Choosing a physician in the Yelp era

In early 2013, my sister gave birth to twins in Austin, TX, and I made plans to visit soon thereafter.* Born at 37 weeks gestation, the babies were healthy and were discharged from the hospital on schedule. By day five, they were scheduled for their first visit with the pediatrician, and I agreed to accompany my sister to mitigate any anxiety about visiting a new physician.

The appointment went smoothly. A friendly staff person greeted us, we did not wait long, and the office was clean. The pediatrician examined my sister’s twins and explained that their slight weight loss was within the normal range; otherwise, they were growing as expected. He was confident, had good bedside manner, and gave us specific, clear instructions about feeding, sleeping habits, and potential problems.

My sister was new to the Austin area, so I wondered how she had selected him among hundreds of other local pediatricians. She said that she chose him after reading what several patients wrote on Yelp.com, a user-based review website of local businesses and services. I was not surprised by this revelation in light of what I learned in the process of writing a recent manuscript on online physician reviews.1 I explained that physicians often have only a few reviews available on websites like Yelp, and it is unclear whether the sites accurately reflect health care professionals’ skills or expertise. She then asked a simple question: “Well, how do you suggest I find the best pediatrician in Austin, Texas?” Despite being a physician and health services researcher, I did not have a simple answer.

Growing trend

In medicine, the “best” is difficult to define. One could argue that performance level may be determined by reputation, years of experience, patient satisfaction, or a predetermined quality metric, such as clinical process or outcome measures. The government, insurers, professional organizations, and for-profit companies have tried to determine the best mix of these of variables. The problem is that the average health care consumer does not know what validated metrics are or where to find them.

On the other hand, physician review websites (PRWs), with user-generated ratings, are easily accessible to anyone with minimal Internet experience. Considering that Yelp recently announced 108 million unique views in the second quarter of 2013, it is clear that online reviews represent the latest step in the evolution of word-of-mouth marketing.1 Given the prevalence of informational asymmetry in the health care system, it is natural for patients to seek reviews about their health care providers. In response to this demand, PRWs have rapidly multiplied.

Even though many health care practitioners do not want to be rated on a PRW, most are, in fact, ranked or have their basic information featured on at least one site.2 According to recent data from the Pew Research Center (PRC), 20 percent of Internet users have visited PRWs, but only 2 or 3 percent have submitted reviews.3 A recent poll by the University of Michigan Health System, Ann Arbor, found that 25 percent of parents (n=2,137) consider online ratings a very important tool when finding a pediatrician.4 Furthermore, 30 percent of these parents selected a pediatrician based on favorable online ratings, whereas 30 percent have also ruled out a physician because of poor ratings.

These numbers may not seem impressive in comparison with the recent Yelp announcement or with the PRC finding that 80 percent of Internet users have read online reviews for product or service information. Still, it should be assumed that PRWs and their users will continue to grow. Jha and colleagues demonstrated that physicians assessed on RateMDs.com (one of the earliest PRWs) escalated from 2,475 in 2005 to 112,024 in 2010.5

Although the potential for increased use of PRWs exists, the research remains limited, as outlined by the following questions:

  • Do patients use PRWs to gather facts (such as a physician’s office location and hours) or subjective information?
  • Do PRWs affect how patients select a physician?
  • Do the reviews affect patient perceptions about a physician with whom they have a longstanding relationship?

For other products and services, studies have shown that online reviews play an important role in consumer behavior. It is unknown at this point if these online reviews also relate to how patients respond to physicians.

The arguments for and against PRWs are straightforward. Advocates contend that PRWs represent the patient’s experience, yield physician feedback, and use easy-to-understand metrics. Critics, however, maintain that these websites are unreliable for the following reasons: they feature too few reviews, the authenticity of the reviews is unverifiable, the information may be inaccurate or outdated, and patient complaints may be associated with factors that are out the physician’s control or unrelated to clinical competence, such as rude office staff.

Although PRW metrics are less than comprehensive and may be inaccurate measures of physician skill, these sites have successfully accomplished what government agencies and professional organizations have been unable to do—broadly disseminate user-friendly, search engine-optimized information on physician quality. The merits of these sites may be debatable, but as more patients are drawn to PRWs, physicians and professional organizations will be challenged to eventually accept them or provide an alternative that is just as accessible, understandable, and applicable to all physicians. Despite millions of dollars in grant funding directed toward developing instruments to measure quality, no alternative to the PRW currently exists. Although outcomes research is certainly important, without wide public dissemination of results by researchers, the private market will maintain a stronghold in this domain. If no alternative is developed and current PRWs gain greater acceptance over time, more patients may be encouraged to submit reviews, thereby creating larger samples and potentially more reliable reviews.

Regarding my sister’s initial question, I decided to use several popular PRWs to look up pediatricians in Austin, TX. The top-rated group had only 14–20 reviews. I asked if she was happy with her current choice, and she confirmed that she had no plan to switch. Relieved I did not have to make a decision that could potentially affect the twins’ health for the next 18 years, I turned my attention to a less critical issue: namely, where to eat dinner. With little hesitation, we picked the best Tex-Mex restaurant around—the one with 598 positive reviews on Yelp.


*Editor’s note: In this article, the first-person references are those of Dr. Ellimoottil.


References

  1. Yelp. Overview. Press release. Available at: http://www.yelp-press.com/phoenix.zhtml?c=250809&p=irol-press. Accessed September 23, 2013.
  2. Ellimoottil C, Hart A, Greco K, Quek ML, Farooq A. Online reviews of 500 urologists. J Urol. 2013;189(6):2269-2273.
  3. Fox S, Duggan M. Pew Internet and American Life Project. Health online 2013. Available at: http://www.pewinternet.org/Reports/2013/Health-online.aspx. Accessed February 7, 2013.
  4. University of Michigan. C.S. Mott Children’s Hospital. How to select a child’s doctor? Parents prefer grapevine to online. Available at: http://mottnpch.org/reports-surveys/how-select-child%E2%80%99s-doctor-parents-prefer-grapevine-online. Accessed February 22, 2013.
  5. Gao GG, McCullough JS, Agarwal R, Jha AK. A changing landscape of physician quality reporting: Analysis of patients’ online ratings of their physicians over a 5-year period. J Med Internet Res. 2012;14(1):e38.

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