The Networking Doctor

The Oxford dictionary defines networking as a system of trying to meet and talk to other people who may be useful to you in your work.

Doctors have always been part of formal and informal networks through which they make patient referrals, take clinical decisions and update themselves on the latest treatment protocols. Even that Whatsapp group of your medical college batchmates is an informal network of doctors. Networking also caters to the continuing need of building one’s professional reputation and impulsive needs like jobs, medicolegal consultations and medical device purchases.

Doctors, as history tells us, can never work alone. Solving healthcare issues like antibiotic resistance, rising healthcare costs, public sanitation and last mile delivery is like killing the ten headed Ravana. Individual doctors and the medical community as a whole cannot hope to overcome the sheer complexity of such evolving villains by themselves. After all, even Shri Ram had to network with Hanuman to kill Ravana.

When Dr. Sidney Farber. a pathologist working to find a cure for childhood leukemia networked with Mary Lasker, a socialite, the war on cancer took a huge stride forward.

Most doctors network wrong. It’s not their fault. Our education system values data absorption and regurgitation more than the art of blending knowledge with empathy and synergy for the cost-effective welfare of a fellow human being. Also between the long study hours in medical colleges and the longer night shifts at hospitals, doctors spend most of their adult life surrounded by either books or fellow doctors. A generic doctor’s exposure to other professionals/fields of work remains very limited.

So in a world where physician burnout claims more lives than Thanos himself, building strategic partnerships or developing interpersonal skills that are helpful to create that ultimate Healthcare Avengers team remains a high effort/low return proposition for the majority of doctors who are either running after that glamorous Radiology PG seat or trying to make a high return on those 5+ years of medical education. 

Those who end up trying their luck at this ‘highly experimental’ protocol learn through trial and error. Some born with that networking gene are successful. But most fail and end up wasting years attending medical conferences and updates hoping for that elusive impactful meeting of a lifetime.

Digital Networking

Networking sites for doctors have been here for a while. Sermo, PlexusMD, Doximity and Curofy are well known names in this domain. Sites like Incision Academy for surgeons, Orthomind for Orthopedicians and MomMD for doctor-mothers are catering to very specific niches.

The most important function of such sites is real-time medical crowdsourcing. Breaking geographical and accessibility barriers, doctors are now consulting each other over difficult cases to improve patient outcomes. The beauty of this is the creation of digital repositories of treatment workflows. Over time efficient search and sort tools can bring up anecdotal cases to assist medical decision making.

Other digital networking applications:

  • Sharing medical updates.
  • Discussions.
  • Sharing practice management ideas.
  • Actualizing issues that faces the profession as a whole and taking a stand for it when necessary.
  • Partnerships with patient advocacy groups, NGOs & non profits.
  • Extension to student communities for knowledge sharing.

The only real concern with digital networking is that it might distract you from your actual work. It’s another way to bring your work home with you, and this could further contribute to physician burnout.

The Economics of Networking

Does the way doctors network affect healthcare costs for patients?

A research paper by James Whisler, Kumar Kanisan & Jesus Leal Trujillo published by Deloitte in 2019 studied physician network dynamics using Medicare Fee for Service claims filed in three US states. They identified six conditions with relatively predictable care and treatment patterns — cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, fracture/dislocation of the hip/femoral head, hypertension (essential) and spinal/back disorders. By retracing patient referrals, they mapped out the structure of physician networks providing care to patients with these conditions and measured the relationship between network characteristics and average spending per episode.

Deloitte’s analysis of these network dynamics in Medicare shows that where physician relationships are tightest, spending for certain health conditions is lower. For instance, an increase in the physician centrality (a measure from network science that captures the degree of coordination between disparate parts of the network) decreases average episode of care cost for hip fracture by almost 15 percent (or US$2,000) and for coronary artery disease by 26 percent (or US$1,050).

This has immense applications in healthcare plans like Ayushman Bharat Yojana and Ex- servicemen Contributory Health Scheme (ECHS). Claims data can be used to identify high and low performing networks and all the physicians who are part of that network. For example, one can find a specific cardiologist whose costs are lower compared to others in that cardiologist’s network. This information can be shared with doctors and patients to encourage them to change their care patterns and referrals or for validation of their efforts in this direction.

Think on the lines of high patient rated and cost effective medical practices in a particular geography being connected digitally. Think about doctors running these practices being so connected to each other that Dr. A knows not to send a child with a broken arm to Dr. B because Dr. B is getting his Xray machine repaired. Think about the peace of mind that we can get knowing that we have made the referral to a dependable highly rated colleague at a cost that the patient can afford. Think cloud connected multi tier healthcare for patient referrals.

Sounds like a startup.

Ars longa, vita brevis.

(The art of medicine is long, life is short.)

Hippocrates

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