Holy Sh%t! The results of the DPC Net Promoter Score are in and what it means.

What the hell is a Net Promotor Score and why it is so important?

In the 2006 book called The Ultimate Question by Fred Reichold, he found this question to be the best way to assess the success of a company:

On a scale of zero to ten, how likely is it that you would recommend _______ to others?

Originally meant for customers it was equally as important for employees.

Reichold explains that companies, like hospitals (which he also looked at), are chasing “bad profits”, which are profits earned at the expense of the treatment, mood, and health of the workforce. He found when looking at hospitals that they: 

1. Focus on productivity only. 
2. Try to save money, but in doing so, they foster a terrible work environment. 
3. Only extract from physicians and don’t create loyalty. 
4. Use complex terms, bonus schemes, threats and excuses. 
5. Create a place where doctors believe administrators lie awake nights thinking up new ways to hustle them. 
6. Create detractors, who cause damage because doctors now warn others to stay away. 
7. Demoralize physicians and create a destructive spiral.  
8. Cut staff. 

Using a physician turnover rate is unhelpful because hospitals lie about this number or make up excuses for why the doctors are leaving.

Regular lengthy surveys don’t work because:

1. Too many surveys have too many questions. 
2. Not every doctor fills them out. 
3. Many hospitals don’t do anything with the information (close the loop) so it becomes a waste of time. 
4. Doctors don’t trust the anonymity. 
5. Doctors think administrators are just placating them or are pretending to care. 
6. There is not good correlation between the results and real satisfaction of the doctors.  
7. There are no good standards to apply the survey to and compare to other hospitals. 
8. Doctors believe the surveys are being used by administrators to attain awards or pay raises for themselves.  

The Net Promotor Score or employee Net Promotor Score is the best way to see if physicians are happy at their employed position. The Net Promoter Score is calculated from the answers to the 10-to-0 scale. The 10 and 9 ratings are grouped together and called Promoters (green in the chart). The 8 and 7 ratings are called Passives (yellow on the chart above), and those who give a rating of 6 or below are called Detractors (red). The NPS formula is the percent classified as Promoters minus the percent classified as Detractors.

The result for employed doctors? The average is a +5 to +10. Not great. In fact, many are actually in the negative range. This does not bode well for word-of-mouth and therefore recruitment by hospitals. More recently, and from his website, Reichold’s team did this for hospitals and found the following: 

Doctors in traditional, doctor-led practices had Net Promoter Scores of + 19—they were likely to recommend their organization as a place to work. But increasingly, more doctors—large majorities of those less than 15 years out of medical school or those who changed jobs in the past five years—work in large, management-led healthcare organizations. Those doctors were detractors—they had a negative Net Promoter Score of negative 13. They’re unlikely to recommend management-led organizations as places to work. 

So, as you can see, even in the best situations, where doctors are leading the group, the average score is only a +19. Most hospitals, unfortunately, don’t even reach these levels and are in the negative range.

What about Direct Primary Care? Well, a Net Promotor Score has never been done with physicians who left the system to be independent and do DPC. We finally did it here at DPC News. We asked only physicians who do DPC to respond to this question:

Please, assess the scale from 0 to 10, would you recommend Direct Primary Care to a colleague as a career choice

Out of the 157 who responded, the Net Promotor Score was a whopping +83.

This blows away any employed physician job I can find. Remember, the best average for them was +19!!!

I will use another post to share all the comments people added to the survey but for now, this is the first official Net Promotor Score for Direct Primary Care. I would recommend you share it anywhere you can with anyone who is interested in DPC (prospective medical students/residents, other employed docs, the media, etc.).

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