Ruth Given has written a paper entitled, MD Rating Websites: Current State of the Space and Future Prospects (PDF), that was recently published on THCB. It’s a 39-page informal analysis (with an emphasis placed on informal) that takes a fairly good and comprehensive look at the space of doctor rating sites as they exist today.

I think that the main issue Given hit upon in the report (but I’m not sure she recognizes as the primary challenge of doctor rating sites) is the numbers issue. With over 700,000 physicians in the U.S., a ratings database of 10,000 or even 20,000 is pitifully and woefully small.

And not only is such a number small, it is statistically troublesome, likely painting an inaccurate picture of providers listed. If most sites only have one or two ratings for any given physician (and such data is statistically useless, if the average family physician is covering between 2,000 to 2,500 patients), then the sites themselves provide little added value outside of the directory listing. Which, as Given notes, is inaccurate or nonexistent more often than not.

For a number to have meaning in research, one needs to look at where the number comes from. In terms of rating sites (any rating site), ratings are more likely to be valid and reliable if:

  • They come from a significant number of people compared to the number of people using the service or product
  • They come from a randomized set of people who have used the product or service
  • They represent both positive and negative opinions
  • They objectively assess certain characteristics of the product or service to arrive at an objective rating number

You’ll notice most ratings sites don’t have much concept of statistics or statistical significance and virtually every physician rating site fails this simple set of minimal requirements for a rating site to have even minimal face validity.

An example of a rating site that meets most (but still not all) of the above requirements is Amazon.com. Because of the sheer number of consumers who use the site to buy stuff from, virtually every popular product has a significant number of reviews. Because it attracts such large numbers, it is likely that it is a fairly randomized sample (as randomized as one can hope for online). And virtually all popular products carry both positive and negative reviews. The one thing Amazon.com doesn’t do well is trying to rate products objectively, instead relying mainly upon a well-written narrative by the reviewer.

So it doesn’t really matter what a physician rating site’s business model looks like in terms of whether it will succeed or fail. Most user-generated content sites online today have an unrealistic, non-existent or unachievable business model that goes something like this (with apologies to South Park’s underwear gnomes):

  1. Gather together a massive amount of users and get them to generate content for our for-profit, commercial site
  2. ???
  3. Profit!

It matters only if under Step 1, these physician ratings sites can generate enough ratings to make their data valuable and worthwhile to most users who visit their site. Because if they only satisfy 1 or 2 percent of their users (or present users with inaccurate, invalid data based 2 or 3 user ratings), people will simply not revisit the site in the future. And more importantly, they’ll fail to recommend the site to others (where most successful social networking sites succeed).

There are other validity problems with the data generated by these sites, which I’ve covered previously last year. None of these problems have been solved, and the fact remains that rating a person on their entire livelihood based on your usually brief interaction with them once is rife with concerns.

Given’s report is a valuable addition to the e-Health landscape, but it also has a few flaws. I think that with a good editor, the report could’ve been half as long and twice as good. And frustratingly, sometimes I found the author seemingly contradicting herself. For instance, on page 14 she writes,

Search ads are indeed cheap. The MD rating websites using them to promote themselves appreciate this. But their low cost means these ads are not particularly lucrative for the sites displaying them.

And then in the next paragraph, she notes the premium that pharmaceutical advertising garners — the main source of revenue for virtually any consumer-focused medical or health website:

One source I came across indicated that pharmaceutical display ads typically pay between $50 and $100 per 1,000 page views, while other advertisers pay at most $15. Unfortunately, we haven’t seen many drug ads on these sites thus far.

Which is fine as far as an observation goes while randomly looking at a particular site a few times over a 2 or 3 month period. But it’s not really contributing to the understanding of the underlying business model in this space unless you’ve done an actual, objective analysis (or simply asked them in the survey conducted, which wasn’t done).

And then some opinions are just in contradiction to other professional forecasts and data:

And the opportunity for profiting from generous pharmaceutical industry spending may decline significantly in the future as more brand name drugs go off patent, since brand competition is what drives advertising outlays.

Yet eMarketer, which tracks trends such as online pharmaceutical and health spending, actually reports that 2008 ad spending will again rise by approx. 20% from 2007 (when it also rose about 19%), and is expected to grow another 20 to 25% in 2009. This objective data doesn’t jive with such opinion.

Overall, however, I found the report a must-read for anyone who wants to understand how these kinds of sites are doing and whether they provide any real value to e-Patients and other consumers. I have my doubts as they exist today, because they still lack the volumes necessary to make their data of value (and valid).

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