Same Doctor, Different Site: Lower Patient Satisfaction

Maureen Salamon November 06, 2017

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WASHINGTON, DC — Patient-satisfaction scores for individual physicians vary, depending on the health setting, new research suggests, raising questions about patient perception.

Physicians who practice at both hospital-based and freestanding emergency departments consistently received higher ratings from patients at freestanding facilities, said investigator Erin Simon, DO, from the Cleveland Clinic Akron General.

Although the study did not directly probe the reasons for the difference in patient-satisfaction scores, the average door-to-provider time at hospital-based emergency departments was nearly 40 minutes longer, Dr Simon reported here at the American College of Emergency Physicians 2017 Scientific Assembly.

“Working in both types of practice environments, and knowing wait times are lower at freestanding EDs, I thought patient-satisfaction scores would be higher there,” she told Medscape Medical News.

“Our hospital-based EDs have a lot of other factors to consider, such as volume and length of stay, and a lot of those things improve at freestanding EDs,” she said.

Dr Simon and her colleagues assessed Press Ganey patient-satisfaction sores from nine hospital-based and eight freestanding emergency departments in an Ohio healthcare system, obtained over a 2-year period.

Quality Benchmarks

Press Ganey scores are often used as quality benchmarks in healthcare systems, some of which tie scores to physician pay, Dr. Simon reported.

Forty-nine physicians were evaluated with more than 7500 patient surveys.

Questions addressed four factors: physician courtesy; whether the doctor kept the patient informed about treatment; physician concern for patient comfort; and physician listening ability. Responses were rated on a scale of 1, indicating very poor, to 5, indicating very good.

Across the board, Press Ganey ratings for individual physicians were higher at freestanding emergency departments. For every survey measure, freestanding scores were 0.25 to 0.33 points higher than hospital scores.

Data recorded at both types of facility included age and sex of the patient, door-to-provider time, and length of stay for discharged patients.


Table. Time Spent in Emergency Departments

Mean TimeFreestanding Departments, minHospital-based Departments, min
Door-to-provider time2968
Length of stay113214


These findings could encourage emergency physicians to enhance their communication with patients, said Dr Simon.

Future research should tease out why patient-satisfaction scores differ for individual physicians by setting, she added, and determine whether it is related to variations in physician behavior or patient characteristics.

“Hospital-based emergency departments are larger and see greater volumes, so explaining this to patients may affect their overall experience,” she said.


People are let go because they don’t have the Press Ganey scores their leadership expects them to have.

This study shows “there is some doubt” about the accuracy of Press Ganey scores, and how they reflect on individual physicians, said Mark Sochor, MD, of University of Virginia in Charlottesville, “You’re judged by peers and your hospital on Press Ganey scores, and people are let go because they don’t have the Press Ganey scores their leadership expects them to have,” he told Medscape Medical News.

“I don’t know that this is always the way to go,” he added. “That said, how do I maximize my Press Ganey scores? And if I’m being judged on Press Ganey, can I model certain behavior to do that?”

Dr Sochor said he wonders if, because physicians practicing at freestanding emergency departments automatically receive higher scores because of lower wait times, there is a way to “level the playing field” for physicians or to modify the clinical environment to improve patient satisfaction.

“If environment isn’t the confounder, then we can grab those lessons,” he pointed out, “to maximize the experience for those patients.”

Dr Simon is a consultant and member of the physician advisory board for Tandem Hospital Partners. Dr Sochor has disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2017 Scientific Assembly: Abstract 391. Presented October 31, 2017.