5 Questions About How Employees Find Doctors

To hear the full conversation, watch the webinar.

Most benefits strategies still assume employees find doctors the way they did 20 years ago, through a primary care referral or the carrier's directory. Garner CEO Nick Reber joined me on our webinar to test that assumption against the data, and very little of it held up. That matters because the doctor decides where most of the money goes. "Doctors are only 20% of your health plan premium, but the doctor's pen really controls the other 80%," Reber said. Across a basket of surgeries, the top 25% of doctors in Garner's data have a 75% lower risk-adjusted complication rate than the bottom 25%.

Garner's data team combined its claims database of over 320 million patients with member surveys and academic research to see how employees actually choose. The data shows most of them are choosing on their own, using tools that say little about the quality of the doctor. Here’s what it shows on five common questions about how that happens.

Question 1: Do most employees already have their doctors?

Employers often hear that it's too hard to change where members go for care, because they've already settled on their doctors. The data says otherwise. About 63% of the doctor-patient relationships members form in a given year are new, meaning the member hadn't seen that doctor when the year started. "Most of the people are free agents," Reber said.

The new relationships are also where the spending sits. Employees tend to keep a primary care doctor for years, but few have a standing relationship with an orthopedist or a cardiologist. So most new relationships each year are with specialists, and Reber said those visits account for the vast majority of plan dollars. For employers, that changes the question. Steering care doesn't mean pulling anyone away from a longtime doctor. It means reaching employees at the moment they need a new specialist.

Question 2: Do doctor referrals still decide where people go?

The old model ran through primary care. Your knee hurt, your doctor tried to treat it, and when that didn't work, you got a referral to an orthopedist. That path has been shrinking for 20 years. Garner's data shows that only 25% of people nationally now find a new provider through a referral from another provider. "Most people are searching and finding and self-referring on their own," Reber said. In rater8's 2026 survey of 992 U.S. adults, patients who had searched for a new doctor in the past year cited AI tools (36%) and Google search (34%) as top influences, ahead of doctor referrals (32%).

In Garner's analysis, online search is now the single biggest way Americans find care, through Google and Yelp, and more recently tools like ChatGPT. Even people who get a referral or a friend's recommendation usually check online before they book. When Garner's survey asked whether they look up a doctor's reviews before a first visit, almost half of people said always and another 37% said sometimes. A separate 2025 survey of 1,008 U.S. patients found that 84% check online reviews before choosing a new doctor.

Question 3: Do employees use the carrier directory, and can they trust it?

In Garner's analysis, only 15% of people primarily find care through their carrier directory. Most employees are on broad networks and assume nearly every doctor and major hospital system will be in network, so they skip the directory, search on their own, and call the doctor's office to confirm. Online search has taken share from referrals and directories alike.

Accuracy is the bigger problem. Garner's data shows that only 39% of carrier directory listings lead to a doctor who is taking appointments, at the phone number and address listed, in the right subspecialty. "Most of the time you're making two, three, four phone calls," Reber said. Navigation tools usually don't fix it, because "a lot of those folks are just grabbing the data from the carrier, throwing it into their tool." Garner has spent six years checking the directory data for the doctors it recommends. It verifies each recommended doctor three ways: using claims data that shows the doctor is taking new patients, automated checks of online booking and website availability, and calls to the doctor's office. Reber said that work has pushed accuracy well into the 90s.

Question 4: Does a five-star review mean a good doctor?

Because most people search online, and reviews feature prominently in provider search results, review scores steer many choices of doctor. But when Garner compared online review scores against surgical complication rates, it found no relationship. Reber said the same holds for other outcome measures, such as hospitalization rates and mortality. At most, he said, reviews reflect the doctor-patient interaction. "There are plenty of people that can have a surgical complication and still give their doctor a five-star rating for bedside manner," Reber said.

Meanwhile, Garner's methodology paper finds significant differences in how doctors practice in every geography. In the webinar, Reber showed one measure of that difference, with the top doctors in Garner's data having 80% lower odds of sending a patient to surgery before trying physical therapy or other less invasive care. A five-star rating can't tell an employee which doctors those are.

Question 5: Do employees want quality information?

Employees lean on online reviews, but few think those reviews matter much. Asked which factors matter when choosing a provider, people rank online reviews at or near the bottom, behind insurance tier, wait time, distance, education, years of experience, subspecialty, and even a friend's recommendation. Reber sorted most of those factors into three buckets: cost (insurance tier), convenience (wait time and distance), and quality (education and years of experience). Per Garner's survey, only 22% say they have enough information to choose a doctor on quality. What people really want, Reber said, is "actual information on who will take care of me, who treats my disease really well, who has the best outcomes for people that look just like me."

Without that information, employees fall back on stand-ins like where a doctor went to school or whether they're board certified. "Well, everybody's board certified," Reber said, and the data largely backs him up, with over 90% of U.S. physicians board certified. Reviews win by default because it's hard for employees to find information on the cost, convenience, and quality factors that matter most to them. For employers, Reber said, reviews "do nothing to improve the performance of your health plan."

Give employees a better place to search than a review site

As I heard it, employees aren’t the obstacle. To help employees find the best-performing doctor in their network, an employer has to put trustworthy information where employees already search and give them a reason to act on it.

Changing behavior starts with the money. Price transparency tools alone rarely change behavior. When Harvard researchers studied one at a large public employer, only 12% of employees used it in the first 15 months. Reber pointed out that most of these tools don't change what the member pays. In Garner's client data, a $20 copay difference barely moves engagement. But when an employer covers the deductible for employees who see a recommended doctor, almost half of members use the search tool, and some designs reach 90% or more. Covering the deductible is the carrot. I asked Reber what happens when an employer adds a stick as well. Most do both, he said, pairing a bigger incentive with a somewhat higher deductible.

We also took audience questions on how center of excellence prices compare with the best rates already in your network, why a doctor can drop off a recommended list from one month to the next, and how engagement holds up in multilingual workforces. Watch the full session to hear Reber's answers, and how intentional benefit design can change where your employees go for care.