Association Between Physician Online Rating and Quality of Care

Abstract

Background: Patients are increasingly using physician review websites to find "a good doctor." However, to our knowledge, no prior study has examined the relationship between online rating and an accepted measure of quality.

Objective: The purpose of this study was to assess the association between online physician rating and an accepted measure of quality: 30-day risk-adjusted mortality rate following coronary artery bypass graft (CABG) surgery.

Methods: In the US states of California, Massachusetts, New Jersey, New York, and Pennsylvania-which together account for over one-quarter of the US population-risk-adjusted mortality rates are publicly reported for all cardiac surgeons. From these reports, we recorded the 30-day mortality rate following isolated CABG surgery for each surgeon practicing in these 5 states. For each surgeon listed in the state reports, we then conducted Internet-based searches to determine his or her online rating(s). We then assessed the relationship between physician online rating and risk-adjusted mortality rate.

Results: Of the 614 surgeons listed in the state reports, we found 96.1% (590/614) to be rated online. The average online rating was 4.4 out of 5, and 78.7% (483/614) of the online ratings were 4 or higher. The median number of reviews used to formulate each rating was 4 (range 1-89), and 32.70% (503/1538) of the ratings were based on 2 or fewer reviews. Overall, there was no correlation between surgeon online rating and risk-adjusted mortality rate (P=.13). Risk-adjusted mortality rates were similar for surgeons across categories of average online rating (P>.05), and surgeon average online rating was similar across quartiles of surgeon risk-adjusted mortality rate (P>.05).

Conclusions: In this study of cardiac surgeons practicing in the 5 US states that publicly report outcomes, we found no correlation between online rating and risk-adjusted mortality rates. Patients using online rating websites to guide their choice of physician should recognize that these ratings may not reflect actual quality of care as defined by accepted metrics.

Keywords: cardiac surgery; online reviews; physician quality.

Figure 1

Average online rating versus risk-adjusted mortality rate. Ratings are out of 5.

Figure 2

Risk-adjusted mortality rate, by average online rating. Note that the categories of average online rating differ in size. Error bars indicate 95% CIs, which vary in magnitude due to the number of ratings in each category (n=13 for 1.00-2.99, n=94 for 3.00-3.99, n=324 for 4.00-4.99, and n=159 for 5.00). Ratings are out of 5. There were no significant differences between the groups (P>.05).