Exploring physician specialist response rates to web-based surveys

Cunningham et al. BMC Medical Research Methodology (2015) 15:32 DOI 10.1186/s12874-015-0016-z RESEARCH ARTICLE Open Access Exploring physician specialist response rates to web-based surveys Ceara Tess Cunningham1*, Hude Quan1, Brenda Hemmelgarn1,2, Tom Noseworthy1, Cynthia A Beck1,3, Elijah Dixon1,2, Susan Samuel4, William A Ghali1,2, Lindsay L Sykes1 and Nathalie Jetté1,5 Abstract Background: Survey research in healthcare is an important tool to collect information about healthcare delivery, service use and overall issues relating to quality of care. Unfortunately, physicians are often a group with low survey response rates and little research has looked at response rates among physician specialists. For these reasons, the purpose of this project was to explore survey response rates among physician specialists in a large metropolitan Canadian city. Methods: As part of a larger project to look at physician payment plans, an online survey about medical billing practices was distributed to 904 physicians from various medical specialties. The primary method for physicians to complete the survey was via the Internet using a well-known and established survey company (www.surveymonkey.com). Multiple methods were used to encourage survey response such as individual personalized email invitations, multiple reminders, and a draw for three gift certificate prizes were used to increase response rate. Descriptive statistics were used to assess response rates and reasons for non-response. Results: Overall survey response rate was 35.0%. Response rates varied by specialty: Neurology/neurosurgery (46.6%); internal medicine (42.9%); general surgery (29.6%); pediatrics (29.2%); and psychiatry (27.1%). Non-respondents listed lack of time/survey burden as the main reason for not responding to our survey. Conclusions: Our survey results provide a look into the challenges of collecting healthcare research where response rates to surveys are often low. The findings presented here should help researchers in planning future survey based studies. Findings from this study and others suggest smaller monetary incentives for each individual may be a more appropriate way to increase response rates. Keywords: Survey methodologies, Healthcare, Response rate, Specialists, Physicians Background With the rise of the Internet and email in recent decades, online and web-based tools offer promising advances for healthcare survey research methods [1,2]. Immediate survey delivery, real-time data tracking and inexpensive costs are selling points of email or webbased surveys [2]. Electronic surveys may also increase response rates through ease of access, as well as greater individual anonymity compared to face-to-face or telephone interviews [2,3]. Despite the increased use of web-based surveys, considerable debate about the success * Correspondence: 1 Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada Full list of author information is available at the end of the article and usefulness of this type of survey mode exists [4-6]. Studies using both email and mail paper surveys demonstrate conflicting evidence as to whether email surpasses mail as a delivery modality [6]. Survey response rates have also in general been on the decline for the past decade in the field of health related research [1,6-8]. Despite the declining use of survey research methods, this type of research remains an important way of research to gather information about physicians’ knowledge, attitudes, and to evaluate the impact of clinical research on practice [9]. Soliciting physician input is also essential when existing healthcare policies are being updated or to inform new policies [10]. Unfortunately, physicians are a professional group with low survey response rates in general [11,12]. While family doctors © 2015 Cunningham et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Cunningham et al. BMC Medical Research Methodology (2015) 15:32 have typically had low survey response rates [12,13], specialist physicians historically have demonstrated variability in response rates [14-17]. Kellerman and Herold [8] reviewed the variability of demographic characteristics on physician responses to surveys and found that medical specialty type was not associated with response rates. There is a clear dispute in the literature as to whether survey recruitment methods that are successful with general practitioners are also successful with other physician specialties. Also it is actually uncommon in the survey methodology literature to see surveys conducted across multiple physician specialties. Our study allowed us to look at variations in response rate across multiple specialties and in addition, our recruitment methodology was unique in that individualized/personalized emails were sent to each physician. As survey research with specialist physician groups is on the rise [18-20], more survey research involving physician specialists is needed in order to understand the reasons for differences in response rates within this medical group. Specifically, identifying new recruitment methods that may be uniquely related to the physician specialist groups is needed. Differential effects by medical specialty may be the result of several factors including preference for survey mode, survey design, survey length and potential confounding factors such as the gender of respondents [6,8,21]. For example, in one survey study of family and specialist physicians, pediatricians not only had higher response rates overall and within the promised-incentive group but were also the least sensitive to the timing of the incentive. One possible reason for this is that the response rate may be confounded by gender; women may be more likely to respond to surveys than men and women make up a larger proportion of pediatricians [21]. Response rate can be further affected by the survey topics. When the topic is of high interest to respondents, potential respondents are more likely to respond to the survey [6,22-24]. In addition, whether survey topics are sensitive or non-sensitive or concern attitude or fact is likely to affect response rates in web surveys [6,22,24]. For example, obtaining data on physicians’ billing practices is often challenging due to the sensitive nature of the topic [25]. Only a handful of studies have examined and compared survey response rates among physician specialists, in whom different survey methodologies may be necessary to achieve acceptable response rate [14,26]. As part of (...truncated)