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.

Additionally, not every doctor in the U.S. is analyzed by U.S. News Top Doctors. The publication’s website states that “Castle Connolly has identified more than 31,000 excellent doctors. But with close to 800,000 physicians in America, more are surely worthy of the recognition. In pockets of the country, a Top Doctor has yet to be identified, in some cases because an insufficient number of nominations have been submitted.”

Pete Batra, MD, FACS, associate professor and co-director of the comprehensive skull base program in the department of otolaryngology-head and neck surgery at the University of Texas Southwestern Medical Center in Dallas, feels that just because a doctor is on a list doesn’t make him or her a top doctor. “While there is some value to certain publications where peers identify colleagues whom they feel are the best, this is only one metric. There are so many metrics to identify physicians who are good at what they do.”

Patient Review Sites

Online reviews of hotels and restaurants are ubiquitous and have arguably made these industries better. Yet doctors have yet to register a fraction of the number of reviews found online for those services—an inherent flaw when a prospective patient is searching for guidance online. Sites abound that offer users reviews and rakings (such as HealthGrades.com, RateMD.com and Angie’s List.), but the doctors who are listed tend to have a handful of reviews, a majority of which are positive.

In a study published last year in the Journal of Medical Internet Research, researchers concluded that, despite the overall positive reviews given to physicians by patients, a “few of these ‘reviews’ have become an outlet for patients who are dissatisfied for not getting what they want despite receiving appropriate medical care. Even worse, some [negative] reviews are believed to be acts of sabotage from competing providers or organizations” (J Med Internet Res. 2011;13(4):e95). Some physicians have attempted legal action against negative reviewers—an act that surely doesn’t instill confidence in the reviewer.

Take Control

It’s imperative for otolaryngologists who value their online reputation to take the initiative, said Dr. Segal. “Control what the world is reading about you online,” he added. In fact, Medical Justice offers a system called eMerit that gives doctors an iPad that allows their patients to review their experience immediately upon completion of their visit.

Nevertheless, despite every caution, the old adage holds true: You can’t please all of the people all of the time. But in the world of online reviewing, this is actually a good thing, said Dr. Segal. “We did a study that concluded that if a doctor received 100 percent positive reviews, the public perceived it as solely marketing material. People understand that these reviews are subjective and that everyone is different.”

Ultimately, said Dr. Batra, it’s up to doctors to communicate to potential patients that reviews, both peer-and patient-driven, should be only one of several factors taken into consideration when selecting a physician: “Rankings or reviews shouldn’t be used in lieu of collective expertise or a physician’s qualifications. They should be used to support the decision-making process.”