Online clinician communities

Clinicians have always valued the “doctors lounge” and the ability to connect with one another but in recent years they have increasingly relied on clinician-only online communities and open social media channels for quick, filtered information and instantaneous insight from people who feel like their peers. For example, over 800,000 verified doctors across 150+ countries are members of Sermo. Nearly all types of clinicians - including physicians, specialists, surgeons, PCPs, medical students, NPs, APPs, PAs, and pharmacists, are members of Doximity.

Like most health care technologies and apps, these communities are designed around the clinician as an end-user. They offer a variety of point-of-care decision support tools (e.g. drug interaction checkers), case-sharing forums, and real-time newsfeeds to share new clinical literature, customize content formats to individual’s preferences, and encourage discussion about new evidence. These communities also continuously adapt to meet evolving clinician needs. For example, Doximity introduced an in-app telehealth platform during the pandemic.

Of course, Covid-19 and the shift to virtual working accelerated clinicians’ use of these online communities. In fact, one survey conducted by Real Chemistry found that doctors’ posts on public social media rose by 167% between February 2020 and March 2020, and are still 148x higher per week on average versus pre-pandemic levels. However, other trends in the health care landscape, such as increasing patient complexity, lack of applicable research, and the accelerating pace of medical knowledge generation, also contribute to accelerated usage. To date, most clinical research has focused on removing cofounding variables from clinical trials and studies. Yet today’s patient populations increasingly present with multiple comorbidities and conditions –and this type of complexity is not captured in existing research. This trend, coupled with medical knowledge and insight doubling nearly every two months, causes clinicians to turn to online communities for help treating complex patients, and for assistance in keeping up with the rapidly growing medical evidence base.

Additionally, changing demographics and generational shifts in the health care workforce will continue to accelerate the adoption. Although online communities and digital platforms have always attracted early and mid-career digital-savvy clinicians and medical students, the increasing retirement of older clinicians (accelerated in part by Covid-19) and growing demographic shifts will continue to exacerbate digital use. In addition, this shift means that individuals in positions of influence will increasingly be frequent users of these communities.

Despite rapid growth, the popularity of these platforms is still early-stage. Notably, Doximity just recently filed for initial public offering (IPO); many other platforms are still growing and establishing their role in the overall landscape. As a result, health care stakeholders must start grasping and shaping the downstream positive and negative effects these communities may create. For example, online clinician communities have the potential to help reduce physician burnout and loneliness by connecting peers across the globe, and can even help health systems and organizations embrace value-based care models by providing broader access to specialists and sources of knowledge. However, they can easily contribute to the generation and spread of medical misinformation and create mistrust of the medical community.

Online clinician communities allow clinicians to access crowd-sourced solutions to individual cases, learn about new advances in medicine, and access real-world evidence to better support decision-making. For example, data from Figure 1 found that 40% of clinicians who are unable to resolve a patient case on their own find a resolution through peer-to-peer collaboration on Figure 1.

These communities also allow clinicians to form medical consensus outside of traditional pathways. While clinical guideline/standard creation and consensus-building traditionally occur at in-person medical society conferences or in-house committee (e.g pharmacy and therapeutics or value analysis) meetings with a select number of individuals, online communities allow all clinicians to weigh in – regardless of geography, specialty, or tenure.

While these use cases are in line with the consumer-driven movement towards personalized medicine and provide clinicians with another tool to deliver more individualized care, they’re also in tension with broader industry pushes towards care standardization (e.g. guidelines, pathways). As clinicians using online communities increasingly have more data and tools available to support personalized treatment decisions, they are more empowered to go against guidelines and standards.

Health care stakeholders must recognize that these changes will inevitably impact the overall nature of evidence generation, the use and acceptance of real-world evidence, the formation of clinical guidelines, and the role of traditional medical societies and conferences in shaping medical consensus. While the exact impacts remain to be determined, stakeholders must start preparing for the ripple effects that online clinician communities will have on the overall evidence landscape.

In online clinician communities, a large and diverse range of voices – rather than a small group of traditional academic thought leaders– have established credibility and influence. Notably, the most influential clinicians online are those who frequently engage with their peers and who invest time in teaching and disseminating knowledge. Although specialists and traditional high-profile academic thought leaders do have influence in some online channels, clinicians with “lived experiences” (e.g. serve unique/diverse patient populations, have experience treating a specific condition, have historically marginalized identities) and can share unique clinical stories are rising in influence. These clinicians can help bridge knowledge gaps across geographies by helping diagnose uncommon conditions or by sharing new-in-kind ways to treat patients.

We already see these new types of “influencers” and a more expansive set of voices weighing in on care decisions and shaping the practice of medicine. One example was when The Lancet retracted its hydroxychloroquine RWE study in April 2020, after the online medical community found flaws in study methodology. 

Online communities also create more avenues for clinicians to amplify critiques of power structures and equity issues within the medical field. For example, when the editor-in-chief of JAMA promoted a podcast discussion on structural racism and questioned its presence in health care by tweeting “No physician is racist,” the medical community took to Twitter to express their anger and call out how traditional medical journals and societies have traditionally mishandled discussions of race. As a result, the editor-in-chief stepped down from his position.

To what extent these individuals start to influence, and become part of, traditional power structures (e.g. medical societies, guideline-generating groups, regulatory agencies like FDA) remains to be seen. Some researchers are taking active steps to first understand how online influence is correlated with traditional notions of academic prestige. There’s even a current debate in the medical community over the role of social media influence in an individual’s academic promotion.

Conversations from online clinician communities can help health care stakeholders glean information about unmet medical needs, physician’s clinical decision-making processes, and gaps in research/clinical evidence. For example, they can provide insight into physician’s perceptions of standards of care and treatment options, how clinicians decide what medical products to use, and how the current evidence base (or lack thereof) informs treatment decisions. They can also help stakeholders better understand what messages resonate with customers. For example, life sciences companies can use these platforms to identify clinician’s data and evidence needs and tailor solutions accordingly.

In the future, this data may even provide insight about the efficacy of medical interventions (e.g. drugs, devices, procedures). With AI, machine learning, data mining capabilities continuing to improve in validity and usefulness in health care, stakeholders can use these tools to extract real-world evidence at scale from online clinician communities. However, this type of large-scale data extraction raises many concerns about data privacy and stakeholder comfort with data use. Many patients, doctors, and even organizations may not know or fully understand when sensitive health care data is used and how. Notably, Google and Ascension Health’s 2019 scandal may be a harbinger of times to come. When the public found out that Ascension was secretly sharing patient’s medical data with Google for “treatment and administrative purposes” (essentially for RWE generation), both patients and doctors were uncomfortable with the way the data was collected and shared, even though it was technically permissible under federal law. In the future, health care stakeholders need to determine how and when to handle this type of data with privacy and security in mind.

We already see researchers, vendors, and tech companies developing advanced analytic capabilities to better extract clinical insight from these platforms in a compliant way. For example, companies like Voxx Analytics, Larvol, H1 Insights, and even online communities themselves like Doximity and Sermo increasingly partner with stakeholders across the industry to run social listening and large-scale data analysis. In addition, some surgery-specific online communities – like C-SATS from Johnson & Johnson, Proximie, and Avail Medsystems – have developed platforms to utilize surgeon-to-surgeon discussion boards and videos to provide feedback on procedures.

However, most providers, payers, life science companies, and key players in clinical decision-support tools (e.g. guidelines) have yet to fully realize how to use this data to advance clinical care. In the near future, stakeholders who actively invest in identifying and accelerating use cases will be better positioned to generate more comprehensive and representative real-world evidence, uncover opportunities (e.g. change in clinical practice, new treatment use cases) to advance care, and better understand the health care ecosystem overall.