived physicians' professionalism and communication, clinical outcome, bedside manners, and office management, leads to higher calculated overall scores and online perception.

A Comparison of Online Physician Ratings and Internal Patient-Submitted Ratings from a Large Healthcare System

BACKGROUND

Physician online ratings are ubiquitous and influential, but they also have their detractors. Given the lack of scientific survey methodology used in online ratings, some health systems have begun to publish their own internal patient-submitted ratings of physicians.

OBJECTIVE

The purpose of this study was to compare online physician ratings with internal ratings from a large healthcare system.

DESIGN

Retrospective cohort study comparing online ratings with internal ratings from a large healthcare system.

SETTING

Kaiser Permanente, a large integrated healthcare delivery system.

PARTICIPANTS

Physicians in the Southern California region of Kaiser Permanente, including all specialties with ambulatory clinic visits.

MAIN MEASURES

The primary outcome measure was correlation between online physician ratings and internal ratings from the integrated healthcare delivery system.

RESULTS

Of 5438 physicians who met inclusion and exclusion criteria, 4191 (77.1%) were rated both online and internally. The online ratings were based on a mean of 3.5 patient reviews, while the internal ratings were based on a mean of 119 survey returns. The overall correlation between the online and internal ratings was weak (Spearman's rho .23), but increased with the number of reviews used to formulate each online rating.

CONCLUSIONS

Physician online ratings did not correlate well with internal ratings from a large integrated healthcare delivery system, although the correlation increased with the number of reviews used to formulate each online rating. Given that many consumers are not aware of the statistical issues associated with small sample sizes, we would recommend that online rating websites refrain from displaying a physician's rating until the sample size is sufficiently large (for example, at least 15 patient reviews). However, hospitals and health systems may be able to provide better information for patients by publishing the internal ratings of their physicians.

The Influence of Physician Information on Patients' Choice of Physician in mHealth Services Using China's Chunyu Doctor App: Eye-Tracking and Questionnaire Study

BACKGROUND

Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services "to your fingertips." However, it also brings information overload and makes the patient's choice of physician more difficult.

OBJECTIVE

This study aimed to identify the types of physician information that play a key role in patients' choice of physician and to explore the mechanism by which this information contributes to this choice.

METHODS

Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients' choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients' choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model.

RESULTS

The results of Study 1 revealed that seven types of physician information played a key role in patients' choice of physician. The results of Study 2 revealed that (1) physicians' profile photo information affected patients' choice of physician by positively influencing affective trust (P<.001); (2) physicians' nonprofile photo information affected patients' choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients' choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients' choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively).

CONCLUSIONS

Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients' trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients' choice of physician.

Online Ratings of Neurosurgeons: An Examination of Web Data and its Implications

BACKGROUND

Patient satisfaction ratings are increasingly used for hospital rankings, referral base and physician reimbursement. As such, online physician rating websites (PRWs) are quickly becoming a topic of interest.

OBJECTIVE

To analyze the distribution of neurosurgeons' ratings on the 3 most widely used PRWs, and examine factors associated with positive and negative ratings.

METHODS

We used a key term search to identify board-certified neurosurgeons on 3 widely used PRWs: RateMD.com, Healthgrades.com, and Vitals.com. Data were collected on average rating and number of ratings. Demographic, training-related and practice-related data, as well as location of practice, and place of training were also collected.

RESULTS

Data was non-normally distributed (P < .001 for all 3). Having fewer reviews was associated with higher variance in ratings between PRWs for a given surgeon (odds ratio 0.99, P = .001). All surgeons below the 25th percentile with respect to the number of reviews that had been written about them were eliminated. Of the remaining surgeons (n = 3054), the median composite score was 4.11 out of 5, interquartile range (3.69, 4.44). Surgeons had higher median modified composite scores if they were fellowship-trained (P = .0001) or graduated from a top 25 medical school (P = .0117), but not if they graduated from a top 25 residency (P = .1056). Surgeons located in major cities had higher median composite scores (P = .0025).

CONCLUSION

Online ratings for neurosurgeons must be evaluated in context. Median ratings are generally high, but variable between websites. Median scores also vary among regions and practice settings. Higher scores were associated with ranking of medical school, recent graduation, and fellowship training completion.

Is There an Association Between Physician Review Websites and Press Ganey Survey Results in a Neurosurgical Outpatient Clinic?

OBJECTIVE

Recent studies suggest a poor association between physician review websites and the validated metrics used by the Centers for Medicare and Medicaid Services. The purpose of this study was to evaluate the association between online and outpatient Press Ganey (PG) measures of patient satisfaction in a neurosurgical department.

METHODS

We obtained PG survey results from one large academic institution's outpatient neurosurgery clinic. Popular physician review websites were searched for each of the faculty captured in the PG data. Average physician rating and percent Top Box scores were calculated for each physician. PG data were separated into new and established clinic visits for subset analysis. Spearman's rank correlation coefficients were calculated to determine associations.

RESULTS

Twelve neurosurgeons were included. Established patients demonstrated greater PG scores as compared with new patients, with an average physician rating increase of 0.55 and an average Top Box increase of 12.5%. Online physician ratings were found to demonstrate strong agreement with PG scores for the entire PG population, new patient subset, and established patient subset (ρ = 0.77-0.79, P < 0.05). Online Top Box scores demonstrated moderate agreement with overall PG Top Box scores (ρ = 0.59, P = 0.042), moderate agreement with the new patient population Top Box scores (ρ = 0.56, P = 0.059), and weak agreement with established patient population Top Box scores (ρ = 0.38, P = 0.217).

CONCLUSIONS

Our findings demonstrated a strong agreement between PG ratings and online physician ratings and a poorer correlation when comparing PG Top Box scores with online physician Top Box scores, particularly in the established patient population.

Online Ratings of Urologists: Comprehensive Analysis

Background

Physician-rating websites are being increasingly used by patients to help guide physician choice. As such, an understanding of these websites and factors that influence ratings is valuable to physicians.

Objective

We sought to perform a comprehensive analysis of online urology ratings information, with a specific focus on the relationship between number of ratings or comments and overall physician rating.

Methods

We analyzed urologist ratings on the Healthgrades website. The data retrieval focused on physician and staff ratings information. Our analysis included descriptive statistics of physician and staff ratings and correlation analysis between physician or staff performance and overall physician rating. Finally, we performed a best-fit analysis to assess for an association between number of physician ratings and overall rating.

Results

From a total of 9921 urology profiles analyzed, there were 99,959 ratings and 23,492 comments. Most ratings were either 5 (“excellent”) (67.53%, 67,505/99,959) or 1 (“poor”) (24.22%, 24,218/99,959). All physician and staff performance ratings demonstrated a positive and statistically significant correlation with overall physician rating (P<.001 for all analyses). Best-fit analysis demonstrated a negative relationship between number of ratings or comments and overall rating until physicians achieved 21 ratings or 6 comments. Thereafter, a positive relationship was seen.

Conclusions

In our study, a dichotomous rating distribution was seen with more than 90% of ratings being either excellent or poor. A negative relationship between number of ratings or comments and overall rating was initially seen, after which a positive relationship was demonstrated. Combined, these data suggest that physicians can benefit from understanding online ratings and that proactive steps to encourage patient rating submissions may help optimize overall rating.

Understanding Your Online Ratings: A Methodological Analysis Using Urogynecologists in the United States

OBJECTIVE

The influence of online physician ratings is growing, yet their interpretation remains difficult. Our aim was to analyze the online content of urogynecologists on 1 website to transform these ratings into practical tools for care improvement.

METHODS

This cross-sectional analysis studied the ratings and reviews of every board-certified urogynecologist listed on Healthgrades.com. The ratio of 5:1 ratings was compared between various physician characteristics and practice qualities. Four investigators classified narrative reviews into one or more of the following themes: about the (1) physician, (2) clinical outcomes, (3) and/or staff. The content of the narrative reviews was analyzed, and word clouds were created to understand the primary motivators behind ratings.

RESULTS

In February 2018, the Healthgrades pages for 689 urogynecologists were evaluated, and 523 physicians were included in the study. Higher 5:1 ratios were found among men versus women (4.0 vs 3.0; P < 0.01), and OB-GYN-trained versus urology-trained (4.0 vs 2.2; P < 0.01) physicians. A benchmarking rubric was developed to illustrate the 5:1 ratio distribution for all physicians stratified by number of ratings. A total of 3300 narrative reviews were assigned themes with strong inter- and intrarater reliability (Table 3). Physician qualities most influenced extreme scores (1 or 5 stars), whereas average reviews were more influenced by staff. Commonly discussed physician qualities included professionalism, time with patient, and counseling.

CONCLUSIONS

Using the 5:1 rating ratio and simplified review themes as tools, physicians can understand what their ratings signify both as an indicator of their online reputation compared with their peers and as a means for improving the patient experience.