Factors Influencing Patient Selection of a Foot and Ankle Surgeon

A Survey Analysis of Patient Understanding and Preferences for Podiatrists Versus Foot and Ankle Orthopaedic Surgeons

BACKGROUND

Recent studies suggest poorer outcomes and higher costs associated with patients treated by podiatrists, yet no studies have evaluated patient perception and preference for foot and ankle providers. This study aims to determine patient perception of training for podiatrists compared to orthopaedic surgeons and patient preference for type of provider seen.

METHODS

A 20-question survey was administered to new patients seeing either a podiatrist or foot and ankle orthopaedic surgeon. Questions pertained to demographics, patient knowledge of their provider, perception of training requirements, number of years in professional training, and differences in surgical volume during training. Patients were asked their preference for a particular type of foot and ankle provider, and whether they perceived a difference in surgical skillset or a provider's ability to manage different pathology.

RESULTS

In all, 147 podiatry and 115 orthopaedic patients were included in the study. Demographics were similar between groups. Both groups believed orthopedists required more years of education and surgical training. In all, 61.5% of orthopaedic patients believed that orthopedists performed more foot and ankle surgeries and were more skilled as compared to podiatrists, while only about a third of podiatry patients believed this to be true (68.7% vs 38.6%; P < .001). Most patients believed orthopedists were more skilled in treating fractures. In all, 48.7% of orthopaedic patients preferred seeing an orthopedist compared to only 3.5% of podiatry patients.

CONCLUSIONS

Our study demonstrates that patients are knowledgeable about the type of foot and ankle provider they are seeing. Most patients believe orthopaedic surgeons require more years of education and surgical training compared to podiatrists and believe they are more skilled in fracture-related surgery. Fewer podiatry patients expressed a preference for an orthopaedic surgeon. Providers must play an active role in discussing their training background prior to treating foot and ankle patients, especially in the setting of fracture-related pathology.

CLINICAL RELEVANCE

This study demonstrates that most patients seeking care from a podiatrist or foot and ankle orthopaedic surgeon are relatively knowledgeable about the type of provider they are seeing; however, there are some differences. Most patients understand that orthopaedic surgeons require more years of education and surgical training and also believe orthopaedic surgeons are more skilled in fracture work and taking care of arthritic conditions. In general, podiatry patients have less preference for seeing an orthopaedic surgeon; however, many of these patients are seeking care for wounds and infections. With expanding roles and scope of practice among podiatry providers, it is important that providers become more active in explaining their training background and qualifications when treating foot and ankle conditions.

LEVELS OF EVIDENCE

Level II: Prospective.

A Post-COVID Population-Based Analysis of Mohs Micrographic Surgeon Distribution in the United States

BACKGROUND

Policy changes to Mohs micrographic surgery board certification eligibility and population shifts in the wake of the COVID-19 pandemic have significant implications for the accessibility of Mohs micrographic surgeons across the United States.

OBJECTIVE

To examine the geographic distribution of micrographic surgery providers considering recent population trends and assess the impact of certification eligibility changes and population shifts on accessibility.

METHODS AND MATERIALS

Medicare claims data were utilized to identify micrographic surgery providers. Surgeon densities were calculated per 100,000 people by county and state. Population changes were analyzed using US census data.

RESULTS

Practicing micrographic surgeons were concentrated in metropolitan and nonmetropolitan areas. Overall, 80.4% of counties lacked micrographic surgery providers, with rural areas being the most underserved. Population changes varied among states.

CONCLUSION

Shifts in micrographic surgery certification requirements, US population distribution, and micrographic surgeon location emphasize challenges in accessibility, especially in rural areas across the United States.

Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA)

INTRODUCTION

The importance of identifying how patients choose their healthcare providers has grown with the prevalence of consumer-centric health insurance plans. There is currently a lack of studies exploring the factors associated with how patients select their hip and knee joint arthroplasty surgeons. The purpose of this study was to determine how patients find their arthroplasty providers and the relative importance of various arthroplasty surgeon characteristics.

METHODS

An electronic mail survey was sent to 3522 patients who had visited our institution for an arthroplasty surgeon office visit between August 2022 and January 2023. The survey consisted of multiple-choice questions, which aimed to inquire about the patients' referral sources for their current arthroplasty surgeon. In addition, patients were requested to rate the significance of 22 surgeon-related factors, on a scale of 1 (Not Important At All) to 5 (Very Important), in choosing their arthroplasty surgeon.

RESULTS

Of the 3522 patients that received the survey, 538 patients responded (15.3%). The most common referral sources were physician referral (50.2%), family/friend referral (27.7%), and self-guided research (24.5%). Of those that were referred by a physician, 54.4% of respondents were referred by another orthopaedic provider. Patients rated board certification (4.72 ± 0.65), in-network insurance status (4.66 ± 0.71), fellowship training (4.50 ± 0.81), bedside manner/personality (4.32 ± 0.86), and facility appearance (4.26 ± 0.81) as the five most important factors in picking an arthroplasty surgeon. Television (1.42 ± 0.83), print (1.50 ± 0.88), and online (1.58 ± 0.93) advertisements, along with social media presence (1.83 ± 1.08), and practice group size (2.97 ± 1.13) were rated as the five least important factors.

CONCLUSION

Patients are most likely to select an arthroplasty surgeon based on referral from other physicians, namely orthopedic surgeons, in addition to board certification status, in-network insurance, and fellowship training. Overall, these findings highlight the importance of physician credentials and reputation within the orthopaedic community in order to attract and retain patients.

What factors do patients consider when choosing a hand surgeon?

This study evaluated what patients consider in choosing a surgeon. A survey was given to 303 patients. Most found their hand surgeon through a medical or family/friend referral (p < .05). Surgeon credentials and accepted insurance were statistically more likely to be rated first (p<.001). We recommend educating referring physicians about our practices.

Word of Mouth and Online Reviews Are More Influential Than Social Media for Patients When Selecting a Sports Medicine Physician

Purpose

To (1) identify the percentage of patients seen in an orthopaedic sports medicine practice who use social media and (2) identify the role that social media has in physician selection as compared with other factors.

Methods

After institutional review board approval was received, new patients aged 18 years or older who attended a single orthopaedic sports medicine office from February 2020 to May 2021 were identified for inclusion. Sociodemographic information was recorded, and each patient was asked to fill out a questionnaire that assessed social media usage and online resources used to choose and formulate opinions regarding the patient’s provider.

Results

Two hundred patients met the inclusion criteria and completed the questionnaire. Of these, 96.5% reported social media use. The most common online method of searching for and identifying a physician was Google (50.5%). Social media outlets such as Facebook, Instagram, or LinkedIn were only used 15.5% of the time to search for and select a physician. Older patients were more likely to use recommendations from friends and family in their consideration when selecting a physician.

Conclusions

Despite almost all participants stating that they use social media, only 15.5% of patients reported that they used social media to search for and potentially select their physician. Our study suggests that although social media can be a helpful tool for patient education, other factors such as physician education and physician reputation through word-of-mouth referrals, online reviews, and online ratings seem to play a larger role in the patient’s selection of his or her physician.

Clinical Relevance

This information may be of value to orthopaedic surgeons looking for ways to build their patient base, online reputation, or other aspects of their practice on the Internet.

What factors are important to new patients when selecting an orthopedic oncologist?

BACKGROUND

Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.

AIM

To identify factors that patients consider important when choosing an orthopedic oncologist.

METHODS

New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey. The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.

RESULTS

A total of 101 new patients with a median age of 66 years (range, 14 years to 91 years) responded. Most were referred by another doctor (n = 63, 62.4%), and of the referring providers, the most frequent specialty was orthopedic surgery (n = 32, 51%). Using a Likert-type scale with 1 representing ‘least important’ and 5 representing ‘most important’, the most important factor was the hospital reputation (mean, 4.65; SD, 0.85). Additional factors of importance were the number of years in practice (3.87 ± 1.3) and a primary care provider referral (3.71 ± 1.6). Patients younger than 40 years old found social media (P = 0.016) and internet presence (P = 0.035) of their surgeon to be more important than older patients. In contrast, older patients considered care within an academic center to be of greater importance than younger patients (P = 0.014).

CONCLUSION

This investigation suggests a primary care referral, as well as hospital and physician reputation, are among the most important factors when selecting an orthopedic oncologist. Furthermore, social media utilization appears to be more important for younger patients.

How do patients choose their surgeon? Example of anterior cruciate ligament reconstruction

INTRODUCTION

In this age of social media, with an ever-higher profile for surgery and rankings for the general public, patients' criteria for choosing a surgeon or team are not precisely known, especially in France. We therefore conducted a prospective study concerning anterior cruciate ligament reconstruction: (1) to determine how patients came to know their surgeon; (2) to identify factors affecting final choice.

HYPOTHESIS

Patients' choice of surgeon is affected by scores found in social media and rankings found in the press.

MATERIAL AND METHOD

A prospective continuous study included all patients operated on, without standardization of technique, in 3 hospitals (public and private sector). An anonymous questionnaire on surgeon selection criteria, scored 0 to 10, was distributed on a voluntary basis on the day of surgery scheduling.

RESULTS

One hundred and five patients were included. They had come to know of their surgeon via family or friends or their personal physician in more than two-thirds of cases. The essential criterion of final choice was the clarity of the written and oral information provided in consultation (mean score, 8.09±1.83). Other factors included wait-time to surgery (7.39±2.25) and to first consultation (7.26±2.01) and the surgeon's reputation (7.42/10±2.43).

CONCLUSION

"Word of mouth" and the quality if information provided in consultation motivated final choice, more than any influence of social media or press hospital rankings.

LEVEL OF EVIDENCE

IV; prospective observational study without control group.

Choosing a Provider: What Factors Matter Most to Consumers and Patients?

Enhancing consumer and patient choice has been proposed as a means to improve care quality and reduce health-related costs. Choosing a medical provider is one of the most critical and often complex decisions patients make about their health care. We investigated the perceived importance of factors patients may consider when selecting a practitioner and if rated importance of the factors varies with their characteristics and prior experiences with different types of clinicians (physicians, physician assistants, and nurse practitioners). Participants most often identified medical license, certification, and whether the provider accepts the patients’ health insurance as important, while provider type, others’ recommendations, and online reviews were among the least important. We found wide-ranging differences based on patient characteristics. Prior experience with providers was also a strong determinant of patterns of factors patients considered valuable. Policy-makers, health systems, insurers, and providers need to take into account that patients rely on a range of factors that vary based on their distinct needs, backgrounds, and previous experiences—requiring tailored information to make more informed decisions.

What Factors Determine the Patients' Choice in Finding Their Office Urologist?

PURPOSE

The present study aimed to investigate how patients identify a quality urologist in primary health care and how they determine and evaluate their provider's qualities before their first examination.

PATIENTS AND METHODS

A specific questionnaire (The ESUO Questionnaire) was prepared to describe the domains that influence the patient's evaluation and summarize the urologist related characteristics and behaviours that the patients estimate are more important. A total of 335 patients, over 18 years of age, presented in primary healthcare urology practice, completed the survey. The participants were divided into three age groups; 18-39 years of age (111 patients), 40-59 years of age (111 patients) and 113 patients 60 years of age and older.

RESULTS

The majority of patients (68.4%) selected that the urologist must be efficient and well trained. This attitude was primarily expressed in patients ≥60 years of age. Individuals under 60 years old stated that they expect a detailed examination and that the patient should be the urologist's priority. The majority of the patients evaluates friends or family's proposals concerning the urologist's quality primarily and believes that there is at least good quality of urological health care.

CONCLUSION

Most patients evaluate primarily the effectiveness of the care they receive instead of the urologist's personality traits or personal relationships.

Success of Various Marketing Strategies for a New-to-the-Area Orthopedic Practice

Background Competition for patients among orthopaedic private practices, multi-specialty groups, and hospital systems continues to persist. An effective marketing campaign is essential for a practice to succeed in this competitive environment. The purpose of this study was to investigate the cost-effectiveness and efficacy of each marketing campaign and the influence of patient demographics on efficacy. Methods The first 300 consecutive, new patients were prospectively surveyed on how they initially discovered and then selected the orthopaedic practice. Demographics and marketing costs were tabulated and categorized to analyze the effectiveness of each marketing strategy. Results A substantial portion of the marketing budget was allocated for traditional (67.0%) and online advertising (25.0%). However, only 56/300 (18.7%) patients surveyed were brought to the practice by these methods combined. In contrast, expenditure on a marketing liaison (8.0%) delivered 128 patients (42.7%) through referrals: 80 (26.7%) from physicians, 28 (9.3%) from urgent cares, 17 (5.7%) from physical therapists, and 3 (1.0%) from attorneys. Conclusion Marketing strategies were not proportionally beneficial during the first six months of the orthopaedic practice start-up period. During this early ramping up period, the most cost-effective marketing strategy was utilization of a liaison for direct in-person visits to various healthcare facilities.

The Effect of a Surgeon’s Online Presence on Surgeon Selection in Elective Joint Arthroplasty

The purpose of this study was to investigate the role that a surgeon’s online presence plays in patients’ decisions to be treated by that surgeon. Postoperative patients from our arthroplasty clinic were enrolled in a retrospective cross-sectional questionnaire. Results from 101 patients demonstrated that the most searched information was education and training (68.8%), online ratings (53.1%), online reviews (50%), associated hospital and/or university (46.9%), insurance coverage (37.5%), location (21.9%), and awards (9.4%). The results of our questionnaire suggest that orthopedic surgeons could more effectively shape their online presences by highlighting these characteristics that patients are more likely to research.

Correlates of Google Search Rankings for Spine Surgeons: An Analysis of Academic Pedigree, Social Media Presence, and Patient Ratings

STUDY DESIGN

Prospective observational study.

OBJECTIVE

The objective of this study is to identify correlates of search ranking among academic pedigree, online ratings, and social media following.

SUMMARY OF BACKGROUND DATA

Patients increasingly rely on online search in selecting healthcare providers. When choosing a spine surgeon, patients typically value surgical skill and experience as well as demeanor/bedside manner. It is unclear whether current search engine ranking algorithms reflect these preferences.

METHODS

A Google.com search for the top 25 spine surgeon websites by search ranking was conducted for each of the largest 25 American cities. Resulting websites were then perused for academic pedigree, experience, and practice characteristics. Surgeons' research output and impact were then quantified via number of publications and H-index. Online ratings and followers in various social media outlets were also noted. These variables were assessed as possible correlates of search ranking via linear regression and multivariate analyses of variance.

RESULTS

A total of 625 surgeons were included. Three categorical variables were identified as significant correlates of higher mean Google search ranking-orthopedics (vs. neurosurgery) as a surgical specialty (P = 0.023), board certification (P = 0.024), and graduation from a top 40 residency program (P = 0.046). Although the majority of the identified surgeons received an allopathic medical education, there was no significant difference in the mean rank of surgeons who had an MD versus DO medical degree (P = 0.530). Additionally, none of the continuous variables collected, including years in practice (P = 0.947), publications (P = 0.527), H-index (P = 0.278), social media following such as on Facebook (P = 0.105), or online ratings such as on Healthgrades (P = 0.080), were significant correlates of Google search ranking.

CONCLUSIONS

Google search rankings do not always align with patient preferences, currently promoting orthopedic over neurosurgical specialists, graduation from top residency programs, and board certification, while largely ignoring academic pedigree, research, social media presence, and online ratings.

LEVEL OF EVIDENCE

3.

Factors Influencing Patient Selection of Urologists

OBJECTIVE

To describe the factors affecting patients' selection of a urologist, and the utilization of the Internet and social media.

MATERIALS AND METHODS

All new patients presenting to a single-institution for evaluation were invited to complete an anonymous 26-item questionnaire between April 2018 and October 2018, including demographic information, use of Internet and social media resources, and relative importance of factors when selecting a urologist. Descriptive statistics were reported, and a stratified analysis was performed for age, gender, and education.

RESULTS

A total of 238 patients responded. More than half (53%) of patients searched their medical condition prior to presentation. When stratified by age, younger patients were 3 times as likely to utilize Internet resources (Group 1 vs Group 2; OR 3.3, 95%CI 1.5-7.2, P <.01). Few patients utilized Facebook (7%) or Twitter (1%). The 3 most important surveyed urologist selection factors included hospital reputation (4.3 ± 1.0), in-network providers (4.0 ± 1.3), and appointment availability (3.9 ± 1.0). The 3 least important included medical school attended (2.7 ± 1.3), urologist on social media (1.9 ± 1.2), and TV, radio, and/or billboard advertisements (1.7 ± 1.3).

CONCLUSION

This study suggests a significant proportion of patients search the Internet regarding their medical condition prior to presenting to clinic. Further, younger patients utilize this methodology significantly more than the senior population. Important factors when selecting a urologist may be driven by a hospital's reputation, in addition to scheduling convenience.

Physician Extenders in Hand Surgery: The Patient's Perspective

BACKGROUND

Physician extenders, such as physician assistants (PAs) and nurse practitioners (NPs), have been incorporated into health systems in response to the rising demand for care. There is a paucity of literature regarding patient perspectives toward physician extenders in hand surgery.

METHODS

We anonymously surveyed 939 consecutive new patients before their clinic visit. Our questionnaire assessed patient perspectives toward physician extenders, including optimal scope of practice, the effect of the extender when choosing a hand surgeon, and pay equity for the same clinical services.

RESULTS

Of 939 patients, 784 (84%) responded: 54% were male and 46% were female with a mean age of 44.1 years. Most (65%) patients consider the extender's training background when choosing a hand surgeon, with 31% of all patients considering PAs to have higher training than NPs and 17% the reverse. Patients responded that certain services should be physician-provided, including determining the need for advanced imaging (eg, magnetic resonance imaging), follow-up for abnormal diagnostics, and new patient visits. Patients were amenable to services being extender-provided, including minor in-office procedures, preoperative teaching, and postoperative clinic visits. Patients lacked a consensus toward reimbursement equity for hand surgeons and physician extenders providing the same clinical services.

CONCLUSIONS

Our data suggest that patients presenting to a hand surgeon are comfortable receiving direct care from a physician extender in many, but not all, circumstances. Hand surgeons can use these data when deciding how to use extenders to optimize patient satisfaction and practice efficiency as health care systems become increasingly consumer-focused and value-based.

Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine

BACKGROUND

Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine.

PURPOSE

To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians.

RESULTS

Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation.

CONCLUSION

As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient satisfaction. Physicians may consider these data in clinical workforce planning, as patients preferred specific services to be physician or midlevel provided. It may be worthwhile to consider midlevel providers in marketing efforts, given that patients considered the credentials of the physician's midlevel provider when initially selecting a new physician. Patients lacked consensus regarding reimbursement equity between physicians and midlevel providers, despite responding that the physician provides a higher-quality consultation. Our findings are important for understanding the midlevel workforce as it continues to grow in response to the increasing demand for orthopaedic sports care.