title: Impact of patient satisfaction ratings on physicians and clinical care.
abstract: BACKGROUND
  Although patient satisfaction ratings often drive positive changes, they may have unintended consequences.
  
  
  OBJECTIVE
  The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care.
  
  
  METHODS
  A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous.
  
  
  RESULTS
  One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians). The respondents were predominantly male (85%) and practicing in solo or private practice (45%), hospital (43%), or academia (15%). The majority were ED (57%), followed by primary care (16%) physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive.
  
  
  CONCLUSIONS
  These pilot-level data suggest that patient satisfaction survey utilization may promote, under certain circumstances, job dissatisfaction, attrition, and inappropriate clinical care among some physicians. This is concerning, especially in the context of the progressive incorporation of patient satisfaction ratings as a quality-of-care metric, and highlights the need for a rigorous evaluation of the optimal methods for survey implementation and utilization.
authors.affiliation: Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.affiliation: Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI.
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.affiliation: American Society of Addiction Medicine, Chevy Chase, MD ; Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, Oconomowoc, WI, USA ; Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Miller
keywords: health services; patient experience of care; physician satisfaction; quality of care
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