Doximity: Professional network for physicians (transcript)

This is the transcript of my recent podcast interview with Doximity CEO Jeff Tangney.Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Jeff Tangney.  He is co-founder and CEO of Doximity.  Jeff, thanks for being with me today.Tangney:            Thanks David.  Great to be here.Williams:            Jeff, with so many existing social networks out there, why would you start a new one?Tangney:            Good question.  All of us feel we’re getting all these notifications and updates and requests, but as a physician, there’s actually no good way to communicate with other physicians.Email is illegal because it’s not HIPAA compliant. Neither is texting.  Today, if a physician wants to get --for example-- a lab value on a patient that they saw last week, most of it happens over the fax machine.  In fact, 15 billion faxes were sent in health care last year in the United States.We’re making that whole process a little easier, a little bit more like the teenager sitting in the patient waiting room on Facebook or Twitter and a little less like the 1970s.Williams:            It’s amazing --the fax machine.  It’s the seventh birthday of the Health Business Blog; seven years ago in one of my first posts I wrote about my disbelief that fax machines were still around.  And they’re still with us today.  Maybe in another seven years they’ll slow down a bit.Tangney:            They’re going strong.  Our goal is to rip it out of the wall.Williams:            You mentioned similar functionality to Facebook or other mainstream social networks.  How does the functionality of Doximity compare to LinkedIn or Twitter or Facebook?Tangney:            Reid Hoffman from LinkedIn has a good quote which is that today’s online social networks are really just representations of the offline networks that we’ve had for lifetimes. Facebook is the backyard barbeque, LinkedIn is the corporate office; who’s getting promoted, who isn’t, and Twitter is the bar; people talking about the latest news.We’re bringing in the hospital; the place where you can have those HIPAA compliant discussions.  We offer authentication of every user.  You not only tell us you’re a doctor, you have to prove that you are.  That allows folks to have HIPAA compliant discussions about patients.We work on the iPhone, the Android and the web.  About three-quarters of our use is actually on mobile devices because doctors are more mobile than your typical professional.  They can take a photo of a tough case on their iPhone and post that.   We offer iRounds, a curbside consult forum organized by specialty.  That’s not something you would find in your typical forum.We also do a lot in pre-loading. We pre-populate the CVs of all of our doctors.  We know what articles they’ve published, what clinical trials they’ve done, what insurance they accept, their office phone and fax from a number of public databases. So that even if someone is not yet a member of the network  (and today we have about 8% of U.S. physicians as active members) another doctor can still look them up and find their basic office, phone, fax and clinical history.Williams:            Do you integrate with other social networks like for example Twitter?  Some of the things I tweet might still be relevant within Doximity.  Is there a way to bring tweets over the wall or is that not part of what you do?Tangney:            David, I’m guessing you’ve used the product.  Yes, actually that’s one of the popular features.  Doctors who are on Twitter can actually tweet and add a #dox.  You’ll see it in a lot of places these days and that will automatically bring it into their Doximity stream.Also we integrate with LinkedIn and Facebook.  A lot of people pull over their profile.Our goal is to provide a place that is safe to talk about patient issues.  It is recreating that offline doctor’s lounge in some ways.  Integrating with these other networks we view as positive.Williams:            There are some physician-only platforms already.  Sermo is one example. Your prior employer, Epocrates is another platform.  Is there a relationship between Doximity and those?Tangney:            Sermo is a physician only network, but all the physicians who participate in it are anonymous so that they have a “handle,” nightdoc2 for example.  The discussions tend towards politics.  It’s an interesting social case study.  When you let people wear masks, they have a different discussion than if they’re there as their real person.  There’s a place for Sermo, but we’re offering something quite a bit different.  When you have a real name authenticated network, people discuss different things.I was one of the two founders of Epocrates and was president and COO for about ten years.  I have a long history and great knowledge of Epocrates.  I left there about two years ago.  We do partner with Epocrates on some things.  Epocrates really isn’t a physician network.  It’s a clinical reference that’s used on iPhones.  We’re evaluating other partnership opportunities that are down the road.Williams:            One topic that people are always interested in as it relates to social networks is the business model.  What kind of a business model do you have today and what are you expectations about its evolution?Tangney:            Today we make money from market research firms; Gerson Lehrman Group, Coleman Research Group.  Such firms paid over $100 million last year to physicians in the U.S. in honoraria, typically to talk with someone who needs their expertise.  It’s a hedge fund manager who wants to know what you think of this new stent that just got approved or it’s a medical malpractice lawyer who wants your quick opinion on who the top experts in this area might be.We require that they pay our doctors a minimum of $250 per hour. In most cases it’s been around $500 per hour. We provide them a LinkedIn for doctors, a place where they can find who really is the expert on specific subjects  --for example neuroendocrine tumors because they have a reporter who wants to talk about Steve Jobs’ disease.  We charge the market research firm a matchmaking fee of $200 per doctor. It’s been a decent revenue source for us and for our member physicians.Down the road this certainly will evolve.  There are a lot of other directions that we can go.  We have some hospitals, some alumni associations who are partnering with us and paying us to host their medical networks.As we learned at Epocrates there are a lot of different players who are interested in a physician audience.  Physicians make billions of dollars of decisions every year. Our goal here is like we did at Epocrates, to walk that line, not to make it crass advertising but to offer platforms for folks to communicate about the newest treatments, the newest CME and those types of things.Williams:            You mentioned that you have about 8% of U.S. doctors on your platform.  Say a little bit more about that in terms of what the typical user profile is and also how you measure utilization.  What are the metrics that are relevant here and what are you achieving?Tangney:            We are 8% today.  We’re adding about 1,000 new doctors a week right now so we’re continuing to grow at an accelerating pace.Our average physicians have profiles that are 57% complete.  That means that they have filled out more than half of the fields that we have on our profiles; education including undergrad and medical school, residency and fellowship, work history, clinical interests, faculty, photos, titles, the insurance they accept, and ACOs or medical groups they’re part of or affiliated with or hospitals they’re affiliated with.  Those are the various things that are all very searchable.  Our average user fills in slightly more than half of those.Our utilization is something that we look at very closely.  We have utilization that is several times LinkedIn. We have about three times as many U.S. doctors on Doximity as are currently on LinkedIn.  Our utilization s well above 10% per week that are coming back and using us to send a message to another doctor or read a news post on iRounds.As we grow the network, we see that people are finding more people that they know and are more and more likely to use it.  That engagement stat we measure on a weekly basis and it’s continuing to grow.Williams:            Can you provide an example of a doctor using Doximity to achieve something for a patient that would not have been possible without Doximity?Tangney:            We’ve got a bunch of examples.  We’ve had a least a dozen major cases solved on iRounds.  One example is a pediatric gastroenterologist in Texas who is the expert in Texas on treating pediatric gastric disorders. He had a patient who he just couldn’t figure out and he posted about the patient in a moment of distress; “Does anyone know what to do?”  He got a reply from a doctor in California who was just finishing a clinical trial on a new type of treatment that has been recently published.  Through that dialogue he was able to find a new course of treatment for his patient and solve her problem.We had an ER doc, a surgeon who posted about a patient he had seen who had accidentally swallowed a metal bristle from a grill brush.  It had mistakenly gotten into his hamburger and it perforated his intestine.  He posted it as what he called a fascinoma; an interesting and rare case.  He actually found two other emergency room physicians who had encountered the same thing in the last year and so now they’re asking, ah ha, I wonder how common this is.  They are writing a paper on safety standards around grill brushes because if grill brushes are a problem and will perforate bowels across the U.S. they thought that they should bring that to people’s attention.Williams:            My image of somebody who would be on a service like Doximity is somebody younger, maybe right out of residency.  Is that accurate or what are you seeing in terms of diversity of profiles and users?Tangney:            Our average age is 40, but it’s a bimodal distribution.  In other words there are some of the young doctors --fewer residents but more fellows.  These are folks who have just finished ten years of training and are hanging out their shingles now, for example as a thoracic surgeon. They are super connectors.  They are the ones who have the greatest business need to stay connected to primary care physicians and referral sources in their areas.  They have the greatest number of colleagues on the network.  They have the greatest amount of activity.Then we see another bump in the late 50s where you see physicians who realize they’re falling a little out of touch or that they have more time to reengage with some of this technology.  They’re great.  They’re some of the best responders to these types of questions because they have decades of experience and they’re in a place where they have some time now to give back, to mentor, to help folks who haven’t had as much experience.You’re right that the busy years in the middle, those 40s, they’re our later adopters.  The users are mainly younger docs.  Then we have little blip again in the late 50s and 60s.Williams:            Doximity strikes me as tool that would be very useful for an independent physician.  How does it fit in with some of the trends toward provider integration?  I’m thinking about phenomena like patient centered medical homes or accountable care organizations.  Would you see yourself having corporate customers or people that are using it as more of an enterprise product?Tangney:            Yes.  You’re right that private practice physicians see us as having value as a referral network tool, absolutely.  We have 600 doctors from Kaiser Permanente who are in our network, which is more than I ever expected to get.  When you boil it down, even though they’re inside Kaiser and don’t worry about referrals very much and it’s a completely closed system, they still need to collaborate. The tools that they have today don’t have secure texting --and we do.They don’t have a quick way of pulling up their colleagues’ training just to see for example who wrote the paper on laparoscopic hysterectomies.  We provide them an easy way of doing that and that’s an additional social layer over a lot of the EHR and other systems that they’re currently using.Williams:            I’ve been speaking today with Jeff Tangney.  He is co-founder and CEO of Doximity.  Jeff, thank you very much for your time.Tangney:            Great, thanks David.