Top Doctors list is out again; how accurate is it?

It's January, and once again Mpls.St.Paul magazine's popular Top Doctors issue has hit the newsstands.

For 17 years, the magazine has had a virtual monopoly on rating doctors in Minnesota, and the issue is a top seller every year, despite some skepticism about the survey's methodology.

Love it or hate it -- and there are plenty of physicians on both sides -- the annual top doctor list is taking on new importance, as more patients shop for medical care. With out-of-pocket costs soaring, hospitals, clinics and insurers are offering price and quality information. But much of the data is dense and not about individual doctors.

That may change soon, with a variety of doctor-rating efforts underway in the health care industry. But for now, the magazine remains the most visible attempt to rate doctors.

Just how influential is it? Ask Dr. Brian Zelickson, a dermatologist who graces this year's cover.

Congratulatory e-mails are flowing in, a couple of regular patients showed up clutching the magazine and the clinic has received a handful of calls from new patients. "If I look at the other degrees and awards and publications I have, being in that magazine probably does more for my visibility in the community than all that combined," Zelickson said between patients at Zel Skin & Laser Specialists in Edina.

The Mpls.St.Paul list breaks out "top" doctors in different specialties, interspersed with snappy profiles. Doctors grouse that the list is subjective and that the methodology is suspect. But they concede that it feeds a growing need.

Some doctors complain that the survey neglects to measure objective criteria such as patient outcomes.

"It's certainly better than the Yellow Pages and better than the list of doctors your insurance company gives you," said Dr. Richard Morris, an allergist at Allergy & Asthma Care in Maple Grove who regularly makes it onto the list. But with the concentration of good doctors in the Twin Cities, he notes, "Being off the list may not mean a darn thing."

Still, last year the survey resulted in Mpls.St.Paul's top-selling issue, at more than 30,000 copies, compared with about 20,000 for other months, publisher Deborah Hopp said. "Top Doctors" is the top-searched phrase on the magazine's website.

Mpls.St.Paul started the list in 1992, joining glossy magazines from New York to San Diego that compile such lists.

City magazines tell people "where the good stuff is," said Hopp, "whether it's restaurants or doctors or parks." A competitor, Minnesota Monthly, runs a list of top doctors for women.

Popularity contest of sorts

Dr. Loie Lenarz recalls making the list every year for much of the 1990s, when she was a full-time family doctor. But she doesn't think it had much to do with her skills as a physician.

"Physicians who are very active outside of patient care are the most likely to be well-known by nurses," Lenarz said. "If you are chief of staff or happen to be a chair of a department or happen to be an extroverted person or happen to chat with nurses more, [you get listed]. It's very subjective and not really a reliable source of who your best physicians are."

Does it affect business?

"Of course it does," said Lenarz, who is chief clinical officer at Fairview Health Services. "People pay attention. I never got tons [of new patients as a result], but every late winter, there were some."

This year, the magazine mailed surveys to 5,000 randomly selected licensed doctors and nurses in the metro area. They were asked to nominate two doctors in each of 71 specialties. About 600 doctors made the list; about 200 are on it for the first time.

The magazine got 800 surveys back. That works out to a 16 percent response rate, too low to be representative, said Ken Doyle, director of the research communication division at the University of Minnesota. "I'd like to see it a lot closer to 50 percent or 60 percent."

Still, he added: "In the land of the blind, the one-eyed man is king."

Brian Anderson, the magazine's editor, defends the survey as the best out there. He said a 16 percent return is typical, and that magazines that send out mailings to subscribers consider 3 to 4 percent a good response rate.

The fact that many of the same doctors show up on the list year after year validates the survey, Anderson said. And the magazine polls nurses precisely so that it's not just doctors voting for one another.

This time next year, Minnesota health care consumers will have another option for assessing where to get their health care. Minnesota Community Measurement, which rates hospitals and clinics, is launching a "patient experience" survey, with the first results out at year's end.

Questions will include "How much time did your doctor spend with you?" and "Would you recommend this doctor to your family and friends?" However, the results will be published by clinics, and won't name individual doctors.

Until other doctor-rating systems emerge, Zelickson is taking a pragmatic stance on the Mpls.St.Paul list: "I'd rather be on it than not on it."