Staff and Office Factors May Negatively Affect Online Ratings for Spine Surgeons

Peer Reviewed

Spine surgeons are more likely to receive positive online ratings for factors pertaining to their individual skills—such as competence and likeability/character—while negative comments are more likely to be related to their office staff interactions, billing, and office environment, according to an observational study published online ahead of print in Spine. In addition, a second study by the same researchers found that social media presence on Facebook, Twitter, and Instagram increases the number of ratings/comments but not overall scores on physician review websites, as reported online ahead of print in The Spine Journal.
Social media tablet icons.“Social media gives a practice and the surgeon a unique opportunity to connect with potential patients and engage them in a way that is personable and educational." Photo Source:“While social media is considered merely an entertainment platform for some, surgeons should appreciate the value of this direct to consumer marketing,” said lead author Chester J. Donnally, III, MD, Chief Resident, Orthopedic Surgery, at the University of Miami Hospital. “Social media gives a practice and the surgeon a unique opportunity to connect with potential patients and engage them in a way that is personable and educational. It is a platform to display the spine surgeon’s expertise, and provides a venue to help educate patients about various treatment options.”

In both studies, the researchers analyzed online reviews and social media presence of over 200 spine surgeons who are members of the North American Spine Society (133-137 orthopedic surgeons; 77-78 neurosurgeons).

Physician Rating Sites

Comments from the following physician rating sites were reviewed: Vitals (2,839 comments [60.4%]), Healthgrades (1,214 comments [25.8%]), and Google (648 comments [13.8%]). Nearly 90% of comments pertained to surgeon-dependent comments (competence and likeability/character) and the remaining 10% pertained to surgeon-independent comments (ie, office staff, ease of scheduling, and office environment).

“Currently, this is the largest review of internet comments and surgeons, and is the only medical study to have evaluated Google as a healthcare review site,” Dr. Donnally said.

The highest ratings (5 stars) were more commonly associated with surgeon-dependent comments compared to surgeon-independent comments (P<0.001). The lowest ratings were more commonly associated with surgeon-independent comments including wait times, interactions with office staff, and practice characteristics.

“In a profession that relies on referrals, it is imperative that the entire team works together to maximize patient satisfaction,” Dr. Donnally told SpineUniverse. “We found that online review scores are not just based on surgical outcomes and physician likeability. Yes, these traits are by far the most important factors in healthcare, but other variables such as the attitude of the front desk staff, wait times, and perceived fairness in billing are all factors that patients will write reviews about.”

“It is difficult for the surgeon to experience many of these independent variables as he or she does not have to navigate through a new office complex/hospital, interact with the front desk staff, spend significant time in the waiting room, and be interviewed by a series of nurses/physician assistants,” Dr. Donnally said. “Instead, the surgeon should directly ask his/her patients if there were difficulties with the office appointment or surgical scheduling. The surgeon should encourage the patient take an active role in billing prior to undergoing a surgical procedure in an attempt to provide more transparency for the patient.”

Spine Surgery Practices Should Be Mindful of Rating Site Scores, Experts Say

Commenting on the article, Donald S. Corenman, MD, DC, said that physician review sites “can be helpful to convey information involving the overall patient experience regarding interaction with doctors and their offices. In fact, it is not uncommon that rating sites play a major role in patients’ choice of which physician to consult.”

“It is true, however, that a negative office experience can overshadow a positive doctor-patient interaction,” said Dr. Corenman, Orthopaedic Spine Surgeon at The Steadman Clinic in Vail, CO, and SpineUniverse editorial board member. “The competency of the physician may not affect the negative impression an unhelpful staff member may convey to the patient. I would also agree that waiting time can play a major role in the negative experience of the global interaction.”

“Unfortunately, these physician rating sites allow great power for a single unhappy patient,” Dr. Corenman added. “One sole disgruntled patient can input multiple reviews to undermine a physician’s reputation.”

“It is quite clear that not only is safe, high-quality care mandatory for physicians, but customer service and the associated skill of service recovery are increasingly critical elements of a successful spine practice,” commented Joshua M. Ammerman, MD, who is a Neurosurgeon at Washington Neurosurgical Associates in Washington, DC, and a SpineUniverse editorial board member. “This element of the doctor-patient relationship falls upon both the provider and their staff; often, patients have greater interaction with proactive staff then they do with the actual provider.”

“The front desk is the face and voice of your spine practice,” Dr. Ammerman noted. “On-line physician rating services are notoriously biased toward the negative (it is human nature to complain more often than to compliment) and often contain artificial reviews to attempt to achieve balance. Physicians are greatly handicapped in their ability to address negative reviews due to HIPAA. Nonetheless, patients do review these sites and make decisions based upon them.”

“As such, it is important for physician practices to remain mindful about internet presence and experience scores,” Dr. Ammerman said. “These patient experience scores are a growing component of at-risk hospital revenue for government insurers and certainly someday will affect physician reimbursement as well.”

The Impact of Social Media Presence in Spine Surgery Practices

In the study of social media presence, 39% of spine surgeons had at least one social media account on Facebook (35%), Twitter (10%), or Instagram (0.5%). Physicians with these accounts had a significantly greater number of ratings and comments on physician rating websites (Vitals, Healthgrades, and Google; P<0.05).

Wait times of >30 minutes were significantly associated with worse overall scores (–1.68) across all three review sites on multivariate analysis compared with a wait time of 0–10 minutes (P<0.0011). On Vitals ratings only, each 10-year increment in surgeons’ age was associated with 0.1-point decrease in rating (P=0.02). Overall ratings between all three physician rating websites were significantly positively correlated (P<0.001).

“For better or worse, it does not appear that a social media account (Facebook, Instagram, Twitter) has an impact on physician online scores when we looked at three of the more common online review sites,” Dr. Donnally said. “We did find that those with a social media account, had more total comments on his or her online review site profiles. This might indicate a higher level of patient feedback and interaction for surgeons that are routinely trying to connect with their patients online.”

How Should Surgeons Successfully Use Social Media

Dr. Corenman emphasized the value of using social media sites to educate the patient. “There is precious little time during the office visit to inform and then reinforce the information the patient needs to gather about the surgical decision, let alone know the potential risks and benefits of surgery. A social media site filled with the surgeon’s educational material with references to expectations, surgical success rates, post-operative rehabilitation, and risks/benefits is quite valuable to the patient’s experience,” he said.

“In addition, in the legal arena, information the patient is ‘required to review’ on the social media site allows the surgeon to document the risks and benefits in this portion of the patient interview as informed consent, essentially making this information part of the patient’s chart,” Dr. Corenman noted.

Dr. Ammerman, Dr. Corenman, and Dr. Donnally have no relevant disclosures.

Updated on: 03/15/19
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Half of Patients Expect Physicians, Nurses to Protect Them Against Hospital Shootings
Chester “Chet” Donnally, III, MD
Chief Resident
Orthopaedic Surgery
University of Miami
Joshua M. Ammerman, MD
Washington Neurosurgical Associates
Washington, DC
Donald S. Corenman, MD, DC
Orthopaedic Spine Surgeon and Chiropractor
The Steadman Clinic
Vail, CO

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