Assessing traditional Chinese medicine service quality from physicians’ perspectives: a nationwide survey in China

Service quality is important for strengthening traditional Chinese medicine (TCM) within contemporary healthcare systems, yet provider-based evidence remains limited, particularly for TCM-specific aspects of clinical practice. We conducted a cross-sectional online survey of physicians in China in January 2025. The Chinese Medicine Service Quality (CMSQ) scale integrated general service-quality principles, patient-centered care, and TCM-specific service characteristics. We evaluated its psychometric performance, compared service-quality scores across physician and institutional characteristics, examined associations with willingness to recommend institutions using ordinal logistic regression, and analyzed open-ended suggestions using topic modeling. The primary analytic sample comprised 393 physicians from 27 provincial-level regions. The six-domain CMSQ demonstrated high internal consistency (total Cronbach’s α = 0.945; domain α = 0.784–0.896) and acceptable CFA fit (CFI = 0.946, TLI = 0.938, RMSEA = 0.056, SRMR = 0.053), with measurement invariance supported across hospital levels and hospital types. Pre-visit responsiveness (mean 4.31) and appointment service accessibility (4.30) received the highest domain ratings, whereas medication supply services received the lowest (3.96); decoction waiting time was the lowest-rated individual item (3.61 ± 1.22). City tier showed the most consistent subgroup differences. In the adjusted ordinal model, higher recommendation intention was associated with pre-visit responsiveness (aOR = 1.278, 95% CI 1.112–1.469; P < 0.001), medication supply services (aOR = 1.132, 95% CI 1.036–1.237; P = 0.006), and TCM practice evaluation (aOR = 1.144, 95% CI 1.019–1.284; P = 0.022). Topic modeling of 283 substantive responses identified priorities related to institutional capacity and clinical standardization; clinical quality, affordability, and care experience; and operational management, workforce development, and service accessibility. Physicians evaluated service accessibility and responsiveness relatively favorably, whereas medication supply and selected TCM-specific service components received lower ratings. Recommendation intention was associated with both operational service quality and TCM practice evaluation. The findings point to the importance of strengthening operational reliability alongside TCM-specific clinical quality and organizational support, while providing preliminary psychometric support for the CMSQ as a physician-centered framework for evaluating TCM service quality. Not applicable.