1.
Understanding Physicians OnlineGreg MatthewsOctober 18, 2012 Contents are proprietary and confidential.1 #MayoRagan | @chimoose

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Fundamentally, Twitter allows for medical content curation in easily consumable bites with rapid visual access. Truly the popcorn version of medical news (and yes, with movie butter!). Farris Timimi Medical Director, Mayo Clinic Center for Social Media twitter.com/farristimimi Contents are proprietary and confidential.2 #MayoRagan | @chimoose

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With over 18,000 followers from medical communities, with the right strategy and communication, I can leverage the real power of my networks by using crowdsourcing very difficult questions and issues. Twitter is the fastest and most interactive social media channels in my work.” Dr. Bertalan Mesko twitter.com/berci linkedin.com/in/bertalanmesko Scienceroll.com Contents are proprietary and confidential.3 #MayoRagan | @chimoose

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They’re here…#MayoRagan | @chimoose

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A benchmark In 2010, Dr. Katherine Chretien of the VA Medical Center in Washington led a team in producing the first known scholarly study of physicians’ use of twitter5 [ New, automated tools have enabled us to broaden the scope of our study Contents are proprietary and confidential. #MayoRagan | @chimoose [

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Standing on the shoulders … The Chretien Study 260 5,156 Data Collected and tweets Analyzed between May 1st US Physicians and May 31st, 2010. from 260 physicans – the most recent 20 from each The power of automation Study 1,397 403,553 Data Collected and Analyzed US Physicians tweets between October 3 and validated against CMS’ National generated between October 15, 2012 Provider Identifier database May 1, 2012 and September 30, 20126 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Study Demographics7 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Connection promotes health, and twitter proves the model that simple digital tools can vastly increase connection. Aaron Stupple Resident, Beth Israel Deaconness Medical Center twitter.com/astupple http://adjacentpossiblemed.blogspot.com/ Contents are proprietary and confidential.8 #MayoRagan | @chimoose

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Reflecting the Population Plastic Surgery 3% … indexed within1,397 +/- 3 % of the total count US Physicians* 99.5 % Of Specialties… Residents -6 %9 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Reflecting geographic distribution 49 states indexed within +/- 4% of the total count overindexes underindexes10 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Reflecting gender distribution Overindex on twitter by 8% Underindex on twitter by 8%11 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Accounts Created per Year 532 301 216 165 154 1 28 28 2006 2007 2008 2009 2010 2011 201212 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Early Adopters ’06 -‘08 Emergency Medicine Pathology Preventive Medicine13 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Rate of Adoption by Specialty Internal Medicine Neurological Surgery All MD Dermatology Anethesiology Psychiatry & Orthopedic surgery Neurology Ophthalmology Urology Plastic Surgery Family Medicine Obstetrics & Org. Health Care Gynecology Ed/Training Student Surgery Pediatrics Preventive Radiology Medicine Otolaryngology Pathology Allergy & Emergency Immunology Medicine14 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Physician Profiles 78 % identify themselves clearly as such in their twitter bio 32 % link to a personal blog or website 80 % contain a URL in their bio15 Contents are proprietary and confidential. #MayoRagan | @chimoose

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How are MDs using their accounts? Bio URL Distribution 6.90% 1.90% 93 % of all Plastic Surgery 37.70% URLs are links to their practice 31.90% Business Medical Resource Personal Blog/Website Practice16 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Twitter Activity – Time and Frequency17 Contents are proprietary and confidential. #MayoRagan | @chimoose

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I use Twitter not to apologize but as an apoligist. I introduce the view from the other side of the stethoscope. Jordan Grumet, Internal Medicine twitter.com/ordangrumet http://jordan-inmyhumbleopinion.blogspot.com/ Contents are proprietary and confidential.18 #MayoRagan | @chimoose

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Tweets Over Time Trending steadily upward 4500 4000 3500 3000 2500 2000 1500 1000 500 0 1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 15119 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Tweets per day over Account Lifetime Pediatrics Ophthalmology Radiology Otolaryngology Emergency Medicine All MD Average20 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Tweets per day over 5 months May’12 Jun’12 Jul’12 Aug’12 Sep’12 Anesthesiology Radiology Ophthalmology Family Medicine Pediatrics All MD21 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Tweets per day over 5 months May’12 Jun’12 Jul’12 Aug’12 Sep’12 42 are % increasing frequency 34 are % tweet at least 1 time per day 9 % maintaining frequency 50 are % decreasing in frequency22 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Tweets per day over 5 months May’12 Jun’12 Jul’12 Aug’12 Sep’12 MOST ACTIVE Anesthesiology LEAST ACTIVE Neurological Surgery23 Contents are proprietary and confidential. #MayoRagan | @chimoose

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When can I find MDs on Twitter? Eastern time Morning Workday Work PM Evening Overnight (0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459) 18 % 22 % 32 % 12 % 17 % 32% 22% 18% 17% 12% Morning (0500 - 0800 Workday (0801 - 1200) Work PM (1201 - 1800) Evening (1801-2300) Overnight (2301-0459) 0500-0800 0801-1200 1201-1800 1801-2300 2301-045924 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Twitter and the MD Workflow Localized time Morning Workday Work PM Evening Overnight (0500 – 0800) (0801 - 1200) (1201 - 1800) (1801-2300) (2301-0459) 18 % 21 % 31 % 8% 22 % 31% 21% 22% 18% 8% 0500-0800 0801-1200 1201-1800 1801-2300 2301-045925 Contents are proprietary and confidential. #MayoRagan | @chimoose

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The Connected Physician26 Contents are proprietary and confidential. #MayoRagan | @chimoose

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I think using Twitter and other social media outlets has benefited me by letting me know where the patients are. I learn from their stories and I have a chance to truly hear them. In addition, I find social media beneficial as a learning source to interact with other physicians and med students I never would have met if I were confined by the walls of my own hospital. Danielle Jones, Medical Student twitter.com/daniellenjones Mindonmed.com Contents are proprietary and confidential.27 #MayoRagan | @chimoose

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My use of twitter allows me to expand the diversity of my network, and therefore my knowledge in my areas of interest : prevention, diversity/equity, integrated care, and Washington, DC (the #epicenter!). It also allows me to model open leadership as a physician, and promote this approach among my medical and nursing colleagues. Ted Eytan Family Medicine, Kaiser Permanente twitter.com/tedeytan linkedin.com/in/tedeytan tedeytan.com Contents are proprietary and confidential.28 #MayoRagan | @chimoose

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How Many People do MDs Follow? 23.9% 21.3% 15% 13.4% 13.5% 8.2% 4.8% 0 to 10 11 to 50 51 to 100 101 to 300 301 to 1000 1001 to 3000 3000+ Number of Following29 Contents are proprietary and confidential. #MayoRagan | @chimoose

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How Many People Follow MDs? 30.8% 16% 16.7% 14.4% 14% 6% 3.9% 0 to 10 11 to 60 61 to 150 151 to 700 701 to 2000 2001 to 10000 10001 + Number of Followers30 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Ratio of following to followers Ratio of Following to Followers 32.40% Median 21.50% Ratio 1.1 : 1 16.20% 14% 6.70% 4.90% 2.80% 1.60% 0.- .1:1 .11-.2:1 .31-.7:1 .71-1.5:1 1.51-3.0:1 3.1-11.0:1 11.1-100.0:1 100.1-2808:131 Contents are proprietary and confidential. #MayoRagan | @chimoose

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MDs Most likely to be followed by peers* 25% 53% Personal Blog/Website 27% Business/ Organization All_Doctors No Bio URL practice 34% 40% *Percentages measure MDs followed by at least 20 others in the data set32 Contents are proprietary and confidential. #MayoRagan | @chimoose

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How connected are online physicians? % 34 of all MDs are followed by at least 20 MDs Pediatrics Specialties who Emergency are followed by Medicine other MDs Family Medicine33 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Who are MDs talking to? TOP @ MENTIONS @kevinmd @drdubrow @hrana @ryanmadanickmd @drmikesevilla @drghaheri @healthcarewen @kentbottles @drjengunter @hjluks34 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Connected MDs – Nearly half follow Kevin Pho Most followed by other MDs in the database 43% 25% 22% 21% 20% kevinmd Atul_Gawande MtnMD Doctor_V SeattleMamaDoc Follow the most other MDs in the database 41% 37% 27% 27% 26% KreinMD DrScottPearlman docpreneur medicalaxioms DrJenGunter35 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Topics36 Contents are proprietary and confidential. #MayoRagan | @chimoose

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The biggest advantage to tweeting for me has been learning what people I admire are reading, using, watching, listening to, both within social media and outside of it. Even better have been the IRL connections, and the DM possibilities: its great to be able to meet someone at a conference whose thought processes, links or research I admire and have discovered thru a tweeted link. I dont think Ive had any new patients because of a tweet, but my relationships with existing patients are probably better because Im better informed about what theyre reading and watching. John La Puma Internal Medicine; Author twitter.com/johnlapuma Contents are proprietary and confidential. linkedin.com/in/johnlapuma37 #MayoRagan | @chimoose

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Top Hashtag used by MDs health teamfollowback ncsc12meded hitsm mhealthparenting ff healthcare phm2012 gopfail p2 socialmedia 30s4health amee2012tcot hcsm abcdrbchat telemedicine digitalhealth dnc2012 hcsmny tedx medxmhealth medicine meded aafpalf hcmktg ehr fmrevolution futuremedbreastcancer med2 gop orthopedics h20chi topprog healthtap eyes leadership ipadipodteletrauma bcsm melanoma womenshealth hcsm myeloma ags12 obamacare dr4afb medsm scotus healthdata science diabetes olympics flavorwire aafp cdomfmrevolution asco12 hrs2012 cancer diet obesity mccsm quote s4pm nutrition hiv palliative homebased healthitpediatrics jobs cnn aafpncsc hpm music vision ilovebreasts testosterone aafpnc plasticsurgery meditation primarycare hcr aca medicare familydoc 38 Contents are proprietary and confidential. #MayoRagan | @chimoose

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What are MDs Talking About? TOP HASHTAGS Family Medicine Most used by #health(8,215) #meded (4,547) Most used by Residents #hcsm (4,532) #mhealth (3,412) #fmrevolution (2,721)39 Contents are proprietary and confidential. #MayoRagan | @chimoose

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#hcsm 63% 73% 13% of #hcsm Of all #hcsm of all #hcsm mentions were hashtags are classifications from MDs with a from mention Health Care personal blog or Anesthesiologists #hcsmSocial Media – website . Socially Savvy MDs40 Contents are proprietary and confidential. #MayoRagan | @chimoose

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A closer look at conversations… Top Hashtags for Top Hashtags for Top Hashtags for Family Medicine MDs with Business URLs Pediatrics #health (3,349) #jobs (12,634) #meded (1,307) #fmrevolution (2,223) #homebased (1,562) #hcsm (596) #hcsm (728) #mhealth (816) #med2 (521) #aca (621) #healthIT (815) #pediatrics (450) #30s4health (597) #ff (490) #health (437)41 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Mining the Data A sample • Breast Cancer: (breast AND (cancer OR carcinoma)) OR (inflammatory AND breast) OR (inflammation AND breast) OR (breast AND (metastasis OR metastic)) OR (duct AND (carcinoma OR cancer)) OR (lobe AND (carcinoma OR cancer)) OR "DCIS" OR "LCIS" OR (estrogen AND receptor AND positive) OR "HER2" OR (breast AND MRI) OR (breast AND biopsy) OR (breast AND ultrasound) OR "mammogram" OR "mammography" OR "tamoxifen" OR (aromatase AND inhibitor) OR "exemestane" OR "trastuzumab" OR "Herceptin" OR "lumpectomy" OR "mastectomy" OR "komen" OR "BRCA1" OR "BRCA2” • Diabetes: "Diabetes" OR "Mellitus" OR "Insipidus" OR "Diabetic" OR "Gestational" OR "blood glucose" OR "Blood Sugar" OR "NIDDM" OR "IDDM" OR "LADA" OR ("Antiduretic Hormone" OR "ADH") OR ("Arginine Vasopressin" OR "AVP") OR "oral glucose tolerance" OR "fasting plasma glucose" OR "glycated hemoglobin OR HbA1c OR A1c" OR "insulin" OR "SMBG" OR "hyperglycemia OR hyperglycemic" OR "biguanides" OR "Sulfonylureas" OR "Meglitinides" OR "thiazolidinediones" OR "alpha glucosidase inhibitor" OR "GLP-1 agonist" OR "DPP-IV inhibitors" OR "DKA" OR "HHS" Contents are proprietary and confidential.42 #MayoRagan | @chimoose

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Diabetes & Breast Cancer – Sample Search Contents are proprietary and confidential.43 #MayoRagan | @chimoose

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Disease Conversation Volume Over Time 100 90 80 70 60 50 40 30 20 10 0 Diabetes Breast Cancer Prostate Cancer44 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Disease Conversation Volume Over Time (Minus 1 “Zealous” Physician) 100 90 80 70 60 50 40 30 20 10 0 Diabetes Breast Cancer Prostate Cancer45 Contents are proprietary and confidential. #MayoRagan | @chimoose

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The PSA Controversy 36 117 Doctors who state an opinion are more than 3:1 against the USPSTF’s ruling on PSA Tests 182 Negative Neutral Positive46 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Top Diabetes Tweeters Talking About • Internal Medicine • Family Medicine DIABETES • Pediatrics 83 % of all classifications mention diabetes keywords at least 1 time in their tweets.47 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Top Breast Cancer Tweeters Talking About • Internal Medicine • Surgery BREAST CANCER • Radiology 77 % of all classifications mention breast cancer 1 or more times in their tweets48 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Top Prostate Cancer Tweeters Talking About • Urology • Internal Medicine PROSTATE CANCER • Family Medicine 70 % of all classifications mention prostate cancer keywords 1 or more times in their tweets.49 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Top Links OVERALL TOP HOSTS TOP HOSTS WITH CROSS- CLASSIFICATION LINKS yourhealthchoice.net online.wsj.com www.handsontelehealth.com www.usatoday.com hchlitss.blogspot.com www.nytimes.com www.drken.us www.nhlbi.nih.gov online.wsj.com www.cnn.com50 Contents are proprietary and confidential. #MayoRagan | @chimoose

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Twitter primarily helps me remain amazingly current in topics of my interest. I also reciprocate and share much of this with my followers. Steven Tucker Medical Oncology twitter.com/drsteventucker linkedin.com/pub/steven-tucker/13/6b/235 Contents are proprietary and confidential.51 #MayoRagan | @chimoose

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Twitter has been very helpful in helping me crowd source information from my community of practice of 7200 twitter followers. For example, when I was asked to give a presentation to a medical school about how social media could be used in undergraduate medical education, I posted on twitter: "Help, need best practices examples of how to use social media in med school education" I received dozens of response with concrete examples I was able to use in my presentation. Kent Bottles twitter.com/kentbottles http://www.kentbottles.blogspot.com// Contents are proprietary and confidential.52 #MayoRagan | @chimoose

53.
Thank you #MayoRagan | @chimoose

54.
AcknowledgementsPhysician Advisor – Bryan Vartabedian (@doctor_v)R&D Lead – Matthew Hager (@iSmashew)Research Analyst – Kayla Rodriguez (@Kaylarodrigue11)Visualizations – Ryan Ebanks (@ebanksre)Designer – Nidhi Raina (@NidhiRaina) #MayoRagan | @chimoose

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#MayoRagan | @chimoose

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Appendix #MayoRagan | @chimoose

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Appendix – Classification Count Row Labels Count of classification Internal Medicine 314 Family Medicine 168 Pediatrics 116 Psychiatry & Neurology 100 Student in an Organized Health Care Education/Training Program 83 Obstetrics & Gynecology 76 Surgery 74 Orthopaedic Surgery 74 Dermatology 55 Emergency Medicine 53 Plastic Surgery 46 Otolaryngology 42 Anesthesiology 28 Radiology 27 Opthalmology 26 Urology 24 Allergy & Immunology 16 Pathology 14 Neurological Surgery 10 Preventive Medicine 10 #MayoRagan | @chimoose

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Appendix – Classification Count Thoracic Surgery (Cardiothoracic Vascular Surgery) 9 Physical Medicine & Rehabilitation 9 General Practice 8 Pain Medicine 4 Colon & Rectal Surgery 3 Hospitalist 2 Nuclear Medicine 2 Neuromusculoskeletal Medicine & OMM 2 Medical Genetics 1 Phlebology 1 (blank) Grand Total 1397 #MayoRagan | @chimoose

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Appendix – Specialty count Allergy & Immunology 16 Allergy 7 Allergy & Immunology 8 Clinical & Laboratory Immunology 1 Anesthesiology 28 Anesthesiology 21 Pain Medicine 6 Pediatric Anesthesiology 1 Colon & Rectal Surgery 3 Colon & Rectal Surgery 3 Dermatology 55 Clinical & Laboratory Dermatological Immunology 1 Dermatology 36 Dermatopathology 2 MOHS-Micrographic Surgery 5 Procedural Dermatology 11 Emergency Medicine 53 Emergency Medical Services 2 Emergency Medicine 51 Family Medicine 168 Addiction Medicine 3 Adolescent Medicine 1 Adult Medicine 5 Family Medicine 151 Geriatric Medicine 2 Sports Medicine 6 General Practice 8 General Practice 8 Hospitalist 2 Hospitalist 2 #MayoRagan | @chimoose

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Appendix – Specialty Count Internal Medicine 314 Adolescent Medicine 1 Allergy & Immunology 2 Bariatric Medicine 1 Cardiovascular Disease 39 Clinical Cardiac Electrophysiology 5 Critical Care Medicine 2 Endocrinology, Diabetes & Metabolism 10 Gastroenterology 18 Geriatric Medicine 19 Hematology 2 Hematology & Oncology 17 Hospice and Palliative Medicine 5 Hospice Care & Palliative Medicine 2 Hospitalist 1 Infectious Disease 9 Internal Medicine 135 Interventional Cardiology 7 Medical Oncology 9 Nephrology 14 Nuclear Cardiology 1 Nutrition 1 Pulminary disease 1 Pulmonary Disease 3 Rheumatology 7 Sleep Medicine 3 Medical Genetics 1 Clinical Genetics (M.D.) 1 Neurological Surgery 10 Neurological Surgery 10 #MayoRagan | @chimoose

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Appendix – Specialty Count Neuromusculoskeletal Medicine & OMM 2 Neuromusculoskeletal Medicine & OMM 2 Nuclear Medicine 2 Nuclear Cardiology 1 Nuclear Medicine 1 Obstetrics & Gynecology 76 Gynecologic Oncology 5 Gynecology 6 Maternal & Fetal Medicine 2 Obstetrics 1 Obstetrics & Gynecology 57 Reproductive Endocrinology 5 Opthalmology 26 Opthalmology 26 Orthopaedic Surgery 74 Foot and Ankle Surgery 5 Hand Surgery 6 Orthopaedic Surgery 48 Orthopaedic Surgery of the Spine 5 Orthopaedic Trauma 2 Orthopedic Surgery 1 Sports Medicine 7 Otolaryngology 42 Facial Plastic Surgery 9 Otolaryngology 23 Otolaryngology/Facial Plastic Surgery 6 Pediatric Otolaryngology 2 Plastic Surgery within the Head & Neck 1 Sleep Medicine 1 #MayoRagan | @chimoose

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Appendix – Specialty count Pain Medicine 4 Interventional Pain Medicine 3 Pain Medicine 1 Pathology 14 Anatomic Pathology & Clinical Pathology 13 Blood Banking & Transfusion Medicine 1 Pediatrics 116 Adolescent Medicine 4 Developmental Behavioral Pediatrics 1 Neonatal-Perinatal Medicine 1 Pediatric Allergy/Immunology 3 Pediatric Cardiology 3 Pediatric Critical Care Medicine 1 Pediatric Emergency Medicine 2 Pediatric Endocrinology 4 Pediatric Gastroenterology 2 Pediatric Hematology-Oncology 3 Pediatric Infectious Diseases 3 Pediatrics 89 Phlebology 1 Phlebology 1 Physical Medicine & Rehabilitation 9 Pain Medicine 4 Physical Medicine & Rehabilitation 5 Plastic Surgery 46 Plastic Surgery 42 Plastic Surgery Within the Head and Neck 2 Surgery of the Hand 2 #MayoRagan | @chimoose

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Appendix – Specialty Count Preventive Medicine 10 Occupational Medicine 2 Preventive Medicine/Occupational Environmental Medicine 3 Public Health & General Preventive Medicine 5 Psychiatry & Neurology 100 Addiction Psychiatry 1 Child & Adolescent Psychiatry 10 Clinical Neurophysiology 3 Forensic Psychiatry 2 Geriatric Psychiatry 1 Neurodevelopmental Disabilities 1 Neurology 25 Psychiatry 56 Psychosomatic Medicine 1 Radiology 27 Body Imaging 1 Diagnostic Radiology 17 Diagnostic Ultrasound 1 Radiation Oncology 6 Vascular & Interventional Radiology 2 Student in an Organized Health Care Education/Training Program 83 Resident 83 #MayoRagan | @chimoose

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Appendix – Specialty Count Surgery 74 Pediatric Surgery 7 Plastic and Reconstructive Surgery 22 Surgery 32 Surgery of the Hand 1 Surgical Critical Care 2 Surgical Oncology 4 Trauma Surgery 4 Vascular Surgery 2 Thoracic Surgery (Cardiothoracic Vascular Surgery) 9 Cardiothoracic Vascular Surgery 8 Surgery 1 Urology 24 Urology 24 (blank) (blank) Grand Total 1397 #MayoRagan | @chimoose