Where is TripAdvisor for Doctors?

Would you give your doctor a poor rating just as you might flunk a bad meal or hotel? What if you needed that physician's services again? John A. Quelch discusses why it's difficult to create a TripAdvisor for doctors.
by John A. Quelch

TripAdvisor demonstrates the reach and power of recommendation services for consumers: it has become the world’s largest travel site with 340 million unique monthly visitors and 350 million reviews online covering 6.5 million hotels, restaurants, and attractions. Perhaps it's no surprise then that 85 percent of consumers make a purchase after reading such online reviews.

But in the world of doctors, nothing compares in assisting consumers to make decisions that are arguably more involved emotionally and with higher financial risk. Beyond checking public records for malpractice judgments and fines against doctors, consumers can visit sites like ZocDoc and RateMDs. ZocDoc.com, founded in 2007, claims 5 million patient appointments with doctors booked through its site. RateMDs.com, founded in 2004, claims only 2 million doctor ratings.

What is holding back the growth of TripAdvisor-style review sites for family doctors, pediatricians, heart surgeons, psychiatrists and others involved in health care delivery? There are seven key barriers. Some can be overcome by a cleverly designed website, others are more structural and intractable.

1. Inertia. Consumers are used to being told what to do by care providers and payers. Consumer empowerment in health care is nowhere as advanced as it is in the travel industry and financial services, for example. Doctors are not especially interested in providing transparent data about their patient populations nor about their success rates. In addition, they regard gathering such data as a poor use of their time. There is also the adverse-selection concern that doctors might avoid difficult cases and difficult patients to boost their ratings.

2. Privacy. Rating a doctor is more personal than rating a hotel where the efforts of many staff combine to determine overall consumer satisfaction. Hotels can perhaps be evaluated more dispassionately. In addition, rating doctors may require reviewers to recall details of their own conditions and/or treatments which might be uncomfortable and make them more readily identifiable.

3. Lack of Funding. TripAdvisor recently compromised perceived objectivity by accepting hotel bookings on which it earns commissions. Previously, TripAdvisor revenues depended on travel-related advertising on the site. Having become the highest traffic travel site, TripAdvisor’s owners are now aggressively seeking to monetize this opportunity. But the medical profession, let alone consumers, might frown on doctor advertising and on doctors paying fees for referrals.

4. Restricted Choice. Many consumers are restricted by their health care plans to in-network providers. They have few choices and often have to see whichever physician is on duty. The best family doctors often aren’t accepting new patients. Health care is a local business, travel is global. Hotel consumers have vast numbers of options and no hotel is permanently closed to new customers; the efficiency of consumers’ decision-making and their final choices can be aided by multiple reviews aggregated from the wisdom of global crowds.

5. Few Comparables. Many business travelers stay in more than 20 hotels each year. They develop a smart shopping expertise that enables them to write insightful reviews. Each stay is a separate transaction. Consumers do not bounce from doctor to doctor nearly as often and therefore lack comparative expertise. In many cases, they develop relationships with their caregivers that render their reviews idiosyncratic.

6. Fear of Reprisal. Hotel reviews are numerous and reasonably anonymous. Hotel customers need never return to the same hotel again. In the case of doctors, however, patients may need to see them repeatedly. If their reviews are sufficiently detailed to be useful, they may be identifiable. Negative reviews may be investigated by providers.

7. Long-Term Problems. Consumers with specific conditions than can be solved with a prescription or a surgery can cleanly evaluate the results of their doctors' interventions. But the reviews of consumers with chronic conditions may not be so reliable. They may never be "cured" and, often, any improvement depends as much on their own behavior as their doctors' interventions.


So, creating review sites around the medical profession has built-in challenges. But do some medical specialties lend themselves more than others to online reviews?

Say I need a hernia operation. It would be helpful to identify experienced hernia surgeons in my area by going online and reading patient reviews, rather than just relying on a referral from my primary care physician, no matter how much I trust him or her. Hopefully, the operation goes well and I recover promptly with no ill-effects. I might then go online and offer a review. By sharing my experience, I can reduce risk and increase convenience for other consumers, but would I bother? I may need to book another hotel next month, but hopefully, surgery is a rare occurrence. The frequency of purchase transactions is not sufficient to motivate my participation or provide enough reviews to make the site reliable.

On the other hand, what if I require mental health counseling? Here, we are talking about a relationship rather than a transaction. Even after having counseling, I can’t precisely evaluate the quality of the service. Would I trust reviews of psychiatrists by other patients? Would I want to write a review of my psychiatrist that, to be thorough, might have to reveal my weaknesses? Wouldn't I benefit more from just paying for an initial visit to see if the personal chemistry is right rather than to read reviews?

In the case of the hernia surgery, it’s a transaction. I can't test drive several, I have to choose one. Likewise, if I have to overnight in Cleveland next Tuesday, I can't try two hotels, I have to choose one. That's when TripAdvisor reviews become helpful: experiences that don’t allow for too many idiosyncratic evaluations of quality.

As consumers become more empowered in general, we are likely to see more efforts to review physicians, surgeons, psychiatrists and other health care professionals. But getting to scale is the key challenge for such websites.

In any geography or medical specialty, there must be enough doctors being reviewed by patients often enough for the overall ratings to carry credibility. The number of hotel night stayovers far exceeds the number of doctor visits. The same chicken-and-egg issue faces all website developers: you need consumers to submit reviews but you need reviews from which they benefit to persuade them to reciprocate by adding reviews themselves. In addition, you need a business model that monetizes the site traffic without diminishing the site’s credibility.

Once these issues are resolved, health care consumers will potentially have a powerful new weapon to help them make the most important and complex decisions of their lives.

Related Reading:

How Consumers and Businesses are Reshaping Public Health
Can Consumers be Trusted with Their Own Health Care?
Five Imperatives for Improving Health Care

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