An analysis of Yelp reviews identifies a wide range of surgeon- and practice-related factors that influence whether plastic surgery patients leave positive or negative reviews, reports the September issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons(ASPS).

“Our study also identifies some sources of bias that may affect patients” perceptions of their care – although the plastic surgeon’s gender or race doesn”t appear to affect the overall quality ratings,” comments senior author Brent R. DeGeorge, MD, PhD, of University of Virginia in Charlottesville.

Five-Star Vs. One-Star Ratings

The researchers analyzed 5,210 Yelp reviews of plastic surgery provider practices from 49 cities across the United States. Reviews were coded for the presence of positive and negative themes. Surgeon- and practice-related factors associated with positive or negative ratings were identified, including the effects of the physician’s race and gender.

Eighty percent of reviews included in the analysis were five-star reviews, indicating the highest level of patient satisfaction. Another 13.5% were one-star reviews, reflecting the lowest patient satisfaction. Two- to four-star ratings accounted for only about 6% of reviews. In positive reviews, the most frequently mentioned surgeon-related factors were the surgical outcomes achieved, the physician’s temperament, the physician’s competency and knowledge, and physician-patient communication.

“Patients with positive experiences emphasized having results that looked natural and matched the look they had discussed with the physician prior to surgery,” DeGeorge and colleagues write. “Patients felt most comfortable with physicians who gave thorough explanations of the procedures beforehand, often spending several hours over multiple consultation sessions.”

How Online Reviews Can Improve the Patient Experience

In adjusted analyses, positive physician factors associated with higher Yelp ratings were surgical outcomes, physical exam/procedures, injectable outcomes, competency and knowledge, and temperament. Negative mentions of the same factors were linked to lower Yelp ratings, along with cost consciousness.

On analysis of practice-related factors, interactions with office staff and issues related to scheduling significantly affected whether patients left positive or negative reviews. Additional negative practice-related factors included billing/insurance issues and wait times. The study “corroborates the results of past studies, which have found that practice factors such as wait time and courtesy of registration staff were correlated with a patient’s likelihood to highly rate a practice,” according to the authors.

Yelp ratings were not significantly associated with the physician’s race or gender. While that’s an encouraging finding, the researchers note some differences in both positive and negative factors related to race and gender. “Further research is needed to identify the effect of patient characteristics on their ratings and reviews of providers,” DeGeorge and colleagues write.

While noting some limitations of the study—including the inherent subjectivity of online ratings—the researchers believe their analysis lends new insights into the range of physician- and practice-related factors influencing patient perceptions of quality of care. 

DeGeorge and coauthors conclude: “Plastic surgeons can learn from patient ratings and reviews to develop initiatives to improve the patient experience and learn more about general biases held by patients as the field becomes more diverse.”