What Physicians Are Reading about the 2016 Election

Nov 11, 2016 - Guest Author


In the days after our national election, citizens, physicians, and patients alike observed election results that may potentially change the direction of healthcare.

On November 10th, 2016, Donald Trump released a new plan for health reform on his transition website. Read it here.

These are the top-trending, post-election articles among Doximity physicians:

  • Day One and Beyond: What Trump’s Election Really Means for the ACA. [Health Affairs Blog]
  • Doctors to Donald Trump: First Do No Harm. [STAT]
  • Affordable Care Act Enrollment Surges Following Election. [Wall Street Journal]
  • Women Rush To Get Long-Acting Birth Control After Election. [NPR]
  • 4 Things Trump Can Do to Improve Mental Health Care for Veterans. [STAT]
  • Hospitals Ponder Financial Impact of ACA Repeal. [Modern Healthcare]
  • Donald Trump and the FDA [Forbes]
  • 10 Twitter Experts to Help You Navigate Trump’s Health and Science Policy [STAT]

How the country voted on state healthcare propositions:

  • San Francisco, Oakland, Albany, and Boulder passed ballot measures to place a one or two cent-per-ounce tax on sodas and other sugar-sweetened beverages. [NPR]
  • Colorado passed a ballot initiative allowing physicians to prescribe lethal drugs to terminally ill adults who want to end their lives. [Kaiser Health News]
  • California, Massachusetts, and Nevada legalized recreational marijuana use. [The New York Times]
  • Tax increases on cigarettes and vaping devices passed in California, but not in Colorado, North Dakota and Missouri. [Reuters]
  • California voted against lowering prescription drug prices. [STAT]
  • Florida voted in favor of releasing millions of Zika-fighting mosquitos. [Wired]
  • Colorado voted against ColoradoCare, a single-payer healthcare system. [The Colorado Independent]

To read about all of the healthcare propositions, click here.

Disclaimer: The views and opinions of authors expressed in this post do not necessarily state or reflect those of Doximity.

How this Johns Hopkins Orthopaedist & Military Colonel Battles Burnout

In celebration of Veteran's Day, we wanted to highlight 30-year military veteran, Colonel James Ficke, MD

Nov 11, 2016 - Guest Author


Colonel James Ficke, M.D., is Robert O. Robinson Professor of Orthopaedic Surgery at the Johns Hopkins School of Medicine and director of the Department of Orthopaedic Surgery. He is also orthopaedist-in-chief of The Johns Hopkins Hospital. During his deployment as deputy commander of clinical services at the 228th Combat Support Hospital in Mosul, Iraq, from 2004 to 2005, he was the senior orthopedic surgeon, treating more than 600 U.S. soldiers and Iraqi patients for war injuries. He is nationally renowned as an expert on the treatment of complex foot and ankle patients, lower extremity trauma patients and amputees. This is how he works.


How has the military shaped your active orthopaedic practice?

To start with, I wouldn’t be an orthopaedic surgeon if it weren’t for the military.

The military created my orthopaedic practice. I joined the Army at West Point and studied engineering then went on to Uniformed Services University for Medical School. Originally, I thought I wanted to do wilderness medicine but was exposed to an Air Force orthopaedic surgeon for a 2 week required rotation, and he was so excited about his practice that I was inspired. His name was “Doug Harryman.” He was a mentor for a short period but had a tremendous impact on me.

Ultimately, I served in the military for 30 years because I came into a position of leadership near the 9/11 events. I was at San Antonio, a level 1 trauma center, where we received many of the casualties from Iraq and Afghanistan and it inspired me to stay on Active Duty. Orthopaedic surgery through the military, research, and service of others has inspired my career in foot and ankle and trauma, which were both areas that were needed in the military.

This is a picture in the olive garden of the Benham Monestary in Nineveh Iraq where we had a Medic Baptized. The caretaker served us olives from the trees behind us.

What is the last book you read for fun?

You’re going to get a kick out of this. I must confess, the last book was A Passion for Leadership, by former Secretary of Defense, Robert Gates. I enjoy reading about other people’s successes. It’s a first hand account of leadership by a highly successful individual and icon for us as leaders in academics and organizations. The book depicts his many trials and tribulations and was a remarkable story about how one person came to a position of leadership - especially with such a humble upbringing.

Where is your favorite place you have visited with the military?

Sigh… that’s a little harder question. I have a hard time with favorites and I’m not avoiding your question. Every day in life there is something incredible.

One of the most exciting places was when I served for 1 year in nothern Iraq. We had a Christian soldier baptized in Benham Monastery built in 400AD – this area had one of the largest libraries outside of Rome at the time.

An Iraqi priest was able to baptize him. This was a man practicing his Catholic faith in 2005 in Iraq in peace. I think the most exciting thing about it was that we were at a place defending the freedom of mostly individuals with Islamic faith but freedom of religion was still permitted.

It was one of the highlights of my life because it signified what we did in the military: Preserve freedom of religion/expression for many of those who may not traditionally have it.

What is the first thing you do when you wake up?

Well, like most people, I guess, I shave – shower – grab a cup of coffee – kiss my wife goodbye and head to work.

After taking care of the ‘mechanics of the morning,’ I arrive ½ hour early at work before anyone is there to plan my day, collect my thoughts, and think about the opportunities in front of me for that day.

What’s your favorite type of exercise?

Running. I try to run 3-4 times per week. It gives me time away from distractions and it’s a known fact that people who incorporate an exercise habit into daily practice are happier. They have better health overall. These days in medicine and specifically for Doximity viewers, the notion of burnout is significant. A recent paper showed that up to 45% of physicians are suffering from burnout. I score very low on the burnout ratings, and I have lots of energy and enthusiasm and attribute much of that to getting outside with my regular exercise. Certainly not everyday, but regularly, and that’s valuable.

How has Doximity influenced your career and practice?

Our Department (Johns Hopkins Orthopaedic Surgery) is partnering with Doximity with the “physician referral network,” which is a pilot right now. I’m not a big social networker, but I know many of my colleagues use that feature to keep up with other professionals. It’s a growing way to have a referral network. And clearly the articles are very valuable.

What’s the most important lesson you learned as an Eagle Scout?

Well, you’ve done some checking. I still have the rank of Eagle Scout on my CV. It’s deeply ingrained in my core values including the Twelve Points of Scout Law: Trustworthy, Loyal, Helpful, Friendly, Courteous, Kind, Obedient, Cheerful, Thrifty, Brave, Clean, and Reverent (And yes, he did name them all).

Who has influenced you the most?

Well… I mentor people and I think it’s a skill you have to practice. Sir Ernest Shackleton was a tremendous leader. He influenced my life in the way he led his endurance expedition and brought all of his people home. He kept the unruly members close and taught them accountability.

I study biographies. I think any biography you read can really influence your life and how you practice.

One of Dr. Ficke’s former residents whom he mentors, Chad Krueger, and one of his own mentors, Mike Yaszemski

How this Doctor-Turned-Podcaster Manages His Time

Continuing our "How I Work" series, join us as we pick the brain of ObGyn, Dr. Patrick Beeman

Nov 08, 2016 - Guest Author


Patrick Beeman is an ObGyn and writer, and founder of the podcast InsideTheBoards. This is how he works.


Choose one word that best describes your work style:

Collaborative.

What is your device of choice?

My iPhone

Favorite apps & software?

For USMLE/COMLEX preparation, I love telling people about some of the "new kids" in the board-review space: Osmosis, OnlineMedEd and Picmonic. I think these companies approach their business first as servants of the students who use their platform(s) and offer innovative, high quality, and disruptive products that are revolutionizing the way people learn medicine.

For podcasting, I use Audacity for recording software and record interviews with guests via Skype. To keep the quality as high as possible, my home studio includes my iMac, Audio Technica ATR-2100 microphone, an Audio Technica headphone amplifier and pair of ATH MSR-7s cans (headphones) I got while I was on temporary duty in Japan, and a Yamaha MG10XU mixing board.

For daily clinical work, my go to app is Wheel SP, an Ob wheel app that calculates estimated due dates, allows input of fetal biometrics, and other essential stuff for an obstetrician. I use Epocrates and UptoDate a lot on my phone as clinical references. My newest discovery is the social media/secure medical multimedia app Figure 1.

How does Doximity help you in your work as a clinician?

Doximity pushes useful articles, tailored to my specialty to my dashboard. I've also used it to find specialists to whom I might refer patients. Plus, it's helped me connect with influencers to be guests on the InsideTheBoards podcast.

What’s your secret to staying productive?

Setting goals for the day before going to sleep and using the very early morning hours when I'm "fresh" for tasks that require the most creative energy (like working on content for InsideTheBoards or writing an article on bioethics) while saving more time-consuming, but mundane tasks for the evenings when I'm tired (like catching up on email, editing articles or podcast shows).

What do you wish you knew when you were a student?

I wish I had known the "mind hacks" that make undergraduate medical education more efficient, especially studying for board exams. Someone should have told me on day one of first year to do USMLE-style questions. I wrote about the difference that multiple choice questions make in your medical education here. Osmosis, the medical education platform I mentioned above, is doing its best to integrate the best principles of learning discovered in neuroscience into its platform. Things like spaced repetition, memory anchoring, and just doing a bunch of self-assessment questions can drastically increase your retention, efficiency, and long-term memory.

Who is your mentor?

The late Edmund Pellegrino, who has been called the father of bioethics, was my inspiration for becoming a physician. He became my mentor and I've always wanted to model my career after his. One of the best academic experiences I ever had was being his fellow at the Georgetown Center for Clinical Bioethics when I was a medical student.

As an MD-turned-podcaster, do you have advice for other doctors who are interested in alternative ways of using their clinical knowledge?

Many doctors sell themselves short. But a medical education and practice imparts more than just clinical knowledge. There are a bunch of skills a person acquires on the way to becoming a doctor. Besides learning your specialty, you have to be somewhat of a teacher, researcher, communicator, executive, manager, mediator, counselor, scientist, humanist, and writer (although interminable clinical note-writing can have a detrimental effect on one's writing skills) to become a physician. In the first two years of medical school, I was always writing and submitting popular and academic articles on bioethics topics while in class. I wrote boards-style questions during third and fourth year and eventually became the director of content for one of the major Osteopathic question banks. As a resident, I became a MedSchoolCoach.com advisor and have helped premeds perfect their applications to medical school, practice their interviewing skills, etc. I still do a little bit of this work because working with med school hopefuls helps maintain the original idealism that inspired me to pursue medicine as a career.

My dad was in radio broadcasting growing up; I always admired what he did and wanted to emulate it. I was a philosophy and theology major in college and always fancied myself a writer. The result? After becoming a doctor (and during the process, too) I found ways to apply my clinical expertise to writing and media. Clinicians should ask themselves what they think about at work, what they do when they leave the clinic or wards, or what they wish they had more time to do. And then consider ways in which their role as a doctor could be applied to these.

What’s the first thing you do when you wake up?

I try to get in some quiet time/religious devotion and/or exercise.

What’s the last thing you do before you go to sleep?

It's a bad habit, but I'm usually checking my social media feeds for news (and opportunities to troll my friends' by antagonizing—I mean commenting on—their profiles).

How do you decompress?

Working out or writing.

I can’t live without...

My family. I'm in the military and stationed nine hours from three of my kids, who live in Cleveland with their mom, and five hours from my wife (who is a psychiatry resident) and newborn, who live in Cincinnati.

What are you currently reading?

Faulkner's The Sound and the Fury.

Do you have a favorite song?

So glad you asked this. I love music. It's a little-known secret that part of the reason I'm doing the InsideTheBoards podcast is to connect with some of my favorite artists and share some of the songs I love with a wider audience. My favorite song is by a little-known artist, Rich Mullins, "We Are Not As Strong As We Think We Are" which, I think, captures the agony of loss better than anything I've ever heard: "I tremble like a hill on a fault line just at the thought of how I lost you."

What’s the best advice you’ve ever received?

From my mom and dad: stop living so far in the future.


Patrick Beeman is an Ob/Gyn and writer. He worked on the Case Files series and has written practice questions for four question banks including USMLE-Rx. Most recently he was the director of content for a leading board-preparation question bank until founding InsideTheBoards to teach students the principles board exam question writers use to construct test items in order to help them reduce stress, improve efficiency in studying, and to help them achieve the scores they deserve. Listen to the InsideTheBoards Podcast for the USMLE, COMLEX, and Medical School tips.

Doctors Love the iPhone 7. Even More Than You Do.

How physicians are using smartphones today

Oct 27, 2016 - Doximity Blog


Whether it’s the iPhone 7 flying off the shelves, or the Samsung Galaxy 7 being put on the No-Fly List, our favorite hand-held device has been making the rounds in recent news stories. Apple, in particular, has been front and center - and with their announcement of a revamped MacBook Pro at today’s Apple October 27th event, they seem to be headlining the news every week.

Our researchers at Doximity started wondering: exactly how are physicians are currently using smartphones? With over 60% of all U.S. physicians on the Doximity network, our member data provides an unparalleled wealth of information on physician technology habits and implementation to get the most accurate look at device trends in medicine.

Physicians adopted the iPhone 7 faster than the rest of the population

When it comes to new technology updates, physicians are often at the top of the curve. In the first two weeks after the release of the iPhone 7, 3.7% of the general population updated to the new device. However, 4.1% of physicians adopted the iPhone 7 in this same time period - proving once again that those in the medical field are tuned in with tech.

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Overwhelmingly, the iPhone 6 holds the first place spot - with over 80% of Apple-using physicians in tow. The standard iPhone 6 (not iPhone 6s or 6 Plus) was the most commonly used of all the iPhone 6 versions, by 45% of all physicians using iPhone 6 versions. The iPhone 5 and 7 claim the second and third places respectively, but at 11% and a little over 7% each, the iPhone 6 is most popular by a large margin. (Did you know that we predicted the iPhone 6’s popularity among physicians before its release, in 2014?)

After the initial wave, is it possible iPhone 7 adoption will slow with doctors? It could, given that the iPhone 7 doesn’t have ‘enough’ features for people to make the change. There’s a better camera, better speakers, and no headphone jack (which some would count as a negative feature), which are all new features, but nothing as exciting and noteworthy as the changes from the iPhone 5 to the iPhone 6.

Perhaps it’s not that the iPhone 7 is underwhelming, but rather that the iPhone 6 has enough features to keep customers, and physicians, happy.

How quickly did physicians upgrade to the iPhone 7?

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Our findings showed that certain iPhone users were much quicker than others to adopt the iPhone 7. Those physicians with the iPhone 4 were the group that most quickly adopted the iPhone 7 upon its release.

After that group, physicians with the iPhone 6 were second most likely to make the upgrade to the iPhone 7.

From our sample, around 3% of total Doximity physicians made the switch to the iPhone 7 in the first month of its release. After the first month, the adoption rate of the iPhone 7 doubled to over 7%.

In past releases, the iPhone 5 and iPhone 6 have been adopted much quicker in the first month, at rates up to 37% in the month of the initial release.

Code Red! How many physicians are carrying the flammable Samsung Galaxy 7?

By our standards, thankfully not too many! Our researchers found that less than 1% of physicians on Doximity were using the fiery phone. This is good news. If you think a phone catching fire on an airplane is bad, imagine it happening in a hospital surrounded by oxygen tanks.

Are you a reporter interested in more data from Doximity's research team? Email today.

How this Ochsner Physician Executive is Transforming Healthcare Through Technology

In another 'How I Work,' article, we feature technology evangelist and cardiologist, Dr. Richard Milani.

Oct 20, 2016 - Guest Author


Dr. Richard Milani currently serves as Chief Clinical Transformation Officer and Vice-Chairman of the Department of Cardiology for Ochsner Health System. This is how he works.


Choose one word that best describes your work style:

Nonstop.

What is your device of choice?

My new iPhone 7. I even got the shiny black color, Matrix-style.

Favorite apps & software?

It changes every day. In the last 24 hours, I’ve been really into iBooks. I have all my books, PDFs and keynotes in there, just stored in the Cloud! It’s crazy.

How does Doximity help you in your work as a clinician?

Right now, it’s in the Colleague Connect Platform, where we’ve been able to generate information about Ochsner as a tertiary center for potential referring doctors and have them better understand what we do, in an easy-to-digest way.

What’s your secret to staying productive?

Never taking no for an answer. You find a way to make things happen that need to happen -- I guess I’m just pushy (smiles).

What do you wish you knew when you were a student?

You sort of divide medicine into two parts: science and healthcare. You can learn the science in school, but then there’s the healthcare side, which is really how it works - workflows and the business of medicine. That’s the part you learn over time, but don’t learn in school. I wish I knew more about that as a student.

Who is your mentor?

Today, there isn’t one, but I’ve had various mentors along the way. Dr. Alex Leaf, who was Chief of Medicine at Massachusetts General Hospital, stands out as a mentor in my life.

You’ve worked with Apple extensively in the past, utilizing technology to enhance patient care. How has this transformed the patient experience at Ochsner?

The transformation has been dramatic. Let’s take a step back: what healthcare needs to do is identify the issues that the population you are surrounded by face - and match those. What is the epidemic of our time? Chronic diseases. 86% of all dollars spent in the United States - 2.86 trillion dollars, is spent on chronic diseases. We do a lousy job of managing it, and we’re not doing anything different to change that. In contrast, if you were running a business, wouldn’t you look at inventory on a daily basis or sales on a daily basis? You’d be evaluating all these variables hourly or daily - you’re constantly monitoring to match supply and demand. In healthcare, we say “you have diabetes, it changes by the hour or the day, and we’ll see you in 6 months.” Then in 6 months you’ll be fine, or in 2 months you’ll be crashing. With chronic diseases, we need a different model of delivery with multiple streams of data between physician and patient.

For example, patients who have been enrolled in a digital health program in managing hypertension will work with their internal medicine doctor to measure readings wirelessly, right from their home. In addition, we have multiple “O Bars” in our primary care centers to help patients seamlessly manage their health. Now patients don’t have to call their son or daughter for technical assistance - we have a full-time technology specialist behind the bar to help if they have any issues. This way, patients have tools that empower them to stay healthy.

This week we rolled out Connected Mom, a program to promote a healthy pregnancy. Pregnancy is very scripted within health systems, usually 14 visits for the average expectant mother. At some of these visits, all that takes place is ensuring that the woman is gaining the appropriate amount of weight and her blood pressure is within normal range. Some visits would be unnecessary if everything is going well. With Connected Mom, women can go to the O Bar to receive a wireless scale and a blood pressure cuff. The program also gives women tips throughout their pregnancy, including milestones, and what to expect next. The value is that women can skip unnecessary visits, and doctors can fill that appointment slot with patients who need to be seen.

How do you decompress?

Exercise. I’ll do whatever my body will allow me to do - yoga and weights, in particular.

Do you have a favorite song?

Whatever my wife and kids are listening to.

What’s the best advice you’ve ever received?

The dean of students at my medical school told me this: it’s just as important to know what you don’t know, as it is to know what you know.