[tptacek]

At the very top tier, the most advantaged professionals will be those doctors who are fundamentally effective and apt at customer service. Surfacing them is a win for consumers.

But the next tier after that will be a raft of professionals who are not necessarily effective, but still apt at customer service. Elevating them is a loss for consumers.

The question you then want to ask is, is it harder to be good at customer service, or harder to be good at internal medicine? I think customer service is easier, and thus worry that the second tier will be the largest of the tiers.

An easy response to this is to say that doctors will learn to get better at customer service. Maybe. But the effect I'm talking about also happens if we stipulate that none of these professionals really change at all, and instead the market just changes the way we sort them. I think that is likelier than the scenario where doctors who are not simultaneously good at medicine and managing an office suddenly figure out customer service.