Physician pricing mechanisms and communication barriers behind low patient satisfaction in online dermatology consultations

Amid the rapid advancement of digital health, teledermatology faces distinctive challenges, including incomplete clinical information, the absence of palpation, and asynchronous physician–patient communication, which urgently call for targeted improvement measures. This study aimed to quantify the relationships between physicians’ professional titles, consultation volumes, and pricing, and to identify communication shortcomings underlying low-satisfaction reviews, thereby providing evidence for platform improvement and quality enhancement. Using a cross-sectional mixed-methods approach, we extracted publicly available data (as of August 2025) from Chunyu Doctor, including 510 registered dermatologists and 46,833 text-and-image consultation records. Descriptive statistics, Kruskal–Wallis tests with Dunn–Bonferroni post hoc comparisons were used to examine pricing and consultation volume differences across professional title categories, while Spearman correlations and multiple linear regression models (dependent variable: ln (price) examined pricing determinants. A qualitative thematic analysis was conducted on 4143 “average/unsatisfactory” reviews, with selected cases examined in depth. Most physicians were based in eastern China. Pricing was significantly higher for chief physicians compared to associate chiefs (β = 0.202, 95% CI: 0.097–0.306), while consultation volume showed no significant association with price ( r = 0.069, P = .120). Overall patient satisfaction was 84.3%, but varied markedly across physicians (38%–100%). Common reasons for low satisfaction included nonspecific advice (n = 252), slow responses (n = 149), perceived lack of expertise (n = 115), and insufficient explanations (n = 81). Case analysis revealed that generic first replies failing to address core patient concerns were the primary triggers for trust breakdown and order cancelations. Physician title, rather than consultation volume, is the primary determinant of pricing, and no direct relationship exists between price and satisfaction. Improving online dermatology services should prioritize making first replies more specific and explanatory to enhance patient experience and reduce cancelations.