
The Doctor Will See You Now: Physician Race and Patient Evaluations
Management Science, forthcomingPreprint
Patient experience scores are prevelant and have far-reaching consequences for physicians, shaping their pay and day-to-day work. Asian and Black physicians are less likely than White physicians to receive top-box ratings, and these gaps are largest among early-career physicians and those who did not attend top-ranked medical schools.
Abstract
Patient experience surveys (e.g., HCAHPS) are increasingly used to evaluate individual physicians, shaping performance reviews, compensation, and career advancement. However, their validity as unbiased measures of physician quality is uncertain. We examine whether and when these evaluations encode racial disparities using more than 700,000 patient surveys collected in a large Northeastern U.S. health system (2018–2021), covering 4,579 physicians across seven hospitals and 33 specialties. Asian and Black physicians are about 3% and 5% less likely, respectively, than White physicians to receive “top-box” ratings. These gaps persist after accounting for endogenous patient-physician matching. Mechanism tests show that disparities are largest among early-career physicians, with gaps widening to 17% for both Asian and Black physicians, and among those with less prestigious medical training, reaching 5% and 6%, respectively. Disparities narrow when evaluation items direct patients’ attention to concrete and verifiable behaviors (e.g., protocol adherence) or to dimensions for which clearer norms exist (e.g., basic interpersonal demeanor). Overall, the patterns suggest that the organizational design of the evaluation process meaningfully shapes the extent to which patients rely on status-based expectations when evaluating physicians. We outline design and policy implications for using patient experience scores in performance management while preserving the patient voice and limiting the potential to entrench racial inequality.













