Patients rarely use online ratings to pick physicians

But experts say online word-of-mouth is still considered a powerful tool, as people look for personal stories when learning about a new doctor.

By — Posted June 23, 2008

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For all the concern and mistrust over physician rating sites, recent research shows that, for now, few patients are using them to decide where to get their care.

A Harris Interactive poll commissioned by the California HealthCare Foundation found that although more than 80% of the state's adults turn to the Internet for health-related information, less than one-quarter have looked at physician ratings sites. Only 2% of those surveyed made a change in physicians based on information posted on a rating site.

That lack of reliance on ratings is not limited to choosing a physician. The survey, released in June, also found that only 1% of respondents made a change in their hospital or health plan based on ratings sites devoted to those entities.

To some, the numbers indicate that it may be a long time before physician rating sites catch on, if ever. To others, the numbers indicate that the market is new and that in time, use of the sites will grow as their information becomes more robust, or as insurers apply more pressure on members to use them through tiered networks. In such networks, health plan members pay less out of pocket for seeing physicians who meet the insurer's quality criteria, which doctors generally have criticized as faulty.

But even if rating sites aren't catching fire right now, experts say that doesn't mean that physicians shouldn't worry about their online reputations.

Word-of-mouth has long been considered the best -- and most critical -- advertisement, and that communication is happening on the Web, particularly on sites that are dedicated to specific diseases or conditions, experts say. The foundation survey discovered that the most frequent reason for using the Internet for health was finding information about specific diagnoses or symptoms.

"Certainly a professional should be concerned with online reputations regardless of rating sites," said John Grohol, PsyD, a psychologist from Newburyport, Mass., who runs the patient Web site Psych Central, dedicated to mental health issues.

"At the end of the day, people talk about two extremes in the field," Grohol said. "Really great, expert doctors who are collaborative with their patients and know the condition inside and out and understand the patient's needs. And the other side is really negative doctors that don't listen to patients and patients who have had a negative experience."

Lack of information

Indeed, more people are looking at physician rating sites than they were three years ago, even if a relative few take action with information from those sites.

According to the survey of 1,007 Californians conducted by Harris Interactive between Nov. 5, 2007, and Dec. 17, 2007, the number of people who said they had looked at physician rating sites grew from 14% in 2004 to 22% in 2007. The percentage of people who considered a change in doctors because of those sites increased from 2% to 5% in the same period. The percentage of people who did make a change increased from 1% to 2%.

The survey did not report why consumers did or did not rely on ratings. But Maribeth Shannon, director of the market and policy program at the California HealthCare Foundation, said that based on comments from those surveyed and other research, patients won't rely on a site if they aren't finding information specific enough to their needs.

For example, she said, much of the growth in physician ratings sites has come from health plans pushing a consumer-driven approach to health care. But although scores relating to quality and safety mean something to the insurers, they don't mean as much to patients, because they use proprietary metrics to measure quality -- metrics that aren't shared with anyone, Shannon said.

Most experts agree that people relate to personal stories more than numbers when it comes to using the Web to find a physician.

Gilles Frydman, founder of the Web site, which stands for the Assn. of Cancer Online Resources, said one of the first things some people do after being diagnosed with a rare disease is to go online and look for support and recommendations for a doctor. But many times they also get advice on who not to see, he said.

Cheryl Greene, along with her husband, pediatrician Alan Greene, MD, founded the Web site in 1995. The site added a physician rating portion after receiving requests from parents.

Greene said the response has been small, as most people look to change doctors only when they have either moved or experienced some other life change, including a major illness for which they need a specialist. "If people are happy, if they aren't sick and don't need help, they aren't looking for a doctor."

Dr. Greene is a clinical professor of pediatrics at Stanford University School of Medicine.

Watching ratings sites

Still, organized medicine and others are keeping a critical eye on physician rating sites.

The AMA has monitored the practice and has opposed it in some cases. For example, it joined with medical societies in Missouri to roll back a plan offered by UnitedHealth Group that would have used claims data to rank physicians.

Last year, New York Attorney General Andrew Cuomo, with advisement from the AMA, threatened to sue several large plans for the way they were constructing their tiered networks. An agreement between the plans and the state placed regulations on the creation of the networks.

Several plans agreed to apply similar regulations in other states. Those regulations included using quality measures for rankings instead of costs, allowing physicians to see the basis for the ratings, and giving physicians the right to appeal. This follows AMA policy passed in 2005 relating to principles and guidelines for pay-for-performance programs, which use quality rankings.

Meanwhile, the Connecticut State Medical Society is involved with an aggregation project that is combining data from all of the state's health plans. This way, patients don't get "small snapshots of physician practice patterns" that might not portray an accurate picture, said Angelo Carrabba, MD, the society's president and an ob-gyn from Rocky Hill, Conn.

Also of concern are insurer-based sites, such as the Healthcare Scoop published by Blue Cross Blue Shield of Minnesota, and other online forums that allow patients to post unfiltered comments about their doctors.

"Some allow postings to be published anonymously, and there is no guarantee that the opinions about a physician even come from that physician's patient," said Nancy H. Nielsen, MD, PhD, then president-elect of the AMA, in a statement to AMNews.

"Online opinions of physicians should be taken with a grain of salt, and should certainly not be a patient's sole source of information when looking for a new physician," she said.

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Lack of influence

A California HealthCare Foundation survey found that while more consumers are looking at physician ratings online, the overwhelming majority don't. And very few people use the ratings to make health care decisions.

Saw ratings aboutConsidered changeMade a change
Health plans27%/26%5%/4%1%/1%

Source: California HealthCare Foundation, "Just Looking: Consumer Use of the Internet to Manage Care." Harris interactive survey of 1,007 adult Californians from Nov. 5 to Dec. 17, 2007

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Healthy surfing

A California HealthCare Foundation survey found that 80% of the state's consumers used the Internet for health-related purposes.

Find information on specific medical conditions or drugs51%56%
Find a physician in a health plan network23%32%
Review claims or obtain benefit information19%34%
Find ratings of physicians or other health professionals19%26%
Fill a prescription9%12%
Get advice from a doctor via e-mail8%13%
Make an appointmentN/A13%
Purchase health insuranceN/A10%

Source: California HealthCare Foundation, "Just Looking: Consumer Use of the Internet to Manage Care." Harris Interactive survey of 1,007 adult Californians from Nov. 5 to Dec. 17, 2007

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Consumers mostly ignore ratings

Surveys have found that online ratings have only a small effect on nonmedical purchasing decisions.

MusicReal estateCell phone
Used Internet in product research56%49%39%
Said online information had a major impact on decision7%11%10%
Posted a rating or comment online after purchase5%4%3%

Source: Pew Internet and American Life Project, "The Internet and Consumer Choice: Online Americans use different search and purchase strategies for different goods," May 18. Results based on telephone interviews conducted Aug. 3 to Sept. 5, 2007, among 2,400 adults 18 and older. Margin of error is 2 percentage points.

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