Patients more satisfied when doctors treat fewer people

Doctors who see fewer patients may get better online reviews than physicians who have higher-volume practices, a study of U.S. urologists suggests.

Researchers examined data on 665 urologists with Medicare patients in California, looking at how many patients they treated as well as what types of reviews they got on four websites: Yelp.com, Vitals.com, Healthgrades.com and Ratemd.com. Half of the urologists treated at least 426 patients covered by Medicare in 2014. Overall, the physicians who treated fewer patients got higher satisfaction ratings online, the study found.

“There could be more than one explanation for this but our hypothesis is that patients are happier when there is less waiting and more time to communicate with the doctor,” said lead study author Dr. Gregory Murphy, a researcher at Washington University School of Medicine in St. Louis, Missouri. “I think it shows that patients value efficiency, ease of access and communication,” Murphy said by email.

Although the accuracy, usefulness and meaning of online reviews is debated by doctors, they increasingly influence decisions about where patients choose to receive care and impact how hospitals and health systems evaluate doctors’ performance, the study team writes in JAMA Surgery, online March 21.

Online reviews may be influenced by a variety of factors that go beyond the quality of care to include things like waiting times to see physicians, the ease of scheduling appointments and how long doctors spend in exam rooms, the authors note.

For the study, the researchers examined physician billing and reimbursement data as well as the number of Medicare patients they saw and how many services they billed for in 2014. Most of the urologists in the study were male, and they predominantly worked in nonacademic settings.

On a scale that ranged from a low of 1 to a high of 5, academic doctors on average scored a 4.2 rating on the various patient satisfaction websites in the study. Outside of academic settings, doctors scored an average rating of 3.7. Female urologists got similar satisfaction ratings as males, the study also found. For every 100 patients seen, average patient satisfaction ratings dropped by 0.04 points.

Limitations of the study include the use of Medicare data from propublica.com, which may not accurately represent a physician’s non-Medicare patient population, the authors note. The study also wasn’t a controlled experiment designed to prove whether or how the number of patients doctors treat might influence satisfaction ratings on consumer websites.

Even so, the results suggest that doctors need to spend some time talking to their patients, Murphy said by email. When complications happen during treatment or surgery, patients may feel better about the experience when they feel like their doctor listens to them. “Patients want someone who communicates well and listens in those unfortunate and frightening moments,” Murphy said.

It’s possible that the results might not fully capture how many patients doctors treat, however, because it only focused on people insured by Medicare, the U.S. health program for people 65 and older, said Dr. Brian Radbill, chief medical officer and vice president of medical affairs at Mount Sinai St. Luke’s in New York City.

Older patients may have more complex medical needs and require more time and attention than younger patients, Radbill, who wasn’t involved in the study, said by email. Specialists, especially in urology where surgery is often involved, may only interact with patients a few times and have limited opportunities to build a relationship Radbill added.

“To the patient, it is often a completely alien, frightening experience so the patient may get the absolute highest quality of care, but the experience may be perceived as poor,” Radbill said. “They may leave feeling like they were not treated well - perhaps the doctor swooped in and swooped out, did not engage them like they are used to.”