Beyond Ebola: Doximity and Doctors Without Borders Work to Fight Infectious Disease

21 October 2014

Beyond Ebola

It’s an understatement to say that the Ebola outbreak is gathering significant media attention. While the disease is a real issue in Africa, the extensive press coverage in the United States implies a risk to Americans that is far greater than really exists. A search on Google News for US media coverage mentioning “Ebola” in just the last month yields no less than 30 million results.

Doximity recently formed an alliance with Doctors Without Borders (Médecins Sans Frontières or MSF) to assist in their physician recruitment initiatives. Through our conversations with their team it has become clear that, at the same time that the international relief organization is leading much of the work to combat the Ebola virus, they are facing negative side-effects from the surge of US media attention. The agency has become overwhelmed with physicians wanting to volunteer for Ebola, while at the same time facing shortages in medical staff for other projects.

“Doctors Without Borders is no longer recruiting specifically for the Ebola emergency in West Africa,” said Douglas Mercer, Field HR Recruitment Outreach and Administration Manager with MSF. “We are encouraging physicians interested in working with our organization to be open to considering other field assignments.”

Physicians volunteering where it matters most

Together, Doximity and Doctors Without Borders are working to recruit physicians to long-running medical campaigns, starting with HIV/AIDS and tuberculosis (TB). In 2012, 8.6 million people fell ill with TB and 1.3 million died from the disease. In the same year, 35 million people were living with HIV/AIDS and 1.6 million died from the virus. As of this writing, Ebola has killed 4,500 people.

Doctors Without Borders is able to search Doximity’s platform of 300,000+ physicians for specific areas of clinical expertise, languages spoken and international experience to find the right candidates to fill their most pressing roles across the world. In 2013, MSF provided antiretroviral treatment to 331,000 people living with HIV/AIDS, while more than 30,000 people were treated in MSF programs for TB and multidrug-resistant TB (MDR-TB).

MSF is seeking infectious disease physicians prepared for field work for a minimum of 9 to 12 months, who have experience working/traveling outside the US and who have some surgical and obstetrical experience for this initial campaign. In addition to the infectious disease campaign, Doximity and MSF are reaching out to physicians across a broad variety of specialties to educate them about opportunities for medical aid work around the world.

Tweet it: Beyond Ebola: @Doximity & @MSF_USA team up to find physicians for international relief work

What do doctors really think about Ebola?

As the coverage of Ebola in US media continues to surge, Doximity is following the uniquely pragmatic perspective on the outbreak among medical providers in real-time. In-line with Doctors Without Borders’ sentiment, our physician discussion boards are full of calls for reason and relativism. This anonymous statement from a physician is representative:

“It is clear that areas of wide publicity get the most attention, even if the real burden of disease and risk to our patients is low. It would be nice if our hospital’s CHF and COPD “preparedness” plans got this much attention.”

As a practicing physician in San Francisco’s VA hospital emergency room, I have seen the negative impact of outbreak hysteria personally. Patients are at far greater risk for flu or diabetes than Ebola, yet we see schools being closed because of the worry that someone at the school has been in contact with someone who had treated an Ebola patients but was totally symptom free. A silver lining to all of this would be if people take communicable diseases more seriously and get their flu shot. We can all hope.

So, in sum, I would ask our community of US physicians to, at a minimum, do no harm–talk to your patients, friends, neighbors, anyone who will listen to use this opportunity to educate people about risk. Tell them Ebola is a theoretical risk but one that is essentially zero for anyone in the US (who doesn’t decide to fly to Liberia on a whim). As an internet meme has reminded us, more Americans have been married to Kim Kardashian than have died of Ebola. Let’s keep things in perspective.

I would push for childhood vaccines. I would make sure your TB shots are up-to-date–we have have to keep ourselves healthy, physicians! And I would stop worrying about Ebola and donate to Doctors Without Borders so that they can continue their excellent work promotion global health in a pragmatic manner.

Tweet it: A physician’s view on Ebola, TB and HIV - @Doximity and @MSF_USA tackle #infectiousdisease

Peter Alperin, MD is an internal medicine physician practicing at San Francisco’s VA Medical Center, and VP/GM, Connectivity Solutions at Doximity. Email research@doximity.com for more details on our work with Doctors Without Borders or perspectives on Ebola.

PS: A few more charts we we found interesting, showing the relative coverage of Tuberculosis, HIV and Ebola outbreaks over time via Google:

Doximity interviews Dr. Sandeep Jauhar on physician authors, burnout and the future of medicine

09 October 2014

Doximity interviews Dr. Sandeep Jauhar

Sandeep Jauhar, MD, PhD, captured the nation’s attention this summer with his book Doctored about rising career disillusionment among physicians. In this Doximity exclusive interview, Dr. Jauhar talks about his unique career path and the process of becoming a physician author with Alex Blau, MD - Doximity’s Medical Director and a former journalist.

Alex Blau, MD: Dr. Jauhar, Doctored is your second book after first publishing in 2009 about your residency training. What initially drove you to start writing about your experiences in medicine?

Sandeep Jauhar, MD, PhD: I’ve always enjoyed writing, and writing has helped me process and make sense of the many profound, touching, infuriating, and puzzling experiences that I (and all of us) have as doctors. I started writing in medical school. I got an opportunity in 1998 to write about my medical residency in The New York Times, which has resulted in a long and productive relationship. I published my first book, Intern, in 2008, based on copious notes I took nearly 10 years prior (when I had no idea I’d ever write a book). Over time, writing has become a bigger part of my professional life, though I still consider myself first and foremost a practicing clinician.

“I’ve deliberately kept my practice relatively small so that I can take care of my patients the way I want.” Tweet this »

AB: If you could snap your fingers and change one thing about healthcare in the US, what would it be?

SJ: Increased pay to primary care physicians, so they don’t have to run on a demoralizing treadmill everyday, seeing patients every 10-15 minutes. Besides being the right thing to do for a segment of our profession that, in my view, is underpaid and under-appreciated, I believe increasing “cognitive care” reimbursement will have the added benefit of reducing unnecessary consultations and tests (or rather, tests and consultations that are necessitated by the lack of time doctors have to devote to their patients).

I wrote a piece in the New York Times recently in which I note that physician incomes make up only 10-20% of healthcare costs. However, our decisions (whether to hospitalize a patient, order that MRI, etc) determine close to 80% of healthcare spending. Take doctors off the office treadmill — the biggest driver of that treadmill is decreasing reimbursements — and you will likely see healthcare savings.

AB: Do you see any hopeful signs on the horizon for physicians in their working lives? What can we do as healthcare professionals to drive positive change?

SJ: I do. Some of this hope stems simply from a greater recognition among doctors of the burnout problem. About a third of physicians will experience burnout at some point in their professional lives. Sometimes the lowest point is also the tipping point. I think we’re at that point today. Perhaps the most important message of my book is that unhappy doctors make for unhappy patients. If doctors don’t find ways to take care of themselves and find ways to adapt to the maelstrom of changes afoot in American medicine, there is little hope for our patients.

AB: You talk in your book about feeling overwhelmed—how do you balance a busy career as a cardiologist with your writing and media work?

SJ: I’ve deliberately kept my practice relatively small so I can take care of my patients in the way that I want, the way I was trained, and the way I expected I would when I entered medicine. It’s not perfect, but it’s a lot better than when I was running on my own daily treadmill. The writing thing is sort of cyclical. When a book is published, there is a lot of media coverage and as an author I have to make myself available for interviews and so on. But then I go back to being my relatively anonymous and normal self.

AB: Who are other physicians who have inspired you or who you see as mentors?

SJ: Abe Verghese, Oliver Sacks, and Elisabeth Rosenthal are three physician writers who immediately come to mind. One of my favorite books about medicine is A Fortunate Man, by John Berger, about an English country doctor named John Sassall. Sassall’s affecting story and photographs have been a great inspiration to me and many physician readers (even though he suffered from depression and eventually took his own life).

“Keep a journal. Write a little bit everyday. Find threads in the material. And feel free to email me.” Tweet this »

AB: What advice would you offer to physicians looking to publish about their experiences and perspective on medicine?

SJ: Keep a journal. Write a little bit everyday. Find threads in the material. And feel free to email me. I’m happy to read and suggest venues for publication. Most major newspapers like The New York Times and the Washington Post are interested in medical narratives. JAMA and Annals of Internal Medicine also have widely read columns by physicians.

For more information on Dr. Jauhar’s writing, please visit his website at www.sandeepjauhar.com. Have a physician leader to recommend for a future Doximity interview? Email pr@doximity.com with your suggestions.

Physicians going rogue to share medical records

01 October 2014

Are carrier pigeons HIPAA-compliant?

It’s a well-known fact that physicians tend to share a propensity for A-type personalities. When told they can’t do something that they know is right for patients, they have a way of finding a workaround.

Yesterday, The New York Times posted a thoughtful article by Julie Creswell about the lack of systemic medical record sharing despite billions of dollars in national investment in electronic health record technology. “Doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems.”

What we see at Doximity is an emerging trend of physicians finding ways to share records by maneuvering outside the confines of institutional and EHR systems. In a sector that still relies on 15 billion pages of faxes each year, doctors are getting creative to digitally share medical records. They’re turning to social networks.

Over 300,000 US physicians have joined Doximity to share and read HIPAA-secure messages - making the network far larger than any EHR (even Epic). While only 14% of physicians have access to EHRs-based record sharing systems, any doctor can go “off-the-grid” to send through a private network. Networks are entirely physician-to-physician and independent from the economics that drive large health system policies.

While Doximity began as a professional network and directory for physicians, HIPAA-secure messaging quickly proved to be in high demand by physicians struggling to navigate the fragmented and often-isolated medical sector. This led to rapid membership growth in rural areas such as Alaska, where providers were starved for peer communication to support the care of their patients. The grassroots growth of messaging across Doximity’s social network shows just how thirsty physicians are for ways to communicate. Here’s how one physician puts it:

“In our disconnected healthcare system, coordinating care for a chronically ill patient is an immense challenge. I can think of several instances where having access to a large database of doctors has really improved patient care. We had a chronically ill elderly person who travels to a different state in the winter months. She had seen another doctor in the other state but was unable tell us the outcomes of their visits. Doximity allowed me to quickly find and contact this other physician thereby allowing me to coordinate her care in real time rather than waiting for records to be faxed over. Fortunately, we found out about all her medication changes and testing that had already been done” — Shabbir Hossain, MD

What would the parallel be for this behavior outside of the medical sector? For most of us, being legally-prohibited from using email or SMS would be unthinkable. It would be ludicrous to use Snapchat for communicating with colleagues instead of email.

And yet, every day, thousands of physicians securely send records through these independent, doctor-to-doctor, social network-based channels. Medicine is an information profession. Physicians will never cease to be creative and resourceful when it comes to improving patient care. Physicians don’t care that interoperability is a regulatory quagmire, they just need to get the charts sent.

Peter Alperin, MD is VP and GM, Connectivity Solutions at Doximity. Email pr@doximity.com for more data on the secure messaging trend among Doximity physicians.

Physicians + iPhones: A Data Love Story

16 September 2014

Physicians love iPhones

With the announcement of the iPhone 6 last week, our researchers took a close look at how physicians are using smartphones. We used anonymous login data for the nearly 50% of US physicians active on Doximity to get the most accurate look at device trends in medicine.

Apple or Android? Doctors are overwhelmingly Apple fans. Over 85% of physicians are using an iPhone device. Compare that to the mere 32.5% of the general population that chooses Apple over Android. The 80/20 split has been consistent in our data over the last year and a half.

How quickly did physicians upgrade to the iPhone 5? Fast. The graph above shows that the iPhone 5 was already the most popular phone in use on Doximity only six weeks after it was announced on September 10, 2013. That’s about 4x faster than the general population upgraded to the new phone.

What about the iPhone 5c and 5s? Neither of these iPhone versions received the same pick-up as the original iPhone 5. The iPhone 5s was adopted fairly quickly by physicians, but wasn’t quite able to nab top market share from the iPhone 5. The iPhone 5c barely registered.

Will doctors love the iPhone 6? Trends from our data suggest it’s going to be a hit. Our prediction: the iPhone 6 will be in use by 35% of Doximity physicians before Thanksgiving. A larger screen for viewing digital scans and promises of an upgraded battery that can keep up with a physician’s long workday should be a nice fit for the medical sector.

So, will this love last? Physicians have been leaders in adapting hand-held devices to the medical workflow ever since the early Palm Pilot days. Small enough to fit in a white coat pocket and packed with volumes of quickly accessed clinical information, the smartphone—or external brain, as they’re often called on the wards—is an ideal physician tool. Through Doximity’s mobile app physicians send HIPAA-secure messages to colleagues, stay current on the latest news in their specialty, get second opinions from specialists and send patient referrals every day. iPhone 6 might just be love at first sight for medicine.

Are you a reporter interested in more data from Doximity’s research team? Email pr@doximity.com today.

2014 Residency Program Rankings for Medical Students

09 September 2014

Get ready for residency rankings

15,000 medical students are waiting anxiously for residency applications to open on Monday, September 15. With a few clicks and a quite a bit of stress, they’ll make their program choices and hold their breath for six months, before ripping open an envelope that reveals their professional future. It’s a dramatic, reality TV-style ritual in medicine that has unsurprisingly spawned thousands of teary-eyed Match Day videos online.

Fourth-year medical students have been given a powerful new tool today designed to help with these gut-wrenching residency choices. With Doximity’s Residency Navigator, future physicians can find programs that are the best match for their interests based on specialty, intended fellowship, region, clinical interests and alumni connections for the first-time.

The best of the best residency programs

Doximity, in collaboration with U.S. News & World Report, has also published national Top 10 rankings across 20 medical specialties as part of its residency research. These rankings were calculated using over 50,000 peer nominations from board-certified physicians collected between January and August 2014 (see methodology.

Two medical education programs emerged as clear national leaders: University of California, San Francisco with placement in the Top 10 across 16 specialties and three No. 1 awards; and Johns Hopkins University with placement in the Top 10 across 14 specialties and four No. 1 awards.

Looking at results at the city-level, Boston holds firm as the hub of medical education with 23 national Top 10 ranked residency programs. At the state-level, California takes the lead with 35 top programs and Pennsylvania joins the list with 22. The relative quality of programs is certainly significant for the public health in these regions, since many physicians establish their practice where they complete their residency.

We invite you to take a look at the new residency data for youself. Top 10 national rankings by specialty are available to the public through Residency Navigator. Complete program lists and individual program details are free for any U.S. physician or medical student to access through Doximity.

Why conduct this medical education research?

We were frustrated that more qualitative data wasn’t available for the core professional training of our nation’s physicians — a frustration shared with medical students, medical education faculty, the Association of Health Care Journalists and the Institute of Medicine. While Doximity’s research includes several never-before-seen data points on medical residency training, it is disappointing that there still isn’t public access to board pass rates for most specialties.

Our launch of this research isn’t perfect — we already have a growing list of new features and data we want to add — but it is an important first step. We hope that Residency Navigator will help future physicians choose residency programs that are their own perfect match, training programs that help them become the type of physician who will love their work and will find joy in the profession of medicine for decades to come.

Questions about Residency Navigator? Email pr@doximity.com.