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Physician Rating Scales Do Not Accurately Rate Physicians: A Systematic Review
Matthew B Burn, MD; David M Lintner, MD; Pedro E Cosculluela, MD; Kevin E Varner, MD; Shari R Liberman, MD; Patrick C McCulloch, MD; Joshua D Harris, MD
Houston Methodist Hospital, Houston, TX

Introduction: Physician rating systems are becoming widely utilized. Many surgeons argue that the multifaceted nature of these questionnaires includes factors outside of the physician's control. The purpose of this investigation was to perform a systematic review to determine (i) the components of care evaluated by currently available online physician rating scales, and (ii) which of these factors are under the direct control of or directly rate the physician. The study hypothesis was that less than 50% of the factors used to rate physicians are under their direct control and/or directly rate them.

Materials & Methods: A systematic review was performed to identify online, patient-reported, physician rating scales. Data extracted from these scales included: (1) website demographics/characteristics, (2) components of the physician rating scale relevant to the physician, and (3) components of the physician rating scale not relevant to the physician. Descriptive statistics were calculated.

Results: Fourteen websites were identified containing patient-reported physician rating scales. There was a mean of 11 (SD 16, Range 1-62) checkbox questions and 1 (SD 1, Range 0-2) comment box. Overall, 31% of questions directly rated the physician, 47% rated both the physician and office, and 21% rated the office alone. The most common questions used were versions of: (1) "courtesy/helpfulness of office staff" (79%), (2) "overall rating" (57%), (3) wait times/promptness/punctuality (57%), (4) "trust/confidence in physicians' knowledge & decisions" (50%), (5) "time spent with patient" (43%), (6) "listens to and answers questions" (43%), and (7) "recommend to family/friend" (43%). While 2 questionnaires (14%) included a patient-reported "treatment success" question, none (0%) included patient-reported "surgeon skill" questions or reported any outcome scores to measure success.

Conclusions: Only 4 of the 14 rating scales reviewed had the highest proportion of questions rating the physician directly. The other 10 systems focused their questions on either: the physician and the office together or the office alone. Overall, the proportion of questions directly rating the physician was well below our hypothesis at 31%. This tendency for ratings to be determined by "the office staff and dˇcor, rather than the quality of care received" has been mentioned in prior studies. It is vital that physicians understand these systems and help to shape them into something more pertinent by incorporating questions focused on the interactions with the physician themselves and incorporating objective outcome scores. This will allow patients to make more educated choices about their care.

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