Understanding the history of online reviews

In 1999, shortly after the impeachment trial of Bill Clinton was dismissed by the Senate, three websites—RateItAll.com, Deja.com, Epinions.com—appeared on the internet¹ and set in motion a social trend called “online reviews” that influences nearly every type of consumer purchase today including choosing a doctor.

By January of 2000, the three pioneering websites had accumulated over 1,146,201 reviews on everything from products to movies and sports teams.² Despite the exponentially growing trend of online reviews, the medical community largely flew under the radar until 2004 when RateMDs.com was born.

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Rating Doctors Becomes Big Business

RateMDs was a new type of review website exclusively focused on doctors. On April 30, 2004, RateMDs had 320 ratings in its directory.⁴ By June 24, 2007, that number had risen to 534,999 ratings.⁵ One year later, in 2008, two websites, Healthgrades.com and Vitals.com, launched online rating directories for doctors which eventually took the lead in the doctor market. Today, a combined 11.6 million people each month visit web properties owned by Vitals and Healthgrades.⁶ These two companies have respectable market share; still, they are small fish in a vast sea of websites. (By comparison, Google would be a Baleen whale.)

The landscape for online physician reviews is highly fragmented. EMPATHIQ estimates that as many as 70+ review websites can affect a physician’s public image.⁷ Based on a sample size of 230,000 doctors, EMPATHIQ estimates that more than 440,000 reviews were added for U.S. doctors in January 2014 alone.^7a Changes in a physician’s online ratings can happen abruptly as new reviews are added. In the words of top pain medicine physician, Dr. Kenneth Candido, doctors today must navigate the online review “land-mines” that are constantly being placed on the web.⁸

Many doctors ask, “Why am I on this website?” The answer is internet advertising. Internet advertising is the revenue engine that powers online review websites. Every time a consumer visits a website, a banner advertisement is shown. The website gets paid a CPM (cost per thousand) which is a payment for every 1,000 ads they show. A website’s job is to get more viewers so they can sell more CPMs. In our estimation, the average CPM on a physician directory, like RateMDs, fetches $15 from advertisers.

There are two strategies to get viewers on the web.

• 1. The first strategy is what a traditional publisher like the New York Times uses. The New York Times writes award winning journalism; a single article can attract a crowd of 1,000,000 people.
• 2. Review websites, like RateMDs, do not use this strategy to get traffic. Instead, they build pages for a million doctors and hope that one patient a month visits each doctor’s page. That still equates to 1,000,000 viewers a month or $15,000 in monthly advertising revenue without the need to employ award winning journalists.

Because of the low barrier to entry, review websites have proliferated. In doing so, they caused excessive competition for each other. Their main problem is that they cannot all appear in the first 10 results in Google. Search engines work by prioritization. If you search for ‘David Engel MD,’ Google looks through through trillions of web pages to deliver the top 10 results. With so much competition for the first page, Google must pick and choose which websites get traffic. The websites that get more traffic sell more CPMs to advertisers and make more money. Online reviews have become a determining factor for which review websites receive search engine traffic.

Search engines like Google, Yahoo and Bing will often prioritize a webpage higher in the search results if it contains ‘unique content.’ Unique content means text that does not appear elsewhere on the web. Because there are so many websites publishing the same thing (doctor’s name, address, and phone), online reviews are exactly the unique content that Google looks for when deciding which website to show at the top of a search.

Why Review Sites Love Negative Reviews

Therein lies the major conflict of interest between doctors and the 70+ review websites. If a website like RateMDs has reviews for Dr. Engel, they are winning search results because the doctor’s reviews provide unique content. The reviews need not be true in order to sell advertising. In fact, the more ‘sensational’ the reviews, the more readers the website receives. ‘Sensational’ stories are a reliable way to attract viewers and sell advertising. Newspapers figured this out in the 1900s with the advent of Yellow Journalism. Website companies figured this out in 1999 with the advent of online reviews.