Dr. Oren Gottfried is Clinical Vice Chair and Associate Professor of Neurosurgery at Duke University School of Medicine. You can follow Dr. Gottfried on Twitter: @OGdukeneurosurg

Choose one word that best describes your work style

Effective. I aim to be productive, efficient, thoughtful, and caring with every effort.

What is your device of choice?

iPhone. If a task can be achieved on my phone, I will find a way.

Favorite apps & software?

For social media, I use Facebook,Twitter, LinkedIn, and Instagram.

I read the Doximity app for its featured articles and to look at my call schedule. The articles are very relevant to my neurosurgery practice. I read the PubMed app for original clinical and research articles and references.

What’s your secret to staying productive?

I am constantly setting daily and long term goals and work hard to accomplish all of them in the most efficient and efficacious fashion.Taking care of patients motivates me to be very effective. I do everything in my power to provide excellent care to my patients, and the rewards of these interactions and interventions keep me going.

What do you wish you knew when you were younger?

I wish I had the skills and wisdom of experience at an earlier age. I could achieve more in life skipping all of the standard learning curves. Saying that, I would never give up the journey and being a lifelong learner.

Who is your mentor?

In residency, fellowship, and generally, at every stage of my education and clinical practice, I have had the fortune to have multiple mentors to inspire and encourage me to be the best that I can be. I live by the motto “Everyone has something to teach me,” and I try to learn from every person I encounter.

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

I spend time with my family. Next, I usually check into the electronic health record portal on my phone to answer any questions or concerns from my patients.

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

Similarly, I check on my patients one final time for any concerns or questions or new test results. I also read the news, articles about current events, and med tech articles before I go to bed.

How do you decompress?

I enjoy spending quality time with my three children. I like doing athletic activities with them and reading to them. I particularly enjoy entertaining them with elaborate fictional stories I create nightly.

Also, I have an additional role outside of my main one as a neurosurgeon at Duke University: I work on multiple TV shows. It provides great balance in my​ life, and I find it very relaxing. It also allows me to use my medical knowledge creatively to make TV more accurate and sometimes even more entertaining.

I can’t live without...

Communication... just being connected. I’ve given out my cell phone to patients for over 10 years, and I like being there for my patients whenever they need some help. Taking a short call when someone is in need and just being available can really make a difference and can improve quality of care.

What are you currently reading?

I am constantly reading the neurosurgery and medical literature for improving clinical care and quality, for my outcomes research, and even for a good TV story. I enjoy reading nonfiction as well.

What’s your favorite book?

I enjoy books about understanding the art and practice of medicine.

Do you have a favorite song?

I used to be a DJ. I play the violin as well, and I have very wide musical interests. I listen to and am moved by practically all genres of music. I have different favorites based on different circumstances, such as operating versus exercising.

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

Early in life, I was told to try to learn something from everyone I met. I try to learn a skill, fact, or lesson from each and every conversation or interaction.

This article is contributed by Dr. Griffin Myers, Doximity Fellow, board certified physician and entrepreneur

Residency is hard. Really hard. In fact, I completely underestimated how hard it would be. My sweet wife loves to remind me that she didn’t think I’d be able to finish it for the first 2 years. And, honestly, I thought the same.

Because it’s hard, it’s common for residents to complain about it together. We all did. We sat around the resident lounge and commiserated by complaining together. We built great friendships, learned medicine, and cared for a great group of folks together. We also all agreed we were underpaid. Now that I’m a few years out of that formative experience, I want to revisit this touchy topic. Are residents actually underpaid?

The Truth Behind Residency Pay

Last week I met a resident at a local training program here in Chicago who told me, “I’m a highly educated doctor, and I make less than minimum wage!” I had heard that before, but could it possibly be true? Here’s what the numbers say.

The national minimum wage is currently $7.25 per hour. The highest state minimum wage isn’t from a state at all; it comes to us from the District of Columbia at $11.50. There are higher minimum wages in some cities, but they’re almost definitionally exceptions. If you want to see the minimum wage in your state, you can find state data here.

Those are hourly wages, but, remember, residents aren’t paid by the hour. They’re paid a salary. In fact, they’re paid via a very specific process within Medicare regulations. Salaries are based on seniority, specialty, and location/cost of living. Thankfully, we have really good data on this. In fact, the American Association of Medical Colleges publishes a report every year with exact numbers. Here’s a quick breakdown: last year, the average first-year salary (i.e. lowest year) was $51,586. The middle half of all residents had a salary between $49,396 and $53,273. (Not a lot of variation.) For the same year, the Social Security Administration reports the average salary nationally for everyone was $46,481. So, major point here: residents made a full 10% more than the average American.

I know the next part of the argument, though: “Residents work so many more hours that their wages must be below minimum wage.”

Let’s look at that. A few years back the Accreditation Council for Graduate Medical Education, the group that accredits residency programs, put a new 80-hour work week rule in place. It’s pretty simple: residents can’t work more than 80 hours per week, or the program gets in trouble. (For neurosurgery residents it’s 88.) Here are two things important to note: (1) Nearly every resident you ever talk with will tell you that they break the rule. (2) Very few programs have ever been shut down for violating this rule.

Trust me, when you’re doing a residency, it feels like you’re breaking the rule. In fact, if you’re reading this during your residency, you might be thinking right now: “I know I’m over the limit!” In truth, statistically, you probably aren’t. Remember, it’s not one week over 80 that counts; it’s an average over a period of time. You can come up with occasional weeks that push past 80, sure. But, overall, you likely aren’t averaging over 80 hours.

For argument’s sake, let’s say residents work that full 80 hours every week for an entire year. With an average salary of $51,586 divided by 80 hours per week for 48 weeks (4 weeks vacation being standard in residencies), the hourly wage becomes $13.43.

I’ll admit, as a physician that feels low. If you compare that to the long list of hourly wages published by the Bureau of Labor Statistics, that puts residents just above “Driver/Sales Workers” at $13.41 and just below “Grounds Maintenance Workers” at $13.50. There are obviously differences in education and skill level, but, another major point: that is absolutely not below minimum wage.

But is that the whole story? Not at all. In fact, if you look up “physicians” on that same list, you’ll find the average hourly wage to be $97.33. That’s right: finish your residency, and you get a whopping 624% raise. That logic leads you to believe that up to $89.30 per hour of a resident’s compensation comes in the form of training and education. It’s not green money, but it’s real. And pretty soon it becomes green money, assuming you finish the residency program.

Important Factors in the Compensation Equation

Residency makes for a long, long runway to higher compensation ahead. But you don’t do a residency for the money; you do it for the training and the future value of that training. In other words, it’s an investment today to make more money tomorrow. Feels weird not to include that in the compensation equation.

I know this might be tough for a resident to read after another grueling day, but taking care of patients is an incredible honor. That skill and daily privilege is worth something. In fact, I think it’s worth a lot. Can you pay the rent with that honor? No, but if you discount it entirely or say it’s not worth anything, well, you may need less help with economics and more help from a career advisor.

Dr. Griffin Myers is a board certified emergency physician, entrepreneur, and nationally recognized thought leader in healthcare innovation and value-based care. His writings do not substitute for professional medical advice, diagnosis, or treatment. No patient relationship is created by your use of this content. You can follow him on Twitter @griffinrmyers and find this and other media at his website: www.griffinmyers.com.

In just a few short weeks, fourth year medical students will enter arguably the most important period in their careers -- the residency application process. This can be an overwhelming and expensive process, fraught with dozens of factors to consider. In an average year, each medical student applies to 36 programs, travels to 12.3 interviews, and pays as much as $7,000 on travel and fees. All told, this process piles on another $100 million in medical student debt per year.

To help medical students in their quest to find the right residency program, Doximity is pleased to release the 2016-2017 Residency Navigator, a comprehensive guide to over 4,000 residency programs across 27 specialties. Along with objective data, program pages include 260,000 nominations, ratings and reviews from 52,000 U.S. physicians, giving medical students an insider look of what resident life is like at that program. Residency Navigator is built around personalized search filters, allowing students to customize their searches based on the factors most important to them, including geography, practice setting, clinical reputation, and alumni “outcomes” measurements of board certification, subspecialization and research output.

What are medical students searching?

We analyzed students’ searches over the past year and discovered a few trends.

Specialty searches

Orthopedic surgery was by far the most disproportionately explored specialty (relative to the total number of applicants in 2015*). Perhaps this is an indication that orthopedic surgery applicants are conducting more thorough research because of the specialty’s competitive nature. We asked orthopedic surgeon and sports medicine specialist Jerome Enad, MD to explain the specialty’s appeal:

“Orthopedics provides an enjoyable and stimulating specialty to medical students. Most of us can see ourselves in the role of an orthopedic patient - shoulder sprain, knee injury, low back pain, etc. Thus it is professionally rewarding to use our training and expert knowledge to diagnose and treat these common conditions. The specialty of Orthopedics allows us to provide both non-surgical and surgical treatment options to help our patients. Therefore we act as advisors as well as technicians. It can be mentally challenging to find the right treatment option, but our results are usually definite and satisfying.”

Otolaryngology beat out urology by a nose for the second most searched specialty (sorry, we couldn’t resist).

Location searches

One of the most-used search features of Residency Navigator is to discover programs by geography. Med students seem to have set their sights on major coastal states.

Most popular region

• Northeast

Most popular states

• New York
• California
• Illinois
• Texas
• Florida

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Residents who train together, stay together... right?

Residency is an intense time in a physician’s life, so the bonds between co-residents are often strong. In fact, 60% of co-authors who trained together first did so in residency. So when residency wraps and it’s time to plant roots, it can be a shock when their colleagues move away.

With this in mind, we examined which states are lucky enough to keep the residents who trained in those states 2-12 years post-residency. It turns out, there’s big love for the Big Sky Country, whereas physicians trained in D.C. perhaps “Don’t Connect” enough to stick around longer.

States with the highest post-residency physician retention rate

• Montana (77%)
• California (75%)
• Texas (63%)
• Oklahoma (59&)
• Florida (58%)

States with the lowest post-residency physician retention rate

• Connecticut (34%)
• New Hampshire (32%)
• Delaware (29%)
• Rhode Island (29%)
• D.C. (20%)

Which specialties plant their roots in residency vs. cut and run?

Child neurologists, family physicians and pediatricians are among the top five specialists that stayed in-state post-training. Perhaps their bonds with families in the community grow deep while in residency, making it harder to relocate, or perhaps these specialties are most supportive of starting one’s own family.

On the other hand, surgeons are more eager to ship their scalpels across state lines. This could be due to limited available positions for specialized surgeons in some regions.

State-loyal specialties

• Child neurology (61% of physicians trained in-state, stayed in-state)
• Family Medicine (59%)
• Psychiatry (58%)
• Pediatrics (56%)
• Oral & Maxillofacial Surgery (55.7%)

Specialties that say sayonara

• Thoracic Surgery (72% of physician trainees leave state)
• Colon & Rectal Surgery (70%)
• Plastic Surgery (67%)
• Vascular Surgery (66%)
• Ophthalmology (65%)

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Happiness

Satisfaction with one’s residency experience derives from a number of variables, including but not limited to culture and people, training environment and geography. We asked current and recent alumni across the country for an “overall rating: willingness to recommend this program to others.” For this analysis, physicians who rated their programs at least 4 out of 5 stars on this gestalt satisfaction metric were considered to be “happy.”

By Geography

Like last year, residents who trained in Oregon, Vermont, Minnesota and North Carolina were among the most satisfied with their programs. Residents in Idaho, however, would be the most likely to recommend their training programs. Apparently Idaho is a pretty “apeeling” place to train. How do you like them potatoes?

Happiest States

• Idaho (100%)
• Vermont (98.3%)
• Oregon (97.7%)
• Minnesota & North Carolina (96.2%)
• Utah (95.7%)

Unhappiest States

• Oklahoma (84.6%)
• Nebraska (83.7%)
  
• Mississippi (82.8%)
• Nevada (77.8%)
• South Dakota (76.2%)

For some states, overall satisfaction varied between those who had trained as specialists versus in primary care. For example, specialists who trained in West Virginia were unanimously satisfied with their programs (100%, at the time of this publication), but primary care physicians were much less satisfied, placing the state in the bottom five on the satisfaction scale (84%).

By Gender

As we saw last year, female residents tend to be somewhat less satisfied than male residents (M = 93%, F = 90%), and the gender gap widens in some historically male-dominated specialties. Orthopedic surgery, for example, has the largest satisfaction divide (82 percent for women vs. 96 percent for men ; p<0.01), followed by surgery (85 percent vs. 92 percent; p< 0.01) and anesthesiology (88 percent and 93 percent; p<0.01). However, female Physical Medicine & Rehabilitation residents are more satisfied than male residents (94 percent vs. 92 percent).

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Gender Balance*

Historically, medicine has been a male dominated industry, however in recent years there has been a growing number of females entering the field. According to the AAMC, 47 percent of current medical students and 46 percent of residents are women.

The gender divide, by state

• Who runs Delaware? Girls. (Or rather female residents.) Delaware has the largest number of female residents -- there are 14% more female residents than male. Other female dominant states include: Idaho and Oregon.
• Where does M.D. stand for “Male Dominant”? Mississippi. For every female resident, there are almost 2 male residents. A significant imbalance also exists in Oklahoma and Minnesota.

Most gender balanced states

1. South Dakota
2. Washington, D.C.
3. Rhode Island
4. Maine
5. North Dakota

* Based on Doximity profiles of current and recent program alumni

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Doctors know best

We’d like to thank our Doximity members for sharing their training experiences to help the next generation of physicians find the right program fit. It’s an inspirational example of what the world’s largest body of physicians can achieve together.

Visit Residency Navigator: https://residency.doximity.com/

This post comes from Dr. Joyce Park, current resident at NYU Medical Center. You may view the original article on Dr. Park's blog, TeawithMD.

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It’s August and that means a) the summer is passing by way too quickly and b) it’s getting to that time of residency program applications again! For my friends out there who are in medicine, I know what you’re going through, and I’ve put together a bunch of #PathtoMD posts to help you out along the way, from how to pick your interview outfit to rocking your residency interviews. But before you get too deep in the interview process, first things first: you have to choose which residency programs you want to apply to. It can be hard to figure out which programs to apply to, which is why I wanted to write a post about some of the factors that came into play when I was deciding between programs to apply to and to rank.

Location, Location, Location

When I talk to my colleagues about their experiences choosing between residency programs, many expressed that location of the program was one of their top deciding factors. This was particularly true for my colleagues who are married, have children, or have other familial obligations or ties to a certain area. Let’s be completely frank here, when you’re looking at residency programs in a similar tier, the training you will get at each one is more or less equally strong. The little differences between each residency program, as mentioned in the rest of this post, can sway you one way or another, but if the training is equivalent, location can make a big difference and sometimes be the ultimate deciding factor.

Mentorship

I think the further I got in my career, the more I grew to fully appreciated the importance of a good mentor, someone who will take you under his or her wing and be your role model in your professional life. I touched on this topic before in my post about how to match into dermatology (or other competitive specialties), but I can’t stress this enough. A mentor can inspire you to go into a certain specialty, explore a certain area of research, decide to subspecialize, set up your practice a certain way, and more. If you have a certain faculty members that you really admire at a certain program, whether it is their research area or their career path, consider exploring those relationships further in residency.

Research

Some individuals know that they want to devote their lives to academic medicine and scientific or clinical research. Others want to be able to do research to explore and/or get into a competitive subspecialty. Whatever your reason, if a certain medical center is particularly strong in your research interest, that is a good reason to take a closer look at that residency program. The Doximity residency navigator compiled top ten programs in each field filtered by research output, so if that is something that interests you, take a look here (scroll to the bottom for ranking by research output). To find a research advisor in your particular field, pay attention to the authors and the institutions putting out major landmark trials and publications in your area of interest. This will also be something you can talk about at interviews.

Track Record

Medicine as a whole is becoming more and more subspecialized, so the track record of alumni from different programs after graduating is another thing to consider. For example, if you are applying in dermatology and know that you want to be a Mohs surgeon right off the bat, you want to try to train at a program with a strong Mohs department, a Mohs surgeon who can mentor you, and with a good history of sending past trainees onto Mohs fellowships. If no one from that program has ever gone into the subspecialty you are considering, your path may be a bit harder (though definitely not impossible).

Subspecialties

This goes along with the track record point above. If you know you want to end up in cardiology, it would help to go to an internal medicine program with a strong cardiology department. During residency you can get to know the cardiologists, do research with them, and improve your chances of staying on for further training. Even if you don’t want to stay at that institution for fellowship, working with respected physicians in their subspecialties can only help you when it comes to applications, because they can help you write letters of recommendation, vouch for you, etc.

Extras

I used this as a catch all for the miscellaneous factors left. There are a lot of things that go into this category, such as work-life balance, happiness of the residents you meet, elective time and opportunities, global health opportunities, salaries (because that changes depending on what region of the US your program is in!), culture and fit of the program, etc. There’s also a lot of personal preferences, which only you will know.

Reputation

I put this one last because I think reputation is very subjective. I included reputation as one of the fields because if someone has no idea which are the highly regarded programs in a field, this is one place to start looking. I remember when I switched into applying for dermatology (you can read the brutally honest saga here), I didn’t really know much about which programs were considered to deliver the best training. I remember googling “top derm programs” and coming across Dr. Wu’s article from Cutis published in 2014. Reading through the top NIH funded programs and the top regarded dermatology programs gave me some inkling as to which programs seemed to be research powerhouses and which had a reputation of excellent resident training. Now, just as a demonstration of how subjective rankings are, NYU Dermatology ranked 17th in Dr. Wu’s methodology, whereas it has ranked either 1st or 3rd for the last two years according to Doximity’s residency navigator. Where does NYU Derm actually fall? It doesn’t matter because at the end of the day, I know that NYU delivers excellent clinical training in the field of dermatology and no ranking will change that. So what I’m saying is that the reputation of a residency program according to the Doximity navigator is just one piece of a much larger picture to consider when evaluating different programs.

What factors played into your decision about medical residency programs? Would love to hear!

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Joyce Park is a dermatology resident in New York City and health and beauty blogger at TeawithMD. Originally from California, she completed undergraduate and medical school at Stanford, and has a background in medical journalism at NBC News. She is passionate about educating the public about skincare topics and raising awareness of skin cancer.

In a letter sent to U.S. clinicians by mail and via Doximity, Surgeon General Dr. Vivek Murthy launches a clinician-led movement to turn the tide on the nation's opioid crisis.

Read Dr. Vivek Murthy's letter (August 25, 2016)

To learn more about the campaign, take the pledge or explore additional resources for clinicians and patients, visit www.TurnTheTideRx.org

Download the Turn The Tide Pocket Guide, adapted from the CDC Opioid Prescribing Guideline

By Dr. Joseph Murray

Since the passage of the National Cancer Act in 1971, overall cancer death rates in the United States for both men and women have declined. Strides have been made over the last 45 years since the beginning of this purported War on Cancer, with particular attention paid to the underlying biology of cancer. Today, the war on cancer has an expanding front, due to knowledge gained from cancer genetics and host interactions. Mutation-specific inhibitors and immunotherapies represent promising and precise targeted therapies in the oncological armamentarium derived from this knowledge.

Independent of our exciting advances in these burgeoning areas of cancer research, declines in cancer mortality can be attributed to a significant decrease in preventable deaths. The decrease in lung cancer deaths, a principle driver of age-adjusted cancer mortality, mirrors decreased rates of tobacco use in the United States. Although informed by carcinogen studies of cigarette smoke, primary prevention through public health advocacy remains a most effective method for decreasing lung cancer mortality. Similarly, the decrease in breast cancer mortality has been attributed to increased mammographic screening, even with the recent controversies in determining recommendations for age at first screening.

However, prevention has been aided by therapeutic advances in reducing cancer mortality. Significant strides in combinatorial therapy, for example surgical, radiological, and hormone-targeted therapy in breast cancer, have dramatically contributed to survival. Bolstered by the Human Genome Project and our ever-expanding trove of “‘omic” – genomic, epigenomic, transcriptomic, proteomic, and metabolomic – data, cancer has never been a more described entity. With the informatic integration of this and clinical data, a more complete understanding of the landscape of cancer continues.

This is the first wave of the War on Cancer. Even with the research gains and notable declines in cancer, malignancy is poised to overtake cardiovascular disease as the most common cause of death in the United States.

Hence, a second wave of the War on Cancer has begun: still targeted, but also personalized and precise.

Perturbations in gene expression in cancer, through mutation or otherwise, have yielded innumerable targets of small molecule, biological, and cellular therapies. In subsets of lung cancer, kinase inhibitors to mutation-specific EGFR and ALK mutations have yielded modest success. In breast cancers, even where targeted therapy to those tumors overexpressing HER2 has failed, new antibodies carrying a potent cytotoxin have improved survival. Other antibody immunotherapies that block the inhibitory effects cancer cells exert on immune responses continue to demonstrate success in melanoma and now other solid malignancies. Cellular therapies using engineered “killer” T cells derived from and infused into patients are demonstrating efficacy in treatment-resistant hematological malignancies, with hopes for efficacy in solid cancers. Looking beyond these advances, cancer-targeted gene expression and direct genetic editing represent the next wave of the War on Cancer.

There is no guarantee that these exciting personalized and precise therapies will yield the magnitude of benefits attained by cancer prevention and combinatorial therapy. Cancer will only become more prevalent as our healthcare system better manages other chronic disease. Whether we “shoot the moon" or not on cancer, it deserves the research and policy attention it garnered in 1971 and, now, in 2016.

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Doximity is proud to be a supporting association for The Economist's War on Cancer Forum 2016. On September 28, 2016, over 200 thought leaders from all corners of the healthcare industry will meet in Boston to discuss innovative approaches to combating this deadly disease.

In partnership with The Economist, Doximity is offering 15% off the current registration fee to anyone interested in attending the event. To register, go to https://waroncancer2016.eventbrite.com/?discount=DOXIMITY15 and enter DOXIMITY15.

By Erin Gray, Product Manager for Doximity Residency Navigator

ERAS opens in less than one month, and fourth year medical students are actively researching programs while program directors are fielding their eager questions. During this time Doximity receives a steady flow of questions and ideas from educators about our research tool, Residency Navigator.

The goal of Doximity Residency Navigator is to assist medical students in the residency exploration process by providing a transparent look at graduate medical programs.

Here are the top 5 questions we are asked about Residency Navigator:

1. What is Residency Navigator?

The Doximity Residency Navigator is an interactive tool designed to help the medical students research and compare residency training programs nationwide based on their unique career interests. We are excited to announce the launch of the 2016-2017 Residency Navigator. Our latest version includes over 4,000 residency programs spanning 27 specialties, providing medical students a more in depth look at the programs in which they’re interested.

2. Where does all the information come from?

Residency Navigator combines objective data with 260,000 nominations, ratings and reviews from over 52,000 U.S. physicians. Objective data is compiled from a variety of public sources as well as our proprietary Doximity database, which covers all U.S. physicians, regardless of membership with Doximity.

Program pages include:

• Detailed program statistics: Users can filter programs by alumni subspecialization rates, time spent at affiliated hospitals, gender balance, program size, and more.

• Satisfaction reviews: Current residents and recent alumni anonymously rated and reviewed aspects of their experience, like career guidance, schedule flexibility for pregnancy and other life events, program culture and clinical diversity.

• Personalized search options: Students can customize their searches based on their personal interests and career goals.

• Practice setting: Interactive maps highlight where alumni work, and applicants can find and filter programs by region, urban vs. rural environments, or training at large public hospitals.

• Clinical reputation: Peer nominations provide insight into which programs board-certified U.S. physicians hold in the highest regard for quality of clinical training.

• Research publications: Doximity's comprehensive database of physician profiles highlights programs whose alumni publish most extensively, bypassing commonly used proxies for quality of research training such as faculty grant funding.

• Board pass rates: For specialties such as internal medicine, board pass rates highlight which programs teach to national exam standards. For specialties whose medical boards have yet to release pass rate data, Residency Navigator offers the percentage of board-certified alumni as surrogate.

Program pages may be refreshed throughout the year to account for updated data such as new alumni publications, fellowships, board certifications and practice settings. This may affect the Research Output, Percent Subspecialize and Percent Board Certified rates, as well as their respective sort orders. For more information about these data elements, please view our research methodology.

3. What do med students and current residents think about it?

"The Doximity Residency Navigator has become an oft-cited reference amongst senior medical students evaluating training options. I referred to it during my own residency interview experience and found the data valuable in the assessment of various programs beyond sporadic anecdotal information.”
-Pooyan Rohani, MD

"The Residency Navigator. I love this feature. After our match list came out this year, I was searching all the time for the different programs and their highlights. It was great to find everything about a program listed at once."
-Natalie P., Current Medical Student

4. As a program director, how can I make updates to our page?

Add a description: Many programs have chosen to personalize their page by adding a paragraph that highlight special attributes about their institution. Program administrators are welcome to send a description (150 words or less) to be included on their program’s page.

Review data accuracy: We take the accuracy of Residency Navigator data seriously. If you are a program director or coordinator and notice your program information is incorrect or missing, please let us know.

Encourage resident reviews: Your residents can write a review for your program. Eligible residents and recent alumni can contribute reviews for their residency program until early fall 2016. After logging in, eligible residents and alumni will be prompted to complete the Satisfaction Survey on the Doximity homepage.

To update your program page with a description, or if you have any other questions, you can reach our Residency Navigator team any time at residency@doximity.com.

5. How can programs share their Residency Navigator page?
You can include a badge on your email signature or your website that links directly to your Residency Navigator program page.

To add a button or a badge to your residency program page, please fill out the following form: https://goo.gl/forms/8bKgrN8D4OpMVoB52

This article is contributed by Doximity Fellow and medical student Piyush Sharma

Research and innovation are two lasting pillars of medicine. This is clearly the case in drug development, as we watch for the newest medication to break onto the scene and change how we care for patients. But there’s more to drug treatment than simply applying the latest FDA-approved chemical. Trends over the past decade have shown that physicians are increasingly prescribing treatments off label. This type of prescribing has tremendous potential to affect how we treat patients, so why don’t we monitor and study off-label drug use (OLDU) more effectively?

Patients using drugs for unindicated purposes aren’t part of clinical trials. But that doesn’t mean we can’t learn from them. Monitoring and analyzing off-label use, its side effects, and which type of patients do well on a drug is a novel form of clinical research -- an experimental study of drugs already on the market.

AN EXAMPLE IN DERMATOLOGY
A prime example of effective OLDU can be seen with the skin disease vitiligo (a disease I happen to have). Currently, tacrolimus is designated for the treatment of eczema and not as a first-line treatment for vitiligo. However, off label, tacrolimus has shown great results in vitiligo patients. Yet, patients haven’t been educated about this additional option. Information on the drug’s effectiveness isn’t readily available to physicians. After years of unsuccessful vitiligo treatment, I found tacrolimus to be immensely beneficial in my treatment and maintenance of outbreaks. We should be doing more to see if others can reap that benefit.

Physician records of tacrolimus (and any other OLDU drug) could provide the FDA with data on populations that have benefited from the alternative use of market-approved drugs. With enough data, drugs deemed safe and beneficial for unindicated diseases could go through an expedited FDA approval process for additional uses.

HOW IT CAN WORK
The most efficient way to monitor, record, and track OLDU is through EMRs. We could use the system to mark prescriptions “OLDU,” use the database to document their success, and share the information with others. In medicine, percentages and numbers speak volumes. Providing OLDU candidates with stats on successfully treated patients can help them understand the process.

A collection of OLDU statistics would allow physicians to know how often a medication is prescribed off label and help them determine if it could benefit a patient. This type of data is crucial not only to current disease prognosis but to future treatment as well.

Monitoring OLDU, in association with data collection and analysis, provides significant opportunity. It could reduce risk in hospitals, inform current and future patient treatment, and provide a foundation for medico-legal issues that may stem from drugs being prescribed off label.

OLDU hasn’t spent much time under the microscope for fear of bringing attention to what some may consider drug misuse. But, working with available therapies may be one of the safest ways a physician can experiment with treatments. It also helps to skirt the high costs new drug development.

OBSTACLES & LIABILITY
Of course, OLDU is not without its barriers. Physicians who prescribe off label subject themselves to liability. If an OLDU treatment doesn’t work, the responsibility falls squarely on the physician’s shoulders. Physicians must justify the use of a drug and its dosage in a particular scenario, which is a challenge without guidelines. To deal with this, some OLDU prescribers start small and increase the dosage gradually if the treatment works.

The current OLDU set-up will need to be adjusted. In order to maximize a standardized OLDU database, physicians must initiate a low dosage regimen and record any adverse effects thoroughly. Once an off-label treatment is deemed successful, those results can be repeated with high internal validity.

USING THE TOOLS WE HAVE
New epidemics spread rapidly, and testing and approving experimental drugs takes up vital time. Why not use drugs that have already gone through regulatory vigilance? Environmental influences, population dynamics, and other factors change over the course of time it takes the FDA to approve a drug for a disease. By using EMRs to implement OLDU databases, we can take positive steps to provide safe and effective treatment options more quickly.

Let’s make more of what we have. It’s time.

Disclaimer: The views and opinions expressed here are solely those of the author and do not necessarily represent Doximity’s views.

This article is contributed by Dr. Mahboob Alam, Doximity Fellow and Assistant Professor of Medicine-Cardiology at Baylor College of Medicine

In medicine, expressing our thoughts and findings in the form of research papers is of utmost importance. Our research helps spread knowledge and may both directly and indirectly impact patient care. Through published research, we learn from each other’s experiences -- whether the outcomes are desired or adverse.

When writing papers, our co-authors are a vital source of ideas and support. Writing a manuscript and getting it through the rigorous process of peer review and publication can be painstaking. Co-authors are closely involved with manuscript from the beginning, and they’re the best peer reviewers one can have. I’ve been fortunate to work with co-authors who are well known in academic medicine. They were essential to our papers’ successes and made each one better, which ultimately led to faster publication.

Since research and co-authorship are so important, it’s worth wondering: When are doctors most likely to meet their co-authors? And how do they shape our trajectory in academia? To find out, let’s take a look at some data.

According to new Doximity research, 60% of co-authors who trained together first did so in residency training. Of the rest, 20% were medical school classmates, 18.5% met during fellowship, and 1.5% met during internship.

This data highlights an important fact about our training as physicians and the paths we take as we advance in our careers. Internship is an extremely busy year of one’s training and, more so, it’s a critical year in which we lay the foundations for our future in clinical medicine.

Based on my personal experience, I was least productive in terms of writing papers during my internship year. This was mostly due to extended work-hours and call schedules. Despite the fact that 20% of my classmates from intern year ended up in the same specialty (cardiovascular medicine), I hardly remember collaborating with one of my co-interns on a research paper or a project. Internship year, however, helped me plan for the future. It also helped me meet seniors and faculty members who were actively engaged in clinical research and who would later become my co-authors.

As I write this, our new interns have recently started and finished their orientation week. The year ahead is going to be a busy one, and the race towards excellence in academic medicine starts on day one. Identifying your co-authors starts right away too! Remember, there’s a high probability you’ll meet your co-authors early in your career. It all starts with an idea that blossoms into a research abstract and ultimately, with the help of right minds, into an outstanding research publication.

As the co-founder of the first nurse practitioner program in the U.S., Dr. Loretta Ford is often referred to as the mother of the NP movement. And while her name will live on in NP history books, we wanted to know if the name “Loretta” literally carries on among the ranks of today’s NPs. To find out, we searched across NP names in the U.S. to see what naming trends we could uncover.

Where have all the Loretta’s gone?

The most popular female first name overall among NPs is Jennifer, followed very closely by Mary. Whether you are named Jennifer or Mary probably depends on your age. The average age for a NP in the United States is 49. Mary was the most popular name in the 1940’s-1960’s, while Jennifer rose to popularity in the 1970’s-1980’s.

For male NPs, Michael is the most popular by a wide margin, with David, James & John in a dead heat for second place. Interestingly, this does not quite match the lineup of Doximity’s recap of most popular doctor names, where John commands the winning spot. This may be because the average male doctor is 55, which is six years older than the average NP. John has been a popular male name for more than 100 years, especially in the 1940’s-60’s. By contrast, Michael achieved especially strong popularity in the 1970’s, 80’s and 90’s, when many current NPs were born.

The state of a name

The state trends follow the overall nationwide naming trends. Jennifer is the number one female NP name in 26 states. It is followed closely by Mary, which wins in 19 states. And in fact, if you look at the number of states where a name is ranked either #1, 2 or 3, Mary slightly edges out Jennifer, 46 states to 43. With two names that are both so popular, it’s hard to discern strong regional trends. Jennifer seems to be slightly more popular in the South and West, while Mary is pretty evenly spread across the country. The stronghold for the name Susan is in the Northeast, and Patricia makes its lone appearance in the #1 spot in New York State.

Michael tops male NP name in 25 states. David, James and John trail behind as distant runners-up, with only 7-8 states each. Michael dominates the Northeast and Midwest. David is strongest in the Northwest, while James does best in the South. There are also a couple of interesting anomalies here and there, such as Frank being the fourth most popular name in Delaware, but it doesn’t make the top 5 list in any other state. Similarly, Jeffrey is ranked #4 in North Dakota, but no other state seems to have a significant NP population with that name.

What’s your speciality, NP So-and-so?

Among female NPs, the popular names for most NP specialities match the overall ranking. For example, for acute care, family NPs and psychiatric NPs, the most popular names are Jennifer and Susan. But there are a few specialities which buck the trend. For example, among geriatric NPs, while Mary is the most popular, Linda is also a common name, which suggests that many geriatric NPs were born in the 1940’s and 50’s, when Linda was most prevalent. On the other hand, Karen stands out as third among neonatal NPs, a name that had its heyday in 1960’s.

Male NP names by specialty match the overall popularity for the most part. Michael and David are top names for geriatric, neonatal and family NPs, and they are also in the top five for most other specialities. Christopher makes an appearance as a popular name for acute care NPs, and James is on the list for psychiatric NPs.

Will the real NP please stand up?

When we look at the most popular last names across all NPs, Smith and Johnson reign supreme. Miller, Brown and Williams are on the list as well. Smith is slightly less common in the Northeast and West, while Johnson has the lead in the South. These are also the most common surnames in the United States as a whole.

What’s your name?
How does your name stack up against the most popular nurse practitioner names? The odds suggest your name probably isn’t Loretta Ford but it might be Jennifer Smith or Michael Johnson. What’s your prediction on what new names will start to trend among NPs in the next 5-10 years?

Do you know any of these Jennifers or Michaels? Claim your profile and find out: www.doximity.com.