BY MALACHI G. SHEAHAN III, MD MEDICAL EDITOR, VASCULAR SPECIALIST
Recently I received an email from a woman I will not name. She was happy to announce that I had been selected as a Top Cardiologist representing Durham, North Carolina. Since I am not a cardiologist, nor have I ever been to Durham, this was a bit puzzling. What was genuinely surprising about the email, however, was not this woman’s mercurial relationship with facts. Instead, it was the reality that I wanted to believe it. For a split second, wild rationalizations came quickly. “Did I give medical assistance on a layover in Charlotte? Am I Duke basketball coach Mike Krzyzewski’s personal doctor? Of course I don’t deserve this award. But maybe?”
Compliment a physician’s appearance, and he or she will probably be suspicious of your intentions. But compliment their clinical ability? The one thing they have spent their entire lives honing? Doctors will take this at face value. That is our weakness, and it is a weakness that drives a very lucrative industry.
My experience is not unique. A few years ago, a New York-based firm informed Marshall Allen that he had been named a “Top Doctor.” The problem was that Mr. Allen was not a doctor; he was an investigative journalist. Mr. Allen’s subsequent research uncovered a number of these organizations awarding such dubious honors as “Super Doctor,” “Best Doctor,” and “Top Doctor.” Mr. Allen did receive his plaque (at a discounted rate of $99) and noted: “Obviously, the Top Doctor Awards company has questionable standards.”1
Sorting out the various organizations that purport to select the best doctors can be an arduous process. At least a dozen currently exist. In 2012, ABC News investigated the Consumers’ Research Council of America, the issuer of the “Top Doctor” awards.2 The ABC probe revealed that many of the currently listed honorees had significant, even criminal issues. Dr. Conrad Murray, convicted of manslaughter in the death of Michael Jackson, was still listed as a “Top Cardiologist” years later. Dr. Earl Bradley remained on the “Top Pediatrician” list even while serving 14 life sentences for molesting 103 children.
If you live in a metropolitan area, your regional magazine almost certainly publishes an annual “Best Doctors” issue. Many of these lists are compiled by Castle Connolly, a research company founded in 1992. In full disclosure, I am listed in the Castle Connolly database (at least until we publish this article!). John Connolly, the president and CEO of Castle Connolly, reports that they employ a full-time research team and update their lists annually. Their selection method is unique in that it relies heavily on peer nomination. Critics call the process a popularity contest, which favors doctors from bigger groups and ones who have been in practice for many years. Since the awards can bring in patients and money, many hospital systems buy in. Advertising campaigns are formed around the best doctor lists. There are even reports of hospital CEOs offering cash incentives to Castle Connolly doctors who nominate peers from within their hospital. While I don’t recall ever receiving an invitation for nominations from Castle Connolly, I have gotten requests from institutions where I previously worked to nominate physicians from within their systems.
For many of these best doctor businesses, the money flows directly from the awarded physician to the company. Of course, the cash is usually laundered through plaques or advertisements. For Castle Connolly, it is a bit more complicated. Doctors can’t pay directly for listing, but their full profile isn’t available online unless their institutions have paid at least $11,000 to join the “Partnership for Excellence Hospital” program. Castle Connolly also offers to place physicians in a New York Times ad for $3,350. They claim this ad will allow physicians to not only attract new patients but also ”reinforce your status with current patients!”2 How exactly would that work? Yes, Mrs. Jones, shame about your above-knee amputation, but have you seen my glossy spread in the Times?
Castle Connolly also partners with American Registry to offer plaques commemorating these awards. Some include a mock-up of the cover of the “Best Doctors” issue of your local magazine, reminiscent of the fake Wheaties box covers I coveted as a child. Of course, I would never buy something so frivolous, but if YOU wanted to get me one, the Museum Quality Prestige Series Mahogany With Gold Trim looks nice.
What is a “Top Doctor” anyway? What claims do these sites make? Michael Doherty, president and CEO of TopDocs.com, told ABC News that the name of his website is “not inferring in any way that the doctors in the site are top doctors.” Hmmm, maybe the “Top” stands for Top Dressed? Super Doctors offers this disclaimer: “Super Doctors” is the name of a publication. It is not a title or moniker conferred upon individuals. No representation is made that the quality of the medical services provided by the physicians listed in this Web site will be greater than that of other licensed physicians.”1
So not only can I not call myself a “Super” doctor, I’m not even better than anyone else? Maybe the “Super” is supposed to be sarcastic? Even the Castle Connolly list only claims that these doctors are “among the best.” Among the best? That sounds like Loser Town to me. Where do the BEST DOCTORS go to broadcast their preeminence? Let’s check the commercial airline magazines.
Where did this begin? I’m not sure who thinks Southwest Airlines is a reliable source for medical referrals. What is the thought process here?
Well, I’ve read the Taylor Swift puff piece, learned Five Ways To Do Pasadena, and stared at the North Atlantic route map for 20 minutes. I guess it’s time to find a hair transplant surgeon!
Still, flip through the pages of an airline magazine and there they are, between the lists of Top American Steakhouses and ads for shady online universities. Behold the Top Neurosurgeons of New York, complete with the image of a happy looking gentleman helpfully holding a disincorporated spine. I miss Sky Mall.
Of course, these lists proliferate because there is no perfect system for picking the best doctors. Peer nominations are nice but in no way comprehensive. Let’s face it, on most days I wouldn’t even be voted best doctor in my own house (although my polling numbers do improve dramatically on the nights I bring home pizza).
Online physician rating sites are also deeply flawed. While I would like to rest on the laurels of my 5-star grade on vitals.com, the five patient sample size seems insufficient. So the public is left to sift through meaningless awards, google rankings, and terrible advice. Even doctors have trouble explaining how to find the best among them. Writing for Slate Magazine, Dr. Kent Sepkowitz, a New York City physician, offered this awful guidance: “… it’s OK to hate your surgeon. You simply need him to cut and sew very intelligently. So always select the surgeon who has already done the most iterations of whatever procedure you need.”3 Sexism aside, there is much to hate here. We all know the best surgeons are distinguished by their knowledge of when to operate as much as how to operate. If you go to the doctor who performs the most laser veins you are probably gonna come out with some veins lasered.
In the end, maybe our ventures into physician quality metrics will pay off. I expect there will be many hurdles to jump before systems such as the Vascular Quality Initiative are made public. For now at least, anyone can seemingly declare themselves a Top Doctor. Unfortunately the burden of proof lies with the patients.
References
- www.propublica.org/article/top-doctors-award-journalist.
- https://abcnews.go.com/Health/top-doctor-awards-deserved-abc-news-investigation/story?id=16771628.
- https://slate.com/technology/2006/06/what-swrong-with-magazine-best-doctor-lists.html.