Physician Choice Making and Characteristics Associated With Using Physician-Rating Websites: Cross-Sectional Study

Background Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. Objective To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. Methods This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. Results In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be demonstrated for female participants (P<.001), those who were widowed (P=.01), covered by statutory health insurance (P=.02), and with higher health care utilization (P<.001). Health care utilization was significantly associated with all dependent variables in our multivariate logistic regression models (P<.001). Furthermore, significantly higher scores could be shown for health insurance status in the unweighted and Internet use in the weighted models. Conclusions Neither health policy makers nor physicians should underestimate the influence of physician-rating websites. They already play an important role in providing information to help patients decide on an appropriate physician. Assuming there will be a rising level of public awareness, the influence of their use will increase well into the future. Future studies should assess the impact of physician-rating websites under experimental conditions and investigate whether physician-rating websites have the potential to reflect the quality of care offered by health care providers.

[1] Have you ever used the internet to find information about a physician?
Yes No [2] Which sources do you use when searching for a physician? [multiple response possible] Recommendations from family, friends or colleagues Printed business directories (e.g., yellow pages) Information from (professional) journals and newspapers Online-physician directories / physician rating websites Online-search engines (e.g., Google) Recommendations from your ( Physician rating websites provide a variety of information about a physician. There is information about the physician himself (e.g., age, gender, languages, nationality, education) as well as about the practice in general (e.g., consultation hours, equipment, parking spaces). Additionally other patients' rating results are indicated. The illustration below shows an exemplary physician's profile from the website jameda.
[9] Of what importance is the information listed in the following for you when choosing a physician?
No importance Very high importance Pictures of furnishing and equipment Physician's education (e.g., university) Gender Accessibility by public transport Technical equipment (e.g., MRT, CT, 3D-ultrasound) Physician's further training Proximity between practice and my place of residence Consultation hours Physician's specialization Picture of the physician Parking spaces Other patients' opinions about this physician Scientific publications Map and directions Some physician rating websites provide the possibility to filter results according to particular characteristics, e.g., a practice's specializations, insurances accepted or employee-friendly consultation hours. An example of such a filter is shown in the following illustration.
[10] Now we would like to assess the usefulness of different filter characteristics for your physician choice.
Not useful Highly useful Filtering for very positive patient ratings Filtering for special consultation hours (e.g., evening or weekend) Filtering for accepted insurances (e.g., physician only treats privately insured patients) Filtering for a minimum number of ratings Filtering for the assessment of the waiting time to get an appointment Filtering for particular additional training courses or further education of a physician Filtering for the physician's gender Only show practices for which pictures are provided Filtering for particular specializations of the physician Filtering for the assessment of the waiting time within the practice The physician rating website jameda provides a physician's recommendation based on different categories (e.g., treatment, information, trust) which are aggregated to an overall score. Additionally, it is possible to leave a short narrative comment. The following illustration shows an exemplary rating.
[11] Please estimate each category's importance to you when choosing a physician.
Not important Highly important (1) Other patients' satisfaction with the treatment (2) Other patients' opinions about the quality of the treatment information provided by the physician (3) Other patients' opinions about their relationship of trust with the physician (4) Assessment of the time the physician spends with the patient (5) Other patients' assessments of the physician's friendliness Overall score based on the categories mentioned above (1-5) Other patients' experience reports (narrative comments) Now, we turn towards the narrative comments. Here patients can report about their personal experiences with a particular physician without any guidelines. For example, they comment "Competent, experienced physician, hardly any waiting times", "Practice very well organized, hardly any waiting time, physician seems to be very competent" but also "unfriendly person, despite having an appointment, I had to wait at least one hour and that happened three times". We would like to know how important these narrative comments are for your physician choice.
[12] Do you read available narrative comments other patients left attached to the ratings?
Yes No [13] What is the importance you attribute to other patients' narrative comments for the significance of a rating? No importance Very high importance Importance of narrative comments for a rating's significance [14] What is more important to you when choosing a physician? The overall score or the narrative comments?
Overall score Narrative comments Equally important [15] How useful are the following functions of a physician rating website for you? Not useful Highly useful Write a narrative comment about my physicians myself Read other patients' narrative comments about a physician Conduct of an online-search including all general practitioners, specialists and dentists in Germany Obtain information about a physician and his practice before the first visit Conduct of online-physician-search for a general practitioner, specialist or dentist close to my place of residence