An insider peek on how he started to care about the quality of health by creating a start up online business.
Name: Steven R. Feldman, MD, PhD
Location: Winston-Salem, NC
About: Dr. Steve Feldman is a professor of dermatology, pathology and public health sciences at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. His research studies into patients’ compliance with their topical treatments helped transform how dermatologists understand and manipulate patients’ use of topical medications over the course of chronic disease. Dr. Feldman’s work has been published in over 500 articles in peer-reviewed journals. He is the author of Compartments: How the Brightest, Best Trained, and Most Caring People Can Make Judgments that are Completely & Utterly Wrong (Xlibris) and Practical Ways to Improve Patients’ Treatment Outcomes (Informa), he founded the DrScore.com
Can you tell us a little bit about you and how you got started in patient satisfaction and doctor rating?
Physician rating is in the news. It wasn’t when I started in it. I thought I was giving my patients great medical care by giving them the right diagnosis and the right treatment. But when our University started collecting patient satisfaction data, I found that I was leaving too many patients feeling dissatisfied with their care. While the patient satisfaction data we were collecting was very helpful to me, the way were collecting the data was a pain in the neck. I thought there must be a better way to do it, coming up with the idea of using an Internet-based doctor rating website—www.DrScore.com— as an easy, efficient, high quality, low cost way to collect patient satisfaction data.
The strategy for development of DrScore took a number of factors into account to tailor the experience to be mutually beneficial to the patient and physician. Patients are not required to give any identifying information on the site, which allows people to give honest, open feedback. In addition to the 1-10 rating a patient gives on a variety of variables, open comments are also taken. These comments are shown only to the doctor and are necessary to inform him/her what they are doing well and what could be better. This type of system allows for positive reinforcement, but also identification of problem areas where action can immediately be taken. One reason open comments aren’t public is that some patients might not feel comfortable giving doctors negative feedback in a public forum. This discourages people that just have an axe to grind from airing their potentially slanderous comments on this forum. We use a validated survey, and I think that’s one reason, along with the low cost, why the American Board of Dermatology approved DrScore as a means for dermatologists to collect and report their patients’ experience of care data for maintenance of certification.
Can you tell us more about your service?
Doctors’ receive zero to ten ratings which are public. These ratings consist of numerical valuations for aspects of their visit including how long they had to wait before being seen, how well the doctor answered questions, how friendly the staff was, and how easy it was to park. The interactive design of the survey minimizes the burden on the participant, while at the same time encouraging patients to provide a high level of detail. This allows docs to know as specifically as possible, what can be improved. The fact that these ratings are public both encourages patient participation, as well as allows the public to see how good doctors are doing. DrScore believes that physicians have nothing to fear from the public seeing representative ratings. While some doctors might worry about public rating, I think transparency is terrific for physicians. We’re doing a great job and don’t need to hide! Of the doctors with 10 or more ratings on DrScore, the average score is a 9.3! My 9.1 might look respectable, but it puts me solidly in the bottom half of U.S. physicians.
Can you give us some insight on how your business works?
Because the DrScore.com business model is an online business, there isn’t a large staff or need for a lot of hiring and firing. I would be the first to admit that business administration is not my long suit.
What are your thoughts about the technologies you’re using now?
The DrScore business relies heavily on the Internet. By getting rid of paper-based surveys or telephone calls, the costs of doing business are dramatically reduced. Those savings are passed on to the physicians and clinics who use DrScore to collect and assess patient feedback. Instead of doing surveys for 1 week every quarter (and having staff be especially attentive and well dressed that one week), the low cost of online ratings allows the practice to survey every patient all year long. Online ratings minimizes the burden of survey administration, while still getting formally validated information on how to improve aspects of one’s practice.
How does DrScore work?
As the DrScore.com ratings database has grown, it has allowed us to do research studies showing how to achieve higher levels of patient satisfaction. Cosmetic specialists should know that the fundamental key to success is making sure patients feel cared for. DrScore also reports on the very top doctors each year. To be in that category, a doctor needs a rating of about 9.98 or more (on a 0 to 10 scale).
How do you generate profit?
Nearly all the DrScore revenue comes from medical practices using DrScore to collect patient satisfaction data. Our biggest revenue sources are the larger medical practices with hundreds of physicians.
What have you learned about practicing medicine?
I now strive to make sure every patient I see feels how much I care for them. I used to think that it was enough to care about people, but I learned that you have to show it, too. I had studied for years to be a good dermatologist, and in the area of psoriasis in which I specialized. I could walk in an exam room and know exactly what the patient had and what they needed. I was very efficient! But it wasn’t until I got back patient satisfaction reports that I saw things from their perspective, how they perceived my efficient practice as being uncaring.
What advice would you give to other physicians based upon your experiences?
Before you open the door to the exam room, remind yourself to act in such a way as to convey to patients a sense that you care for them. To start, open the door to the room slowly, so they won’t think you are in a hurry!
About: He directs the Center for Dermatology Research, a health services research center working to improve the care of patients with skin disease. Dr. Feldman’s chief clinical interest is psoriasis. He received a Presidential Citation from the American Academy of Dermatology in 2005 for his psoriasis education efforts and received one of the AAD’s highest awards, the Clarence S. Livingood Lecturership, at the 2006 AAD Meeting. Dr. Feldman also was awarded the Astellas Award (and its $30,000 prize) by the American Academy of Dermatology in 2008 for scientific research that improved public health in the field of dermatology.
He has studied the quality of medical, surgical, and pathologic dermatology services provided by dermatologists, reinforcing effects of UV exposure in frequent tanners, and the quality of life impact of psoriasis. His research studies into patients’ adherence to topical treatments are transforming how dermatologists understand and manipulate patients’ use of topical treatment of chronic disease.