Although numerous anonymous physician review sites exist, our analysis focused on surgeon self-promotion through personal websites or web pages. Within these sources, there exists a wide array of information and methods that physicians utilize to present themselves. Some physicians merely post their educational background and qualifications. This appears most often when the physician is associated with an academic institution and their profile is part of an institution’s website. Others post extensive self-promoting statements about technical skill and innovations in clinical practice. They sometimes include information regarding charity donations, level of community involvement, and practice philosophy.
Materials and Methods
Categorization of Surgeon Websites and Ratings
Surgeon websites were selected from the 5 largest population centers in the United States. Analysis was undertaken to categorize the self-promotion content of each selected website using an objective scale to quantitatively assess the number of times that physicians referred to themselves in a positive manner. A thorough search of the literature did not reveal any validated questionnaire or assessment tool usable for this purpose. Five blinded raters were asked to count the number of positive self-directed remarks made by the author of each website. Websites were ranked based on the number of such statements. No rater was exposed to any styling or graphical information from any website. Only textual statements were used for the purposes of this study. All statements were printed on paper and evaluated without the use of a computer to prevent any searching or contamination of the subject or rater pool.
Websites were considered as self-promoting (using language that promotes the physician beyond the use of basic facts), or non-self-promoting(presenting little beyond basic biographical information) based on the presence of many (more than 5) or few (less than 5) self-promoting statements. The breakpoint of 5 self-promoting statements served to highlight a clear transition between the 2 general types of websites and provided a good demarcation between self-promoters and non-self-promoters. This distinction allowed for the choosing of contrasting websites, which could directly probe the question in our hypothesis about the effect of such websites on naïve or surgeon-peer respondents.
Each website was judged independently by 5 blinded raters. Inter-rater reliability scores were then calculated using Fleiss’ Kappa to assess reliability of the categorization of self-promoter or non-self-promoter. This value was calculated to be k = .80, 95% confidence interval (0.58-1.01), which is suggestive of a “substantial level of agreement.”9 Websites categorized as non-self-promoting contained a mean number of self-promoting statements of less than 2 (0-1.8) as judged by the 5 raters. By contrast, websites categorized as self-promoting had a mean number of self-promoting statements of 6.4 or higher (6.4-22.6). When the self-promoting websites and the non-self-promoting websites were compared, they were significantly different in the number of self-promoting statements t (43) = 7.90, P < .001, with self-promoting websites having significantly more self-promoting statements than non-self-promoting websites.
Surveys and Respondents
Next, a survey of 10 questions of interest was developed. A thorough literature search revealed no validated measure or survey to measure the effects of surgeon or physician self-promotion. We developed a 10-question survey to prove the impressions and allow for assessment of differences between respondent groups to measure the effect of promotion. The questions (see Appendix for survey questions) included a forced Likert rating system. Each response occurs and is presented on a scale from 0 to 3 (0 = Strongly Disagree, 1 = Disagree, 2 = Agree, and 3 = Strongly Agree).
Respondents were true volunteers recruited from 2 groups that were termed “surgeon-peers” and “naïve subjects.” Surgeon-peers were board-certified orthopedic surgeons (N = 21, all with medical doctorates). Demographic breakdown of the surgeon-peers revealed them to be reflective of the general population of orthopedic surgeons (71.4% male, 28.6% female, 90.2% Caucasian, 4.8% African American, and 4.8% Asian, all with professional degrees). Naïve subjects (N = 24, average age 41 years) were selected based on the criterion of having no affiliation with a healthcare system and no history of interaction with an orthopedic surgery or surgery in general. The demographic breakdown of naïve subjects was 45.8% male, 54.2% female, 79.1% Caucasian, 16.7% African American, and 4.2% Asian. Half of the naïve respondents had a Bachelor’s degree, 17% had a Master’s degree, 4% had a professional degree, and 29% had a high school diploma. No volunteer, in either group, received any form of inducement or reward for participation so as not to skew any responses in favor of physicians.
All participants were asked to read each surgeon’s statements and then complete a survey for each statement. Volunteers were not informed of a surgeon’s calculated level of self-promotion, and they were presented the survey questions in random order. Survey completion required unreimbursed time of approximately 1 to 2 hours.