By Donavyn Coffey

A Virginia Beach-based psychiatry nurse practitioner posted in a private Facebook group asking for reviews.

“Would anyone be willing to endorse Google reviews?” they wrote. “We can never have too many Google reviews.”

Her fellow group members didn’t hesitate. A flurry of responses followed: “I posted a review for you. If you Google my name…you can find my Google and leave me a review as well,” one provider from Washington wrote. “Me too,” another provider wrote, leaving a link to their Texas-based practice. Then one commenter suggested they move the conversation to “the group chat for mutual endorsements”: a separate chat within the Facebook group devoted to review trading. A screen recording showed hundreds of nurse practitioners soliciting good-review trades from fellow providers they had never worked with or treated.

According to healthcare law experts, these trades incentivize reviews and could be considered deceptive advertising by the Federal Trade Commission and professional misconduct by some medical associations. Yet hundreds of providers jumped headlong into the exchange, likely because they’re afraid.

In 2026, a positive online presence is the cost of doing business — in medicine and every other industry. But unlike other sectors — clinicians’ hands are tied. Ethically, they can’t solicit good reviews from patients. And, legally, they’re prohibited from responding to negative reviews. The keyboard courage of a few disgruntled patients can skew the online reputation of an entire clinic. Feeling like they have no other option, trading reviews is a last-ditch attempt to protect their practice from unfair online opinions.

While it’s true that providers do need to take steps to manage their online reputation, experts agree these trades are not the way. Trading reviews and endorsements is at best unethical and at worst, illegal. Plus, it’s not nearly as effective as it may seem in the moment. There are better ways to shield your business.

Fragile and Frantic

“I think it’s such a shady, unethical thing to do,” said Maria Ingalla, DNP, owner of an Arizona-based psychiatry practice who is not a member of the above Facebook group trading reviews. However, she has seen similar grabs for online credibility in the professional groups she’s part of. And while it’s far from acceptable, she said it does reveal just how fragile doctors feel against their reviewers.

Ingalla learned the hard way not to stand up for herself when it came to bad reviews. Several years ago, a patient complained about her practice online. She responded, sharing one of her clinic’s policies. The next thing she knew, she was hearing from the Office of Civil Rights and hiring her own attorney.

“Any commentary you give back acknowledges them as a patient and violates HIPAA [Health Insurance Portability and Accountability Act],” Ingalla said.

“Without question, the biggest challenge [of online physician reviews] is that doctors want to address negative reviews by telling their side of the story,” said Elizabeth Jackson, a Chicago-based healthcare attorney. But those absolving details aren’t an option because they undermine patient privacy.

“HIPAA prevents covered physicians from confirming or denying patient status. This makes it impossible to respond to specific allegations, even when they’re outrageous and untrue,” she said. There are HIPAA-compliant ways to respond, but Jackson said doctors should always get trusted outside or legal help before doing so.

As a provider, it’s easy to feel trapped, Ingalla said. You spend all this time and money to help people, and then they say negative things about you online. Providers think “nobody who’s happy is reviewing me,” Ingalla said. So in their panic — they resort to trading or buying reviews.

While it may seem like a solution in the moment, Ingalla said these superficial reviews don’t build credibility like providers might hope. They’re easy for patients to see through. Ingalla runs into it when she’s looking for doctors for her own children. “The language is too bizarre,” she said. Or the post contains content that doesn’t sound like a patient.

A 2024 survey of 10,000 consumers confirmed Ingalla’s theory. The results show consumers found high-quality reviews more convincing than the number of reviews or overall star rating. Plus, 97% of patients say fake reviews make them lose trust in a brand. The power of reviews is in their authenticity, but traded reviews with far-flung professionals don’t offer patients the insights they’re looking for.

Increasing the Good Reviews

Jeff Ellis, MD, a dermatologist in Connecticut, makes a different argument. “Trading reviews can never get you the volume you need to protect your business. Asking friends, family, and colleagues, or trading online isn’t enough. It’s a waste of time,” Ellis said.

Today, Ellis’s Connecticut-based dermatology practice has over 2000 reviews from real patients — most of them positive. The occasional negative, unhelpful, or misleading comment still happens — but it’s not nearly as troubling because the negative is dwarfed by the positive. But his online presence wasn’t always this strong.

When Ellis started the practice nearly 20 years ago, his plan was to ignore reviews — to be above the online fray.

But it wasn’t that simple. Reviews matter.

According to a 2015 study, parents are more likely to choose a neighbor-recommended doctor with positive online reviews than a recommended doctor with no online reputation. And those positive reviews aren’t easy to come by.

Other research shows online reviews are plagued with negativity bias, meaning patients with negative feedback are significantly more likely to leave a review (and with more details) than patients with positive feedback. And a 2018 study showed negative physician reviews carry more influence than positive reviews even when most of the reviews are positive.

“What happens is the online presence becomes skewed toward negativity in a very real way,” Ellis said. Back then, “we didn’t have that many reviews — maybe 15. But if out of 15, four [reviews] are bad, percentage-wise, that doesn’t look so good,” he said.

At first, Ellis and his staff tried to track down every negative commenter to correct the problem. “That was almost never successful,” Ellis said. “There’s a lot of keyboard cowboys that would rather insult you online than discuss a problem face-to-face.”

If they couldn’t reverse the negative comments, their next strategy was to turn up the volume on the positive commentary. As a sounding board, they started with a one-question internal survey. After 6 months, their results were almost exclusively positive, so they decided to move things online.

The practice added a tagline to their existing follow-up text: A number to call with any concerns or complaints and a link inviting them to share their experience on Google. And for every review posted, good or bad, they promised to plant a tree. “It was a little scary because we weren’t doing anything to filter [their comments about us],” Ellis said.

Today, it’s still a small fraction of patients writing reviews — about 3%, Ellis said. But it’s been enough to build their review-base so that it reflects the majority of their patients and isn’t swayed by every nay-sayer.

Ingalla has had success with a similar approach. Her practice sends out a text to new patients inviting them to schedule a follow-up. In the same text they include a link to review platforms inviting patients to “share their experience.” They still get negative reviews — but most of the feedback is overwhelmingly positive.

Don’t Negate the Negative

Ellis and Ingalla have taken steps to insulate their businesses from online negativity bias, but that doesn’t mean they ignore negative reviews.

“I think there’s total value in it. Most negative reviews are a way to look at the way my business is doing,” said Ingalla. At one point, she got six or seven negative reviews in just 3 months saying that her “billing was horrendous.” She fired her biller, and the complaints went away almost immediately.

There’s a real temptation to feel angry or hurt about negative reviews, Ingalla said. “But it’s a business…you have to take that information and see what you can do better.”

Ellis also took a lead from his negative feedback. Patients repeatedly complained about long wait times at his office — and assumed Ellis and his colleagues were greedily double booking. But that wasn’t the case.

Ellis spent months figuring out what was driving the wait times. He finally learned, patients were being taken back based on when they arrived, not their appointment time. People who were late or early were delaying on-time patients.

A small switch at check-in “and wait-time reviews stopped happening,” Ellis said. “I am very proud of how we’ve used feedback to make ourselves better for patients.”

Not All Specialties Are Reviewed Equally

For Avigail Lev, PsyD, owner of Bay Area CBT Center in San Francisco, reviews — good and bad — are an ethical issue. “This keeps me up at night,” she said.

She’s had consistent clients for 10-12 years, the majority stay for at least 3 years. “If I wanted to ask them to write a review, they would do it. But why do that? That puts them in a compromising position; they expose that they are in therapy and maybe more. It can be coercive and risks the relationship.”

Asking for reviews isn't prohibited, as long as testimonials are voluntary and not misleading, psychiatric associations often take a very different stance, according to Jackson. Some say signage asking for reviews is okay but not asking patients directly. While others have “outright bans on soliciting testimonials or reviews from clients,” she said.

It’s one thing to review your cardiologist, Lev said. “But people don’t want to write they cured my erectile dysfunction or bipolar disorder” — nor should they have to, she said.

With no way to respond to negative reviews or solicit good ones, Lev said there is enormous pressure on mental health providers to avoid upsetting patients. She said, she would prefer to exchange reviews with other providers — but only after they’ve actually met and done consults.

Ingalla agrees that psychiatry is particularly vulnerable to not getting reviews. Plus, she’s had providers get bad reviews because of their expression — or lack thereof — when a patient exposed a trauma. People seek out psychiatry for help, she said, but they are not necessarily comfortable writing about their experience, good or bad, online.