Why are so few patients rating their physicians on German physician rating websites? A qualitative study

Background: Physician rating websites (PRWs) allow patients to rate, comment and discuss physicians' quality online as a source of information for others searching for a physician. It is generally assumed that PRWs will only be helpful for users, and fair for the rated, if there are a high number of ratings. However, the number of ratings on PRWs remains low internationally and there is currently a lack of research examining the reasons why patients are not rating their physicians. The aim of this study is to therefore identify the spectrum of factors influencing people's willingness to rate their physician on PRWs. Methods: A mailed cross-sectional survey sent to a random sample from 4 North German cities between April and July 2016. Fifty participants who had previously used PRWs but not rated a physician provided reasons for why that had not rated a physician in a free text response. Semi-structured qualitative telephone interviews were then conducted with 22 interested participants to explore factors influencing their willingness to rate their physician on PRWs in more detail. Results: Participants identified a total of 21 distinct incentives and disincentives for rating physicians on PRWs, which could be further categorised under the headings: user-specific, PRW-specific and physician-specific. Two key overarching groups of factors emerged: (1) factors concerning the physician-patient relationship, and (2) factors issues regarding technical aspects of PRWs. Conclusion: These findings will be helpful in guiding future research and health policy initiatives to increase the usefulness and fairness of PRWs.