Online reviews of spine surgeons—Staff and office factors may negatively affect ratings

Spine surgeons earn high ratings for their skill and good clinical outcomes on internet review sites -but are more likely to receive negative ratings and comments on factors pertaining to clinic staff, billing, and wait times, reports a landmark study in Spine.

As online reviews and ratings become increasingly influential on healthcare decisions, surgeons and physicians need to account for the full range of factors that affect the patient care experience, according to new research, led by Chester J. Donnally III, MD, and colleagues of University of Miami Hospital. "As the leader of the healthcare team, surgeons should continue to take an active role in modifying factors a patient perceived as negative, even if these do not directly relate to the physician," Dr. Donnally comments.

Fewer 'Stars' for Office/Staff Factors versus Surgeon Factors

The researchers analyzed the patient ratings of 210 Florida spine surgeons from three physician rating websites: Healthgrades, Vitals, and Google. Healthgrades and Vitals are dedicated healthcare review sites, while Google is a newer outlet for physician reviews. Including a total of 4,701 comments, the study is the largest evaluation of physician website reviews to date. About 60 percent of comments were from Vitals, 26 percent from Healthgrades, and 14 percent from Google.

About 90 percent of the comments were classified as related to the surgeon's competence or surgical outcomes (type 1) or the surgeon's character and communication ability (type 2). In these areas, ratings were highly positive. On Vitals, 5-star ratings accounted for 89 percent of type 1 comments and 63 percent of type 2 comments. Ratings in these areas on Healthgrades and Google were also strongly positive.

The remaining 10 percent of comments were related to "surgeon-independent" factors, such as the office staff, office environment, or billing (type 3). Most ratings for these factors were also positive. About 57 percent of ratings were 4 or 5 stars on Vitals, with a similar pattern for the other sites.

However, it was noted that negative comments and scores were more likely to pertain to office staff, physician assistants, or the office environment (type 3) than they were factors such as outcomes and surgeon character. The percentage of 1-star ratings for type 3 comments was 33 percent on Vitals, 28 percent on Healthgrades, and 20 percent on Google. On statistical analysis, ratings for these type 3 comments averaged about 2 to 2.5 "stars" lower than for type 1 comments.

"Physician review websites continue to grow in popularity, guiding patients to specific healthcare providers, for better or for worse," according to Dr. Donnally. The study sought to clarify why patients leave comments on review sites and how certain types of comments affect a physician's overall score—focusing on spine surgeons. The results show that comments directed to surgeon-dependent factors are predominantly positive, while factors not directly pertaining to the surgeon are more likely to be negative.

"Negative scores and reviews originating from this source may be particularly frustrating to the surgeon who otherwise has optimal patient outcomes," Dr. Donnally and coauthors comment. "However, these 'surgeon-independent' factors likely should be attributed to the surgeon's overall care in that physicians largely influence staff hiring, compensation, office morale, and scheduling decisions."

The researchers point out some limitations of their study—including ongoing questions about the validity and fairness of online physician review sites. However, the finding that comments about surgeon-independent factors are more likely to lead to lower ratings "should alert healthcare providers to the importance of factors such as office environment, parking, ease of scheduling, and ancillary staff interactions," Dr. Donnally and colleagues conclude.