How Much Weight Should Otolaryngologists Give Physician Rankings?

The American Film Institute’s 100 greatest American movies of all time; People’s Sexiest Man Alive; Forbes’ World’s Most Powerful Celebrities list: It’s human nature to love lists. But when it comes to raking America’s top doctors, feathers can get ruffled. For one thing, as powerful as Jennifer Lopez or Oprah Winfrey may be, they certainly aren’t responsible for making life-and-death decisions. And, second, because the methodology used to rank physicians is predominantly subjective, assessing how “good” a doctor is calls into play many different factors that aren’t easily quantifiable. Here, we examine both peer-nominated and patient-nominated ranking and tell you what you need to know.

According to Jeffrey Segal, MD, founder and CEO of Medical Justice Services, a legal consulting firm for physicians in Greensboro, N.C., patients have always sought advice when selecting physicians. The difference now, he said, is that instead of solely asking family or friends for advice, people are increasingly turning to the Internet for guidance. “Prospective searchers qualify their doctors,” said Dr. Segal. “They rely heavily on advice from friends and family. But, second to that, they’re searching online for reviews. The world is changing, and doctors need to pay attention.” While he feels that patient-review sites may not hold as much sway as peer-review sites, “user-generated content is beginning to have a more prominent effect.” (For more on how patients use social media as a health resource, see “Cyber Connections” in ENT Today, October 2012, p. 22.)

By nature, both peer-generated and patient-generated reviews and rankings are subjective, but that doesn’t mean that a savvy otolaryngologist should discount them or their impact.

Peer-Generated Rankings

One of the most prominent of peer-generated rankings is U.S. News Top Doctors, which was developed in collaboration with Castle Connolly Medical Ltd., publisher of America’s Top Doctors. Designed to mimic how physicians offer referrals, the list is compiled by licensed doctors, each of whom nominates up to 10 other doctors in their own specialty and up to three per specialty in other areas. Last July, ABC News aired a special report investigating the validity of “top doctor” mentions and interviewed John Connolly, president and CEO of Castle Connolly. Of their selection process, he said: “We have a research team of 11 people who work full time who check on the backgrounds, education and disciplinary records” to complement the peer nominations.

The system may seem sound, but problems can arise. Hospitals looking to increase their standing within the community, especially in competitive markets, tout “top doctor” mentions, and may spend a great deal of effort getting as many of their doctors ranked as possible. ABC News reported on an anonymous hospital employee who claimed that $300 gift cards were offered to the first 100 doctors to nominate their peers for a Castle Connolly top doctor award. While this is probably not the norm, it does underscore the fact that the process may not be entirely unbiased.