The State of Patient Reviews in American Medicine

Abstract. We analyze 15,061,473 Google reviews across 142,417 US medical practices spanning nine patient-facing specialties. Three findings organize the report. First, review volume is scarce and heavily skewed: the median practice holds 19 reviews, while the mean is 105.8. Second, ratings no longer differentiate: 68.2% of rated practices hold 4.8 stars or better and 46.7% hold a perfect 5.0, so the visible separator between practices is count, not stars. Third, visibility is winner-take-most: the top decile of practices holds 61.5% of all reviews at a mean rating only 0.33 stars above the bottom half, a 112-fold volume difference at near-identical quality. We additionally document that 26.7% of practices combine excellent ratings (4.8 or higher) with near-invisibility (10 or fewer reviews), quantify the gap between typical practices and their local leaders, and introduce the Review Gap Index, a city-level measure of local review concentration. City tables and topline statistics are released under a permissive citation license.

1. Half of American medicine has 19 reviews or fewer

The median practice in our data has 19 Google reviews. Not 190. Nineteen.

Table 1. Distribution of Google review counts across 142,417 rated US practices.

38.5% of practices have fewer than 10 reviews. 54.1% have fewer than 25. Meanwhile the average is 105.8, more than five times the median, because a small group of practices at the top holds most of the volume. That skew is the story of this entire report.

A practice with 12 reviews is not unusual. It is the norm. It is also, as Section 3 shows, nearly unfindable.

2. The stars stopped meaning anything

The average rating across American medicine is 4.61. The median is 4.9. 68.2% of rated practices sit at 4.8 or above, and 46.7% hold a perfect 5.0. Only 11.3% fall below 4.0.

Think about what that does to a patient comparing two practices. When two thirds of the market is clustered inside two tenths of a star, the rating cannot separate them. The patient’s eye moves to the only number left: the count. The data says the count is where the real separation lives: the top decile averages 650 reviews at 4.79 stars, while the bottom half of American medicine averages 5.8 reviews at 4.46. That is a difference of 0.33 stars, and 112 times the review count. Quality, as the stars measure it, is nearly flat. Visibility is not.

3. The visibility economy is winner-take-most

Add up all 15.06 million reviews and ask who holds them. The top 10% of practices hold 61.5% of everything. The bottom half of practices, all 71,000 of them, hold about 2.7% combined.

Figure 1. Share of all 15.06M reviews held by each practice decile (deciles by review count, lowest to highest), with the mean star rating of each decile. The entire rating spread is under half a star, while the volume spread runs 650 to 1.

This is not a quality ranking. It is an accumulation ranking. The practices at the top are the ones that ask, consistently, at scale, over years. Most of medicine never asks, and the reviews that arrive unasked arrive at a rate of a handful per decade.

The consequence is structural. Google’s own guidance names review count as one of the factors behind how prominently a business ranks in local search results,^[1] so review volume feeds local search placement, placement feeds patient flow, patient flow feeds more reviews. The staircase compounds. The longer a practice waits, the taller it gets.

4. One in four practices is excellent and invisible

Here is the finding we did not expect. 38,085 practices in our data, 26.7% of everything we rated, hold a rating of 4.8 or better on 10 reviews or fewer.

These are not struggling practices. Their patients love them. Every signal they have earned says excellent. But at 10 reviews, that signal is statistically silent to a patient scrolling past a competitor with 400, and nearly silent to the ranking systems deciding who shows up when someone searches their specialty.

We started calling this group invisible excellence, and a quarter of American medicine lives in it. If this report has a single sentence worth repeating, it is this one: the review economy does not reward being good, it rewards being counted.

5. Your local leaders are 56 times ahead

Averages hide the thing a practice owner actually feels, which is the practice up the road. For every practice, our audit system records the three most reviewed practices in the same specialty within about 15 kilometers. These are the local leaders, the names that occupy the top of the list when a patient searches.

Table 2. Practice-level gap to the best-reviewed same-specialty practice within 15 km (n = 142,349).

Two honest notes on this measurement. First, it compares practices to leaders by construction, and we say so; it answers “how far ahead are the names my patients actually see,” not “how do I compare to a random neighbor.” Second, we also computed a construction-free version city by city: in the median American city, practices at the 90th percentile hold 13.6 times the review count of the city’s median practice, and the top tenth of practices hold 56.3% of the city’s entire review pool. Same staircase, measured two ways. We publish the city version as the Review Gap Index, and we will track it edition over edition.

6. The map: where the gap lives

637 cities in our data have at least 50 rated practices. The spread between them is enormous.

Table 3. Cities with the highest and lowest median review counts, among the 637 US cities with at least 50 rated practices.

The pattern we can state from the data: fast-growing Sun Belt suburbs dominate the top of the table, and the bottom is a mix of dense, older metro areas and legacy industrial cities. A practice in St Johns, Florida needs 126 reviews just to be average. A practice in Detroit needs 6. Same country, 20-fold difference in the local price of visibility. Why these geographies diverge is a question for a future edition; we are publishing the observation, not a theory.

7. The specialties: cosmetic dentists figured it out

Table 4. Review statistics by specialty, ordered by median review count.

Cosmetic dentistry is the proof of concept. Median 93.5 reviews, five times the national median. This is what a specialty looks like when asking became standard practice: cash-pay patients, competitive markets, and a decade of consultants telling them to ask. The staircase can be climbed.

Dermatology is the starved end. Median 12, the lowest share of 4.8+ ratings in the table, and nearly half of all dermatologists under 10 reviews. Insurance-fed patient flow meant nobody had to ask. In a world where patients check reviews anyway, that is 18,000 practices running on referral momentum.

Medical spas sit in a strange middle. The best ratings in the table and a median of 41, well above the national number. But medical spas compete almost entirely on local discovery, and their local leaders hold hundreds. Being above average nationally while hundreds behind the practice up the road is the specific squeeze this specialty lives in.

8. If you run a practice

Five things this data says, stated plainly.

1. Find your number. Search your specialty in your city and count your reviews against the top three names. That multiple, not your rating, is your visibility position.
2. Your rating is table stakes. At 4.8 you have matched two thirds of the country. Nobody chooses you for it. They choose the count they can see.
3. The gap grows on its own. The leaders add reviews weekly through systems, not luck. Every quiet month widens the multiple.
4. Your happiest patients are the untapped asset. If you are in the invisible excellence quarter, the evidence already walked out your door unrecorded. Most practices have years of patients who would say yes if asked: separate survey research puts the share of consumers open to writing a business review at 96%.^[2]
5. Whatever system you use, never gate.Asking only happy patients for public reviews is prohibited by Google’s own policy, which tells merchants not to “selectively solicit positive reviews from customers”.^[4] The FTC’s 2024 rule is the wider backdrop rather than the governing text here — its suppression section reaches a business’s own review display, not who it chooses to ask.^[3] Volume built honestly is the only kind that survives.

Methodology

Source

applaud’s operational audit database: 218,361 patient-facing practice locations compiled through our Google Maps audit operations across dentistry, dermatology, medical spas, plastic surgery, weight loss, wellness, and skin care. Reviews and ratings are Google Business Profile data. Google hosts the large majority of healthcare reviews, but this report does not cover Yelp, Healthgrades, or other platforms.

Included

142,417 US practices with a live rating and review count. 5,161 rated rows were excluded: non-US locations our audits picked up in border and international markets (Tijuana alone contributed 1,876), rows with no usable state, and a small set of state-format outliers held for cleanup. 70,783 unrated rows were excluded because Google returns no rating for them; some genuinely have zero reviews and some were not fully fetched, and we will not guess which. The refresh pass before publication resolves this; until then, every number describes rated practices only, and the true share of near-zero practices is understated, not overstated.

Statistics

Percentiles are nearest-rank on sorted values. Deciles split the rated universe into ten equal groups by review count. City tables require at least 50 rated practices per city, following the disclosure-threshold convention in industry data publishing. The local-leader comparison uses our audit system’s competitor records: the three most-reviewed same-specialty practices within 15 km of each practice (40 km where fewer than three exist). That benchmark selects leaders on purpose, and the text says so where it is used. The Review Gap Index is computed without that selection: per city, the 90th-percentile review count divided by the median, published as the median across the 637 qualifying cities.

Not in this data

Review recency and velocity (a future edition), non-Google platforms, hospital systems, and any demographic overlay.

Data license

The city-level tables and topline statistics are free to cite and republish with attribution to “Applaud, The State of Patient Reviews in American Medicine, 2026” and a link. If you are a journalist and want a cut we did not publish, ask; if it is computable and honest, you will have it within a day.

Corrections

Errors found after publication will be corrected in place with a dated note. We would rather be corrected than quietly wrong.

References

1. Google. “How local results rank on Google Search and Maps.” Google Business Profile Help. support.google.com/business/answer/7091. “Prominence... is also based on info like how many websites link to your business and how many reviews you have. More reviews and positive ratings can help your business’s local ranking.”
2. BrightLocal. “Local Consumer Review Survey 2025.” Published January 29, 2025 (n = 1,026 US adults). brightlocal.com/research/local-consumer-review-survey-2025. 96% of consumers report being open to writing a business review.
3. Federal Trade Commission. “FTC Announces Final Rule Banning Fake Reviews and Testimonials.” Press release, August 14, 2024; rule effective October 21, 2024 (16 CFR Part 465). ftc.gov/news-events/news/press-releases/2024/08
4. Google. “Prohibited & restricted content.” Maps User Generated Content Policy Help, “Rating manipulation”. support.google.com/contributionpolicy/answer/7400114. Merchants must not “Discourage or prohibit negative reviews, or selectively solicit positive reviews from customers.”

applaud (applaud.you) is a review acquisition service for medical practices, priced on outcomes. We built this dataset to run our audits; we publish it because the market runs better when everyone can see the numbers.