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A Comparison of MedicalProfessionals with Favorableand Unfavorable AttitudesToward AdvertisingUgur Yavas PhD a & Glen Riecken PhD aa East Tennessee State University , Johnson City, TN,USAPublished online: 11 Oct 2008.

To cite this article: Ugur Yavas PhD & Glen Riecken PhD (2001) A Comparison ofMedical Professionals with Favorable and Unfavorable Attitudes Toward Advertising,Health Marketing Quarterly, 18:3-4, 13-26, DOI: 10.1300/J026v18n03_03

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A Comparison of Medical Professionalswith Favorable and UnfavorableAttitudes Toward Advertising:

An Empirical Study

Ugur Yavas, PhDGlen Riecken, PhD

INTRODUCTION

Background

Key rulings in the late 1970s forced relaxation of historic bans onadvertising by professional associations and opened the door for ad-vertising by dentists, doctors, attorneys, pharmacists and accountants.Shortly after, a flurry of studies examined attitudes toward profession-al advertising and related issues from the perspectives of both theprofessionals and the consumers (Carver, King and Label 1979; Dar-ling and Hackett 1978; Folland 1987; Hite and Bellizzi 1986; Kite andSchultz 1987; LaBarbera and Reddy 1987; Meskin 1978; Miller andWaller 1979; Riecken and Yavas 1984; Shimp and Dyer 1978; Smithand Meyer 1980; Swerdlow and Staples 1980; Traynor 1983/1984).About a decade after the relaxation of the ban on advertising, Hite and

Ugur Yavas is Interim Chair and Professor of Marketing, East Tennessee StateUniversity, Johnson City, TN.

Glen Riecken is Interim Dean and Professor of Marketing, East Tennessee StateUniversity, Johnson City, TN.

Address correspondence to: Dr. Ugur Yavas, Department of Management andMarketing, P.O. Box 70625, East Tennessee State University, Johnson City, TN37614-0625 (E-mail: raxyavas@etsu.edu).

The authors gratefully acknowledge the support of the Research DevelopmentCommittee, East Tennessee State University, in this study.

Health Marketing Quarterly, Vol. 18(3/4) 2001� 2001 by The Haworth Press, Inc. All rights reserved. 13

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Fraser (1988) conducted a meta-analysis and concluded that over theyears, the attitudes of professionals and consumers toward advertisinghad become more favorable, their reservations about potential nega-tive impacts had become weaker and their expectations about potentialconsumer benefits had become stronger.

Other writings, however, question the hypothesis of continuallyimproving attitudes (Honeycutt and Wibker 1991; McCann, Stem andMuehling 1993; Stevens, McConkey and Loudon 1991) and suggestthat professionals may still find advertising distasteful and not quitepowerful managerially. According to Becker (1998), the ‘‘bloom maybe off the rose.’’ He also added that now, while the professionals andtheir associations may not be as stirred up as during the height of thecontroversy, some moral indignation may remain and attitudes towardadvertising may cease to grow more favorable. Indeed, the to advertiseor not to advertise question still confronts professionals today (Moser andReed 1998) and causes academics to ponder whether the next generationof professionals will advertise more (Butcher and McPhail 1998). Theanswer to this decidedly critical question undoubtedly hinges on howattitudes will be translated into behaviors (cf. Becker 1998).

Purpose

Against this backdrop, the purpose of the study reported here is toexamine selected characteristics of medical professionals with favor-able versus unfavorable dispositions to advertising. Specifically thetwo groups are compared and contrasted in terms of their:

a. background characteristics,b. opinions on the ethicality of various messages in advertising by

medical professionals,c. likely reaction to more advertising by their colleagues,d. usage of advertising in various media and,e. perceptions regarding the criteria used by patients in selecting a

medical professional.

METHOD

Sample

Data for the study were collected via mail questionnaires from asample of 235 medical professionals, 58 of whom were dentists and

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Ugur Yavas and Glen Riecken 15

the remaining 177 doctors. The target sample consisted of 528 medicalprofessionals (doctors and dentists) whose names and addresses wereidentified from telephone directories covering three cities and severaltowns in a southeastern state. Systematic sampling was used in gener-ating the list of medical professionals from the directories in the cities.A census of medical professionals was used in the case of towns. Tofacilitate returns postage-guaranteed, self-addressed envelopes weremailed to the target respondents. The return rate of 44.3 percent(235/528) is reasonable in the absence of any incentives and comparesfavorably with similar studies among other professionals (Bell andVitaska 1992; Butcher and McPhail 1998; Hodge, Brown and Lump-kin 1990; Parkman 1986; Riecken and Yavas 1984; Traynor1983/1984).

The respondents were overwhelmingly male (90 percent), on theaverage had 17 years of professional experience and were practicingin the same city or town for 14 years. Fifty-six percent of the profes-sionals practiced in a town with a population of less than 50,000people. Seventy-one percent of the professionals were specialists, 40percent owned their practices, 44 percent were members of the AMA/ADA, the national medical professional association in their respectivefields.

Attitude Measure

Respondents’ attitudes toward advertising were measured by a bat-tery of 12 statements which were borrowed and modified from pre-vious writings (see, for example: Allen, Wright and Raho 1985; Bur-ton 1991; Folland, Parameswaran and Darling 1989; Hite and Fraser1988; Hite, Bellizzi and Andrus 1988; Riecken and Yavas 1984).These statements were broadly related to the advertising’s economicand social effects on the profession and the professional, and its poten-tial benefits to the consumer. Respondents were asked to indicate theirlevel of agreement with each item on a five-point scale ranging from‘‘strongly agree’’ to ‘‘strongly disagree.’’ A respondent’s overall atti-tude score was then derived by linearly combining his/her scores to the12 items. Because of the scoring method used, the overall score of arespondent could range from a low of 12 to a high of 60.

The minimum and maximum scores attained by the respondentssurveyed here were 12 and 58 and the composite scores had a mean of35.7 and a standard deviation of 9. The scale was checked for its

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internal consistency reliability by computing Cronbach’s alpha. Itdemonstrated commendable reliability (Cronbach’s alpha .92). Duringthe analysis stage, respondents were arrayed according to their com-posite scores and were subsequently assigned into favorable (top one-third) and unfavorable (bottom one-third) attitude groups.

RESULTS

Background Profile

Although the research evidence is not monotonic in support, it isbelieved that the competitive milieu in which the professionals oper-ate, as well as their own backgrounds, may have a bearing on theirattitudes toward advertising (Allen, Wright and Raho 1985; Chesser,Conway and Moore 1989; Heischmidt and Elfrink 1991; Parkman1986; Shapiro and Majewski 1983; Stevens, McConkey and Loudon1991; Traynor 1983). During the course of the study, data were col-lected on ten such characteristics. Table 1 presents the results fromcomparing favorable and unfavorable groups in terms of these charac-teristics.

As can be gleaned from the table, both groups were predominantlycomprised of male professionals who had specialties in their fields.They tended to work for clinics or had partnership arrangements.Respondents were almost equally divided in their membership inAMA/ADA. Also respondents with favorable or unfavorable attitudestowards advertising felt that the extent of competition in their locali-ties and their patient loads were just right.

The majority of respondents (56 percent of favorable and 60 per-cent of unfavorable group) worked in areas with a population of50,000 or less people. Data also show that the breakdown of thefavorable and unfavorable groups in terms of type of medical profes-sional was about the same; 29 percent of the favorable and 24 percentof the unfavorable group consisted of dentists. None of these charac-teristics yielded significant differences between the two groups. Acloser scrutiny of the results reported in Table 1, however, indicate twosignificant differences. First, respondents with unfavorable attitudeshad been in practice longer years (21 versus 14 years). Second, thesame group had been in practice in the same town for a longer duration(19 versus 11 years). These results, on balance, corroborate earlier

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TABLE 1. Background Characteristics

Favorable Unfavorable

Type of practicea

Private 39.5 42.9Partnership/clinic 60.5 57.1

Membership in AMA/ADAa

Yes 48.0 49.4 No 52.0 50.6

Populationa

50,000 or less 56.0 60.050,001 to 100,000 44.0 40.0

GenderaMale 86.8 93.6Female 13.2 6.4

Specialtya

Yes 64.5 71.3No 35.5 28.7

Number of years in practiceb,c 13.62 21.32

Number of years in townb,c 10.72 18.63

Competitiona

Too many 20.3 24.1Many 24.3 20.3Just adequate 40.5 43.0Few 10.8 6.3Too few 4.1 6.3

Patient Loada

Very heavy 12.2 12.7Heavy 23.0 26.6Just right 40.5 46.8Light 24.3 13.9

Medical ProfessionalaDentist 28.9 23.8Doctor 71.1 76.2

aPercentbMeancSignificant at σ = .05 or better

findings that having more years of experience (Allen, Wright andRaho 1985; Heischmidt and Elfrink 1991) and holding longer tenurein the present city/town are indeed associated with attitudes. It appearsthat more established medical professionals who are likely to havebuilt up patient bases through referrals and repeat visits see less of aneed to advertise and, hence, hold more unfavorable attitudes.

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Response/Reaction to Collegial Advertising

What will be the likely reactions of medical professionals to moreadvertising by their colleagues? Will these reactions exhibit differ-ences in intensity between the two groups? To gain insights into thesequestions, on five-point scales ranging from 5 = very likely to 1 veryunlikely, respondents were asked to rate the likelihood with whichthey would engage in a number of practices. These possible reactionsranged from such aggressive measures as more advertising to suchless aggressive tactics as increasing office hours.

As the Multivariate Analysis of Variance (MANOVA) resultssummarized in Table 2 indicate overall there was a significant differ-ence between the two groups in terms of the likelihood of their reaction(F = 8.14; p = .00001). Further univariate analysis reported in the tablehelp determine the sources of the overall difference. As shown in thetable those professionals with favorable attitudes were much morelikely to engage in more advertising. Also the results tend to suggestthat favorable group is more likely to ask for referrals from currentpatients and colleagues. Otherwise, despite differences in degree, thedirectionality of the reactions of the two groups appear to be similar.Members of neither the favorable nor the unfavorable group are likelyto react to collegial advertising by extending office hours or loweringfees or offering discounts.

Ethicality of Messages

Information about respondents’ perceptions of the ethicality of vari-ous messages/ appeals that can be used in advertising by medicalprofessionals were obtained by asking them how ethical they consid-ered a series of 15 appeals. Responses were recorded on four-pointscales ranging from 4 = very ethical to 1 = very unethical. The twogroups were then compared in terms of their perceptions using MAN-OVA. As shown in Table 3, MANOVA was found to be significant (F =5.58; p = .00001) by the Hotelling’s T2 criterion suggesting that, onbalance, medical professionals with favorable and unfavorable atti-tudes do differ in their opinions. Subsequent univariate analyses indi-cated significant differences between the two groups on fourteen ofthe fifteen appeals. The only appeal which did not significantly differ-entiate between the two groups was limiting patient’s liability to insur-ance coverage. Both groups felt this would be unethical. Both groups

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Ugur Yavas and Glen Riecken 19

TABLE 2. Response/Reaction to More Collegial Advertising

Multivariate Test of Significance

Value Exact F ProbabilityHotelling’s T2 .62 8.14 .00001

Univariate F-tests

Mean

Response/Reactiona Favorable Unfavorable

I will advertise myself.b 3.50 2.17

I will increase my office hours during the week.b 2.43 1.97

I will lower my fees. 2.02 1.81

I will offer specials.b 2.05 1.49

I will make house calls.b 1.88 1.59

I will open my office on weekends.b 2.16 1.83

I will provide additional services. 2.81 2.42

I will offer family discounts.b 2.25 1.70

I will ask my patients to refer their friends to me.b 3.08 2.36

I will ask my colleagues to refer patients to me.b 3.13 2.55

aResponse to each reaction can range from 5 = very likely to 1 = very unlikelybSignificant at σ = .05 or better

also tended to believe that using testimonials by patients, advertisingthe cost of the service, offering weekly or monthly specials and familydiscounts as well as inducements to attract new patients were unethi-cal. In each case, however, the ‘sentiments of the unfavorable groupwas stronger.

Results reported in Table 3 also show that while the unfavorablegroup was negative or ambivalent in their sentiments concerning suchmessages as filing insurance, amount of experience, past awards/ac-complishments and home pages on the web, the favorable group tend-ed to have more positive thoughts. The messages/appeals which elic-ited positive reactions from both groups were office hours, specialtyarea and office location. It should, however, be noted that in each casethe positive sentiments exhibited by members of the favorable groupswere stronger.

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TABLE 3. Ethicality of Messages/Appeals

Multivariate Test of Significance

Value Exact F ProbabilityHotelling’s T2 .81 5.58 .00001

Univariate F-tests

Mean

Appeala Favorable Unfavorable

Filing insurance for patientsb 3.40 2.97

Limiting patient’s liability to 2.20 2.11insurance coverage

Amount of experienceb 3.31 2.64

Area of specialtyb 3.56 3.21

Location of officeb 3.52 3.17

Testimonials by patientsb 2.45 1.78

Educational qualificationsb 3.38 2.93

Past awards/accomplishmentsb 3.10 2.57

Office hoursb 3.55 3.15

Cost of serviceb 2.67 2.38

Types of services offeredb 3.48 3.13

Weekly or monthly special offers 2.25 1.46through coupons or price reductions(e.g., vaccinations 20% off)b

Family discountsb 2.68 1.92

Inducements to attract new patients 2.75 2.05(e.g., free screening)b

Home page on the Internetb 2.98 2.26

aResponse to each appeal can range from 4 = very ethical to 1 = very unethicalbSignificant at σ = .05 or better

Advertising Practices

Do medical professionals’ attitudes toward advertising translateinto their behaviors? Are professionals with favorable attitudes morelikely to advertise in various media? Answers to these questions canbe gleaned from Table 4. As can be seen from the table, the YellowPages, which have been traditionally the most common advertising

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TABLE 4. Advertising Media Usagea

Medium Favorable Unfavorable

Yellow Pagesb 96.1 71.8

Newspapersb 55.3 19.5

Internet web pages 2.6 0.0

Professional publicationsb 5.3 0.0

Popular magazines 1.3 0.0

TVb 9.2 1.3

Radiob 17.1 1.3

Billboard 2.6 2.6

Direct mailb 22.4 2.6

Telephone solicitation 1.3 0.0

Brochures in officeb 60.5 31.2

aReported are percentages of respondents who advertised in that particular mediumbSignificant at σ = .05 or better level of significance based on chi-square test

medium in professional advertising (Butler and Abernethy 1996; Ab-ernethy and Butler 1998), received the most attention. Ninety-six per-cent of the members of the favorable and 76 percent of the members ofthe unfavorable group had advertised in Yellow Pages. More thanone-half of the medical professionals from the favorable group alsoadvertised in brochures distributed in their offices (61 percent versus31 percent) and in newspapers (55 percent versus 20 percent).

Data also show that the tendency of professionals with favorableattitudes to advertise in other forms of media is also significantlyhigher than their unfavorable attitude counterparts. For instance, thefavorable group was seven times more likely to advertise on TV and13 times more likely to utilize radio commercials. Likewise, directmail advertising had achieved much greater acceptance among thefavorable group (22 percent versus 3 percent).

Internet web pages, telephone solicitations, popular magazines andbillboards did not reflect any significant differences between the twogroups. It is interesting to note that none of the professionals withunfavorable attitudes had ever advertised on the internet, or in popularor professional publications. Neither had they used telephone solicita-tions.

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Doctor/Dentist Choice Criteria

To address, the final research issue (i.e., whether medical profes-sionals with favorable versus unfavorable dispositions toward adver-tising are similar (or dissimilar) in their perceptions of the choicecriteria used by the patients), respondents were asked to check whichcriteria (including advertising) they thought patients relied on inchoosing a doctor/dentist. The list of criteria was harvested from re-lated writings (Bush and Nitse 1992; Darden, Darden and Kiser 1981;Leventhal 1995; Smith and Meyer 1980) and a focus group conductedwith a group of consumers. The choice criteria, based on their numberof mentions, were then rank-ordered within each group, and Spear-man’s Rank correlation was employed to determine extent of similari-ty. As can be seen from Table 5, the two groups were quite similar intheir perceptions (rs = .94; p < .0001). For instance, both groups viewrecommendation by patient’s friends, referrals by colleagues and thequality of care as the most influential criteria. Likewise both groupsagree that insurance is of a moderate influence (rank 6). It is alsointeresting to note that neither the favorable nor the unfavorable groupperceives advertising as a critical choice criterion. It ties for a rank of9.5 among the favorable group and the unfavorable group ranks it12th.

DISCUSSION

The results of the study conjure up several implications. First, ad-vertising agencies and media wishing to attract the business of medicalprofessionals might do well to identify and target their efforts towardsthose professionals who have not been in practice in the area for verylong. Not only are they more likely to be favorably disposed towardsadvertising, they are more likely to advertise as a means to enhancetheir market establishment and competitiveness. Advertisers mighteven target a ‘‘package’’ of complimentary, non-competing medicalprofessionals who might cooperate in advertising with the goal ofbuilding a referral network among themselves. This would be a cleverapproach considering that the medical professionals themselves viewreferrals by colleagues among the most important criteria used bypatients in choosing a doctor or a dentist.

Second, in designing ads for the medical professionals, advertisers

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TABLE 5. Perceived Doctor/Dentist Selection Factorsa

Factor Favorable Unfavorable

Number of years practiced 12.5 12

Referrals by other colleagues 2 2.5

Office location 4 4.5

Cost of service 7 7

Advertising 9.5 12

Quality of patient care 3 2.5

Office hours 9.5 8

Recommendation by patient’s friends 1 1

Provision of related medical services (for example X-rays) 11 12

Promptness in giving appointments 5 4.5

Educational qualifications 12.5 9.5

Seeing/hearing doctor participation in seminars/speeches 8 9.5open to the public

Insurance 6 6

aRanks are based on number of mentionsrs = .94σ < .001

need to be sensitive to which appeals are acceptable. Although thosemore favorable to advertising were more lenient in the ethicality ofvarious appeals, they are still not comfortable with many of the pos-sible appeals that could be made. It appears that three themes (apartfrom the common informational appeals of location, office hours andspecialty) are more likely to be accepted. One theme revolves aroundability–experience, academic qualifications and awards/accomplish-ments. A second theme is types of services offered. A third themereflects some sort of inducement to encourage ‘‘trial purchase’’ bypotential patients–something to initially attract them to the office.

Third, as they develop themes, advertisers must simultaneouslyconsider media in which advertisements may be placed. Medical pro-fessionals more favorably disposed towards advertising still are un-willing to place ads in many conventional media. Apart from theYellow Pages, newspapers and direct mail seem to be the more accept-able choices although radio may be seen with some favor. Thesemedia may both reach potential patients and serve as a reminder to

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current patients. Brochures in offices are acceptable to most medicalprofessionals but are of limited value in attracting new patients. Theymight however, serve as a vehicle in encouraging current patients torefer their family/friends to the practitioner. Brochures might also behelpful in informing the people about the range of services offered bythe practitioner.

On a closing note it should be pointed out that even medical profes-sionals favorably disposed to advertising do not feel it is particularlyeffective in consumers’ choice of a doctor/dentist. Advertising agen-cies and media must realize they face a challenge in gaining businessfrom medical professionals and need to be cautious in their recom-mendations of appeals and media. While this study did not directlyaddress the issue of what the future holds, two scenarios are possible.If the current less established professionals maintain their favorableattitude even as they become established and new entrants to theprofession are similar in attitude to those now less established then theprospects are bright. This will be particularly true as those now wellestablished (and unfavorable toward advertising) retire from the pro-fession. If however, those currently more favorable become less favor-able in their attitude as they become more established, then the overallattitude towards advertising may remain basically the same over timeand advertisers will face much the same market conditions as nowexist. Longitudinal studies will be valuable in determining which sce-nario unfolds.

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