- Email: [email protected]
Dermatology Internet Yellow Page advertising
Dermatology Internet Yellow Page advertising Shayla Francis, MD,b Katarzyna Z. Kozak, BS, MS,b Lauren Heilig, BA,b Kristy Lundahl, MBA, MS,b Terri Bowland, DO,b,c Eric Hester, MD,b Arthur Best, JD,d and Robert P. Dellavalle, MD, PhD, MSPHa,b Denver and Aurora, Colorado; and Utica, New York Background: Patients may use Internet Yellow Pages to help select a physician. Objective: We sought to describe dermatology Internet Yellow Page advertising. Methods: Dermatology advertisements in Colorado, California, New York, and Texas at 3 Yellow Page World Wide Web sites were systematically examined. Results: Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names. Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements (61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties. Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy not advertising claims of board certification (68%; 41/60; 32 dermatology, 9 other specialties). A total of 50 advertisements (17%) contained unverifiable or no board certification information, and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology. Limitations: All Internet Yellow Page World Wide Web sites and all US states were not examined. Conclusion: Nonphysicians, physicians board certified in medical specialties other than dermatology, and individuals without verifiable board certification in any medical specialty are advertising in dermatology Internet Yellow Pages. Many board-certified dermatologists are not advertising this certification. ( J Am Acad Dermatol 2006;55:67-70.)
ince 1975, US health care providers have been able to legally advertise for patients.1 Preserving ethical integrity in dermatology advertising presents an increasing challenge2 as the Internet facilitates the broad dissemination of unverifiable and false claims. Patients seeking dermatologic care may not be aware of board certification of dermatologists and other medical specialists.3 Previous studies
S
have found that more than 10% of medical specialists are not board certified,4 and Yellow Page publishers are not required to verify claims of board certification by medical specialists. This study systematically examined dermatology section Internet advertisements of 3 Yellow Page advertising World Wide Web sites for 4 states to examine advertiser characteristics including physician board certification claims.
From the Denver Veterans Affairs Medical Centera; Department of Dermatology, University of Colorado at Denver and Health Sciences Center, Aurorab; St Elizabeth’s Hospital, Uticac; and University of Denver Sturm College of Law.d Supported by the National Cancer Institute grant K-07CA92550 (Dr Dellavalle), National Institute of Health grant T32 AR07411 (Dr Hester), and the Department of Dermatology, University of Colorado at Denver and Health Sciences Center. Conflicts of interest: None identified. Presented as a poster at the American Academy of Dermatology Annual Meeting in New Orleans, Louisiana, February 18-22, 2005.
Accepted for publication March 14, 2006. Reprint requests: Robert P. Dellavalle, MD, PhD, MSPH, Denver Veterans Affairs Medical Center, Department of Dermatology, 1055 Clermont St, Mail Stop 165, Denver, CO 80220. E-mail: [email protected]. Published online May 28, 2006. 0190-9622/$32.00 ª 2006 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2006.03.021
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Table I. Dermatology Internet Yellow Page advertisement characteristics
At least one MD or DO listed At least one MD or DO listed but advertising no claims of board certification* At least one MD or DO claiming board certification in dermatology At least one MD or DO claiming board certification in another medical specialty DPM listed RN listed Name without MD, DO, DPM, or RN credentials listed No names listed
California (n = 167)
New York (n = 65)
Colorado (n = 38)
Texas (n = 22)
151 34
57 17
35 4
22 5
92
30§
28
15y
25z{
10
3k
2
6 1 4 5
0 1 1 6
0 1 0 2
0 0 0 0
DO, Doctor of osteopathy; DPM, doctor of podiatric medicine; MD, doctor of medicine; RN, registered nurse. *Of the 60 MDs and DOs not advertising a claim of board certification, 32 had verifiable board certification in dermatology and 9 had verifiable board certification in other medical specialties. y One unverified claim of board certification in dermatology. z One unverified claim of board certification in family practice. § One unverified claim of board certification in dermatologic and cosmetologic surgery. k One unverified claim of board certification by the American Board of Laser Surgery. { One advertisement failed to mention the medical specialty of board certificationebariatric medicine.
METHODS Three Internet Yellow Page World Wide Web sites initially identified by a Google search for the term ‘‘yellow pages’’ (www.yellow.com, www. dexonline.com, and www.yp.net) were examined for ‘‘dermatology’’ subsection ‘‘physicians and surgeons’’ for the states California, New York, Texas, and Colorado. The 3 World Wide Web sites were selected because they yielded the vast majority of Colorado online dermatology Yellow Page advertisements. Individual unique advertisements were captured and archived between June 28 and July 8, 2004, using the Internet service FURL by two authors (K. L. and T. B.). The advertisements were printed and accessed online as needed to collect the following information: practice names, provider names, board certification claims, and services offered. Duplicate advertisements were excluded. For the purposes of examining board certification claims, one provider was selected to represent each advertisement based on the following algorithm: (1) the first doctor of medicine claiming board certification listed was selected; (2) if no doctor of medicine claiming board certification was listed then the first doctor of osteopathy listed claiming board certification was selected; (3) otherwise the first doctor of medicine listed; (4) the first doctor of osteopathy listed; (5) the first provider with any other medical credential listed was selected; and (6) if no names with medical credentials were listed, then the first provider name listed was selected.
Medical specialty board certification claims of doctors of medicine and osteopathy were checked using World Wide Web sites of the American Board of Medical Specialties, the American Medical Association’s Doctor Finder, and the American Osteopathic Association, and by telephoning individual specialty boards including the American Board of Dermatology, the American Board of Surgery, and the American Board of Family Practice. The offices of those with unverifiable board certification claims were called in 2006 and asked to mail or fax a copy of their practitioner’s certificate of board certification to this study. Duplicate advertisements were excluded and data were extracted independently by two or more individuals. Differences were reconciled by discussion and consensus between the authors, and by reviewing the archived advertisement content. Descriptive statistics were performed using software (SAS, Version 9.1, SAS Institute Inc, Cary, NC). This study received Colorado Multiple Institutional Board approval (04-0843).
RESULTS Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names (Table I). Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements
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(61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties (23 plastic surgery, 4 family practice, 6 otolaryngology, and one each in internal medicine, neurosurgery, pediatrics, anaesthesiology, pathology, bariatric medicine, and laser surgery). Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy (68%; 41/60) not advertising claims of board certification (32 dermatology, 4 family practice, and one each in plastic surgery, pathology, emergency medicine, ophthalmology, and internal medicine). In all, 50 advertisements (17%) did not list a doctor of medicine or osteopathy with a verifiable board certification and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology.
DISCUSSION Yellow page advertising is an important forum for the exchange of information between the medical profession and those who use Internet Yellow Pages advertisements to locate health care providers.5-11 This study reports nonphysicians, physicians with board certifications in other specialties, and persons with unverifiable board certification claims advertising in the dermatology section of online Yellow Pages. There are several limitations to this study. First, only 4 states were examined and, therefore, results may not be generalizable to all locations. Second, physicians may have died, retired, or allowed certification to expire causing the results to overestimate the number of unverifiable physicians who claimed board certification. However, telephone calls placed to the 4 offices of practitioners with unverifiable board certification claims revealed that the physicians were currently practicing. Practice representatives did not state that their provider’s board certification had expired and none provided this study with a copy of the board certification certificate in question. Third, this study was limited to Internet Yellow page advertisements and did not assess other types of advertisements. Fourth, the study examined a snapshot of online Yellow Page advertising and did not monitor change in advertisement numbers or content over time. Because information on the Internet changes often, and because we electronically archived over a 10-day period, advertisements coming online or going offline during the 10-day period might have been missed. Finally, our analysis
assumes that all advertisements collected are independent of one another and represent separate practices. This assumption is limited by the caveat that we cannot exclude the possibility that physicians practicing together had separate advertisements not mentioning each other. Our finding of nonphysicians and multiple medical specialists advertising in the dermatology section mirrors results from studies examining plastic surgery advertising.12 The Yellow Page publisher Dex Media Inc was recently held accountable for allowing a board-certified dermatologist to advertise in the plastic surgery section of the Yellow Pages and claim board certification. A woman who used the Yellow Pages to find this physician and had a bad outcome after liposuction won a judgment of $1.6 million from Dex Media Inc based on jury findings of fraudulent conduct.13 Yellow Page publishers could possibly protect themselves from liability by listing the medical specialty for each board-certified physician claim and by making reasonable efforts to verify credentials before accepting physicians’ advertisements— such as requiring a photocopy of the provider’s board certification. Rather than clustering dermatology providers with different credentials, Yellow Page publishers might also consider more informative labeling of dermatology advertisements under headings consistent with provider credentials such as: ‘‘board certifiede dermatology,’’ ‘‘board certifiedeother medical specialty,’’ and ‘‘others.’’ Lastly, state medical boards and medical specialty academies might consider expanding their roles in ensuring fair and accurate dermatology Yellow Page advertising. We thank Kathryn Johnson, MD, for help in study design, and Amanda Martin for assistance in data entry. REFERENCES 1. Reade JM, Ratzan RM. Yellow professionalism: advertising by physicians in the Yellow Pages. N Engl J Med 1987;316:1315-9. 2. Gold HM. Advertising and the use of the media in dermatologyethis is appropriate in the new millennium. Dermatol Surg 2000;26:974-6. 3. Mainous AG III, Hagen MD, Rich EC. Patient awareness of and attitudes toward physician board certification. J Am Board Fam Pract 1993;6:403-6. 4. Reade JM, Ratzan RM. Access to informationephysicians’ credentials and where you can’t find them. N Engl J Med 1989;321:466-8. 5. Spilson SV, Chung KC, Greenfield ML, Walters M. Are plastic surgery advertisements conforming to the ethical codes of the American Society of Plastic Surgeons? Plast Reconstr Surg 2002;109:1181-6. 6. Trandel-Korenchuk DM. The influence of the mass media on the selection of physicians. J Ambul Care Manage 1998;21:48-66. 7. Butler DD, Abernethy AM. Yellow pages advertising by physicians: are doctors providing the information consumers want most? J Health Care Mark 1996;16:45-50.
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8. Cobb-Walgren CJ, Dabholkar PA. The value of physician advertising in the Yellow Pages: does the doctor know best? J Health Care Mark 1992;12:55-64. 9. Denenberg SM, Smith HW. Ethical use of Yellow Pages listings by physicians. Arch Otolaryngol Head Neck Surg 1988;114:1392-4. 10. Watson NL. Breach of contract and the Yellow Pages. R I Med J 1983;66:465-7.
11. Mathews M. Physicians in the Yellow Pages. N Engl J Med 1982;307:631-2. 12. Youn AS. The Yellow Pages plastic surgeon. Plast Reconstr Surg 2005;115:317-9. 13. Knepper v Brown, 182 Or App 597 (2002). This case is now on appeal (interview with plaintiff’s attorney Gregory A. Smith by Arthur Best, September 23, 2005).
ince 1975, US health care providers have been able to legally advertise for patients.1 Preserving ethical integrity in dermatology advertising presents an increasing challenge2 as the Internet facilitates the broad dissemination of unverifiable and false claims. Patients seeking dermatologic care may not be aware of board certification of dermatologists and other medical specialists.3 Previous studies
S
have found that more than 10% of medical specialists are not board certified,4 and Yellow Page publishers are not required to verify claims of board certification by medical specialists. This study systematically examined dermatology section Internet advertisements of 3 Yellow Page advertising World Wide Web sites for 4 states to examine advertiser characteristics including physician board certification claims.
From the Denver Veterans Affairs Medical Centera; Department of Dermatology, University of Colorado at Denver and Health Sciences Center, Aurorab; St Elizabeth’s Hospital, Uticac; and University of Denver Sturm College of Law.d Supported by the National Cancer Institute grant K-07CA92550 (Dr Dellavalle), National Institute of Health grant T32 AR07411 (Dr Hester), and the Department of Dermatology, University of Colorado at Denver and Health Sciences Center. Conflicts of interest: None identified. Presented as a poster at the American Academy of Dermatology Annual Meeting in New Orleans, Louisiana, February 18-22, 2005.
Accepted for publication March 14, 2006. Reprint requests: Robert P. Dellavalle, MD, PhD, MSPH, Denver Veterans Affairs Medical Center, Department of Dermatology, 1055 Clermont St, Mail Stop 165, Denver, CO 80220. E-mail: [email protected]. Published online May 28, 2006. 0190-9622/$32.00 ª 2006 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2006.03.021
67
68 Francis et al
J AM ACAD DERMATOL JULY 2006
Table I. Dermatology Internet Yellow Page advertisement characteristics
At least one MD or DO listed At least one MD or DO listed but advertising no claims of board certification* At least one MD or DO claiming board certification in dermatology At least one MD or DO claiming board certification in another medical specialty DPM listed RN listed Name without MD, DO, DPM, or RN credentials listed No names listed
California (n = 167)
New York (n = 65)
Colorado (n = 38)
Texas (n = 22)
151 34
57 17
35 4
22 5
92
30§
28
15y
25z{
10
3k
2
6 1 4 5
0 1 1 6
0 1 0 2
0 0 0 0
DO, Doctor of osteopathy; DPM, doctor of podiatric medicine; MD, doctor of medicine; RN, registered nurse. *Of the 60 MDs and DOs not advertising a claim of board certification, 32 had verifiable board certification in dermatology and 9 had verifiable board certification in other medical specialties. y One unverified claim of board certification in dermatology. z One unverified claim of board certification in family practice. § One unverified claim of board certification in dermatologic and cosmetologic surgery. k One unverified claim of board certification by the American Board of Laser Surgery. { One advertisement failed to mention the medical specialty of board certificationebariatric medicine.
METHODS Three Internet Yellow Page World Wide Web sites initially identified by a Google search for the term ‘‘yellow pages’’ (www.yellow.com, www. dexonline.com, and www.yp.net) were examined for ‘‘dermatology’’ subsection ‘‘physicians and surgeons’’ for the states California, New York, Texas, and Colorado. The 3 World Wide Web sites were selected because they yielded the vast majority of Colorado online dermatology Yellow Page advertisements. Individual unique advertisements were captured and archived between June 28 and July 8, 2004, using the Internet service FURL by two authors (K. L. and T. B.). The advertisements were printed and accessed online as needed to collect the following information: practice names, provider names, board certification claims, and services offered. Duplicate advertisements were excluded. For the purposes of examining board certification claims, one provider was selected to represent each advertisement based on the following algorithm: (1) the first doctor of medicine claiming board certification listed was selected; (2) if no doctor of medicine claiming board certification was listed then the first doctor of osteopathy listed claiming board certification was selected; (3) otherwise the first doctor of medicine listed; (4) the first doctor of osteopathy listed; (5) the first provider with any other medical credential listed was selected; and (6) if no names with medical credentials were listed, then the first provider name listed was selected.
Medical specialty board certification claims of doctors of medicine and osteopathy were checked using World Wide Web sites of the American Board of Medical Specialties, the American Medical Association’s Doctor Finder, and the American Osteopathic Association, and by telephoning individual specialty boards including the American Board of Dermatology, the American Board of Surgery, and the American Board of Family Practice. The offices of those with unverifiable board certification claims were called in 2006 and asked to mail or fax a copy of their practitioner’s certificate of board certification to this study. Duplicate advertisements were excluded and data were extracted independently by two or more individuals. Differences were reconciled by discussion and consensus between the authors, and by reviewing the archived advertisement content. Descriptive statistics were performed using software (SAS, Version 9.1, SAS Institute Inc, Cary, NC). This study received Colorado Multiple Institutional Board approval (04-0843).
RESULTS Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names (Table I). Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements
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(61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties (23 plastic surgery, 4 family practice, 6 otolaryngology, and one each in internal medicine, neurosurgery, pediatrics, anaesthesiology, pathology, bariatric medicine, and laser surgery). Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy (68%; 41/60) not advertising claims of board certification (32 dermatology, 4 family practice, and one each in plastic surgery, pathology, emergency medicine, ophthalmology, and internal medicine). In all, 50 advertisements (17%) did not list a doctor of medicine or osteopathy with a verifiable board certification and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology.
DISCUSSION Yellow page advertising is an important forum for the exchange of information between the medical profession and those who use Internet Yellow Pages advertisements to locate health care providers.5-11 This study reports nonphysicians, physicians with board certifications in other specialties, and persons with unverifiable board certification claims advertising in the dermatology section of online Yellow Pages. There are several limitations to this study. First, only 4 states were examined and, therefore, results may not be generalizable to all locations. Second, physicians may have died, retired, or allowed certification to expire causing the results to overestimate the number of unverifiable physicians who claimed board certification. However, telephone calls placed to the 4 offices of practitioners with unverifiable board certification claims revealed that the physicians were currently practicing. Practice representatives did not state that their provider’s board certification had expired and none provided this study with a copy of the board certification certificate in question. Third, this study was limited to Internet Yellow page advertisements and did not assess other types of advertisements. Fourth, the study examined a snapshot of online Yellow Page advertising and did not monitor change in advertisement numbers or content over time. Because information on the Internet changes often, and because we electronically archived over a 10-day period, advertisements coming online or going offline during the 10-day period might have been missed. Finally, our analysis
assumes that all advertisements collected are independent of one another and represent separate practices. This assumption is limited by the caveat that we cannot exclude the possibility that physicians practicing together had separate advertisements not mentioning each other. Our finding of nonphysicians and multiple medical specialists advertising in the dermatology section mirrors results from studies examining plastic surgery advertising.12 The Yellow Page publisher Dex Media Inc was recently held accountable for allowing a board-certified dermatologist to advertise in the plastic surgery section of the Yellow Pages and claim board certification. A woman who used the Yellow Pages to find this physician and had a bad outcome after liposuction won a judgment of $1.6 million from Dex Media Inc based on jury findings of fraudulent conduct.13 Yellow Page publishers could possibly protect themselves from liability by listing the medical specialty for each board-certified physician claim and by making reasonable efforts to verify credentials before accepting physicians’ advertisements— such as requiring a photocopy of the provider’s board certification. Rather than clustering dermatology providers with different credentials, Yellow Page publishers might also consider more informative labeling of dermatology advertisements under headings consistent with provider credentials such as: ‘‘board certifiede dermatology,’’ ‘‘board certifiedeother medical specialty,’’ and ‘‘others.’’ Lastly, state medical boards and medical specialty academies might consider expanding their roles in ensuring fair and accurate dermatology Yellow Page advertising. We thank Kathryn Johnson, MD, for help in study design, and Amanda Martin for assistance in data entry. REFERENCES 1. Reade JM, Ratzan RM. Yellow professionalism: advertising by physicians in the Yellow Pages. N Engl J Med 1987;316:1315-9. 2. Gold HM. Advertising and the use of the media in dermatologyethis is appropriate in the new millennium. Dermatol Surg 2000;26:974-6. 3. Mainous AG III, Hagen MD, Rich EC. Patient awareness of and attitudes toward physician board certification. J Am Board Fam Pract 1993;6:403-6. 4. Reade JM, Ratzan RM. Access to informationephysicians’ credentials and where you can’t find them. N Engl J Med 1989;321:466-8. 5. Spilson SV, Chung KC, Greenfield ML, Walters M. Are plastic surgery advertisements conforming to the ethical codes of the American Society of Plastic Surgeons? Plast Reconstr Surg 2002;109:1181-6. 6. Trandel-Korenchuk DM. The influence of the mass media on the selection of physicians. J Ambul Care Manage 1998;21:48-66. 7. Butler DD, Abernethy AM. Yellow pages advertising by physicians: are doctors providing the information consumers want most? J Health Care Mark 1996;16:45-50.
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8. Cobb-Walgren CJ, Dabholkar PA. The value of physician advertising in the Yellow Pages: does the doctor know best? J Health Care Mark 1992;12:55-64. 9. Denenberg SM, Smith HW. Ethical use of Yellow Pages listings by physicians. Arch Otolaryngol Head Neck Surg 1988;114:1392-4. 10. Watson NL. Breach of contract and the Yellow Pages. R I Med J 1983;66:465-7.
11. Mathews M. Physicians in the Yellow Pages. N Engl J Med 1982;307:631-2. 12. Youn AS. The Yellow Pages plastic surgeon. Plast Reconstr Surg 2005;115:317-9. 13. Knepper v Brown, 182 Or App 597 (2002). This case is now on appeal (interview with plaintiff’s attorney Gregory A. Smith by Arthur Best, September 23, 2005).