Hand Surgeons Value a Positive Online Reputation but Lack Implementation

Hand Surgeons Value a Positive Online Reputation but Lack Implementation

Background: A positive online reputation is increasingly important for hand surgeons to build patient trust and generate patient referrals.  Few studies have evaluated the value of a positive reputation, and those that have used only small cohorts of surgeons and limited review website data.  This study is the first to analyze the value of a positive online reputation for all hand surgeons and correlate the responses to Google search result review volume and star-scores. 


Methodology: A prospective, email-based survey was performed among all ASSH members inquiring about the “value of a positive online reputation” rated from “no value” to “very much” and converted to a 0–3-point score.  Simultaneously, a unique Google search was performed for each member with record of the presence of a Google business profile, the number of reviews, and the review score (measured from 1-5 stars).  Data were analyzed using Excel-style tools and reported as the average number of reviews and stars as they correlate with ASSH member responses regarding the value of a positive online reputation, as well as decade in practice and practice type. 


Results: A total of 1,899 active and 715 candidate members were included in the study (total: 2,614).  Of the 946 that responded to the survey (36% response rate), the mean value score was 2.00. In total, 33.8% and 40.4% stated that a positive online reputation was “very much” or “somewhat” valued, respectively, while 13.7% and 9.9% felt a positive online reputation had “minimal” or “no value,” respectively.  When Googled to determine online reputation status, 60.1% had online reviews, 14.3% had a profile without reviews, 24.3% had no identifiable profile, and 0.7% had profiles listed as “closed.”  The mean number of reviews was 18.2 (median: 4) and the mean review score was 4.48 stars (median: 4.8).  Higher scores correlated with higher numbers of reviews, younger age, and greater perceived value of online reputation.  Private-practice surgeons had a higher number of reviews (mean: 24.5 reviews, 4.45 stars) compared to employed, academic, and government practices (mean: 7.4 reviews, 4.48 stars).  Only 86 hand surgeons had greater than 100 reviews, but those that did had an average score of 4.82 and a value score of 2.53.


Conclusions: 74% of hand surgeons consider a positive online reputation “very much” or “somewhat” valuable.  The average hand surgeon Google profile has 18 reviews with a 4.48 star score.  Only 3% of hand surgeons have greater than 100 reviews.  Higher review volume correlates with higher scores, with an average high value of 4.82 stars.  Hand surgeons may increase patient trust and referrals by soliciting online reviews to increase volume, increase score, and improve their online reputation.

Online Reviews Accelerate Practice Growth

Hypothesis:  The intuitive value of online physician ratings has gained acceptance; however, quantifying the online physician rating impact for a hand surgeon remains a challenge.  This study evaluated the effect of automated online reviews towards building a referral-based hand surgery practice for both a recent fellowship graduate and established senior hand surgeon.

Methods:  This prospective cohort study measured online physician ratings from Yelp and Healthgrades over 28-months for two surgeons in the same practice.  Surgeon A, a junior associate starting practice, utilized automated and active online review requests.  Surgeon B, a senior, established hand surgeon, utilized passive online review requests.    The number of patients who were referred from online review sites was subsequently measured for each surgeon to determine the impact of online reviews based on quantity and value of reviews.

Results:  During the study period, Surgeon A increased total reviews from 1 to 129 (net gain of 128) and simultaneously acquired 128 new patients (Figure 1).  During the same period, Surgeon B increased total reviews from 33 to 83 (net gain of 50) and acquired 93 new patients from online reviews (Figure 1).  Both plots represented exponential practice growth R^2 values of 0.966 and 0.976, respectively.

Summary Points:

        Patient referrals are closely associated with volume of online reviews with R^2 values from 0.96-0.98

        Patient referrals from online reviews are non-linear, resulting in exponential and accelerated practice growth as additional online reviews are acquired


        Online review growth has the potential to augment patient volume for both established and young hand surgeons 

Website Traffic Drives New Patient Referrals

Hypothesis:  Practice websites are a valuable component of hand surgery practices by providing contact information, sharing patient education materials, and helping drive patients to the practice.  Monitoring website traffic is therefore a simple and useful tool for gauging a site’s success.  However, an upward trend in website traffic could have numerous explanations, ranging from overall practice growth to a more internet-savvy patient population.  The hypothesis of this study was that increased website organic search primarily correlates with new patient visits.

Methodology: This prospective study collected website analytics from a hand surgery practice for 3.5 years with a focus on organic search.  In addition, patient office visit data was collected monthly according to visit type: new patient, former patient, follow-up visit, and total office visits.  A scatter plot with a best-fit regression line was drawn for each visit type as it correlates to website traffic to determine the primary influencing factor contributing to website traffic growth. R^2 values were calculated to determine best fit line.


Results:  During the 3.5 year study period, website traffic increased 4-fold with organic search results averaging 138 impressions in the first three months and 531 impressions at the final 3 months (Figure 1).  During that same period total patient visits increased from 326 patients/month to 499 patients/month (Figure 1).  The plot results for new, former, follow-up, and total patient visits with regression lines are shown in Figure 2.  The regression analysis demonstrated the highest correlation with new patients (R^2=0.50), despite the fact that follow-up visits were of higher volume.  These findings suggest that new patients most closely correlate with website traffic over former or follow-up patient visits.


Summary Points:

        Practice websites can be a useful tool for attracting new patients

        Website organic search impressions most closely correlate with new patient visits and not former or follow-up patient visits


        Improving practice website traffic can increase patient volume

Online Referral Volume Correlates with Online Review Volume

Hypothesis:  No direct correlation has yet been proven between online physician ratings and patient referral volume.  Rather, the recent emphasis on optimizing a physician’s online reputation is based on the assumption that enhanced online ratings translate into patient volume and revenue.  This study sought to correlate online rating volume and scores with volume of new patient referrals.

Methods:  This prospective study recorded online physician ratings from Yelp and Healthgrades, as well as practice ratings from Yelp and Google, during a 42 month period (14 quarters).  We simultaneously tracked self-reported referral sources for all new patients, with special attention paid to those referred by online search and review sites.  We then correlated the volume of online reviews with new patient referrals for the practice as a whole, a new hand surgeon (fellowship graduate), and an established hand surgeon (25 years in practice).


Results:  During the 3.5-year study period, the new surgeon acquired 204 reviews and 174 online patient referrals with an average score of 4.9 stars.  The established surgeon acquired 48 reviews and 117 online patient referrals with an average score of 4.3 stars.  The practice as a whole acquired 381 reviews and 387 online patient referrals with an average score of 4.8 stars.  The correlation between reviews and referrals on a quarterly basis are shown in Figure 1, and reflect a very high correlation (R^2 = 0.917) for a new surgeon, but non-correlated (R^2=0.07) for an established surgeon.  The correlation between referrals and reviews for the practice as a whole was moderate, with R^2=0.56 (Figure 2).

Summary Points:

        Patient referrals are directly and highly correlated with online physician ratings (R^2=0.92) for new hand surgeons

        No apparent correlation was identified for established hand surgeons (25+ years in practice)

        Online reviews have the potential to augment practice growth primarily for new hand surgeons 

Google Reviews are EACH Worth $1,000

Background: Positive online physician reviews (ie: Yelp, Google Reviews, Healthgrades) are frequently cited as relevant and important towards managing a surgeon’s online reputation.  However, no study has ever measured the tangible impact of positive reviews for a medical practice.  This study set to quantify the financial benefit from online reviews in an early-career hand surgery practice.

Methodology:  In September, 2016 we instituted a practice protocol to encourage satisfied patients to leave online reviews. Over a consecutive 28-month period, all patients presenting to our hand surgery clinic were queried regarding how they were referred to the office with special attention towards online review sites, which review sites they visited, and analyzed for the financial gain (total dollars collected) during their course of treatment.  Simultaneously, online reviews for all hand surgeons in the practice were quantified monthly during the same period.   A control period was established during the first 3 months prior, to any measurable change in online reviews.  This allowed us to determine the added value of patients referred online relative to the number of total reviews during the same period.

Results:  We found that Yelp and Google Reviews accounted for >90% of all online review referrals.  At 2 years, a total of 146 reviews were acquired above the control acquisition rate.  During the same period, we identified 158 patients referred to the office after reading positive online reviews, and those patients had a total calculated collection amount of $442/patient.  This amounted to a total practice collection of $69,836 from 146 reviews, averaging to a review value of $478 per review (Figure 1).  When including patients who were unable to complete referral data, the estimated total practice collection increased to $155,584 with a review value of $1,065 (Figure 2).


·      Online physician reviews can help refer patients to a hand surgery practice

·      A single Yelp or Google review is worth between $442 and $1,065 in practice revenue


·      In a two-person orthopedic hand practice, introducing an online review protocol yielded up to $155,000 in additional revenue over 28 months


Online Ratings: Influence of Surgeon Factors

Bullet Points:

  • Online physician ratings are important to patients
  • Prior studies concluded that negative reviews are influenced more by surgeon-independent factors (SI) (office and staff) than surgeon-dependent factors (SD)
  • We hypothesized that further study of the relationship between SI vs. SD factors was warranted
  • We analyzed the correlation of SD and SI components of HealthGrades.com reviews for US hand surgeons (78 surgeons across 8 practices)
  • SD and SI factors were highly correlated for surgeons within the same practice
  • In contrast to prior studies, we conclude that surgeon-dependent factors account for 87% of online reviews

Background & Objective:

Healthgrades, a prominent online physician review site, currently has over 100 million users. The literature to date suggests that negative reviews are predominantly influenced by surgeon-independent factors (i.e. admin staff, office environment) and positive reviews more than by surgeon-dependent factors.

In many cases, office-environment ratings can be variable even among surgeons practicing in the same office setting. With this data, it is possible to determine which factors are most closely correlated to overall rating scores.

The purpose of this study was to determine  if surgeon dependent factors had a larger impact on online reviews than surgeon independent factors utilizing correlation analysis.

Materials & Methods:

Study design included evaluation of SD and SI components of HealthGrades.com reviews for US hand surgeons (78 surgeons across 8 practices).

SD factors were based on the Healthgrades overall surgeon rating comprised of trustworthiness, time spent with patient, ability to answer questions, and explanation of conditions.

SI factors included the average Healthgrades rating of office staff, office environment, and wait time experience.

Correlations were analyzed between SD and SI factors within the same practice using the Pearson coefficient.

Mean correlation among all practices and the overall Pearson coefficient and significance were also calculated.

Summary: There were moderate to high correlations for all practices when comparing average SD ratings and average SI ratings within the same practice, range from 0.49-0.98.

Average office scores were narrowly distributed (Range: 4.0-4.7) among all practices allowing for a combined correlation value between SI and SD factors to be calculated. Correlation  was 0.87 with a level of significance <0.001.


Objectively, surgeon-independent factors are consistent within a practice.  However, their ratings appear to correlate very closely with surgeon-dependent qualities (87% correlation). These findings imply that surgeon-dependent factors alone account for 87% of online surgeon reviews.

Acquire Online Reviews: Active vs. Passive Requests

Bullet Points:

  • Online physician ratings are important
  • Improving online ratings is hard
  • Asking patients to leave reviews can be awkward
  • Ignoring the problem is bad for reviews and bad for business
  • We tested out two methods for increasing reviews:
    • A) Handing out “Leave me a Review” cards (active)
    • B) Automated emails requesting reviews (passive)
  • Active requests were 8x more effective than nothing and 6x more effective than passive emails
  • Surgeons can increase their online reviews without much effort or cost by engaging patients

Background & Objective:

Many websites provide an opportunity for patients to leave online physician reviews and ratings (HealthGrades, Vitals, Yelp, Google, etc.) for both individual surgeons and group practices. While these sites are intended to be unbiased, some literature suggests that online ratings can be influenced by encouraging patients to leave reviews.  Increasing numbers of patients are turning to online physician ratings websites prior to selecting their providers.  Thus, it is in the surgeon’s and practice’s best interest to increase the volume and quality of online ratings.  The purpose of this study was to determine the efficacy and superiority of either active (personally handed out review cards) or passive (email) review requests against a control scenario of doing “nothing.”


Materials & Methods:

This prospective, cohort study was performed in a private p

ractice office that did not initially request online reviews from patients (CONTROL).

We then initiated either ACTIVE (verbal request between surgeon and patient with review cards) or PASSIVE (automated email, SurigSurvey LLC) online review requests.

Prior to and during implementation of the new protocol, online reviews for the 4 most popular rating websites for individual surgeons and the group practice were recorded monthly.

Outcomes included the volume of online reviews, overall score, and rate of review accumulation. Rate of acquisition is reported as the number of reviews accumulated divided by the number of new patients seen (%).


Control: (no review requests):  16 reviews among 1,191 new pts = 1.3% acquisition rate

Passive: (email requests):  23 new reviews among 1,253 new pts = 1.8% acquisition rate

Active: (hand out cards + request): 123 new reviews among 1,128 new pts = 10.9% acquisition rate

Group Practice: Accumulation rate of 0.3% during the control and 1.7% after the intervention


Surgeons and practices can increase their online ratings by requesting online reviews actively (verbally + cards) or passively (emails). Both protocols increase the volume of online reviews, but active requests are 6 times more effective at acquiring reviews.  Future studies are in process to identify effective ways to improve automation request volume and improve rating scores.