MDCalc, makers of popular online clinically useful calculators, has been around for over 12 years, and is still owned and run by the two practicing docs who founded it, Dr. Graham Walker and Dr. Joe Habboushe.
Interestingly, MDCalc has seen its largest growth in the past three years, adding dozens of new calculators and swelling its number of users. As the founders quickly pointed out, while speaking with Medgadget, they have traditionally included only the most reliable and validated scores, knowing full well that other services often include everything under the sun, which may be confusing to doctors.
The iOS version of the MDCalc medical calculator was released last year, and recently its companion Android app was released on the 15th of April. This web-based and smartphone calculator has become a steadily improving staple of use while on the clinical wards, and continues to be further refined, updated, and improved with new features and novel new scores. Examples of MDCalc use cases include calculating the osmolar gap or predicting the risk of pulmonary embolism through the Wells’ score.
Even their newly launched discussion platform, “Paging MDCalc,” is focused squarely on exposing medical evidence, hosting a very heated debate on the new vitamin C study in sepsis, including impassioned criticisms of the study and replies from the study’s primary investigator, Dr. Paul Marik. This is all in the name of MDCalc’s mission: educating physicians about decision support and evidence-based medicine.
We had a chance to speak with Dr. Joe Habboushe, a co-founder of MDCalc to understand how the product came to be, how it’s being developed, and what the future holds.
Alice Ferng, Medgadget: Tell me about yourself. What’s your background, and at what point in your career did you decide to start doing things related to med tech?
Dr. Joe Habboushe, MDCalc: I’m am an academic emergency physician at NYU/Bellevue. Originally, I’m from Philly but moved to NYC 16 years ago to study medicine at Weill Cornell, and received an MBA in Healthcare Finance from Columbia, before training in emergency medicine at St. Luke’s-Roosevelt Hospital where I met Graham. Graham is also a practicing emergency physician in San Francisco, who completed medical school at Stanford where he later returned for fellowship. Both Graham and I love to see patients – and we think our passion and excitement for medicine can be seen in MDCalc. There are so many advantages to MDCalc being run by practicing physicians. We know how doctors think, and are connected in the field. We recently realized that we are the largest medical reference owned and run by physicians. That’s very neat – very motivating.
I wasn’t always pre-med! Back in undergrad, I was a math and physics major. My parents are both physicians from Iraq, and I came from a long line of docs – I’m actually a 7th generation physician. I was different from the rest of my family because I was much more mathematical and more entrepreneurial. Going into medicine was therefore the less science-y thing for me to do. MDCalc is the perfect marriage of my passions: (1) medicine (including seeing patients & teaching residents), (2) applying science and statistics, and (3) entrepreneurship. I’m lucky to have a career that mixes what I love to do – and in a way that does so much good for our field and our patients.
Medgadget: Tell me about the conception of MDCalc and your co-founder.
Dr. Habboushe: Graham had first come up with MDCalc while he was a medical student as a pet project, a couple years before we trained together. He was a year underneath me in residency and I was so impressed by his initiative: he saw a problem [too many calcs that docs were trying to memorize] and came up with a simple solution [a clean, easy to use, doc-friendly site]. We joined forces and built the site out – added more scores, as well as content around the scores – so we didn’t just serve as a resource for those who knew the scores well, but also for those who needed a bit of help understanding how best to use them.
MDCalc met a true need and quickly became the website that doctors were using to look up scores.
Medgadget: What were the major challenges when initially creating MDCalc? How about validation of the calculators and updating equations and/or algorithms?
Dr. Habboushe: MDCalc is 12 years old, but in the last few years it has grown a ton. Over the last three years, we have gone from about 80 scores with about 15% of U.S. doctors using them, to almost 300 scores with 55 to 60% of doctors using our calculators every month. I should point out, many other medical references do NOT quote their monthly use numbers – but rather the % of docs who ever used their service – because there are so few references that so broadly apply to physicians’ practices.
And this big recent growth comes from a few different places: first of all, more and more docs are using the internet in general; secondly, medicine has created more and more clinical tools, allowing a better evidence-based backbone for clinical decisions; and finally, MDCalc has now reached many specialties which we weren’t as established in five years ago – for example, psychiatry and oncology. Clinical scores are becoming more common as diagnoses becomes increasingly complex and requires robust scores that allow for more informed and data driven decisions. We’ve actually seen a very cool impact of MDCalc: as we’ve made scores more accessible to physicians, and reduced the burden of physicians needing to memorize calcs, the more recently developed calcs are often more sophisticated than ones in the past. It used to be that a calculator creator had to sacrifice accuracy for memoriazibility – an insane concept, if you think about it: patients have less accurate evidence based treatment based on docs having trouble remembering long scores. This tradeoff is no longer a big issue when docs don’t need to memorize scores.
We are super lucky in that, as we add new scores in nearly any medical field, Google and the other search engines recognize us as the experts in this area and we quickly [within weeks or months] become one of the first search results. So, we have been able to support specialties that are relatively new to us.
We recently partnered with the American College of Emergency Physicians and American College of Gastroenterology, and are in talks with several others. Our hopes are to partner with one of the top medical societies in each specialty. They help keep us stay close to cutting edge research and guidelines.
We’ve also partnered with several peer reviewed medical journals in different specialties, who are publishing clinical reviews – this gives another level of legitimacy to our work, and provides an opportunity for our contributors to get Pubmed IDs. It’s so nice to get close to big academic institutions and work hand in hand with them – as we typically share the same goals and mission.
Sometime soon we hope to launch “MDCalc Ratings” – a scoring system similar to a “Yelp” rating but by distinguished experts in the field. MDCalc Ratings will have subcategories such as evidence supporting use of the score, the clinical utility, popularity, etc., so that the value of a score can very quickly be assessed.
Medgadget: How was MDCalc funded as a company and what is its business model?
Dr. Habboushe: We have been approached – unsolicited – at least a dozen times by funders, venture capitalists, and those interested in acquiring us. We decided to not take any outside funding, as our core mission of providing the best quality for physicians and their patients has always been our highest priority. I worked previously in a venture capital firm and know how such funding can often shift a company’s priorities a bit more towards the financial bottom line, more so than we felt comfortable. We wanted to be owned and run by us: academic and practicing physicians; nerdy, academic docs who really know and care about what is going on in our fields – this describes everyone at MDCalc! For example, when we sell advertising we have very strict divisions between church and state: what looks like an ad is an ad, and what does not look like and ad is not an ad. It surprised me to learn how often medical references can blur this line. We wanted to avoid anything that would put pressure on us to stray from this principle, which funding may have done. Of course, in the future as things change, we may need to change parts of our current business model. Things are always evolving, especially in tech.
Medgadget: Will you be creating other apps or expanding into other spaces as the company advances?
Dr. Habboushe: We want to focus on what we do best: medical calculators and clinical decision scores. The way I look at this is that we are the best medical calculator and decision making tool in the field, and we want to continue leading in this field. I think there’s a lot more that we can do in this space: we are constantly developing more content and adding scores – trying to reach doctors wherever and whenever they need support in making clinical decisions. We are partnering with medical societies, peer reviewed journals, top academics in our field, and other great medical references. We would rather be the best providers of clinical decision tools than try to go too far beyond what we know best. For example, we aren’t trying to be an online version of a medical textbook, like UpToDate or Medscape has done. That is far from what we are and where we excel.
We recently began hosting TheNNT.com – another evidence-based medicine (EBM) site that’s aimed for quick, point-of-care support like MDCalc. TheNNT.com stands for the “number needed to treat,” a way to quantify the benefit of a treatment, and does Cochrane-like reviews that are easy to use when seeing patients. We have a great partnership with the AFP (American Family Physician) journal, which has a Medicine by the Numbers section publishing our reviews.
Medgadget: What makes MDCalc unique? What are some key and interesting upcoming features?
Dr. Habboushe: We are constantly finding new ways to make MDCalc more useful for the millions of physicians who use us around the world, and the tens of millions of patients they take care of. It is a ton of fun.
The way we look at it, there are at least four use cases for our calculators.
- Use Case #1: The Doc knows the calculator name and how to use it.
They simply need to look it up as a reference. Five years ago, that was the only way you could really use a calculator – and it took a while for docs to get there.
- Use Case #2: The Doc knows the calculator name but aren’t 100% confident to use it clinically.
A few years back we started building out reliable and concise content for each score, written by unbiased experts in the field, making it easy to read and apply while seeing a patient. This allows for folks who may know the name of a score, but not really know all the details. The content for each of these scoresis written by experts who are not the original creator of the score and quickly explains when to use it (correct indications), how to properly apply it, what works well and does not work well, and what evidence is behind the score – how robust it is. It also includes what to do next after you get the score. In addition to that we separately interview the calculator creator for their specific input.
- Use Case #3: The Doc wonders “could there be a useful calc for this case?”.The 3rd use is for folks who don’t even know the name of the score! We’re really excited about this new function: a way to present a clinical scenario to MDCalc and receive a list of calculators that should apply – along with the content explaining each score. We just launched this discovery feature this year (and filed a patent on it). For an example, go to the MDCalc’s search bar and select that you are looking for calculators related to PEs that help with diagnosis – and you get scores such as Wells, Geneva, and PERC. After you diagnose a PE, search for those related to PEs and prognosis, and you get a whole new list (PESI, POMPE-C, Khorana, etc). Each score will have a quick 1-liner about the score, and you can click on the score if you want to learn more about it and how to use it. Our users love this – and somewhat surprisingly, it’s not only medical students and residents. So many practicing docs don’t have great ways to about new scores. Maybe they stumble upon them in a conference or podcast, or hear from colleagues, but this is haphazard and inconsistent, at best. On top of that, the world of clinical scores is evolving so rapidly, it’s hard to keep up even for those at big academic centers. We believe this new search tool has already made a huge difference and will continue to be useful as the number and complexity of scores continues to grow.
- Use Case #4: Teaching patients what comes next.
The last use case is to show your patients, and best explain your clinical decisions to them. To this end, we are working on pilot projects to help docs best communicate results with their patients – and where appropriate, have effective shared decision making conversations with them. Recently, we published an article on Paging MDCalc that explored how to discuss surgical risk with your patients and the role that clinical decision tools can play when presenting and quantifying those risks.
Finally, we are in the process of building out a great Scientific Advisory Board of the best known calculator creators and physicians – folks like Dr. Steven Stack, the most recent AMA president, and calculator creators such as Chads-VACS’s Greg Lip, GCS’s Graham Teasdale, Canadian and Ottawa Scores’ Ian Stiell, and many more. It is incredible for all of us at MDCalc to be able to interact with and get guidance from these giants and celebrities of our field, who have made medicine so much better for all of us, so that we can make it better for our patients. Which in the end, is what all of this is about.
Product page: MDCalc Apps…