National College of Physicians
National College of Physicians
physicians

Rating Websites Add Stress For Physicians, Provide Little Evidence

Despite the expansion of commercial physician rating websites, adequate information about individual physicians on commercial rating websites is woefully lacking, according to a research letter published online February 21.

By Diana Swift

Despite the expansion of commercial physician rating websites, adequate information about individual physicians on commercial rating websites is woefully lacking, according to a research letter published online February 21.

Researchers led by Tara Lagu, MD, MPH, an assistant professor at Tufts University in Medford and a scientist at the Center for Quality of Care Research in Springfield, Massachusetts, found that despite increasing consumer demand for online information to help them choose a physician or provide ratings on their existing physician, search mechanisms for commercial websites hosted by private companies were cumbersome, and per physician reviews were very few in number.

In an analysis of 28 commercial physician rating websites, the team found serious information gaps on such private websites as Healthgrades.com, Vitals.com, ComapreHealthCare.com, and RateMDs.com.

The researchers used publicly available lists of registered and active physicians to identify a random sample of 600 physicians across 13 specialties — 200 from each of three cities, Boston, Massachusetts; Portland, Oregon; and Dallas, Texas. They then searched each website for reviews and calculated the average and median number of reviews per physician per site.

Across the 28 websites, the authors found 8133 quantitative reviews (ie, reviews ranking physicians by number of stars); 1784 of these reviews also included narrative comments on physicians. Among the qualities reviewed were physician availability and punctuality, staff characteristics, bedside manner, time spent with patient, and communication.

Among physicians with at least one review on any website, the median number was seven reviews (interquartile range, 2 - 20 reviews) per physician across all sites, whereas many physicians had only one review anywhere, and 34% had no review on any site.

Furthermore, few sites permitted searching by clinical condition (18%), sex of physician (14%), hospital affiliation (54%), languages spoken (11%), or insurance accepted (32%).

"[T]hese results demonstrate that it is difficult for a prospective patient to find (for any given physician on any commercial physician-rating website) a quantity of reviews that would accurately relay the experience of care with that physician," the authors write.

"Methods that use systematic data collection (eg, surveys) may have a greater chance of amassing a sufficient quantity and quality of reviews to allow patients to make inferences about patient experience of care."

The authors noted that methods for publishing patient feedback more scientifically are under development, and some healthcare systems are starting to report quantitative reviews and narrative comments from surveys of patient experience. "Because of the scarcity of reviews on commercial sites, one of these other methods of publishing patient feedback may emerge as the dominant route by which patients seek reviews about physicians," Dr Lagu and associates write.

However, a new study suggests that patients and physicians view such internally generated data differently. Physicians generally consider data posted on health system websites to be more credible than reviews on private sites, whereas consumers place more trust in information from private, independent websites.

For the study, Alison Holliday, MPH, a student at Harvard Medical School in Boston, Massachusetts, and colleagues examined both physician and patient attitudes to rating websites in 2 cross-sectional electronic and paper surveys from 2015. Their sample included 828 physicians (mean age, 49 years) affiliated with one of four hospitals in a large healthcare network in eastern Massachusetts, as well as 494 patients (mean age, 66 years) receiving care in this system in May 2015.

The researchers found that 53% of physicians and 39% of patients had visited a website at least once. Younger physicians were more likely to visit a rating website.

In terms of the accuracy of health system vs commercial website data, 53% of physicians believed numerical data from health system patient experience surveys were more accurate, and 62% believed patient narrative comments from such surveys were more accurate vs 36% for both numerical and narrative comments from private websites.

In contrast, patients more often reported trust in data from independent websites: 57% vs 45% for health system patient experience surveys.

In another divergence, 21% of physicians vs 51% of patients favored posting open-ended narrative comments online for consumers. About a third (34%) of physicians felt such posting would have a negative effect on healthcare overuse, and 33% felt it would negatively affect patient-reported experiences of care. Of surveyed patients, 29% believed posting narrative comments would cause them to be less candid.

The researchers also found 78% of physicians felt that publicizing physician ratings and patient comments by healthcare systems will have a negative effect on physician job stress, and 46% felt it would have a negative effect on physician–patient relationships.

Patients and physician views also differed on whether physician ratings should be shared on public websites, with more patients than physicians supporting publicly available data on health system–based patient experience.

Holliday and colleagues note that survey-based numerical ratings and narrative comments have been collected as part of internal quality improvement programs, but have been available online only at the hospital or physician group practice level. Now health systems are starting to post numerical ratings and free-text comments at the individual physician level.

The authors contend that publicly available data could improve healthcare quality and make patients better-informed consumers. They noted that more than half of patients supported such availability, whereas a quarter felt that sharing ratings online would improve the physician–patient relationship, and a third expected patient experience of healthcare would improve.

"Our study stresses the importance of monitoring the impact of independent and health system physician rating websites on both physicians and patients," the authors write.