A review of a study examining patients’ perceptions of dermatology practices.
In addition to making correct diagnoses, prescribing effective therapies and clearing skin rashes and tumors, achieving high patient satisfaction is one of the goals of the practice of dermatology. Patient satisfaction is important in its own right and may contribute to the more objective goal of clearing rashes by improving patients’ adherence to treatment.1 National accrediting organizations, including the American Board of Dermatology (ABD), recognize the importance of such patient-centered outcomes and require the collection of patient satisfaction survey data as part of the Maintenance of Certification (MOC) process.2,3
Over the past 2 years, one of the approved methodologies for meeting the ABD MOC patient survey requirement has been the www.DrScore.com survey system. DrScore is an online survey system that minimizes administration hassles and offers drill down in areas of potential weakness to provide details about what aspects of dermatology service can be improved. In this article, we describe the characteristics of patients’ perceptions of dermatology practices based on the DrScore survey results.
We used a validated survey to assess patients’ satisfaction.4 Demographic information (age and gender) were collected, along with patient-reported information on wait times, time spent with the physician and whether it was a new or return visit. The survey’s main question was: “On a scale of ‘0’ to ‘10’, where 0 is the worst possible care and 10 is the best possible care, how would you rate your doctor?” Data were obtained from 7,499 such ratings of US dermatologists. Patients also provide ratings of the practice and the staff. Specific information about care provided were assessed with questions about the doctor’s friendliness and caring attitude, thoroughness of the examination, how well the doctor answered a patient’s questions, how well the doctor followed up on any problems or concerns, the extent to which the doctor includes the patient in decision about the patient’s care and treatment, instructions on how to take care of the illness or health condition, getting test results back in a timely manner, time spent with the patient, and treatment success. Questions about the practice included: getting advice or help after hours, convenience (such as parking and office location) and staff ratings. Questions were also asked about ease of getting a subsequent referral and total family care, although these questions were answered by less than 3% of respondents and did not appear relevant to dermatology practice.
The survey asked if things could have been better in any of 7 areas, and 1,550 respondents (21%) said yes. These areas included: staff, record keeping, parking, waiting times, appointments, doctor’s care, getting information and other.
The survey population was predominately female (59.9%), which is consistent with dermatology practice statistics, and ages ranged from 35-64 (72.2%). Children (<18) accounted for 3.9% of surveys received and 2.2% were age 65 or older. More than four-fifths of respondents (82.3%) reported that this was a return visit to this doctor. Wait times were generally 30 minutes or less (<15 minutes, 67.9%; from 15-30 minutes, 24.9%), and 71.1% reported spending more than 10 minutes with the doctor (24.7% from 5-10 minutes and 4.2% less than 5 minutes). Wait times to get an appointment were generally 1 month or less (Figure 1, above left).
Editor's Note: Please click on Figure 1 to see a full-size image.
Of 7,499 responses, the mean overall satisfaction with US dermatologists was 9.52 (9.64 for return patients and 9.08 for new patients). Overall ratings for the practice (mean 9.46, N=7217) and staff (9.38, N=6,631) were also high (though not quite as high as the doctor rating). Patients gave their dermatologists a perfect 10 at 80% of visits, a 9 at 12.1% of visits and an 8 at 3.9% of visits. Scores of 8 or higher were given for 96% of visits. Scores of 0 or 1 were given for 1.75% of visits.
Mean satisfaction scores dropped with longer wait times, with scores of 9.75 for wait times of less than 15 minutes, 9.38 for waits of 15-30 minutes, 8.70 for waits of 30-60 minutes and 5.78 for waits more than 1 hour. Satisfaction also dropped with longer wait times to get an appointment, with a mean of 8.98 for waits longer than 2 months and means of 9.36 or higher for each of the other appointment waiting time categories.
Scores were high across all the specific variables regarding doctor’s care that were assessed, with mean scores of 9.49 (N=7,190) for thoroughness of examination, 9.33 (N=7,166) for time spent with the doctor and 9.45 (N=6,396) for treatment success. For each of the questions regarding specific aspects of the doctor’s care, 90% or more of the scores were a 9 or 10, except for time spent with the doctor (Table 1). There were more patients reporting a 0 for treatment success (2%) than for any of the other areas (1% each).
Editor's Note: Please click on Table 1 to see a full-size image.
Patients also gave high scores to characteristics of the practice, including getting advice or help after hours (9.29; N=3,373), convenience issues such as parking and office location (9.28; N=6,297) and staff ratings (9.40, N=6,320).
For the 1,550 people (21%) who reported that some aspect of care could have been better, the most common areas for improvement were wait time (33%) and appointments (31%). Other areas for improvement were reported for parking (24%), staff (21%), doctor’s care (14%), getting information (11%), other (9%) and record keeping (5%). The most common wait time issue was too much time spent in the main waiting room, which was reported by 77% of the 497 respondents who noted a problem with waiting; 33% reported the wait in the examination room was too long. Of 464 patients reporting a problem with appointments, nearly half (47%) said it took too long to get an appointment. The most common parking problem was not enough parking (for 64% of the 368 respondents noting a parking issue); having to pay for parking was reported as a problem by only 12%.
Of the 213 respondents who reported that the doctor’s care could have been better, 62% said they did not get to spend enough time with the doctor, 47% said the doctor did not spend enough time educating the patient and 46% felt the doctor did not answer all the patient’s questions and did not spend enough time on the physical examination. Only 10% reported the doctor did not do a test the patient wanted and only 5% reported the doctor did not provide adequate information about tests.
Patients perceive that outstanding quality care is determined by several factors, including access, communication, personality and demeanor of the doctor, quality of medical care processes, continuity of care, quality of healthcare facilities, and office staff.5 Overall, patients love their dermatologists. Patients give their dermatologists very high marks, with an overall mean score just over 9.5, and high scores across other measured aspects of the practice. The perception of being a friendly, caring doctor is the most important factor that determines doctors’ overall scores, far more so than waiting times or time spent with the doctor.6 A significant majority (92%) of patients gave dermatologists a 9 or 10 in this regard (and most other respondents gave the dermatologist an 8). The most common issues that could be improved were not direct aspects of the doctor’s care but were more practical issues, including waiting times and the availability of appointments. These issues may relate to the inadequate numbers of healthcare providers in the dermatology workforce. Keeping patients waiting more than 1 hour was uncommon, but is clearly something to be avoided.
The scores identified in this survey were higher than previously reported scores for dermatologists.7 This is likely due to greater representativeness of the survey population in this study. Of the 132 dermatologists with more than 20 ratings in 2012, the mean patient satisfaction score was 9.70. Now that the ABD requires patient satisfaction survey data as part of the MOC process, data are being collected on a larger, more representative sample scale of dermatologists’ practices. Previous reported data collections relied more heavily on a convenience sample of patients who proactively sought to rate their doctors on the Internet,7 and such a sample can select for patients who are dissatisfied with their physicians. As seen in this study, the overwhelming majority of patients are highly satisfied with the care they receive from their dermatologists. The level of satisfaction is so high that dermatologists (and other physicians) get good scores even in studies that rely on the self-selected population that chooses to rate doctors online.
The Internet and digital resources facilitate the collection of patient satisfaction data that can be used to document this important aspect of quality of care and to assess and broadly communicate this measure of quality. The online data collection approach reduces the burden of administering paper surveys in the office and reduces the cost compared to commercial services that rely on telephone or mail surveys. This data collection approach also provides dermatologists with benchmarks by which they can compare their scores to those of peers nationally. (Who knew that a dermatologist with a score of 9.3 — albeit a high level of patient satisfaction — has a score solidly in the bottom half of US dermatologists?). Some practices have incorporated tablet computers in order to easily and rapidly collect patient satisfaction survey data, and we have found that this is a very effective means to meet the ABD MOC requirement.
A number of limitations should be noted. First, there is the possibility for selection bias, as patients who are not satisfied with their doctor might choose not to continue seeing that doctor, resulting in higher positive mean scores for the surveyed population; however, mean scores for new patients still exceeded 9. The study population included a low percentage of young (<18) and old (>65) patients. These populations could be oversampled in future studies if needed to assess specific patient satisfaction concerns in these groups. Finally, while this study found variables associated with lower patient satisfaction, cause and effect cannot be determined from these associations.
Mr. Camacho is with the Department of Public Health Sciences at Milton S. Hershey Medical Center in Hershey, PA.
Dr. Balkrishnan is an associate professor at the University of Michigan School of Public Health and College of Pharmacy in Ann Arbor, MI.
Mr. V. Khanna is an Interactive and Digital Media Strategist at Wake Forest Baptist Medical Center in Winston-Salem, NC.
Ms. K. Khanna is the Director of Sales & Client Services for the DrScore.com website.
Dr. Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology and Public Health Sciences at Wake Forest University School of Medicine.
Disclosure: Mr. Camacho, Dr. Balkrishnan, Mr. V. Khanna and Dr. Feldman all hold stock in the Medical Quality Enhancement Corporation and its www.DrScore.com website.
1. Renzi C, Picardi A, Abeni D, et al. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol. 2002;138(3):337-342.
2. Centers for Medicare & Medicaid Services. The physician quality reporting system maintenance of certification program incentive. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/MaintenanceofCertificationProgram_11-15-2010.pdf. Accessibility verified January 22, 2013.
3. American Board of Dermatology. General MOC requirements. Available at: http://www.abderm.org/moc/requirements.html. Accessibility verified January 22, 2013.
4. Camacho FT, Feldman SR, Balkrishnan R, Kong MC, Anderson RT. Validation and reliability of 2 specialty care satisfaction scales. Am J Med Qual. 2009;24(1):12-18. doi: 10.1177/1062860608326416. Epub 2008 Dec 5.
5. Anderson R, Barbara A, Feldman S. What patients want: A content analysis of key qualities that influence patient satisfaction. J Med Pract Manage. 2007;22(5):255-261.
6. Uhas AA, Camacho FT, Feldman SR, Balkrishnan R. The relationship between physician friendliness and caring, and patient satisfaction Findings from an Internet-based survey. Patient. 2008;1(2):91-96.
7. Poulos GA, Brodell RT, Mostow EN. Improving quality and patient satisfaction in dermatology office practice. Arch Dermatol. 2008;144(2):263-265. doi: 10.1001/archdermatol.2007.58.