A total of 1415 Yelp reviews were analyzed. When stratifying online reviews by clinical and non-clinical correlations, we see that there were several factors significantly associated with the likelihood of a 1-star review. Using univariate analysis, unsatisfactory results decreased the risk of a one star review (RR = 0.74, 95% CI 0.64–0.85, p < 0.001). Factors that significantly predicated 1-star reviews were uncontrolled pain (RR = 1.39, 95% CI 1.16–1.67, p < 0.001), cost/billing/insurance issues (RR = 1.13, 95% CI 1.01–1.28, p = 0.033), and facilities/office environment (RR = 0.81, 95% CI 0.66–0.99, p = 0.042) (Fig. 1).

Fig. 1The alternative text for this image may have been generated using AI.

– Clinical Variables with univariate and multivariate analysis and respective relative risk of receiving 1-star review

When adjusting for all variables and using a multivariate regression analysis, it was confirmed that uncontrolled pain (RR = 1.39, 95% CI 1.16–1.67, p < 0.001) and misdiagnosis (RR = 0.72, 95% CI 0.59–0.88, p = 0.002) were significant contributors to 1-star reviews in the clinical category (Fig. 2). Looking at non-clinical factors, office staff communication (RR = 1.78, 95% CI 1.18–2.67, p = 0.006) and cost/billing/insurance issues (RR = 1.13, 95% CI 1.01–1.28, p = 0.033) were most strongly associated with 1-star reviews.

Fig. 2The alternative text for this image may have been generated using AI.

– Non-Clinical variables with univariate and multivariate analysis and respective relative risk of receiving 1-star review

Reviews were also stratified by geographic location and practice type in terms of group practice or solo practice (Fig. 3). Of the 1415 reviews analyzed, 30% (425) were 1-star. Based on geographical location, the cities with the highest percentage of 1-star reviews were Philadelphia, PA (53%), Jacksonville, FL (47%), and New York, NY (43%). Cities with the lowest percentage of 1-star reviews were Los Angeles, CA (21%), San Antonio, TX (22%), and Phoenix, AZ (28%) (Fig. 4).

Fig. 3The alternative text for this image may have been generated using AI.

– Variability in rates of receiving 1-star reviews across the 10 most populous US cities

Of the clinics that comprised reviews in this study, 55% were group practices. These group practices received 903 reviews, 28% of which were 1-star. Solo physicians obtained 512 reviews, 33% of which were 1-star reviews.

Fig. 4The alternative text for this image may have been generated using AI.

– Wilcoxon Rank Sum analysis of practice type; group practice or solo practice

Finally, reviews were examined after stratifying pain physicians by gender. Using a Kruskal-Wallis analysis, female-only pain physician practices received more 1-star reviews in general when compared to male-only and mixed gender practices (Fig. 5). Female-only pain physicians received a mean of 12.17 1-star reviews compared to 2.90 in male-only practices and 7.00 in mixed gender practices (p = 0.09). The likelihood of receiving a 1-star review in female-only practices when compared to male-only and mixed gender practices was 96.1% (p < 0.001). Interestingly, the likelihood of receiving a 1-star review as a male-only and mixed gender practice was 26.6% and 71.4%, respectively (p < 0.001).

Fig. 5The alternative text for this image may have been generated using AI.

– Kruskal-Wallis analysis of practice by gender

A Poisson regression using female-only practices as a reference point gave a relative risk of receiving 1-star reviews as a male-only or mixed gender practice. In male-only practices, there was a decreased relative risk of receiving a 1-star review compared to female-only practices (RR = 0.58, 95% CI 0.58, 0.58, p < 0.001). As for mixed gender practices, there was an increased relative risk for 1-star of reviews compared to female-only practices (RR = 1.40, 95% CI 1.39, 1.40, p < 0.001).