Q&A with Doximity CEO Jeff Tangney

Jeff TangneyJeff Tangney

Doximity, a medical network based in San Mateo, Calif., has generated a flurry of activity over the past few months. On May 2, the company released an iPad app enabling HIPAA-secure collaboration among member physicians, adding to its exisiting online, iPhone and Android presence. Shortly thereafter, Doximity announced that it had surpassed 170,000 members on its network. On May 20, Doximity and Cleveland Clinic launched a new continuing education platform. And on June 4, the firm revealed a collaboration with U.S. News & World Report to publish a free online directory of more than 700,000 practicing U.S. physicians.

CEO Jeff Tangney (pictured) recently discussed these developments -- and others -- with PhysBizTech during a phone interview with Editor Frank Irving. The transcript of that call follows.

Q: You've had an increase of 120,000 physicians in your network since March 2012. What is driving the tremendous growth?

A: Each month we add more doctors than the month before, and it seems to be growing at an accelerating pace.

In my experience with Epocrates, which I co-founded 10 years ago, we saw great growth there, too. But we're growing three times faster with Doximity. Unlike Epocrates where we hit a threshold around 100,000 to 120,000 and plateaued, at Doximity we seem to be accelerating at that point.

I think the difference is that Epocrates was a great drug reference, and still is. We were on the Palm Pilot and there were 120,000 doctors out there who were ready to buy a Palm Pilot to have a better drug-drug interaction checker and dosing checker in their pocket. However, there were no real network effects.

Here at Doximity, with each new doctor who joins, the product becomes more valuable. We're seeing Metcalfe's Law in action -- the value of the network is exponentially related to the number of nodes or the number of people in that network.

So, if I had the only fax machine in town, it would have no value to me at all. But when everyone else has a fax machine, it has a lot of value to it. The value of the fax machine grows as other people get fax machines, even if I do nothing. That's what we're seeing with Doximity.

We now have over 7 million colleague connections -- doctors who have "friended" or "colleagued" another doctor. About a third of the time they do that, they share their fax line, their cell phone number or pager number.

Two weeks ago, we had more new doctors sharing fax lines or cell phone numbers during that week than we had in all of 2011. So it's really growing at an exponential pace. And the more physicians who join the network, the more valuable it is to those who are in it. You could also call it a "virtuous cycle."

Q: Is the faxing capability the most commonly used function of the network? Is that the engine behind this tremendous growth?

A: It's a combination of things: The faxing, the secure email and the sharing of cellphone numbers are the three main drivers. It's more about private messaging than it is about the form of messaging.

We do have some forums where I can post a top case to the cardiology forum, for example. And we've had tens of thousands of those cases posted. But that's still the minority of the physicians who use the network. The heaviest activity is in the secure messaging, whether it's via fax, cellphone or email.

Q: How have you been able to break through to a hard-to-reach audience to make them believers in this technology?

A: There have been at least a half dozen other attempts at building a physician network, and it comes down to the execution, to the details. No one before has done the free fax number, for example. No one before has offered free CME for discussion of tough cases. It's important to provide real value for physicians out of the gate.

Q: What are you seeing in terms of how doctors interact within the network?

A: We focus on helping them reconnect with old colleagues. When someone joins and they see a co-author of a paper from 10 years ago, and they see that person has written a new paper, we enable them to reach out and congratulate the author. It's a peer-to-peer reconnection. Making that sort of thing easy to do is our biggest growth driver.

There are many of these opportunities -- whether it is winning an award, getting a grant, publishing a paper, running a new clinical trial -- to reach out to colleagues and say "good job" or "congratulations." There's so much negativity in healthcare today that it's nice to be able to provide a forum for offering some positive reinforcement.

Q: Is there any demarcation in the use of your services by size of practice?

A: We have not seen a demarcation. We do well in small practices. In fact, our number one state in terms of penetration is Alaska. And that's because we make it easy for rural docs to connect with hospitals and referring care. Also, having the efax is a popular feature among small practices…having a free phone line so someone can send something to you when you are on the go.

We're empowering people who are smart to be where they want to be and still be connected to the larger medical community.

Q: Let's talk a bit about some of the other practical aspects of the network.

A: We get a good story nearly every week because of a fax that was sent and received. The doctor is typically on his or her iPad or iPhone at the moment of needing to make a decision about a patient.

We had a case a couple weeks ago: A six-year-old child was coding at a hospital in Oakland, Calif. The doctor treating the patient needed to know what medications she was on before he could make the first move. That required him looking up her pediatrician and calling their office while standing at the bedside, asking them to fax over a list of her medications -- which they did -- and having the doctor being able to look at the list right there on his iPad. I'm not exaggerating to say that probably saved the child's life because it eliminated the extra half hour or hour it might have taken to find a fax machine and have the fax delivered through the normal channels. The doctor in this case is a hero for taking that extra effort to get the information faster for that little girl. And that type of thing happens all the time.

In another instance a few weeks ago, a resident at a hospital in Boston had a patient come in with an apparent stroke. The resident rushed the patient down for an MRI stat. On the way to the MRI, the daughter of the patient told the doctor that the patient had a clip put in his body. As you know, MRI machines are really just big magnets; you need to know before you put someone in an MRI machine whether they have any metal in their body. So they had to find out if the clip inside the patient was metal. During the elevator trip, the resident was able to call the other hospital and have them fax over the patient's medical records and determine it was not a metal clip. By the time they got to the MRI room, the patient could be treated right away. That saved minutes if not hours over the normal process.

These things are happening because of real-time, secure connectivity. It may seem hokey that they're doing so much with faxes, but it is a reality, and we're just plugging into that. I think in the future many of these people will be able to send secure email, so it will be even faster.

That type of impact is really gratifying to see. It's easy to underestimate the value of existing technology, but having that be healthcare-grade, HIPAA-compliant is of big value.

Q: What about more day-to-day applications of the technology?

A: Sure, not all of the stories are life-saving. Some are sparing the doctor an inconvenience. For example, the doctor could look at a patient's record on his iPad rather than having to drive in to the practice or hospital. The doctor can then tell a nurse or resident what to do without being there in person. A lot of it is just saving time.

Q: Why is it important that the doctor's CV is available on the network?

A: We have the physician's full CV in a searchable form. We allow recruiters to look through and find candidates for faculty positions, do specialized searches and send them emails about current positions. 

Q: Aren't you wary about your members getting deluged with emails?

A: We were very tentative about it at first. We certainly didn't want physicians to get spam. I want to make sure recruiters are using the network respectfully. We do not allow any recruiter to send more than 15 email messages in any given month. We require that with each message that they send, in the subject line, they have to fill in the salary range and the city/state location of the job. We have beta-tested about 10,000 of these recruiter messages and we've had a 26 percent click-through rate on them. That's 26 percent of doctors not just opening the email, but clicking through and saying "Send me more information, I'm interested." That's a lot higher than I would have thought.

It really boils down to the current physician job-listing market being incredibly inefficient. There are these job boards with postings that say the facility is within three hours of hunting and fishing, competitive salary…and that's all they ever say.

In reality, the hiring facility is looking for an interventional cardiologist with at least seven years experience who's had training at a top hospital and has done research in a specific area. And you can see all that from the physician's CV in Doximity. We provide a nice place to match expertise with need, to match talent with opportunities.

So the physician reaction has been the opposite of what I feared, which was doctors asking to opt out. Instead, they are asking if we can send more of these opportunities.

We just added a layer of transparency that the job boards don't have, and we require that recruiters do a bit more explaining to make it efficient for both sides. We're seeing that it is worth the doctor's time to click through and open the message because it has relevant positions and data that -- even if they aren't actively looking -- they're interested in.

Q: How are you monetizing the recruiting function?

A: We charge $9.000-$10,000 a year per recruiter to have access to the capability to send 15 emails a month to our members.

Q: Are there other areas in which parties are willing to pay for access to the network?

A: Yes, we've had quite a bit of honoraria pulsing through our system. We require a minimum of $300 per hour be paid to participating members. These are ancillary revenue opportunities for our members, but they are growing in importance and need. There are more patients seeking second opinions, there are more new drugs in therapies. Pharma companies are less likely to have consultant dinners and instead just want to do a phone call to get some insight on the market. We're helping serve that by having a CV in one place so that these folks can find the right experts.

And by the way, it's not always the guys who do the clinical trials. I've been surprised by the number of investor phone calls related to the use of electronic health records. There has been a lot of interest in trading the stock market around the major publically traded EHR companies. Who's got the best product? Who is leading in market share and why? What do physicians think of it?

So there has been a fair amount of work that I would say is more technology-oriented.

Q: The last question is about your collaboration with Cleveland Clinic on physician education? What is the most important aspect?

A: Doctors can get CME from a lot of different websites. That's nothing new. The thing that we offer is making it painless.

Other courses may involve watching a half-hour video presentation on pain management, and answering a bunch of multiple-choice questions.

Through Cleveland Clinic, we're able to give doctors credit for searching for relevant news on their patient base. There isn't a multiple-choice questionnaire at the end. You get credit for searching and discussing the "issue du jour" in your practice, which I think is novel.

We're letting you look at a topic in the New England Journal of Medicine, Lancet, JAMA -- wherever you have a clinical interest. You read the news and stay up to date.

The other part is the administrative piece. Other systems email you a PDF file for certification if it's online or they will physically mail you a certificate. Ninety percent of CME today is not online. If I've done something in a magazine, or maybe I've attended grand rounds, it's up to me as a physician to keep all those scraps of paper in a manila folder. At the end of the year, I need to add it up to make sure I've got my 40 hours of credit.

We make that part of it easier by using Web 2.0 technology. If you get an email from somebody with a PDF file, you can just forward it to Doximity and we will automatically add it to your record. We pull out the number of hours and the accrediting source and fill it in for you.

If you're at a live session -- let's say grand rounds -- usually there will be a piece of paper they hand out, and you have to save it. We allow you to use your iPhone to take a picture of that form and that gets uploaded to our system and our tracker. We pull in the number of hours and categorize it for you.