The New England The New England Journal of MedicineJournal of Medicine

Readership Preferences Readership Preferences ofof

Influential PhysiciansInfluential Physicians

September 2004September 2004

NEJM Influential Physician NEJM Influential Physician Study GoalsStudy Goals

To develop a methodology to model behaviors of To develop a methodology to model behaviors of influential physiciansinfluential physicians

To learn where The New England Journal of Medicine To learn where The New England Journal of Medicine and its leading competitors rank in reading habits and and its leading competitors rank in reading habits and perceived value across the influence spectrumperceived value across the influence spectrum

To differentiate the clinical information habits of To differentiate the clinical information habits of highly influential physicians from those of less highly influential physicians from those of less influential physiciansinfluential physicians

“How do you measure influence?”

“Who are the influential physicians?”

“What do they read and why?”

“Which journals are “must read” journals?”

MethodologyMethodology

Mail survey to 4000 physicians in four specialties: Mail survey to 4000 physicians in four specialties: cardiology, infectious disease, internal medicine, and cardiology, infectious disease, internal medicine, and oncology.oncology.

Sample was randomly selected from the AMA file. NEJM Sample was randomly selected from the AMA file. NEJM was NOT identified as the survey sponsor.was NOT identified as the survey sponsor.

Survey package included a one-page cover letter, 3 page Survey package included a one-page cover letter, 3 page survey tool, $5 check, and a prepaid reply envelope.survey tool, $5 check, and a prepaid reply envelope.

Two mailings were sent. Field period was June 1 through Two mailings were sent. Field period was June 1 through

August 16, 2004.August 16, 2004.

3964 surveys were delivered, 953 returned (response 3964 surveys were delivered, 953 returned (response rate: 24%)rate: 24%)

Influence FactorsInfluence Factors

We identified 13 influence factors – all factors were rated We identified 13 influence factors – all factors were rated equallyequally

Sub-specializationSub-specialization Numbers of years since residencyNumbers of years since residency Practice setting and sizePractice setting and size Position/title (indication of leadership position)Position/title (indication of leadership position) Publications in peer-reviewed journalsPublications in peer-reviewed journals First or second author statusFirst or second author status Participation in clinical trialsParticipation in clinical trials Medical meetings attendedMedical meetings attended Work activities (patient care vs. research/education)Work activities (patient care vs. research/education) Type of patients (general or referrals)Type of patients (general or referrals) Medical society leadership positionsMedical society leadership positions Author/reviewer of treatment guidelinesAuthor/reviewer of treatment guidelines Author/reviewer for medical journalsAuthor/reviewer for medical journals

Weighting of Influence Weighting of Influence Factor ScoresFactor Scores

Leadership Activities

51%

Practice Profile

27%

Education

Specialization22%

Percentage of total possible points assigned to each category

Aggregate Influence Aggregate Influence ScoresScores

0

10

20

30

40

50

60

70

80

High Medium Low

%

ID

Onc

Cards

Gen IM

HI >14; MI 10 – 14; LI <10

Information Gathering Information Gathering HabitsHabits

This study was designed to track This study was designed to track information gathering habits of respondents information gathering habits of respondents and tabulate the data based on the and tabulate the data based on the “influence” of the respondents – placing “influence” of the respondents – placing respondents in three categories High, respondents in three categories High, Medium, and Low influencers.Medium, and Low influencers. We first measured which information sources We first measured which information sources

respondents considered important respondents considered important We then asked a series of questions to measure We then asked a series of questions to measure

which journals respondents considered importantwhich journals respondents considered important Finally, we asked a series of questions designed Finally, we asked a series of questions designed

to measure how respondents used the to measure how respondents used the information reported in medical journalsinformation reported in medical journals

Importance of Information Importance of Information Sources Sources

by Influence Categoryby Influence Category

0102030405060708090

100

High

Medium

Low

Information sources fall into roughly three tiers (in order of importance): 1)journals and meetings 2) textbooks, experts, trial

reports 3) Pharmaceutical information

Use of Information Use of Information Obtained from JournalsObtained from Journals

Journals are read for many reasons and the Journals are read for many reasons and the information contained in journals is used for information contained in journals is used for many purposes – this study was designed to many purposes – this study was designed to measure how information from specific journals measure how information from specific journals is used in clinical and academic settings.is used in clinical and academic settings.

We asked a series of 8 questions designed to We asked a series of 8 questions designed to measure the uses of journal content. measure the uses of journal content. Respondents were asked to rate their core Respondents were asked to rate their core specialty journals. We asked them to tell us to specialty journals. We asked them to tell us to what purposes they used information obtained what purposes they used information obtained from these journals. The purpose of this series from these journals. The purpose of this series of questions was to try to measure the impact of questions was to try to measure the impact of individual journals on patient care and of individual journals on patient care and research in the specialty groups surveyed in research in the specialty groups surveyed in this study.this study.

Use of Information Obtained Use of Information Obtained from Journals by Specialists – from Journals by Specialists –

Top 3 JournalsTop 3 Journals

0

10

20

30

40

50

60

70% ofResp.Who Chosetitle

“The information from this journal helped me prepare clinical seminars, lectures, journal articles…”

CardiologistsInfectious Disease

Oncologists

Use of Information Obtained Use of Information Obtained from Journals by Specialists – from Journals by Specialists –

Top 3 JournalsTop 3 Journals

0

10

20

30

40

50

60

70

80

“Made patient-care decisions based on information from this journal”

% ofResp.Who Chosetitle

Cardiologists Infectious Disease Oncologists

Reading HabitsReading Habits

The final questions of this survey The final questions of this survey were designed to quantify were designed to quantify reading habits of each specialty reading habits of each specialty group. The objective was group. The objective was twofold:twofold: Determine which journals Determine which journals

specialists in each group specialists in each group considered a “must read”considered a “must read”

Measure depth of readership of Measure depth of readership of “must read” journals“must read” journals

Oncology: “Which of the following Oncology: “Which of the following journals do you consider “must journals do you consider “must

read?”read?”Depth of Readership by Title

0%

25%

50%

75%

100%

Every Issue Some issues Few issues Not a Must Read

JCONEJMAIMBloodJAMACancer

Internal Medicine: “Which of Internal Medicine: “Which of the following journals do you the following journals do you

consider “must read?”consider “must read?”

Depth of Readership by Title

0%

25%

50%

75%

100%

Every Issue Some issues Few issues Not a Must Read

NEJMAIMJAMAMayo ClinicCleveland ClinicArchive of IM

Infectious Disease: “Which of the Infectious Disease: “Which of the following journals do you consider “must following journals do you consider “must

read?”read?”

Depth of Readership by Title

0%

25%

50%

75%

100%

Every Issue Some issues Few issues Not a Must Read

NEJMCIDAIMJIDJAMAArichive of IM

Cardiology: “Which of the Cardiology: “Which of the following journals do you following journals do you

consider “must read?”consider “must read?”

Depth of Readership by Title

0%

25%

50%

75%

100%

Every Issue Some issues Few issues Not a Must Read

JACCNEJMCirculationJAMAAIM

Study ConclusionsStudy Conclusions

The evidence shows that a larger percentage of The evidence shows that a larger percentage of oncologists and infectious disease physicians participate oncologists and infectious disease physicians participate in activities that could increase their influence among in activities that could increase their influence among their peers.their peers.

Physicians have many information sources, the most Physicians have many information sources, the most important sources of information are journals and important sources of information are journals and symposia (these two sources are even more important for symposia (these two sources are even more important for HI physicians).HI physicians).

The evidence shows that a very limited number of The evidence shows that a very limited number of journals have a large impact on patient care and research journals have a large impact on patient care and research decisions (in the specialty groups surveyed). The impact decisions (in the specialty groups surveyed). The impact of a journal tends to be limited to a specific specialty of a journal tends to be limited to a specific specialty interest (with some important exceptions).interest (with some important exceptions).

The list of “must have” influential journals is very shallow The list of “must have” influential journals is very shallow in each specialty group (usually limited to no more than 3 in each specialty group (usually limited to no more than 3 journals per specialty). journals per specialty).

Study ConclusionsStudy Conclusions

A medical library A medical library could build a core could build a core journal list that journal list that would cover most would cover most of the important of the important “must have” “must have” research for these research for these four specialties by four specialties by purchasing the purchasing the following 8 following 8 publications:publications:

Annals of Internal Annals of Internal MedicineMedicine

BloodBlood CancerCancer CirculationCirculation Clinical Infectious Clinical Infectious

DiseaseDisease Journal of the Journal of the

American College of American College of CardiologyCardiology

Journal of Clinical Journal of Clinical OncologyOncology

New England New England Journal of MedicineJournal of Medicine