Study finds little consistency in doctor reviews on three physician rating websites

"Consumer-driven healthcare and an increasing emphasis on quality metrics have encouraged patient engagement in the rating of healthcare. As such, online physician rating websites have become mainstream and may play a potential role in future healthcare policy," said Benedict Nwachukwu, MD, MBA, who presented the findings at the American Academy of Orthopaedic Surgeons Annual Meeting in San Diego on March 14.

Doctor rating sites have become a popular outlet for patients to express their satisfaction or dissatisfaction. They've also been shown to influence physician selection. HSS researchers set out to evaluate online ratings for orthopedic sports medicine surgeons, determine predictors of positive ratings, and see if there was a correlation in scores posted on three popular websites: Healthgrades.com, Vitals.com and Ratemds.com.

"Although it is debatable whether these websites in their current form truly capture patient satisfaction and objectively evaluate the delivery of care, they represent a potential tool for both payors and healthcare systems to gauge how surgeons are assessed by their patients," said Anil Ranawat, MD, senior investigator and a sports medicine surgeon at HSS. "Historically, three key qualities -- affability, availability and ability, known as the 'three As' -- have been suggested to promote a successful surgical career and favorable interactions with patients."

To identify surgeons for the study, researchers accessed the online member directory of The American Orthopaedic Society for Sports Medicine. Their query in May 2015 yielded 2,813 entries. Investigators selected every tenth surgeon profile on a continuous basis and came up with 275 sports medicine surgeons to include in their study.

The researchers compiled data on years in practice, location, academic affiliation and ratings for each surgeon on the three websites. Patients' written comments were categorized as relating to surgeon competence, affability and the process of care delivery.

Investigators discovered a low degree of correlation in ratings for individual surgeons on the different websites, an important finding that had not been previously demonstrated, according to Dr. Nwachukwu.

With respect to factors that appeared to influence ratings, being female was a significant predictor of higher ratings on Healthgrades. Surgeons with an academic affiliation were also more likely to receive higher overall ratings.

A physician's online and social media presence, including Facebook, Twitter and possession of a personalized website, did not influence the strength of ratings on Healthgrades, Vitals or Ratemds. Surprisingly, across all three websites, an increased number of years in practice generally led to lower ratings.

Out of 2,341 written comments that were analyzed, perceived surgeon competence and communication skills influenced the scores for the highest and lowest-rated surgeons, but did not affect scores for those with average ratings.

"Surgeons with the highest and lowest ratings were significantly more likely to receive comments about their competence or affability," said Dr. Nwachukwu. "As such, it appears that even in the modern era, and with the adoption of online rating mechanisms, the traditional three As of 'availability, affability and ability' still hold sway."

"Online rating websites are for-profit business enterprises, which at this point demonstrate significant growth potential," said Dr. Ranawat. "However, the low degree of correlation between these websites is concerning. It also questions the collective utility of these sites and potentially demonstrates the individually capricious nature of online physician reviews."

The variation in ratings among the sites may be explained by an insufficiency of reviews necessary to appropriately grade a surgeon, according to the researchers, who noted that the number of reviewers needed to improve reliability is unclear and may warrant further investigation. The researchers also indicated that the study was somewhat limited by the data available -- online surgeon reviews may not represent an accurate appraisal of surgeon quality. In addition, it's not possible to determine if the ratings were posted by actual patients. It was beyond the scope of the study to determine the veracity of the reviews.

"An understanding of the factors that influence online physician ratings may have important implications for sports medicine surgeons, and for physicians in other specialties, as well," Dr. Nwachukwu concluded. "Perhaps more attention should be paid to improving the validity of online ratings for assessing quality and the outcome of care provided."