Physician use of Twitter: Examining the data

It’ll be no surprise to the readers of this blog that physicians’ use of Twitter and other social media has been exploding over the last couple of years.  But it may surprise you to know how hard it is to really analyze that data.

Last year Dr. Katherine Chretien of the VA Medical Center in Washington, DC, published an eye-opening study in a JAMA letter.  Until that point, all we really had were anecdotes and survey responses – certainly not the same as analyzing what physicians were actually doing and saying on Twitter.

By leveraging a strong research team, Dr. Chretien was able to narrow a list of 523 potential author candidates to a final group of 260.  The team then looked at the last 20 tweets from each author – a total of 5,156 were included in the study.  This study was and is a big deal.  It answered a lot of questions – but perhaps the most important one was whether physicians, when using social media, would be more prone to share confidential patient information, or to share anything unprofessional in nature (e.g., used profanity or made discriminatory statements).

I know that I breathed a sigh of relief when the team found that only 3% of tweets contained any unprofessional material.  Don’t get me wrong – any amount would be too much.  But as a physician friend of mine likes to say, “we’re a lot worse at the water cooler and in the elevator than we are online.”  The point is that by publishing a credible study in a credible outlet, Twitter for physicians had become suddenly more acceptable.

My colleagues and I have been following thousands of doctors on Twitter for the last few years … and have gotten more and more interested in finding out what we could learn from them if we were to try to automate some of the very difficult process of sourcing and analyzing their Twitter posts at a much larger scale.

To that end, we have created a database of nearly 1,400 U.S. doctors (to date) on Twitter and – this is critical — linked them to NPI (National Provider Identifier). To our knowledge, this is the only database linking doctors using the Twitter platform to an “official” data set. We’ve  captured over 400,000 tweets from those doctors over a 5-month period in 2012, allowing an unprecedented ability to scan for trending topics and relationships, broken out by specialty, gender and location.

  • The specialty mix is a near-perfect match with the overall US physician population; no specialty varied by more than 3% from between our data set and the country’s doctors as a whole.
  • Our geographic mix was also very close; 49 states indexed within 4% of the overall physician population in that state. Only California strayed outside that number; Californian physicians over-index by 7% in terms of their Twitter usage.

Having been satisfied that we had assembled a reasonable data set, we’ve spend the last two weeks poring through that data looking for insights and patterns. Here are a few of our top-line findings:

  • These are active users. They tweet over 2x per day on average.
  • Twitter is a part of their work-day. More than 50% of tweets are sent between 9am and 5pm (in the physician’s local time zone)
  • They have an audience. 2/3 have at least 150 followers (the median is 306)
  • They connect to each other. More than 1/3 of the doctors are followed by at least 20 other doctors in the database.
  • The most-followed physician by those in the database was none other than Kevin Pho; followed by nearly half of the doctors studied.

What’s more interesting, of course, is the substance of their tweets.  We examined a sample of tweets related to 3 therapeutic areas: diabetes, breast cancer and prostate cancer.  Perhaps not surprisingly, 83% of specialties mentioned diabetes in their tweets … though it’s interesting to note that pediatricians discussed it among the most frequently (behind only internal medicine and family medicine doctors).  I suppose that’s a sign of the times – childhood obesity and the earlier onset of diabetes is very much on the mind of the physicians who care for our kids.  It was also interesting to note that prostate cancer was as widely discussed as it was … 70% of specialties mentioned it in their tweets.  Much of the volume there was driven by this summer’s controversy about the validity of the PSA test as a means of lowering morbidity;  In fact, 43% of the tweets about prostate cancer between May and September were related to this specific issue.

Although we’re only six weeks into what will almost certainly be a years-long process, it’s been fascinating to discover – in a scientific and quantitative manner – how innovative physicians are leveraging social media tools like Twitter to improve the health of their patients, to grow their practices, to connect with their peers, and to create a platform for influencing the future of healthcare.

We’re already looking to work with some of the most prestigious healthcare institutions in the world, including the Mayo Clinic, to glean deeper insights from this data.  But as I go into my first presentation of this material, I’d love to know: What are your biggest questions?  What are the thorny problems you’re trying to solve that would benefit from a deeper look at the physician’s perspective?  It’s my hope that we’ll be able to solve some of them together.

Greg Matthews is a Group Director at WCG (a W2O Group Company).  WCG is an independent strategic communications firm providing integrated solutions built upon clear, data-and-analytics-driven insights.

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  • Vartabedian

    Having had the opportunity to review this data I can attest to the fact that WCG has built a powerful machine that will answer key questions about what doctors are really doing on Tw. This will likely evolve to represent the unique meld of academic thinking with proprietary, customized social listening technology.

    Excited to watch this evolve not just for the data but as a new model of interdisciplinary thinking and problem solving.

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Bryan, thanks. I’m so grateful for the guidance and feedback I’ve gotten from physicians like you. The docs on this database are really trailblazers … we have a lot to learn from all of you.

  • http://twitter.com/sardire Steve Ardire

    Hi Greg – interesting work and for a new twist on data and analytics insights check out
    @Tellagence
    We do something no one else can — we predict who will share your information…on *any* network.

  • http://www.mattsnod.com mattsnod

    Great article. It would be great to conduct this study annually to see how these stats are changing over time. Man, I would love to just be able to Tweet my doctor a general question that might benefit her and my followers.

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Matt, thanks! Our plan is for this to be a continually-growing database that we can use for multiple studies – potentially in association with multiple partners. In so many ways, this database is just a beginning … I’m hoping to have 4x the number of docs on board six months from now, and the bigger the data set gets, the richer the potential insights. And once we’ve looked beyond this initial five-month period, we should be in a great spot to track trends over time.

  • TrishaGreenhalgh

    Most interesting. Another research avenue is how Twitter and other social media allow dynamic bridging across disciplines within and beyond medicine. I am a medical academic majoring in research, but many of my Twitter links are with social scientists and/or medical educators.

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Excellent thoughts, Trisha. Now that we’ve established a methodology and a set of tools for adding physicians to the database, we’ll definitely be interested in all kinds of connections … in fact, one of the things we’re looking at is what content physicians link to as their trusted sources of information. In many cases (as with you) those links will take us outside the direct medical discipline. We’re really excited to see what we can learn.

  • http://www.caduceusblog.com/ Deep Ramachandran

    An interesting idea and a fabulous addition to the very little we know about physician use of social media.
    I do question whether physicians will see this as an invasion of privacy, however. For physicians, NPI is like a professional social security number. Even though doctors tweet publicly, I am not sure that all of them will be comfortable with the idea that all their tweets are connected with their NPI number. It would be analagous to connecting people’s facebook posts with their driver’s license number.

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Deep – Thanks so much. The NPI is actually only used in the matching process; at no point is the NPI number publicly connected with a twitter handle (or even a name, for that matter). I’m working with a number of physicians to be sure that we avoid any such pitfalls. After all, the goal of this program is to elevate, celebrate and learn from them … so the last thing we’d want to do is to cause any discomfort.

  • allewellyn

    Have you thought about doing this study with other HC professionals?

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Yes! We’re definitely growing the database in terms of MDs – we have thousands in queue already. But we also want to include nurses, pharmacists, technicians, physical therapists … anybody who has an NPI number is a candidate for future analysis. I encourage you to enter your info in the CONTACT form on the web site mentioned above; we’d love to be able to keep you posted as this evolution occurs.

  • http://twitter.com/DoctorJobsUSA Physician Recruiting

    This is great. Where can I learn more about your research in this area? My company recruits physicians for job opportunities. I am interested to know if physicians are open about their job search via social media? Is this a place they go to do their searching?

    • http://twitter.com/DoctorJobsUSA Physician Recruiting

      And also, how are professionals in different specialties connecting to one another online? In the end, it would be really interested if you found trends indicating that heath care providers in specialty X most commonly connect with providers in specialty Y. For my purposes, I would put job opportunities for providers in specialty Y in the social media streams reaching physicians in specialties X AND Y so that there is a greater chance of referral, so on and so forth… larger audience, more likelihood of finding the perfect candidate for their ideal opportunity.

    • http://blog.wcgworld.com/author/gmatthewswcgworld-com Greg Matthews

      Thanks for reading! To answer your questions: First, I have not done any analysis of physicians’ tweetstreams to see whether they talk about searching for jobs … but it definitely has not been something I’ve ever noticed anecdotally. Second, we can show what kinds of specialties tend to follow each other; look at both the Chords and Clusters tabs in the web site referenced above; they will both show you the magnitude of cross-specialty links.

  • http://www.HealthcareMarketingCOE.com/ Simon Sikorski MD

    Great tips! I’m putting together a list of tips for doctors on medical blogging, Facebook, and Google strategies. Let me know if you’d like a copy.

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