Fig. 1 A SurgiSurvey survey of 4,000 hand surgeons reveals perceptions about positive online reputation.
Courtesy of Orrin Franko, MD


Published 9/27/2021
Orrin Franko, MD

Online Reputation Management: A Necessity for Orthopaedic Surgeons

The value of online physician ratings continues to gain acceptance within the medical community. Orthopaedic surgery patients use online reviews to help find trustworthy surgeons, and a single patient referral can generate thousands of dollars in new revenue, underscoring the financial importance of maintaining a positive online reputation. Just five years ago, most doctors, and certainly those who started practicing before the internet, would have vociferously debated the relevance of Healthgrades and Vitals reviews to their practice. Some still do. Yet in 2021, most new medical graduates and young attending physicians not only recognize the importance of a strong digital presence, but are eager to improve their online reputation.

Online ratings are not about accuracy and honesty, a laughably obvious statement to those who have read their own reviews. Rather, online ratings are now one of the primary metrics that Google uses to rank physicians in search results, a tool that patients use to screen physicians in advance of making an appointment. Online reviews are a vital part of growing and maintaining a healthy medical practice. In the words of one marketing company, “Your website is the door to your waiting room.” Patients will judge a practice by its reviews, and first impressions can be long-lasting. Online ratings are often the first contact point with an office, and just like stained chairs or ripped carpet in a waiting room, poor representation online can send the wrong message to your patients.

Fig. 1 A SurgiSurvey survey of 4,000 hand surgeons reveals perceptions about positive online reputation.
Courtesy of Orrin Franko, MD
Fig. 2 An example of the “Knowledge Graph” populated by Google Business Listings
Courtesy of Orrin Franko, MD

In a survey of 4,000 U.S. hand surgeons in February, 74 percent said they considered a positive online reputation “very” or “somewhat” valuable (Fig. 1), and only 10 percent felt that reviews were of “no value.” Despite the perceived importance of reviews, the median number of Google reviews for a hand surgeon was only four—a low bar that is easily remedied.

There are three primary benefits to improving online reviews: building patient trust, increasing referrals, and protecting one’s reputation against angry patients.

Patients will frequently search for practice names on their phones to find directions to your office, or may look up the name (out of curiosity) while sitting in the waiting room prior to their appointments. Certainly the last thing a patient should see immediately before entering the office is a one-star review from a dissatisfied patient. Collecting five-star reviews will help build patient trust in your competence.

Google’s search algorithm incorporates numerous factors, including review score and review volume. Some estimates put the value of reviews for search result prioritization at as much as 22 percent. Thus, collecting a high volume of high-score reviews is an important part of search engine optimization (SEO), or increasing a site’s visibility in search results. If a practice appears higher in a search for “orthopaedic surgeon,” the practice will likely receive more new referrals. For example, at East Bay Hand Medical Center, online review optimization resulted in a 60 percent increase in new referrals within two weeks.

No surgeon can please every patient, and every surgeon has patients who are unhappy with their experiences. Generating a high volume of high-quality reviews protects a physician or practice from a single negative review from an upset and vengeful patient.

Where to collect reviews

There are a plethora of websites that help practices and physicians collect online reviews. The most important review sites are now Google and Yelp. Registering one’s practice on Google Business Listings populates a “Knowledge Graph” for your business, an informational box on the right side of a search page (Fig. 2). Registering on Google Business is free and can significantly improve your search ranking.

Yelp recently began including medical practices and providers in their business listings, resulting in significant stress among physicians. While Yelp requires reviewers to register an account and attempts to improve the veracity of reviews with a secret algorithm, the company’s aggressive marketing techniques (e.g., repeated calls and emails to medical practices) and suppression of reviews has left a negative impression on many doctors who perceive that advertising dollars are required to improve public ratings—an assumption that Yelp assures is false.

Founded in 1998, is one of the oldest and best-known sites; it ranks physicians and practices on a five-star scale and provides descriptive reviews. Listings are based on public information in the National Provider Identifier database, but physicians may claim their profile to add more accurate information. has existed for more than 10 years and similarly provides both ratings and descriptive reviews, but its popularity and relevance have recently waned as its search rankings have dropped. Other physician-specific sites, such as,,, and, have variable penetrations in different markets.

To find out which review sites are most relevant to one’s practice, physicians can simply “Google themselves” and identify which sites appear in the top 10 rankings. It is helpful to use various search phrases that a patient might use, e.g. “Dr. John Smith hip replacement,” “Reviews John Smith MD,” “Bay City Orthopedic Center Reviews.”

How to start collecting reviews

Most doctors get extremely uncomfortable asking patients to leave reviews. Much of this hesitation is based on cultural and generational differences regarding the appropriateness of self-promotion within the medical field. No one should compromise personal values in the pursuit of patient volume, but for those interested in accumulating reviews, the most obvious and direct method is to ask satisfied patients to leave a review online. However, response rates to direct requests and even handing out “reminder cards” are abysmally low, as typically less than 1 percent of patients asked actually go on to leave a review.

An alternative option is to automate review requests, which involves creating automatic emails or text messages sent to each patient after each visit. In some cases, software can automatically integrate into existing EMR or patient management software, while other companies allow for the direct upload of a patient list. Numerous companies promote these types of software. Each company has a unique set of features, but the result is typically a progressive improvement in review volume, review scores, and new patient referrals.

The benefits to having a strong online reputation cannot be overstated. Again, at East Bay Hand Medical Center, a practice with just two surgeons, the estimated financial impact of new five-star reviews was in excess of $225,000 over three years. Furthermore, a single review was worth $923 in new revenue to the practice, not including ancillary services.

In addition to the financial benefits, positive reviews are personally and emotionally rewarding. Orthopaedic surgeons do not often hear their patients’ heartfelt appreciation unless they request it. It is a compliment to hear from a patient, “I came to you because I knew you were the best surgeon after reading your reviews.”

Now is the time to start

A popular Chinese proverb states, “The best time to plant a tree was 20 years ago. The second-best time is now.” The same could be said of managing one’s online reputation and collecting reviews.

Collecting five-star reviews may be easier than you think: First, pick a review site to direct patients (such as creating a free Google My Business profile). Second, consider choosing a reputation management company. It is tempting to develop one’s own system for soliciting reviews, but the time investment to create a HIPAA-compliant automation protocol is significant.

No doctor will ever be immune from negative reviews, but acquiring significant numbers of positive reviews protects against the occasional disgruntled patient and will simultaneously help grow one’s practice. The data are quite clear that online reviews are prevalent and important to patients, practice referral volume correlates with online reviews, and patient referrals can be quantified by their financial value to the practice. Even surgeons who are “nearing retirement” and “never check their online reviews” would benefit from managing their online reputation, helping their patients feel more comfortable in their offices and increasing the value of their practice by leaving a positive legacy.

Orrin Franko, MD, is a practicing orthopaedic hand surgeon in the San Francisco Bay Area. Dr. Franko is the founder of, an automated marketing system designed to manage a practice’s online reputation.


  1. Franko O: Hand Surgeons Value a Positive Online Reputation but Lack Implementation. Available at: Accessed September 8, 2021.