Dermatologist online ratings for botulinum toxin injections are nuanced and may be misleading

Abstract

To the Editor: Online reviews are an important factor in consumer choice of minimally invasive cosmetic procedures.1Grumbein A. Goodman J.R. Pretty as a website: examining aesthetics on nonsurgical cosmetic procedure websites.Vis Commun. 2015; 14: 485-523Crossref Scopus (7) Google Scholar, 2Smith R.J. Lipoff J.B. Evaluation of dermatology practice online reviews lessons from qualitative analysis.JAMA Dermatol. 2016; 152: 153-157Crossref PubMed Scopus (29) Google Scholar, 3American Society for Dermatologic Surgery2019 ASDS survey on dermatologic procedures.https://www.asds.net/medical-professionals/practice-resources/asds-consumer-survey-on-cosmetic-dermatologic-proceduresDate: 2020Date accessed: July 6, 2020Google Scholar We sought to evaluate online choices for a consumer seeking botulinum toxin from a dermatologist in representative areas of the United States. Through consumer reviews on the websites Yelp.com and Google.com, businesses in 12 communities representative of diverse US health care marketplaces4Resneck J.S. Quiggle A. Liu M. Brewster D.W. The accuracy of dermatology network physician directories posted by medicare advantage health plans in an era of narrownetworks.JAMA Dermatol. 2014; 150: 1290-1297Crossref PubMed Scopus (16) Google Scholar were searched via a combination of search terms (“Botox,” “dermatologist,” city name), and the top 10 clinics by number of listed reviews were selected (June 2019). A total of 140 individual clinics were identified; the number of ratings, proportion of positive (4 or 5 stars) and negative (1 or 2 stars) ratings, providers, and provider qualifications were recorded for each. Websites for the clinics with dermatologists were evaluated for verification of board certification through the board-certification websites (American Board of Dermatology and American Osteopathic Board of Dermatology) and if not verified, then evidence of US dermatology residency completion. Despite the term “dermatologist” being included in all searches, nondermatology practices made up 34.0% of total businesses. Most nondermatologist listings were plastic surgery practices (17.7%), and midlevel providers and aestheticians were frequently listed in the practices (midlevel providers: 58.0%; aestheticians: 37.6%). The proportion of positive and negative reviews were different between dermatology-led, plastic surgery, and other practices (P < .0001). The proportion of positive reviews was higher on both websites for other businesses compared with dermatology practices (Yelp: 90.2% ± 9.4% vs 65.2% ± 18.2%; Google: 94.9% ± 4.8% vs 78.7% ± 14.4%) (Fig 1, A). Furthermore, dermatology practices had more negative reviews compared to other practices (Yelp: 32.7% ± 17.8% vs 8.5% ± 9.6%; Google: 20.4% ± 16.2% vs 4.7% ± 4.8%) (Fig 1, B). Clinics without a dermatologist had more reviews on both sites compared to dermatology practices (Google: 98.8 [95% confidence interval (CI), 74.4-123] vs 66.6 [95% CI, 58.7-74.4]; Yelp: 100.7 [95% CI, 70.1-131.3] vs 64.2 [95% CI, 55.8-72.5]). Ten locations were identified with practitioners who potentially misrepresented their dermatology credentials, including unverified board certification or advertising as a dermatologist in the absence of completing a dermatology residency. These practices had more reviews on both Google (110.3 [95% CI, 84.3-136.3] vs 64.2 [95% CI, 55.1-73.3]) and Yelp (100.6 [95% CI, 70.1-131.3] vs 55.5 [95% CI, 49.4-61.7]) (P < .001 for both); however, they also had more negative reviews than dermatology practices (37.1% vs 22.51%; P < .0001). More than two thirds of consumers report that review websites affect their choice of provider for minimally invasive cosmetic procedures.3American Society for Dermatologic Surgery2019 ASDS survey on dermatologic procedures.https://www.asds.net/medical-professionals/practice-resources/asds-consumer-survey-on-cosmetic-dermatologic-proceduresDate: 2020Date accessed: July 6, 2020Google Scholar Despite the fact that consumers perceive dermatologists as the provider of choice for these services, our study found that dermatologists are represented less favorably compared to other specialists and nonspecialists represented intentionally or unintentionally as a dermatologist.3American Society for Dermatologic Surgery2019 ASDS survey on dermatologic procedures.https://www.asds.net/medical-professionals/practice-resources/asds-consumer-survey-on-cosmetic-dermatologic-proceduresDate: 2020Date accessed: July 6, 2020Google Scholar A possible reason for this difference is that nondermatologists rely more on the internet for recruitment because dermatologists obtain patients for cosmetic procedures from their medical dermatology practices, encouraging greater investment in resources to optimize consumer responses such as incentivizing reviews.5Petrescu M. O'Leary K. Goldring D. Ben Mrad S. Incentivized reviews: promising the moon for a few stars.J Retailing Consum Serv. 2018; 41: 288-295Crossref Scopus (44) Google Scholar Even so, we encourage all specialties to be transparent with training, certifications, and recruitment for online reviews.