Physician Profiling Rears Its Ugly Head

A large health insurer (1) is profiling physicians using so-called quality and cost effective parameters. Physicians are given two designations: one star for quality and two stars if both quality and cost effective standards are met. The information is then displayed in online directories for pubic viewing. They allow physicians a 45 day review period to clarify and request reconsideration of their designation status.

But should any health insurer be allowed to “profile” a doctor? Isn’t there a serious conflict of interest here since the insurer’s profits and the dividends it pays to its stockholders depend in part on how well it can make physicians conform to protocols aimed at increasing corporate profits?

Profiling of physicians has dangerous flaws that can harm doctors. Health insurers have nothing to base their profiling on except statistical data. These statistics don’t reflect the demographics of the communities where doctors practice, the number and types of specialists in their communities (important because it affects doctors’ practice habits), the demands of their patients or how much time they spend with them. Neither do statistics convey any information on how well doctors connect with their patients or how successful they may be in forming effective therapeutic relationships. They have no knowledge of how timely doctors are in making referrals, how hard they may try to get same day appointments when necessary, or how attentive they may be to their patients’ emotional needs.

Worse, profiling data indicates nothing about physicians’ character or their integrity. In short, profiling imposes a faceless personality that at best tells very little about an individual physician.

Insurance companies should not have any role in profiling physicians. Profiling is bad for patients as well because it gives insurers’ dangerous control to determine how medicine is practiced.

Ironically the same organization that is so intent on profiling doctors was recently sued for fraudulent business practices against doctors (2).

Clearly, profiling is an insult to doctors and just another example of how bad it can get for doctors when they let insurers decide on standards for quality and cost-effectiveness. Eventually, profiling will be used to make doctors conform to the conveyor- belt policy that is suited for dealing with inanimate objects like automobiles, computers and radios.

Profiling represents one of modern medicine’s great inconsistencies. Because it is driven by strategies dedicated in part to generating profits for shareholders, it is incompatible with the qualities of caring and service that patients expect from doctors.


1. UnitedHealth Premium Designation Program. Brochure. United HealthCare Services, Inc. Oct. 2008.

2. Nielsen NH. United agreement a victory for fair pay for physicians. Amednews, www.ama-assn.org/amednews/2009/02/09

Ed Volpintesta MD