American College of Physicians: Internal Medicine — Doctors for Adults ®


Patients examine doctors through online rating services

From the December ACP Observer, copyright 2006 by the American College of Physicians.

By Bonnie Darves

Physicians are facing demands for transparency from a new constituency—patients who want to hear from other patients before choosing a doctor.

Services that rate and publish patient ratings of physicians are cropping up in various forms. DrScore, for example, is a new service that employs sophisticated survey techniques and information technology to deliver reports and ratings on physicians. Free-form Web sites, such as, let patients go online to rate their physicians in the same way they would rate products or retailers. Many also have forums for sharing patient experiences, whether positive or negative.

Even HealthGrades, the country's largest healthcare ratings organization, has added patient responses to the satisfaction surveys it uses to compile its physician profiles.

"We are definitely in an age of transparency and accountability, so we can't just sit with our arms folded and act as if it's not happening," said Samantha Collier, MACP, HealthGrades' vice president of medical affairs. "It [experience rating] is subjective, and it scares some physicians because it deals with their reputations. But I think there is merit in knowing what patients think, and physicians need to understand that patients expect things from us that we don't deliver."

Physician concerns

Some internists are concerned that the necessarily subjective nature of patient ratings could skew individual internists' ratings. Like most consumers, patients tend to be more vocal about negative experiences than positive ones, and the opinions of a small sampling of dissatisfied patients could paint a misleading picture.

However,'s co-founder John Swapceinski said that 71% of patient-posted ratings on its site are positive. Likewise, DrScore reports that internists rated via its survey program have an average overall rating of seven out of 10 in areas such as office personnel and physician manner; access to appointment and wait times; and communication regarding recommended treatment and care plans, among others.

Similarly, two-thirds of the 41,000 patients who participated in HealthGrades' September 2006 survey said that their physicians helped them understand their medical condition and that they would recommend their doctor to family or friends.

But even positive comments can confound satisfaction ratings, some physicians contend, as patients tend to rate their doctors highly when there's good rapport, even if the practice is inefficiently run.

"Those are issues with any survey, and the subjective nature of the patient-visit [experience] means that any 'score' might not reflect the true experience," said Daniel G. Federman, FACP, professor of medicine at Yale University School of Medicine and firm chief in primary care at the VA Medical Center in West Haven, Conn.

A patient who had to wait a long time to see a doctor might give a receptionist low marks, for example, but not the physician. And patients have different ideas of what constitutes poor service. One might be angry about being asked to wait 24 hours for an acute-care appointment, while another might deem such service adequate or good.

A value for physicians?

For most physicians, patient-ratings services have yet to register on their radar screens. But some are curious about the trend and some view the services as a potential tool for growing their practices.

The subjective or potentially misleading nature of patient ratings doesn't mean that "the patient-experience information isn't valuable," noted Dr. Federman, a member of DrScore's advisory. Knowing what patients think about things like wait times can be invaluable to a solo practitioner who often does not have time to supervise staff closely or notice what's going on in the waiting room, he explained.

Ultimately, said some observers, physicians should use patients' ratings, satisfaction reports and self-generated profiles to market their practices and enable prospective patients to make more informed choices.

That was the idea behind DrScore, said Steven Feldman, MD, a Winston-Salem, N.C. dermatologist who created the online service. "I think it's in physicians' best interest to let the world know what—and how—they're doing," he said. "This [satisfaction data] could be good information to have on hand when practices are negotiating rates with insurers."

Dr. Collier of HealthGrades said she understands physicians' skepticism. "It's a new mindset for us in medicine to be judged publicly." But, she added, "This isn't going away, and internists who are doing a good job should leverage it and push out that information."

Bonnie Darves is a free-lance writer in Lake Oswego, Ore.


Physician rating services on the rise (An online-only feature of ACP Observer)

Patient ratings of physicians are gaining popularity as a way of helping consumers make informed choices. Here are some of the latest entrants to the field: (Sites will open in a new bowser window, and are not endorsed by the American College of Physicians.)

DoctorScorecard. This site enables users to give their physicians on overall one to 10 "star" rating and to provide individual ratings on nursing and office staff, appointment availability and waiting time, cost and medical equipment. Raters' comments and names are included.

DrScore. This new service represents a twist on traditional patient-satisfaction surveys. Physician subscribers (the fee is $99 annually for an individual physician, with a price break for groups), hand out cards in their offices encouraging patients to go online to complete satisfaction surveys anonymously. Results-the survey covers a range of areas, from doctor, exam, communication and timeliness ratings to treatment success-are collected into quarterly reports for physicians. Overall scores are posted for anyone to view but detailed feedback is given only to subscribing physicians. To date, about 4,100 internists have been rated. Started in 2004 by a Rochester, N.Y., software engineer who previously launched a professor-rating site called RateMDs enables patients to gauge their own physicians and view all posted reviews at no charge. As of mid-October, about 36,000 physicians had been rated on knowledge, helpfulness, punctuality and overall quality. Site operators reserve the right to delete comments not related to professionalism. Physicians may reply to ratings on the site and may request that posted comments be considered for removal, but they cannot insist on removal of either comments or their names.

Vimo. This site, which bills itself as "comparison shopping for health" and links to health coverage product sales, encourages consumers to rate any physician they choose on five areas: knowledge and skill, availability, punctuality, personal skills and office staff. The rating system employs the five-star method (with one being lowest and five highest); comments are posted in full and are accompanied by the patient's (or rater's) name and place of residence.


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