Looking at those “best doctors” lists published in books, Web sites and local magazines, you might get the idea that emergency medicine is the Rodney Dangerfield of specialties: “No respect!”
The fact is, none of the organizations that compile lists of “best doctors” and distribute them include emergency physicians. But all of them say it has nothing to do with a lack of appreciation for the specialty and everything to do with the particular circumstances under which one seeks out emergency care.
“You get who you get when you get there,” said Evan Falchuk, president and CEO of Best Doctors, Inc. “Consumers don't say, ‘OK, when I have an emergency, I'm going to worry about this piece of paper (listing best doctors).’ No, it's sort of, ‘I'm bleeding here. Just let me get treated by somebody.’”
John Connolly, president and CEO of Castle Connolly Ltd., another group that compiles such listings, said his company used to include emergency physicians but “even though we thought were identifying some excellent people … we felt that the emergency department was an inappropriate place for a patient to ask for a specific physician.”
In fact, said Connolly, when Castle Connolly started up in 1992, it did list emergency physicians, but ran into an objection--from the emergency physicians.
“After a couple of years of doing that, we were contacted by a number of emergency department physicians who were actually in our guide, and they asked not to be listed,” Connolly said. “They felt it would be disruptive.”
Jean Morgan, Castle Connolly's vice president of research and medical affairs, adds, “The company's findings are really there for the consumer. They are not for the doctors to be sort of a ‘Who's Who.’”
Yet most listing companies rely largely on peer recommendation, obtained by mailing out surveys to physicians around the country, focusing primarily on the larger metropolitan areas–-a method not without considerable bias potential.
Consumers' Checkbook, a nonprofit organization that lists ratings for doctors (and mechanics, landscapers, electricians, exterminators, tailors and other services), will provide listings of emergency physicians, but only on its Web site, not in its printed publications. As Robert Krughoff, president of Consumers' Checkbook, explains, such a list is probably more “interesting to hospitals and emergency departments and even to health plans” and making it available somewhere will “give appropriate recognition to doctors who are respected by their peers.”
“This is not a perfect system,” admits Krughoff. While it might not be of much value to a patient to have a list of top-rated emergency physicians, it can be helpful to have advance knowledge about which are the best local emergency departments.
Consumers' Checkbook provides such information for hospitals in seven major metropolitan areas. In the Washington, DC area, for example, it lists consumer ratings (for staff pleasantness, relief of symptom, helpfulness in follow-up care and others), desirability scores and other qualifying factors for 30 area hospitals.
“Most people don't realize it, but … you can insist to the ambulance driver that you go to a certain hospital,” says Falchuk.
And emergency physicians certainly have had their fair share of good PR over the years. Who cares about being included on a “best doctors” list when everyone thinks you're George Clooney?
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