Do High (vs. Low) Rated Psychiatrists Have Better Patient Outcomes?
Patient satisfaction is one of the most important factors in delivering optimal treatment within healthcare facilities. Higher patient satisfaction has been linked to greater adherence to treatment and higher patient self-reported improvement.1,2 Among the many aspects of patient satisfaction, satisfaction with the treating physician holds particular importance.3 Together, these findings suggest there should be a psychiatrist satisfaction relationship with patient outcomes, where psychiatrists who are overall rated higher by their patients (“psychiatrist satisfaction”) have better outcomes overall. To test this, data from adult inpatient discharges between January 2022 and March 2024 were used to categorize psychiatrists into high and low satisfaction groups. Psychiatrists with an average physician satisfaction score 4 one standard deviation above the mean were considered high, and those with one standard deviation below were considered low. Psychiatrists with fewer than 30 patients were excluded. Moreover, psychiatrists with high versus low satisfaction did not differ in average number of patients.5 The final dataset included 197 physicians and 57,661 patient stays across 87 facilities.
Symptom Severity and Clinical Outcomes
Clinical outcomes were measured by admission severity, discharge severity, and admission-to-discharge Statistically Meaningful Improvement (SMI6), on two patient self-report clinical measures: patient functioning (BASIS-32™7) and depression (PHQ-98). Interestingly, our data revealed patients treated by high-satisfaction psychiatrists exhibited greater severity in patient functioning upon admission. However, patients under the care of high-satisfaction psychiatrists were less severe in patient functioning at discharge, despite their higher admission severity. Indeed, even controlling for admission severity symptoms, analysis still yielded a small but significant difference between high-satisfaction vs. low-satisfaction psychiatrists in admission to discharge change in patient functioning.9 Patients treated by high satisfaction psychiatrists had slightly more severe depression upon admission, while small differences in depression severity were noted at discharge. Controlling for admission severity, however, there were no meaningful differences in admission to discharge change in depression severity.10 Furthermore, a greater percentage of patients treated by high satisfaction psychiatrists achieved Statistically Meaningful Improvement in depression symptoms (88% vs. 80%). The gap in percentage of patients achieving SMI in patient functioning was even more stark (96% v 81%). It’s worth noting, though, diagnosis is known to impact satisfaction. For example, patients diagnosed with conditions such as posttraumatic stress disorder or personality disorders are more likely to report lower satisfaction levels with their treatment overall. However, analysis did not reveal differences in diagnostic case mix between high and low satisfaction psychiatrists.
Fig 1. High (vs. low) rated psychiatrists' differences in patient functioning outcomes (BASIS-32)
Fig 2. High (vs. low) rated psychiatrists' differences in patient depression symptoms outcomes (PHQ9)
What can we learn from this?
Our data suggest patients treated by high-satisfaction psychiatrists have better patient self-reported outcomes than those treated by low satisfaction psychiatrists, particularly in overall patient functioning. However, it remains unclear whether high-satisfaction psychiatrists are better at helping patients improve due to superior skills, or if patients who improve simply attribute their improvement to their psychiatrist. Individual facilities may enhance patient care and/or improve patient outcomes by learning what sets their top satisfaction psychiatrists apart (e.g., patient engagement, patient/family communications) and applying those learnings broadly.
Footnotes
[1] Barbosa, C., Balp, M., Kulich, K., Germain, N. & Rofail, D. (2012). A literature review to explore the link between treatment satisfaction and adherence, compliance, and persistence. Patient Preference and Adherence, 6, 39-48.
[2] Holcomb, W. R., Parker, J. C., Leong, G. B., Thiele, J. & Higdon, J. (1998). Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients. Psychiatric services, 49, 929-934.
[3] Manzoor, F., Wei, L., Hussain, A., Asif, M. & Shah, S.I.A. (2019). Patient satisfaction with health care services; An application of physician’s behavior as a moderator. International Journal of Environmental Research and Public Health, 16, 3318.
[4] Physician satisfaction was measured on a scale of 1 “Strongly Disagree” to 5 “Strongly Agree” on the following item: “I was satisfied with my physician”.
[5] Note: Patients were only included in the initial sample if they had a valid admission, discharge, and satisfaction score, as well as having an admission-to-discharge change score high enough to detect a statistical change.
[6] Note: SMI refers to a metric used to determine the degree of statistical change from admission to discharge. Based on the amount of change, patients are categorized into one of five SMI categories: Large improvement, small improvement, no effect, small decline, or large decline.
[7] BASIS-32: The Behavior and Symptom Identification Scale is a self-report measure of a patient’s functioning, rated on a scale of 0 “no difficulties” to 4 “extreme difficulties”. BASIS-32 © Mclean Hospital, used by licensee with permission from Mclean Hospital.
[8] PHQ-9: The Patient Health Questionnaire is a self-report measure of a patient’s depression, rated on a Scale of 0 “Not at all” to 3 “Nearly every day”. Developed by Drs. Robert L. Spitzer, Janet B. W. Wiliams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.
[9] ANCOVA, F(1, 39572) = 1278, p < .001, η2= .012.
[10] ANCOVA, F(1, 20375) = 44.7, p < .001, η2 = .001.
