By Shelley Reese
Medscape Business of Medicine, May 28, 2014
The List Is Out — and Your Name Isn’t There
Are you a “top” doctor? Do you care?
Every year, metro magazines around the country publish lists touting the “top” and “best” doctors in town. The issues are money-makers for the magazines and PR fodder for hospitals and health systems. But doctors themselves appear to be wildly ambivalent — and highly skeptical — about the lists.
Who Says Those Are the “Best” Doctors?
Nationwide there are a lot of variations on the top-doctor theme. There are “best” doctors and “most influential” doctors, and selection criteria vary.
While most doctors are quick to recognize and dismiss lists that are simply paid advertisements, their reaction to the peer-nominated “top” and “best” doctor lists frequently published in city and consumer magazines is more complex.
For example, many city and consumer magazines partner with New York-based Castle Connolly Medical Ltd. to compile their lists. Physicians are asked to nominate doctors who, in their judgment, are the best in their field. The firm’s research team then vets nominees to check board certifications, licensing, and disciplinary histories. Physicians cannot nominate themselves and do not pay to be on the list, but they may pay to advertise in the magazine publishing it or for plaques showcasing the recognition.
Physicians are generally happy to make such lists. “Physicians are proud of what they do,” says Kenneth T. Hertz, a principal with MGMA Health Care Consulting Group. “They’re proud of their education and skills.”
But what about the doctors who don’t make the list? A lot depends on the doctor, says Amanda Kanaan, President of WhiteCoat Designs, a Raleigh, North Carolina-based medical marketing firm. Some may have bruised egos. Others may express disdain for the list, while secretly wishing they’d made it. Still others simply don’t care.
Is It a Blow to Your Ego?
Whether the lists have value for physicians beyond bragging rights is open to debate. Hospitals and health systems are quick to issue press releases touting their “top” doctors. Some physicians practicing in competitive markets say making a list can be a huge career booster, attracting new patients and media attention. Others who already have busy practices say they don’t need to have their name on a list to attract patients.
“There are good arguments on both sides,” says Kanaan. “From a marketing perspective, a doctor’s reputation is all that he or she has. They can provide amazing care, but if they don’t have the reputation, patients aren’t going to walk through their door.”
When physicians ask her opinion about whether they should purchase an advertisement in the magazine or a plaque for the waiting room, Kanaan says it’s important to consider their individual circumstances. Do they need help with reputation management? Have patients been slamming them in online reviews? How credible is the list in question and how much do they intend to spend?
“These things can get expensive, and sometimes doctors don’t realize how expensive they are,” she says. “The biggest cost is usually advertising in the magazine, but in some cases, participating is buying into a PR opportunity that entitles you to use the ranking organization’s logo on print and marketing materials.”
Too often, she says, physicians participate not because they want to but because they feel obliged to do so. They participate because the competitor down the street is a “best” doctor or because their partner has a plaque hanging in the waiting room and they don’t want patients to perceive them as inferior. Likewise, if they buy a plaque one year, they feel compelled to do so the next, lest patients think they didn’t make the list a second or third or fourth time.
“For many doctors, it becomes one of their yearly marketing expenses,” Kanaan says. “They realize that if they don’t do it, then there could be repercussions.” In that regard, she says, the lists “somewhat have doctors on their knees: If they don’t participate, they’re going to send the wrong message.”
Specialists, particularly those in highly competitive fields or whose services aren’t covered by insurance, seem to feel the greatest pressure, she says. While patients often choose primary care physicians based on convenient locations, they are willing to travel much further to find a specialist, making it more important for specialists to differentiate themselves.
“I see the value of these as a marketing tool,” Kanaan says. “But this is just one very, very small part of what it takes to market a practice, and it’s not even a necessary part. If I had a limited marketing budget, this would not be my first priority. Not by a long shot.”
What About “Paid” Lists?
Wanda Filer, MD, who practices family medicine in York, Pennsylvania, and earns top marks from patients on Healthgrades and Vitals, says she frequently receives congratulatory letters in the mail that she’s made one list or another. She doesn’t bother to open them.
“I don’t put much credence in the lists. I get notifications fairly often, and to me it always looks like they’re trying to sell a plaque. I’d rather let my work speak for itself.”
Dr. Filer says she thinks other doctors feel the same way. As a board member for the American Academy of Family Physicians, she often introduces speakers at conferences. In preparation for that, “I look at a lot of CVs for physicians from around the country,” she says. “Rarely do I see ‘top doctor’ recognition listed among their accomplishments.”
While a lay audience might put stock in a list of doctors recognized by other doctors, Dr. Filer says physicians themselves know the choice of specialists should be patient specific.
“I just saw a patient who needs knee surgery and asked for a referral,” she says. “I considered two practices. They’re both excellent, but one is more interconnected with an EMR than the other, which is important because he’s an older patient with other health issues. The other group does a great job with knees, but they may not have access to his cardiology record and my records. Nowadays we know that coordination of care is more important than ever, and it’s helpful for me to think through the systems issues when selecting a doctor.”
Another reason Dr. Filer says she doesn’t concern herself with “top” doctor lists: She’s a busy primary care physician. “We’re always trying to find a place to put patients. We’re not out there actively recruiting. A specialist who has more head-to-head competition might feel differently.”
Just a Popularity Contest?
Betsy Tuttle-Newhall, MD, Division Chief of Transplant Surgery at St. Louis University, who likewise earns top marks from patients on Healthgrades, has a different take on the lists. She hasn’t been nominated for one, she says. A relative newcomer to St. Louis, she regards the local top doctors list as “a popularity contest” rather than affirmation of clinical skills.
“CMS tracks my performance. They know my mortalities and my length of stays,” she says. “I know I’m above standard of care, but I never make this list in town.”
Jim Chase, President of Minnesota Community Measurement (MNCM), a nonprofit organization that collects performance data on physicians in the state, says the lists may be revenue generators for the magazines and PR opportunities for the showcased doctors, “but they’re not very important to the quality side or to directing people to the right care providers.”
He says that about eight years ago, MNCM approached Minnesota Monthly about incorporating their patient satisfaction data into its “best doctors” issue.
“They weren’t interested,” Chase says. “They didn’t want to alienate the doctors. They were worried that if the physicians didn’t like the kind of data we were publishing — because we publish both the good and the bad — they wouldn’t advertise with them.”
But What Does the Patient Think?
While doctors may have mixed feelings about the lists, consumer reaction is even harder to gauge.
It’s unclear how much stock the public puts in the lists, which emphasize doctors’ opinions. It would be hard to make a case that they have no value to the public. However, there is solid evidence that patients value the insights of their fellow patients when selecting a doctor and that they do consult doctor-rating Websites.
In a survey of more than 2100 Internet users, 59% say Internet ratings on sites such as Yelp, Healthgrades, and RateMDs are at least “somewhat important” in choosing a doctor, according to a report published in the February 19 issue of JAMA. Of those, 19% say Internet reviews are “very important.”
Patient review sites may be imperfect, but Chase notes that they discuss not only the doctor but also the staff, wait times, follow-up, and other issues that are critical to the patient experience.
“Patient behavior has changed,” Kanaan says. “There are a gazillion doctors out there and patients are confused. They go online just as they would go searching for something to buy. I don’t see these ‘best’ lists competing in the online space.”
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