When It Comes to Ratings for Doctors, We Have a Ways to Go

Let’s say you’re in the market for a new car or camera and you’re trying to decide which one is the best value for the money. Or maybe you’re trying to decide which action-movie or kid’s flick to see Saturday night. Nowadays, it’s pretty easy to comparison-shop among the different choices by turning to a magazine, newspaper or the Internet for reviews and ratings of a host of goods and services.

But what to do when you’re trying to pick a doctor for yourself or another family member? If you are like most Americans, chances are you still choose your doc the same way you would a hairdresser or auto mechanic: You ask a friend or two. If that doesn’t work, you might simply choose blindly, based on the doctor’s gender, name or office location.

It’s a pretty safe bet that you will make this most vital decision with little or no information about the doctor’s medical skills or how he or she compares with others in your community.

Granted, a doctor’s performance in treating asthma or back pain, or a surgeon’s skill at mending broken bones, will never be as easy to measure as how well a camera zooms. And some argue that the complex science and art of medicine are not commodities to be scrutinized and rated like the latest group of sports utility vehicles. That complexity is the reason why there is no credible Top 10 list of local pediatricians, experts say.

“The science really isn’t there yet,” said Brian Schilling, a spokesman for the National Committee for Quality Assurance, a Washington-based group that accredits health plans. While the committee and other organizations publish reports intended to help consumers compare HMOs and other health plans, setting up a system to rate individual doctors is far more difficult, Schilling said.

The few organizations that have developed rating systems for health plans usually make their results available to consumers by publishing some type of “report card.” Although their effectiveness is now being debated, report cards can answer some important questions about how one HMO compares with another: How satisfied are its members?; How well does the plan do in providing key preventive care services such as mammograms, pap smears or child immunizations? Is the plan accredited by the National Committee for Quality Assurance?

But considering that it is the doctor, after all, who makes most of the critical decisions about your medical care, some consumers and health care experts are wondering why there isn’t a similar way to rate doctors.

The quick answer is that there’s very little information available that would be useful to consumers in evaluating their doctors. While you can contact the California Medical Board to find out where physicians attended medical school, the status of their license and whether there have been any disciplinary actions against them, little public information is available beyond that.

Even though that information may not allow one to gauge whether a doctor is the talkative type, or an ace with the scalpel, it should be useful for “pre-screening” doctors you are considering.

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Finding out the basics about a physician has become a less-daunting task recently, thanks to the Internet. Several Web sites have done most of the detective work for you, compiling and publishing data from such sources as state medical boards, medical specialty organizations and the Bureau of the Census, among others.

One such site is HealthGrades.com (https://www.healthgrades.com), launched in August by Specialty Care Network Inc., a Web-based health care information company. HealthGrades features information on physicians across the country, free of cost. After one selects a geographic region and a specialty, the site provides a list of “leading physicians,” defined as doctors who satisfy five criteria, including board certification--a “seal of approval” of a doctor’s qualifications in a specific medical specialty--and lack of sanctions.

Sarah Laughran, a HealthGrades vice president, says the Web site evaluated nearly all U.S. doctors, of which about 58% (some 600,000) met the criteria for listing as “leading physicians.” Besides a physician’s basic credentials, the site also provides such information as languages spoken and hospital and health plan affiliations.

In California, the Pacific Business Group on Health, an influential group of 33 major employers that jointly purchase health insurance for about 2.5 million workers, has also launched a free physician directory on the Web (https://www.pbgh.thehealthpages.com).

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But none of these Web sites can tell you about a doctor’s bedside manner or clinical skills.

There is virtually no data on the types of questions patients really have about a doctor, notes Schumarry Chao, a clinical professor of emergency medicine at the USC Medical School.

“Do patients like him? If I were having a surgery of some sort, how many of those surgeries does he do a year?” says Chao.

The main hurdle to evaluating individual doctors is collecting information to rank them. While HMOs can collect data on thousands of patients with similar conditions, focusing on a single doctor brings in statistical complications.

Answers might come eventually. According to David Lansky, president of the Foundation for Accountability, an Oregon-based nonprofit organization that focuses on health care quality issues, strategies are being developed for measuring doctors’ competency across the board, regardless of their care of specific medical conditions.

Meanwhile, in the absence of doctor rankings, a patient need not pick a physician at random. Cheryl Damberg, director of research and quality at the Pacific Business Group on Health, suggests that once a doctor’s basic credentials have been checked, the patient should investigate the next available quality indicator: the medical group to which a physician belongs.

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In California, three health plans currently publish ratings of affiliated medical groups. Orange County-based PacifiCare Health Systems publishes ratings for 187 physicians groups that provide care for its 2.3 million members. The list, at https://www.healthscope.com, ranks groups on performance in several areas of preventive care. They also include information on how satisfied members are with the plan and their primary care physician.

In a similar fashion, Health Net and Blue Cross of California publish their own medical group ratings, which can be accessed at https://www.healthnet.com and https://www.bluecrossca.com. When looking at the ratings, patients should focus on areas of care that matter most to them, advises Dr. Sam Ho, PacifiCare’s vice president and corporate medical director. A new parent will likely require different services from a medical group than a senior citizen will, and patients should look for groups offering the best care in their specific area of need, Ho said.

Also, choosing a well-ranked medical group makes it likelier that an individual doctor will provide better care.

“The groups that have high scores, in general, might have better performing doctors,” Ho said.

But don’t assume that because a medical group has excellent ratings, their physician will be just as good, experts say.

After you narrow your list of prospective doctors to two or three, the old-fashioned way of picking a doctor--meeting him or her in person--is still the best way to make a final choice.