How Do Patients Choose a Surgeon?

Consumer Preferences and Online Comparison Tools Used to Select a Surgeon

Ziemba JB, Allaf ME, Haldeman D
JAMA Surg. 2017 Jan 4. [Epub ahead of print]

Study Summary

Approximately 25,000 households that use the Internet were surveyed electronically about how they would go about choosing a surgeon for themselves or a family member. Additional questions were asked about their use of online resources and ratings when making such a physician decision.

Respondents were 63% female, 74% were white, and 70% had at least one chronic health condition, with 21% indicating that they had recent or planned surgery. Although 50% of respondents had searched online for a restaurant, only 7% had searched for a surgeon.

The factors identified as most important when selecting a surgeon were:

Accepts my insurance (51% stated this as preference)
Referral from primary care physician (44% stated this as preference)
Physician reputation (38%)
Hospital reputation (28%)
Office location (17%)
Recommendation from family or friend (10%)
Rating website (7%)

Income greater than $50,000 (odds ratio [OR], 1.26), having health insurance (OR, 1.44), and recent or planned surgery (OR, 3.46) increased the likelihood of searching for a surgeon online, while older age, education less than a college degree, and unemployment decreased the likelihood of searching for a surgeon online.

Two thirds of respondents had never used a healthcare comparison website. For the remaining patients, the most frequently used physician comparison websites were:

Yelp.com (12% of all households had used the site for information about surgeon choice)
Healthgrades.com (10%)
Website for a healthcare system, hospital, or group practice (7%)
Insurance plan (7%)
Angie's List (6%)
Consumer Reports Doctors and Hospitals (6%)
U.S. News & World Report (5%)
Medicare.gov Physician Compare (4%)
Vitals.com (3%)
RateMDs.com (1.3%)
Consumers' Checkbook Surgeonratings.com (1.1%)
UCompareHealthCare.com (1%)
ProPublica Surgeon Scorecard (0.6%)

Viewpoint

Every day, more and more basic daily functions, from booking hotel reservations to finding a local electrician, have become completely digitized via the Internet, mobile apps, social media, and smartphones. Has finding and choosing a physician also become like this?

Overall, this study's main finding was that only 7% of respondents indicated that they would search online when having to choose a surgeon. This may seem surprisingly low, especially because a selection bias exists where only households that use the Internet were surveyed, thereby selecting for individuals more likely to use online resources.

The study cohort's average age was 50 years. If a younger generation such as the Millennials had been surveyed, then online use for selecting a surgeon may have been higher. In fact, respondents who were younger, more educated, employed, insured, and who had or planned to have surgery were more likely to search online. Traditional factors such as insurance, who the primary care physician refers the patient to, physician and hospital reputation, and recommendation from family or friends remain the key methods by which patients choose surgeons.

It may also be that the data available about surgeons online is not yet sufficiently compelling to provide value to patients. Respondents indicated that an ideal surgeon comparison website would include information about years in practice, insurance accepted, educational level, and patient comments. In contrast, and of note, less important factors were physician ranking relative to peers, surgical volume, information on legal issues, and complication rates.

There are many online resources that provide physician ratings to help patients make informed choices when choosing a doctor. This study found that the Yelp.com crowdsourcing website was the site most visited by respondents, even though it contains only patient reviews and no outcome data.

Reporting of healthcare quality data via a website available to anyone is mandated by the US federal government. This public reporting will grow for more than 4000 Medicare-certified hospitals and for physicians at Physician Compare. In the future, as these and other sites provide more depth and breadth about quality, cost, and access, and as current Millennials become older and need more healthcare, I expect online search activity for physicians to increase.

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