Good morning, everybody. Welcome to Doximity's Inaugural Investor Day. I'm Perry Gold, and I'm the Vice President of Investor Relations here at Doximity. On behalf of everyone at the company, we're thrilled you could join us, and we appreciate you taking the time out of your busy schedules. Before we begin, I've got a couple of housekeeping items. Firstly, for those of you who aren't in the room today, the slides will be shown alongside our webcast and will be available on our website at investors.doximity.com after the event. In addition, we'll be making some forward-looking statements, as we typically do. This is available on our website, as well as on file with the SEC. We'll also be referring to non-GAAP financials today.
The reconciliations from GAAP to non-GAAP are available on our website, and there's a slide on this in the appendix of the presentation. Finally, after the live presentation today, we'll be issuing a press release, which will recap our key announcements. Okay, let me give you a brief outline of the agenda for today. First, you'll hear from our CEO, Jeff Tangney, who will discuss our progress since IPO two years ago. You will hear from our co-founder, Dr. Nate Gross, who will provide an in-depth product demo. Following that, we'll move on to our physician panel, where you'll have the opportunity to hear from leading physician technology experts. After a short break, we'll hear from two of our newest executives, Ben Greenberg and Craig Overpeck, who will give you a comprehensive overview of our commercial businesses.
We'll wrap up today's presentations with our CFO, Anna Bryson, who will discuss our financials, and finally, we'll close with Q&A. Okay, with that, we're gonna go ahead and get started with our Co-Founder and CEO, Jeff Tangney. Without further ado, Jeff Tangney.
Thank you, Perry, and thank you, everyone, for joining us here today. It's been a busy couple of years since our IPO, so I will dive right in. For those who are new to us, we are the physician cloud company. We build software to help doctors be more productive, so that they can provide the best care for their patients. Today, over 80% of all U.S. physicians and over half of all U.S. NPs and PAs use our platform. Our clients include all of the top 20 pharmaceutical companies and all of the top 20 hospitals, and that's a distinction we think is entirely unique within our industry. We did $419 million in revenue last year, and $184 million in EBITDA for the fiscal year ended March 31st.
Beyond the numbers, I actually think it's our values that have distinguished us the most as a company. We believe that docs and dorks, that is, physicians and engineers, working together side by side, is the best way to actually GSD, as we say, get stuff done in healthcare. That GSD spirit has helped us grow a lot in the last five years. Our platform lets our clients connect with physicians about new treatments, clinical trials, and patient referrals. We then can measure our client's return on investment or ROI, using third-party claims and prescription data. Our median program ROI is more than 10 to one, and it doesn't take many new patient surgeries or prescriptions to cover the cost of our programs.
That proof of value has allowed us to expand nicely within these blue-chip clients, earning us a 124% net revenue retention rate among our top 20 clients last year. We're proud that our biggest and most sophisticated clients are also our fastest-growing on both an absolute and percentage basis. Finally, as you can see, we're also growing profitably, with a 90% gross margin and a 44% adjusted EBITDA margin last year. Compared to our IPO in this very room two years ago, what's changed? We've grown a lot financially. Our revenue, since we were here two years ago, has doubled, and our EBITDA has nearly tripled. We're also pleased to announce here for the first time today that our paid enterprise subscriptions are up 70% since our IPO.
In total, we now serve over 40% of all U.S. physicians with tools to call their patients and check their coverage schedules. As an investor, what's important here is the durability of this enterprise workflow engagement. It is sticky at both the doctor and at the hospital level. For doctors, calling patients or checking schedules with us is just a daily use case, a daily event, and once they're set up, there are real switching costs to moving their phone lines and templates to other places. For hospitals, there is a legitimately lengthy, like, months and sometimes years, privacy review for any new partner that plugs into their private data, into their electronic health records or EHRs. That's why hospital workflows are so slow to change. Coincidentally, that's why doctors still carry pagers.
Speaking of pagers, we work with them now, too, and thanks to our Amion acquisition. We bought the scheduling company 14 months ago, and we've since rewritten their full tech stack to run seamlessly within our site. It's the sort of tuck-in acquisition we'd like to do more of, because workflow is our second act. This chart shows our quarterly active telehealth providers or prescribers over the past four years. We've never shown this chart before, but you could see that pre-pandemic, we had less than 100,000 doctors, NPs, and PAs that were using our telehealth tools. When COVID hit, we soared to over 300,000, but then we dipped in mid-2021 as telehealth usage waned. Now, if we had followed the broader telehealth trends, we would have continued to decline. Instead, a funny thing happened.
Docs got back to their offices, and they told other docs about this great new app called Doximity, and how they could use it to call their patients. Those doctors told their CIOs, who eventually put us inside their EHRs, where we got even more docs to come and use us. The CIOs went and told KLAS, the premier hospital IT ratings body, who gave us the Best in KLAS award for telehealth the last two years, beating out Microsoft Teams, Zoom, and many others. What's more, 86% of those clients told KLAS that we're now, quote, part of their long-term plan, end quote. 96% of those clients renewed their contracts with us last year, despite the many hospital mergers. In short, hospital IT departments are learning to like us. We've become part of their workflow.
We save them money, we keep their doctors happy, and that's a real rarity in hospital IT circles. Now we cross-sell. MedStar in D.C., Maryland, is a good example. They liked our telehealth, after a year, they bought our scheduling services, too. The two apps integrate well inside our physician cloud, now we're proud to power their 5,000 doctors as they see patients every day and check their schedules. You know, one of the reasons we love working on workflow and streamlining physician time, is because there's just so much low-hanging fruit. 80% of U.S. healthcare documents are still sent via snail mail or fax, and 78% of U.S. physicians report IT-related burnout.
We'd love to help, and frankly, so would our clients, as physicians today make 73% of the financial decisions in our $4.3 trillion U.S. healthcare industry. You know, when we started the company, we joked that we would ax the fax in healthcare. Letting doctors unplug their home fax machines really did turn out to be one of our first big hits. As we look ahead, if we could ax the fax with smartphones, we can also cut the scut with AI. Scut work, or tedious note and letter writing, bureaucracy, it's half of what physicians do these days. It takes precious time away from seeing their patients. Little wonder that our new DoxGPT.com pilot was a hit at our Physician Weekend Summit a couple months ago.
Indeed, doctors who've used our DoxGPT AI letter and fax service, in a survey of 322 of them, estimate that half of their admin and bureaucracy time could eventually be saved by artificial intelligence. We see it in the thousands of prompts doctors are sharing and rating on our site. There are prior authorizations and appeal letters for insurers, there's service animal letters for airlines, ADHD letters for students and teachers, follow-up instructions for patients, and so on and so on. A few hospitals have already asked us if they can pay to license DoxGPT for their staff. We're being cautious about having all the right guardrails in place, we hope to offer it in our post-call workflow later this year. Building on this GPT expertise with our 300 engineers, we've announced a new site today called BestDoc.ai.
Based on our existing hospital referral and appointment services, used by doctors to find subspecialists, we are gonna help patients find the right nearby subspecialists for their specific condition. It's in a closed beta right now, but will be open in a few weeks. All right, that's it for my overview. In short, we've doubled our revenue, nearly tripled our profit, and we've become an integral part of the post-COVID physician workflow. All in all, a pretty good couple years. As we look to the future, we think it's bright, because AI is gonna start to level the playing field between doctors and insurance companies. For all that has changed, I'm probably, though, most proud of what hasn't changed here at Doximity.
As a founder-led, mission-driven docs and dorks tech company, it's our life's work to bring technology to medicine, to tackle healthcare's complex problems with both humility and resolve. With that, I have the pleasure of introducing the top of our co-founder pyramid, Dr. Nate Gross. Nate?
Thanks, Jeff. Hello, everyone. I get to be the top of our founder pyramid, not because I'm a doctor, because my co-founder, Shari, easily has the strongest arms. We started Doximity with a mission: to help physicians be more productive and provide better care for their patients. The products I'll be taking you through are purpose-built for physicians' needs. We're putting technology to work for doctors instead of the more typical other way around. That guiding principle is what makes Doximity essential and trusted as we help doctors in their practice. Let's start with Amion, the on-call scheduling platform we acquired last year that has become a cornerstone of our physician cloud. It mobilizes that printed on-call sheet at the nurse's station. Our lock screen widget shows I'm about 1/3 through my shift.
I can review my upcoming schedule and coordinate with coworkers across Amion's 200,000 clinician schedules. Let's look up the cardiologist on call. Here he is, Dr. John Mohammed. I can compare our calendars or even swap shifts, and I can get in touch with him about a patient, whether on his pager or through a secure message, or through a seamless integration into our Dialer suite. We're increasingly the way doctors call patients from their EHRs and call colleagues from their on-call schedules. Let's take a closer look at Dr. John Mohammed by opening his Doximity profile. He's a heart failure specialist and clinical leader with over 500 colleagues on the platform. These are doctors he can selectively share private backline information with to be available for a referral or urgent curbside consult.
Our verified member profiles digitize the traditional curriculum vitae, highlighting clinical expertise and reflecting his unique affiliations and training. Our robust data builds on a useful network effect for each physician in many aspects of their career. For example, tapping on his medical school, class of 2002, finds his classmates nationwide, useful for referrals, new jobs, or connecting during a conference. Continuing the physician profile, licensure, board certifications, awards, clinical trials, research, and press mentions differentiate each member on the platform, and in aggregate, these profiles become a master rolodex of U.S. medicine, enabling physicians to quickly connect and securely collaborate on patient treatment or identify the appropriate expert for patient referrals. For instance, let's find a specialist for patients with aortic stenosis in need of TAVR or transcatheter aortic valve replacement in Atlanta. Here are some expert surgeons and interventional cardiologists and the physicians we have in common.
Medicine is an evolving field. It's important for physicians to stay up to date on the latest treatments and research. The ever-increasing subspecialization of medical expertise and sheer volume of emerging science can make keeping up with it all increasingly difficult. Our news feed aims to address these challenges at opportune moments in their workday by delivering news and information that is customized to each individual physician's clinical practice, patient population, and professional relationships. News cards can take other forms, like updates to clinical guidelines or the latest publications from your colleagues, or their mentions in the press, or what patients are reading in the lay press and how that maps back to a clinical study. Interactive polls, short-form videos. Certain articles and videos in the news feed are marked as sponsored content.
We co-author this content with our partners. It follows the same native formats and is designed to be similarly highly relevant and high fidelity for our members. If we can improve the signal-to-noise ratio for doctors, we can help them be their best at keeping up to date and having enough time for their patients and their families. Doximity Clinical Cloud supports physicians in their day-to-day practice of medicine with mobile-friendly and easy-to-use clinical workflow tools such as digital faxing and secure messaging, designed to digitize workflows that are often highly manual and inefficient. Imagine for a moment if most, let alone any, of all the back and forth required to assemble the 100 or so here and online today, hundreds, had to be done by a fax. Incredibly enough, that's still often the reality of medical professionals coordinating care today.
Our digital fax and e-signature tools allow physicians to send and receive HIPAA-compliant faxes through our mobile app or website. Members can electronically sign, edit, date, add attachments, even CC their EHR, eliminating the bottlenecks of the paper and ink toner workflow. This streamlines patient care and digital record keeping. On to Doximity Dialer, which allows members to convert their smartphone or computer into a telemedicine hub. This helps doctors successfully connect with their patients, reducing complexity, preventing costly virtual no-shows, and helping optimize their time. Dialer allows doctors to make calls from their cell phone while protecting their privacy. They can choose the caller ID number that the recipient will see. This makes it more likely that patients answer the doctor's call on the first try.
These caller IDs are verified with a special process we have through the telephone carriers, so our doctors don't get marked as spam. Before Dialer, physicians would have to call from their office landline or dial star 67 if calling from their mobile phone. Today, I'm pleased to announce integrated directories, which make it easy for physicians to skip the operator and navigate to call any lab, nursing station, or backline in their health system. We're launching with over 50 hospitals. We also work with the most widely used electronic health records to enable one-touch dialing, or for much of U.S. healthcare still stuck on land-locked record systems and paper charts, we're able to leverage the latest in computer vision to dial the number using the camera.
Saving even a handful of seconds per call adds up to thousands of hours across a platform that serves tens of millions of patient calls each year. Let's start a call. If we called the lab, we might end up on hold. We've all experienced the hassle of waiting on hold. Well, today, we're announcing our intelligent hold assistant. This allows the doctor to leave the call and get back to work. We automatically detect when a human joins the call so that the doctor can then rejoin. If we're on with a patient and we want to convert to a video visit, no problem. The patient receives an automated text message with a link to easily join the video call. No app downloads, portal passwords, or steps that often lead to missed visits and missed revenue. It just works on essentially any smartphone.
Even with this easy of a telehealth platform, there's often a bit of waiting for the patient to join. At our scale, that adds up to doctors spending over a year per month waiting. We've been building while you wait widgets that have been a hit. Some docs prefer a clinical case to stay sharp, others save articles to read later. The most popular, calming, meditative videos. It also provides an unprecedented golden moment to connect with our partners in meaningful win-win ways. Once the patient has joined, it's easy to add a family member with one click, or hand off the call to another member of the care team, or even bring in an interpreter. Equity of access to telehealth is a priority for our product team.
Since smartphones are the most commonly used piece of technology across all patient demographic groups, we're able to address disparities that exist with desktop solutions. Our seamless transition between video or voice visits make us a preferred choice for rural patient populations who may not have sufficient bandwidth for video. Patients prefer when doctors use professional name badges in their video visits. You can see an example on the slide. It's a bottom-of-the-screen overlay, which shows the doctor's name, credentials, specialty, and logo, a bit like a TV news anchor, which we have found increased patient ratings by, on average, half a star. Our foundation of over 80% of U.S. doctors, broad app install base, and physician-centric product design led to strong adoption when the pandemic hit the U.S., and it stayed strong.
Over 380,000 clinician providers used our telehealth tools in the last quarter. When the call ends, it's easy to text the patient useful follow-up information like education, referral, contact info, or custom workflows, as well as read niche news and colleague updates. To close, I'll demo a couple projects from our R&D labs. It's been less than 200 days since ChatGPT was released, in that time, it's certainly proven to be an exciting and potentially transformative new technology. When it comes to technology leaps, too often physicians are not given a seat at the table. We're excited to invest, to give them that seat and empower them to navigate this technology according to their needs. After a decade of working side by side with physicians, it's no surprise that their first interests were around reducing administrative burden.
DoxGPT can streamline time-consuming administrative tasks. Here's an example of a popular use case, writing prior authorization appeal letters to insurance companies. Let's write one for a colonoscopy. This is where integration with Doximity's extended platform creates an extra advantage. These appeals often have to be faxed to the insurance company. No problem for our integrated faxing tools. DoxGPT has grown steadily via word of mouth to now serve thousands and thousands of clinician prompts each week. Doctors are sharing their most useful prompts and use cases with one another and grading responses on utility and clinical accuracy. This continuous feedback is helping us prioritize our roadmap and identify where AI can help doctors most. Today, we're excited to show another AI use case from our R&D labs, BestDoc.ai, which taps into our existing referral and appointment services.
We've all had a loved one struggle to navigate the U.S. healthcare system to find the best doctor for their needs. Doctors on Doximity have access to specialists nationwide at their fingertips. Doctors speak their own version of medical Latin. Just like DoxGPT helps doctors crosswalk communication to patients, like explaining the condition at their preferred literacy level, we can now apply AI to help identify and connect with the best expert for a disease, condition, or procedure. Let's find one now. How about, "My family member needs a radiosurgery for a pituitary adenoma?" Here in New York. Here are some nearby experts, their qualifications, and links to learn more or schedule an appointment.
These conversational results can adjust to any level of expertise and tap Doximity's deep knowledge of physician CVs, patient bases, and even a trust graph of who physicians trust to care for their own loved ones. With over 80% of physicians, at Doximity, we're able to leverage emerging AI technologies to achieve an impact that others can't due to our network effect, proprietary data, and unique touch points. More broadly, we're enthused to keep working with doctors to leverage AI's potential and streamline workflows across all our physician cloud. This quarter, we're introducing a new, more comprehensive metric, unique quarterly active workflow providers. This new metric includes all credentials authorized to prescribe medications and measures their engagement across our physician cloud, which today includes telehealth, scheduling, digital fax and e-signature, and DoxGPT.
We're excited to report that we had more than 500,000 quarterly active workflow providers in Q4, and we're still growing. Perhaps the stat we're most proud of comes with the reviews we get from our clinicians. Over 150,000 members rating us an average of 4.8 out of 5 stars in the App Store. That's a few highlights about ways we build tools to serve doctors, and I'd like to now hand it off to Jeff to introduce our physician panel.
Thank you, Nate. That was terrific. We're gonna take a moment to bring some chairs up here and ask our physician panelists to come up. As we get set up, please join me in welcoming our physicians here today. We have six in the room. The first is Dr. Regina Benjamin, sitting right over here. Wave, Regina. There she is. Regina runs her Bayou Nonprofit Clinic using Doximity Dialer, which is how I met her. She's probably better known for being the 18th Surgeon General of the United States under President Obama. Regina, we appreciate your service and advice, and thank you so much for joining us today. All right, next up, we have our five physician technology panelists. Each is a daily user of Doximity, and each has won a Doxy Award, which you see up here.
It's our Oscar-like award that we give out at our Physician Summits each year for those who had the best product idea of the summit. First up is Dr. James DuRant, who heads up a pediatric center at Novant Health with the UNC School of Medicine. He had the great idea at one of our summits to use PIP technology or picture in a picture browser for our EHR integrations, which lets him see his patient and their medical record all on the same screen. Prior to his idea, we spent a lot of time, honestly, wrestling with the EHR partners to fit their aspect ratios and such within their app. It's much easier and cleaner just as an overlay that you can move around like Netflix or YouTube. Next up is Dr.
Fatima Cody Stanford, an obesity medicine physician at Mass General Hospital and associate professor at Harvard Medical School. Fatima is one of the foremost experts on obesity medicine, with over 180 peer-reviewed articles, 200 press interviews, including The Wall Street Journal, The New York Times, and 60 Minutes. I first noticed Fatima's profile because her press mentions, which our bots automatically pick up and add, she was breaking them. There were too many. It's terrific to have her there. As a longtime advisor, she's given us a lot of great product ideas, but probably our favorite is Conference Connect, which you see here. It's a pre-conference e-mail and website that tells you, as a doctor, who else you know is attending a national specialty conference that you're going to.
Rather than wandering around a strange exhibit hall or city alone, makes it easier for physicians to meet up with former classmates and coworkers. Next up, we have Dr. Tommy Korn, fresh off a red eye from Apple's event in Cupertino yesterday. He's an ophthalmologist, a technologist for sure, and chief innovation officer at Sharp HealthCare in San Diego. While he's given us a lot of great ideas, we'll just mention his most recent for us, which is our new scheduling integration with Calendly, helping doctors schedule industry meetings. Next up, we have Dr. Lea Ann Chen, who is a gastroenterologist, clinical trial leader, and assistant professor at Robert Wood Johnson Medical School. As an academic physician, Lea Anne has to deal with a lot of residents, and she needed to fax a lot of recommendation letters each year.
She gave us the idea to make recommendation letter prompts, a category on DoxGPT, and it became one of the most popular ones. We appreciate her helping us again, cut the scut. Finally, moderating our panel today is Dr. Chris Longhurst, who is the chief medical officer and chief digital officer at UC San Diego, and one of the top physician technologists in the U.S. You've probably seen his quotes in The Wall Street Journal and elsewhere about what's new with GPT technology inside EHRs. He's also one of our Deca Docs, which means he joined us at our first summit over a decade ago. I met him when he was CMIO at Stanford, and that's when he first told me about U.S. News Best Hospitals rankings. I didn't know much about them at the time, but he suggested that, you know what?
I take the time, get on the plane, fly out to D.C., and meet with them. Well, 10 years later, thanks to his advice, intros, and nudging, U.S. News has become one of our most strategic partners. You see here, we're proud to be the exclusive polling booth for their Best Hospitals rankings. All right, without further ado, I'll hand it over to Dr. Longhurst. Welcome.
Thank you very much, Jeff, thank you, Dr. Gross, for the terrific introduction and overview. It's really our privilege to be here today, I think all of us are in clinical practice. You're gonna hear a little bit today about how we use these tools in our clinical practice, which is really the first question. Dr. Chen, tell us a little bit about how you use these tools in your day-to-day clinical practice.
Sure. I think I first started using Doximity for the fax feature. I've always worked in academic, you know, medical center, and if you guys know anything about how academic hospitals are made, every few years, like, another building is kind of attached, you know, to the main hospital. Anytime I wanted to send a fax or get, you know, fax lab results for patients, I had to leave my office, go six floors down, walk across, you know, the entire hospital, go 10 floors up to the endoscopy suite, pick up the fax, and then, you know, make the trip back. I just couldn't take it anymore.
I knew that there were other, you know, eFax services, but, you know, we work with PHI and patient information, I was always scared to use any of those things. You know, I love the fax feature, and I signed up for that. Afterwards, I think every, you know, new feature or product that gets made, you know, I, it's something that I really attached on to 'cause it just helps in my day-to-day, you know, work. The other ones that, you know, I use almost daily is the Dialer. I use it to connect with my patients. I also use it to get in touch with other referring physicians.
You know, we work as a referral center, and we have docs that come in and, or docs that refer patients from, you know, across the state, and sometimes you just need a little bit of extra information, or you wanna be able to personally, you know, provide the feedback, you know, after you've assessed their patients. It may not be somebody that you know directly, but almost always I can find them on Doximity, and I can give them a call or send them a message, and we can find a time to connect, and it's, you know, made a world of difference in terms of patient care.
Awesome. Dr. Korn, how about you?
You know, timing is everything. The pandemic really got me using the Doximity app. You know, many of you have had a parent, grandparent, who's had some type of surgical procedure, right? They've gone to the doctor. They probably have talked to you and said, "You know, I don't remember what the doctor said. I'm stressed out. They gave me all these instructions. I'm confused." One of the cool things about Doximity that has this Dialer text, I can actually text them all the information, what to do before surgery. We can also text them after their surgery to check up how they're doing. You know, as an ophthalmologist, I do anywhere from 15-20 eye surgeries a week. Imagine calling these patients. You know how long that would take? They just don't answer the call.
You text them, guess what? Literally, all these senior patients are glued to their screen. Red, red, red. I mean, my gosh, you know, I can't believe it. I've scaled myself. What would normally take me two hours to do, or my staff, I can call 20 patients, text 20 patients in less than two minutes. You know, how cool is that? It allows me to scale, and these are just like the iceberg of all the tools that are available, and they're coming. It's really a huge satisfier and a burnout re-reduction for me as a clinician.
Dr. Stanford.
Absolutely. I think that the pandemic is a pivotal point, but I'm gonna go prior to the pandemic to really talk about how I initially really enveloped Dialer into my workflow. We were doing asynchronous visits for telehealth at Mass General before we kind of moved into this world of doing synchronous care, and we would have to call patients. How would I call patients, and they would actually pick up? Because most would not pick up. If I use Dialer using my office line, I was finding that over 90% of my calls went answered, and so I was able to connect with patients even when I was doing it in an asynchronous fashion. Fast-forward to the pandemic, and I will note that I was only delivering 10% of my patient care via telemedicine prior to the pandemic.
I'm now delivering 90% of my care via telemedicine at the request of patients. They no longer have to come into downtown Boston, find somewhere to park, pay $40 per hour because that's how we roll in Boston. They can just come on, get on the screen. What happens is the Epic's in-integration for getting going with patients can sometimes be cumbersome. They have to remember their password. They have to log into our patient gateway. Many of my patients are racial and ethnic minority populations, many from other countries. How are they going to do that? When I can't get in touch with them, which is more often than I would like to admit, I'm able to use the Doximity Dialer feature to connect with them.
They're able to get on immediately, and they no longer are flustering with trying to find their passwords and connect. That's been invaluable for my patient care. It makes my patient no-show rate less than 1% on an annual basis, which is what I'm sure the hospital wants. For me, it's what I want for my patients, to provide the best possible care. As we think about the work that I do in obesity medicine, what we saw during the pandemic was that obesity became the number one risk factor for both morbidity and mortality during the pandemic. I lost 0% of my patients during the pandemic.
A lot of that had to do with the fact that for 14 months, I was able to connect with them via telemedicine and deliver care and see over 96% of them actually lose weight during the pandemic, which was a shift from what we saw in the American population. I wanna thank Doximity for that, but I do have one other thing to note. Just this morning in my hotel room, before I walked over to here, to be here today, I actually got an urgent page from my husband, because my pager was at home. I'm not on call this week. He said: "Someone's trying to contact you from the hospital." Contacted the hospital, there was a patient that was in the medical infusion unit. I was able to call them through Doximity.
They assumed I was still in Boston at the hospital, connect with them immediately, and allay all of the fears of this patient that was set to undergo a transfusion this morning. I just wanted to know that that can happen. I had no idea I was gonna need to use it this morning. I was shocked that I needed to use it, here I am, being able to be here on the panel. The patient's doing fine. The nurse who was freaking out is no longer stressed about everything, and we're able to move on with life and just carry out. Those are things that really brought me to the panel and keep me here.
Thank you, Dr. Stanford. Compelling story.
Yeah.
Dr. DuRant?
Yeah, to echo Fatima, you know, the Dialer just gives us power as physicians to be connected with our patients, and I think that's so important now when we live in this kind of asynchronous message back and forth, where we can just pick up the Dialer and connect with voice, and that's awesome because I think we've gotten so far away from that. I'm a developmental behavioral pediatrician. That means I, you know, assess families, their children for autism or developmental delays, and there's almost a year wait to see me. What I utilize the Dialer for is to call the patients before the visit. They've been waiting months to see me, and they can hear my voice that I send straight to voicemail so that they feel a little bit more comfortable seeing me before the visit.
When I have patients come in, they tell me, "I love getting to hear your voice. It helped lower my anxiety going into this visit." I do that before the visits for my patients, but I also do it to make phone calls back to the patients. You know, our clinical day is packed, you know, of just patient care, patient care, patient care. We get a lot of messages from patients, phone calls that we need to make or back and forth messages that we're supposed to make. Doximity lets you one-click call the patient back on your terms. I've also got a wife and a three-year-old and a two-year-old at home, and they want me home. I can't stay late doing it.
I do have my commute, where I can one click into my integrated EHR, and it connects with them, and I can call them and try to address any of their concerns. It just helps me maximize my time and, you know, to speak to Dr. Korn's comment about burnout, I think being able to address the issue by voice through the Dialer rather than back and forth, I don't want to call it, just messages, I think that lowers burnout because you get it done. So I think it helps with my provider satisfaction, but I think it helps with patient satisfaction as well.
Awesome. Well, we heard a lot about telehealth and Dialer in particular. I'll share that UC San Diego Health has been an enterprise client since pre-pandemic as well. It was a popular tool for our clinicians and physicians. We contracted at an enterprise level. Immediately we heard from some of our primary care physicians, it was saving them half an hour a day because they didn't have to stay in the office to call back on results, and they were doing it on their commute, like you said. The next request that we heard was: Can you integrate it into our electronic health records, so it's a single click to dial my patients? We worked with our vendor, and that happened not only for us, but for everybody who uses our particular vendor.
Today, I can tell you that we have thousands of UC San Diego Health doctors and care team members who make over 1.3 million calls per day, per year on Dialer from over 400 unique departmental kind of carrier-attested caller IDs. With our integration with electronic health record, both users and usage are up over 20% since 2021. Let's dive in a little bit deeper. Tell us a little bit about Dialer compared to other telehealth tools. Anybody?
I'll start. I'll start.
Dr. Stanford.
I really think it's the ease of use. You know, I mentioned that for many of my patients, they get flustered, they get stressed out trying to connect, log in, they always forget their password. All I have to do is call them directly, and they click one button. For even patients with the lowest health literacy, lowest level of education, they are able to do that. They may be in the grocery store, they forgot about their appointment, whatever. They stop, they take the call, they do the visit. I think from an equity perspective, particularly as the director of equity for our endocrine division at Mass General, I'm thinking about ways to make sure that telemedicine isn't increasing the gap in terms of healthcare and healthcare delivery.
I'm able to get every patient from every demographic to sign on, and I have had to use the translator feature quite often. I'm able to connect them very easily. It takes only a minute or two to get everything together, transferring from the platform that they were struggling to sign on to. It just makes it easy. I know if I can't find them on the platform, even those people that are very savvy, I can call through Doximity and they'll be there, and there's no problem connecting.
You know, life is about friction, and you think about, you know, each of you staring your screens right now. I mean, every second matters. You know, you've been to the doctor's office, right? Are they looking at you when you're telling them you're sick, you're scared, you're afraid, you're afraid of losing your eyesight, you're afraid of dying? You really need them to look in your face, right? We spend a lot of time looking at screens with archaic technologies. Here comes a company out of nowhere that creates great frictionless mobile tools that really gets the job done fast. You know, because when you get it done fast, we can scale and see more patients, but also, more importantly, we can go home to our families.
Boy, does that is that a huge satisfier, because that really improves the user satisfaction, you know, as a physician. That's why for us, it's a very sticky app. You know, for us, If a hospital were to come up to me and say: "You know what? You know, Tommy, Dr. Korn, we're going to take this away from you," I mean, it's like cutting off my right hand. I can't allow that to happen.
Mm-hmm.
Yeah, I'll say, one of my favorite stories from UC San Diego, our medical director of telehealth, Dr. Brett Meyer, created a new workflow where we eliminated the virtual waiting room. Instead of the patient sitting there waiting for the doctor, we said, "We'll call you. We'll give you an appointment between two and three. We'll send a link." He published a paper showing that it increased satisfaction, not surprisingly, and they finished earlier. When the data came back, I said, "Well, Dr. Meyer, that's great. You can see more patients and generate more reviews." He said, "No, no, no. I can go home earlier and see my family." Any other comments on dialer?
Yeah, you know, talking about ease of use, I mean, I think that is what is essential for. I always try to put myself in the position of families and what's it going to take to get connected. Telehealth, you've got some things that need to connect, and sometimes it's multiple apps. Doximity kind of fixes that because it's, there's no extra app. I mean, I treat kids with ADHD, and this afternoon I've got two 18-year-olds in college with ADHD that I have to see, and I still have to see them because I told you I've got a year-long waiting list, so I feel bad about canceling them. What I'll do is I'll log in, send them the link through the Doximity Dialer, and we'll do a telehealth visit so simply.
It's just a message to their text messaging. They click it, and we're in. Last time he told me, "Dude, that's medical magic." You know, that we could just go straight into it without any sort of really login or anything. To speak to Tommy's friction. It takes away that friction, and it just really helps us get connected, because I don't know if I'm gonna get connected with an 18-year-old with ADHD at college if they've got to go through a lot of hoops. I think it makes a big difference.
Well, Jeff mentioned that I'm a Deca Doc, so I get to go to these advisory board meetings and brainstorm new features. What's particularly incredible as a recovering CIO, used to rolling out enterprise technology, is how quickly the team has been able to put these features into practice. We were prioritizing features at our last advisory board meeting just three months ago or so, and that hold, you know, alert me when the person's on hold is already released, which is just amazing. Kudos to Jeff and Nate and the team. I've been really impressed with the feedback loop in terms of getting these doctors' ideas and then creating the tools to help support friction reduction.
What have you seen around sort of, the feedback loop with physicians at Doximity, and how is that a differentiator?
I think for me, I think that that's really one of the distinguishing things about, you know, Doximity and the tools that they make versus, you know, others.
It's just that when I find a feature, when I see something new, I feel heard, even if it's, you know, not an idea that I pitched or thought of, I think it speaks to their ability to listen to doctors and what they actually need and build something, sometimes even with extra things that I didn't think of, that I now use, you know, on a daily basis, not only for, you know, my work with patients, but, you know, even when I'm at home afterwards, you know, I'm going through the digest, I'm catching up on, you know, like CME and medical education, staying up to date with, you know, people that I've trained with. In so many various aspects of my life now, I feel like I'm using Doximity, and I'm using it practically every day.
My team kind of makes fun of me for it. You know, the DoxGPT, I'm on it all of the time. It's just been, you know, incredibly helpful in what I do, and I think it helps, especially because it lets me do the things that I aspire to do in my career. You know, I want to be talking to my patients. I don't wanna have, you know, the nurse call with the labs or have the fellows call with the labs. You know, I would prefer to be, you know, that person. I never regret the call, you know, to the referring physician. I always get more information, you know, out of that. There's so many things that take away from our day.
Doximity helps to kind of bring that back.
As a referring physician, I appreciate the phone call. Dr. Korn?
You know, forgive me if I have some wrinkles because I've actually calculated the math. I've actually wasted eight years of my life in my 20-year-plus career waiting for slow legacy computers. You know, the feedback from the Doximity team, it almost behaves like a startup. When we ask them to fix something or enhance some, I mean, we get a response pretty darn fast. You know, when we look at the legacy tools that we use in healthcare systems and we give the feedback, we sometimes don't get that feedback fast, and we don't see the things build, and these problems build up. It's almost like it's, you know, Doximity is, you know, they're hungry, they're humble, they're foolish, they're just. They listen to our feedback.
I would say when I use legacy systems, I feel like I'm in 1995, using a window pane type like system. When I'm using, you know, the Doximity mobile tools, I feel like I'm in the 21st century.
Nice. Dr. Stanford.
You know, I think of Doximity much like family. I'm not quite a Deca Doc, but I may be, like, two years behind you, Chris. When I think of something, Jeff knows he will receive an email from me, which he will actually quickly respond to. For example, in the current Dialer system, we now have picture-in-picture. I was like, "Okay, if I log on to the system, I need to see the patient." You know, was disappearing behind the screen. We talked about this at one of our advisory board meetings, and within a week or two, it was working on my desktop. I was able to pull that up. I was able to pull back up my Epic chart and immediately get that to integrate. I feel like our voices are actually being heard. They care about the physician voice.
It's not just about what do we think, and a top-down approach, presuming that they're all-knowing. It's like, what do we see would work, and what do we see are pain points in our daily interaction, with our patients, and as a provider, how can we make those things easier? I can tell several different scenarios when that's happened. Jeff, I want to personally thank you for always being there to respond to my East Coast emails, which I start very early in the day, pretty quickly, and then make sure that that's integrated within the system. I hear, you know, my colleagues say: "Oh, did you notice that new feature?" I kind of just chuckle, knowing that thankfully, I may have influenced that, so. Yeah, I'm very thankful for the family.
I want to add that as an enterprise client, they're also very responsive. It's great not only that we fixed the picture for the telehealth tool, but also then adding the brand of the health system, which, you know, we as an enterprise, are really excited about as well.
Yeah. Doximity is nimble. You know, they can get things put together, I mean, so quickly based on our feedback. I mean, DoxGPT, I mean, we had information about that to kind of beta test, you know, almost a week that it seemed like ChatGPT just kind of started to take off. It's amazing what they can integrate, but I think the reason they're able to do some of these things is they value us as physicians and providers and our opinions. You can really tell that based on the features they integrate, it's not based on, you know, that explicit knowledge of what you learn in a course or a boardroom. It's that tacit knowledge or that intuition that comes from providers or physicians.
That's why it just seems to work a lot of times, maybe better than some of the other solutions that are out there. I think that's why you get a lot of uptake from providers and physicians because it just intuitively makes sense to us. Even just the talk about how it's giving us back, as providers, power versus maybe insurance companies or other things that are out there that, you know, are competing for control a little bit. As providers, we feel like we have a heart for what we do. We have a passion, and Doximity helps us to support that. Really, as a provider, I'm very appreciative, you know, and the things they're able to integrate is really just amazing from my perspective.
Doximity doesn't just get stuff done, they get stuff done quickly. Although, I think it's an open question whether GSD really stands for stuff. Do we have time for another question or two from the audience? Anybody here want to dive into something?
Testing.
Hi, David Larsen with BTIG. Thanks very much for all your insights. It's very helpful. Really appreciate it. When you talk about integration with the EMR, I think that that's really important, 'cause, like, what I'm hearing is everything has to be tracked, everything has to be recorded in the EMR for compliance reasons, for billing reasons, for, like, coding reasons. Can you maybe just sort of expand on that a little bit? Like, from an investor's point of view, why wouldn't you be using, like, a Teladoc or an Amwell or Epic's telehealth solution that's, I think, part of the hospital system? Why would you use Doximity's instead, and does all the data get into the EMR when you use it?
I think I can help take that as a recovering CIO. The Doximity tool provides the video solution, and all those other vendors that you mentioned also provide video solutions, and we've used some of those in the past. I think what's really particularly unique about Doximity is not just the EHR integration, it's the tools during the video, right? Jeff mentioned, you know, the Best in KLAS designation beat things like Microsoft Teams. Having a Microsoft Teams, you know, encounter with your patient doesn't give you these additional workflow tools, the ability to give patient education, text links, give a call knowledge, et cetera. From my standpoint, that's really part of the differentiator. I can tell you that none of those other tools are sort of writing things back in the EHR.
I think there's a special sauce there.
Just to follow up, for Doximity, it is integrated into several of our actual EMRs. You're actually using Doximity through Epic. There is a connection between the two. At Mass General, I can link through, and actually call the patient through Doximity from my EHR, it's actually integrated within the system. You have a follow-up, I think. Yeah.
Do you notice sort of before you introduce those, telehealth conversation on Doximity?
No, you're still working within the Epic workflow. Mass General, for example, or the whole Mass General Brigham system uses Epic. We're just using Doximity through Epic, for example, to pull up the patient, call them, have that visit. For example, if our system is down. For Mass General, once we had two days of where our actual telehealth platform, which is through Zoom, was down, but I was able to call my patients and not miss out on any of their visits because Doximity was still integrated. Does that help you understand? Okay.
Question.
Thank you to all of you for making me here today and for your master insights. I wanted to ask a question on product development as that becomes a bigger part of the Doximity story. It sounds like a few of you gave some suggestions to Doximity about what to create. Do you find that their new product development cycle is more doc driven? You guys say, "Hey, I really need referral letters. Can you please automate this? This is too much." Or is this more of an Apple-esque sort of approach where they say, "Hey, we saw this inefficiency. You need to fix it. Here it is." A quick follow-up on that one would just be, how do you keep up to pace with these new product releases? Is it ads, or is it something that you're getting blasted out?
I'll take that one. We do tell them about which things to do. They also come and tell us some really cool tip of the iceberg stuff that they can't reveal for you right now, that's just out of this world. We say, "Wow!" You know, I've said that a few times. Wow. I wish I'd have thought of that. I can't believe it. They have a process, no doubt. They also incorporate us as well. I'm sorry, what was your second question? Or the second part?... Yes.
They have, when the app, mobile app automatically updates, it actually tells you, "Oh, here's what's new," or you know that when they showed you that hummingbird, that feature that was coming in, sometimes they also come in and guess what? Here's our new feature, and it's actually not done with picture text. It's actually done with a nice video, with arrows, things, and telling you what's going on. Almost kind of like a augmented reality type of thing in the screen, which is very, you know, very powerful. Yes.
I guess I would add, as an enterprise client, that we're also working with our team as partners. We'll then disseminate information to our entire medical staff. You know, did you know Dialer can save you 30 minutes a day? Here's how you set it up. One more question.
Hi, thank you so much. It's Jess Tassan from Piper. I think, Dr. Lea Ann, you mentioned the news feed, but I didn't hear any of the rest of you just talk about that. Could you maybe give us a sense of where you go for news in your field? Like, what is your first source of information? Is it Docs or is it Twitter? Can you compare the amount of time you spend in a week on the newsfeed versus, you know, in all the productivity tools? Thanks. Thanks again.
Yeah, I'll take that one, 'cause I think that's been one of the more surprising things in terms of my usage. The newsfeed pulls in articles from The New York Times, also multiple journals that you wouldn't traditionally have access to. You're getting exposed to all these different, you know, articles that it really helps expand your medical knowledge. The surprising part for me is, you know, sometimes I spend some time in the comments, usually, like, you go to Facebook or you go to Twitter, you know, don't go to the comments because they're just, it's exhausting. The people that are in this, you know, are physicians or providers, they do have education, they do have perspective.
Sometimes even by reading those comments, it helps to expand your, you know, just your not only your just knowledge about the subject, but knowledge about other opinions. I find myself, I don't want to call it doomscrolling, but doomscrolling more on that than I do some of the other apps, which, you know, I think there's good data to say that actually causes some mental health problems. I think Doximity helps replace that doomscroll with really productive, good knowledge that not only I'm learning, but I'm also learning about other peoples and their perspectives.
Yeah, I would just really emphasize your point that Doximity helps break the paywall on some of these articles, which becomes a real challenge. You know, there might be a great article that mentions a colleague of yours, but you can't read it because it's behind a paywall. Being able to read it through the Doximity news feed has been fantastic. I've been super surprised in the San Diego region, just what a terrific job it does with the weekly news roundup, you know, for regional news. It's catching things I hadn't seen in other places, and making sure I'm up to date, not only on, you know, what we're putting out at UC San Diego, but on our regional competition and collaborators as well.
You know, the other thing I would add, too, on the newsfeed, that adds value for we as clinicians, you know, I always like to kill two birds with one stone. If we're reading that article, if it happens to offer continuing medical education credit, well, guess what? I get free credit, which normally I would have to pay or play an airplane trip to go to a conference. That's actually saved me time, saved me money. Boom, I've already got some credit there. These are, you know, curated sources of medicine. In the beginning, when this newsfeeds came out, I was still using old email, then it would get buried from all these new feeds, and I avoided all the social media.
It, I mean, it kind of becomes a sticky platform. In fact, it's our only source of, that we go to now for the news.
Tommy, I'm gonna emphasize that one, too. Not only can you get CME credit through Doximity, which I use every couple of years for my re-credentialing, but it also lets you store it.
Yes.
When I came from Stanford to UC San Diego, you know, it was a long-term place where I actually upload my neonatal resuscitation certificates so that I always have access to it for, you know, credentialing and certification purposes. I think that does it for time. I want to thank our panel members for taking the time to come up here. Jeff, thanks for the opportunity.
Great. Yes. Thank you. Thank you. I'd just like to say that, I mean, what a terrific panel, and it's really our honor to serve folks like this. Really our honor. All right, I realize this is a room about money, though, we're gonna take a 10-minute break and come back and talk about how our workflow second act has commercial legs, where the money comes from. 10-minute break. We'll be back. Thank you.
Our clients are the best brands in medicine, including all of the top 20 hospitals and all of the top 20 pharmaceutical companies.
Doximity is really a very large portion of our annual marketing plans to promote our service lines and clinical trials and everything in between.
Working with Doximity helps us enhance our communications with physicians. Realistically, we can't go and meet with physicians at the same scale that we can with Doximity.
We've had new referral patterns and new patients from physicians that hadn't referred to us before outside of our geographic footprint.
Okay, we're back. Next up is Ben Greenberg, our new Senior Vice President of Commercial Products. Ben spent 11 years at WebMD Medscape as their VP of Product and led their growth from $50 million to $500 million in pharma revenue. Based in Brooklyn, Ben leads our growing East Coast commercial product team. With that, take it away, Ben.
Thank you, Jeff. Thanks to everyone for being here today. Guys, you are looking at the luckiest nerd in the room for sure. I have had the amazing opportunity to spend my career building healthcare products that have been used by hundreds of millions of people. I've been shipping software for over 30 years, and in that time, I have never seen the kind of opportunity that we have here at Doximity. Why would I say something so bold? Let me really explain our differentiator here, as if the phenomenal panel here, you know, as if you needed more evidence. Physicians' professional lives are largely spent using crappy software that they have to use, and to some extent, we can all relate. Just think of the times you've had to renew a driver's license online or pay a parking ticket or respond to jury duty.
Now imagine having to rely on that garbage to navigate life and death situations on a daily basis. For all the software that they have to use, Doximity is the one they genuinely want to use. Don't take my word for it. Look at our Net Promoter Score, and these comments on the left, they aren't App Store reviews. They're recent, unsolicited tweets from our users. Better yet, just ask any physician in your real life what they think of Doximity, and come back and tell me what they say. Really, really do it. Okay, another important difference. Think of the way that you interact with a news app that just sits on your phone. You never really open it on purpose, but they send you notifications or emails while you're busy doing something else.
You're doing work, or you're texting, or you're on Instagram, and their notifications pop up with a news headline. Depending on the headline, you either say, "Okay, whatever," or in rare cases, where the clickbait is good enough, you actually say, "Wow, that's nuts," and you tap through and say, "I gotta read more." Think of how fundamentally different that passive, reactive engagement modality is compared to when you're using something like Amazon, which you open purposely because you actually need something. It's a tool we've all grown completely dependent on, and if you're like me, they would have to pry Amazon out of my cold, dead hands. By the way, sometimes I do choose a sponsored product or an Amazon's Choice result, of course, because I trust Amazon, and that's a core part of the Doximity difference.
Physicians are opening our product on purpose because they want to get something done, and that's the foundation, not only of their affinity for the product, but also key to how we integrate life sciences messaging into their workflow. Physicians want and need information from pharma, but they want it on their terms. There is a big difference between sending physicians a bunch of notifications or emails and just hoping they'll click through and see your ads, versus surfacing relevant, personalized, meaningful messaging while doctors are leaned in and paying attention with purpose. That's what's reflected in Doximity's success, our ROI, and why the opportunity here is so unique. We're not your run-of-the-mill email machine, lobbing out desperate little scuds to physicians. Our tools are deeply embedded into daily clinical practice.
Our life sciences messaging is relevant and embedded within the physician's workflow, and that creates immense value for our pharmaceutical and health system customers who want to meaningfully engage with specific groups of physicians, and we still have a ton of room to grow. Let's take a look at some specifics. We integrate multiple flavors of messaging vehicles into various touch points throughout our ecosystem. There's long-form text and video content for deep engagement and short-form bursts for more snackable insights. The topics here can range from quick summaries about clinical trial results to announcing a new treatment approval, and our programs cater to different learning preferences and enable physicians to consume information in an easily digestible format that complements their clinical workflow.
This personalized approach not only enhances physician experience by enabling doctors to stay up to date with the latest advancements in their field and empowering them to deliver better care for their patients, it also ends up improving our customers' ROI. Again, this content doesn't just live in our news feed. Our new point of care and peer-to-peer marketing programs are expanding how physicians access and engage with personalized content across the Doximity platform. Here is the new product that I'm most bullish on. When a physician uses our Dialer feature, as you heard, they spend an average of about one minute waiting for their patients to join the virtual visit. You can imagine what a valuable moment this is.
While the doctor is pausing for pre-patient prep, and in this moment, our vertical video delivers personalized key information right at the point of care, right when it really matters the most. Early results on this product are really exciting, with about 60% of physicians who engage watching the entire video. It's not quite Waystar Royco Living+, but we're on our way. Likewise, the product's preliminary ROI results are strong, and the best news of all, we are now fully approved on all our programs bought by our major pharma clients, including the one holdout Jeff highlighted on our last earnings call. You probably know that Doximity is test obsessed and that our decisions are heavily data-driven.
In reviewing our performance stats for this space, something we found particularly performant is highlighting whether a given medication is likely to be covered by a patient's insurance. Patient access is a major pain point in our healthcare system. It creates billions of dollars of waste annually because a prescription doesn't matter if the patient can't afford it. 80% of physicians say they take cost into account when making treatment decisions, and this turns out to be the perfect place for us to serve personalized data about what percentage of each physician's patients are covered by their insurance for any given drug. It's highly relevant, highly effective for both the physician and the drug manufacturer, and the ROI reflects that. We are very excited about these products.
Not only do they provide great value to our members and clients, they also unlock new pharma budget categories for Doximity. Speaking of room to grow here, Doximity has just done an awesome job of balancing sponsored content to editorial content. It maximizes physician experience and gives optimal ROI. You can take a look here. Today, sponsored content comprises about one in 12 cards on our news feed, and this ratio continues to drive meaningful engagement and industry-leading ROI for our clients. For our pharmaceutical clients, the ROI is over 11 to one, and for hospital clients, it is over 17 to one. Tons of room to grow here with our new point of care product. On the right here, you can see today only around 1 in 100 of our point of care vertical videos are sponsored.
Just gives us ample room to grow and provide even more value to our members and clients. Okay, finally, there are two further dimensions which are going to play out very well for Doximity. One is the fate of the browser cookie. As we all know, it's crumbling, and you can see what's causing that in this timeline here on the left, from when Apple added ad blocker plugins to Safari all the way up to the biggie, Chrome, phasing out third-party cookies in 2024. As the cookie continues to crumble, other networks will weaken because they will lose their ability to target physicians across the Internet. Meanwhile, Doximity's ability to deliver value will only get stronger. We don't rely on cookies from other networks, don't need to spy on our physicians.
We're able to personalize their content solely by the preferences they've expressed by what they do on Doximity on purpose. The other factor here in Doximity's favor is the evolution of pharma budgets toward digital. If you look at the chart on the left, not only is the size of this whole pie increasing, but research shows that the large majority of total HCP digital spend is still allocated to traditional marketing tactics like display, programmatic, and email. Exactly the tactics that will be impacted by the cookie crunch. If you look over to the right, you can see that in 2022, Doximity accounted for approximately 15% of all HCP digital spend.
It's continuing to climb from there, and with the combination of the crumbling cookie and the introduction of our new point of care and peer-to-peer products, we are incredibly optimistic about our ability to continue to take market share and deliver long-term value for our clients. In short, I think you can see why I joined. It is a great time to be at Doximity. Thank you again for your time, and back to you, Jeff.
Awesome. Thank you, Ben. Next up is Craig Overpeck, who just joined us as our Senior Vice President of Commercial Operations. Prior to joining us for over a decade, he was the U.S. Chief Operating Officer at M3, the Japanese physician network. During his time there, M3 grew the revenue from $50 million to over $700 million. With that, Craig.
Thank you, Jeff. You know, Ben, it's not just cookies crumbling that's shifting the spend in digital. Research shows that industries in-person access to physicians has been declining for years and worsened during the pandemic. In 2008, nearly 80% of U.S. physicians were accessible to industry sales reps. By 2022, in a fully post-COVID world, this number has dropped to under 50%. We believe this trend will continue, with more than half of U.S. physicians now considered no-see docs, meaning they're difficult or near impossible to reach. At the same time, our digital reach at Doximity continues to grow and accelerate, with over 80% of U.S. physicians registered on our platform. When I was at M3 a decade ago, we experienced the same market scenario you see here.
Our theory was that if we had both scale and high platform engagement, we could establish more efficient digital connections across the healthcare ecosystem. Just like any two-sided market, going digital represents huge efficiencies for both parties involved. By embracing a digital platform like Doximity, we can unlock benefits for both physicians and industry, streamlining antiquated processes and enhancing communication and productivity for all. In Japan, we had a 10-year head start to become the number one Japanese platform with almost all of the more than 325,000 physicians as members. Here at Doximity, we started later, but have a similar platform in a market with 3x as many physicians. M3 now generates $2,000 in revenue per Japanese physician, and just a couple of years post-IPO, Doximity is delivering just over $400 per physician.
We believe this is just a starting point, that's why I'm so excited to be here. The U.S. has such greater inefficiencies, it's just ripe for disruption. There's so many expensive and inefficient activities that need to be digitized, like doctors waiting on hold to get reimbursement assistance, mystery peer dinners where doctors don't even know which peers are going. They wander cavernous halls looking for their friends from residency at exhibit halls, industry reps sit in their waiting rooms, hoping for a one to three-minute chance meeting, which ironically, is the same amount of time physicians are waiting for their telehealth patients. At Doximity, we already invested in building a core platform with scale and engagement. Let's look at the adjacent monetization opportunities. Physicians are in high demand, they learned the power of digital during the pandemic.
Digital solutions and hybrid clinical workflows are empowering physicians to increase their productivity and regain control over their schedules. U.S. healthcare is finally making the shift to digital, and the doctors are at the forefront. Today, our clinical workflow suite is already helping clinicians across the country be more productive and better serve their patients, and we see a huge opportunity to build on this foundation. For example, through Amion, we are already powering hundreds of thousands of physician schedules. By expanding our scheduling tools to include features like rep scheduling or virtual sessions with expert medical science liaisons, we believe we can unlock multiple high-value benefits that will enhance efficiency for physicians and healthcare as a whole. Deeper integration of generative AI into our workflow tools offers another exciting opportunity to expand our offering.
Nate showed, physicians are just starting to use our DoxGPT to streamline burdensome administrative tasks, such as writing and faxing prior authorization and appeals letters to insurance companies. DoxGPT continues to gain traction, we believe adjacent budgets will become available to our sales teams. We believe Doximity is uniquely positioned to digitize other parts of healthcare as well, thanks to our robust clinical tools, powerful network effects, and deep understanding of the industry. Our dedicated and experienced sales teams are prepared to execute and deliver win-win solutions that meet specific requirements of both our members and clients. Today, we have seven distinct sales teams dedicated to serving our business units.
We have three sales teams devoted to supporting our pharmaceutical clients, one team dedicated to addressing the needs of our emerging medical device and diagnostic clients, and three teams focused on the various needs of our hospital clients, with needs ranging from marketing to workflow and hiring solutions. While we do spend a lot of time thinking about our pharmaceutical clients, we recognize the value in serving a diverse range of healthcare partners who are willing to invest in scale and engagement. By aligning our efforts with each of our clients' distinct needs, we can better meet or even exceed their expectations and bring meaningful efficiency across the healthcare system. I'd like to introduce Anna Bryson, our CFO, to talk us through more of the financials. Anna?
Craig just gave a really nice glimpse into what the future of Doximity could look like. I'm gonna start by taking a step back and talking about the last five years and how we've scaled to date. I'll begin with some of the financial highlights of Doximity. Firstly, we have a large opportunity ahead of us with an $18+ billion TAM in markets that are very under indexed on digital. The largest component of our TAM is the over $7 billion spent in the U.S. by pharma companies marketing to medical professionals. I'm going to deep dive into how we think about that opportunity in the next few slides. Now, the second financial highlight ties into the first. Our customers have large budgets, and we are less than 5% penetrated into those budgets.
Our land and expand business model, focused primarily on cross-selling to additional brands and upselling additional modules, gives us significant potential for future growth within customers that we already work with. Thirdly, the vertical nature of our business model allows us to scale at an incredibly profitable rate, and we have achieved north of 40% adjusted EBITDA margins for each of the last two years. Finally, we have a strong balance sheet with a growing cash balance of over $840 million, giving us significant optionality to invest in future growth. Now, let's focus on that first highlight there and talk more about our market opportunity, specifically in our pharma business.
The best way to conceptualize our largest opportunity is by looking at the universe of pharma mega brands, which are brands with over $100 million in U.S. sales and often have the biggest marketing budgets. I'm going to start by looking back at what this universe looked like in fiscal 2019. Each one of the boxes on the slide represents an individual mega brand. The white brands are ones that we did not work with, and the blue shaded brands are ones that we did work with. The various shades of blue demonstrate the share we estimate that Doximity represented of their total medical professional marketing budgets. Not just digital, total.
The lighter blue represents lower share, and the darker blue, higher share, with the darker blue brands typically being those that buy more modules. In 2019, there were roughly 300 mega brands, and they accounted for a total of about $220 billion in U.S. sales for pharma companies. Back then, we only worked with about 1/3 of these brands, and we had very little share of those that we did work with. In fact, if you add up the budgets of all of these brands, we estimate we only had about 1% share. Over the next few years, as dollars began to shift digital at a faster clip, we move forward to 2021 and see many more brands shaded blue and darker shades of blue.
However, you can also see that the number of boxes has grown as the pharma industry innovates and medicine becomes more subspecialized. While we have been able to successfully sign up more brands and gain more share of the brands we did work with, the growth in our opportunity meant that we still had a very low share of budgets at roughly 2%. Now, fast-forwarding to today, there are now roughly 430 mega brands, accounting for a total of about $350 billion in U.S. sales for pharma companies. Again, despite our growth, we are still less than 5% penetrated into their budgets. The potential number of mega brands we could work with has grown from 300-430 in the past four years.
As we look ahead, Evaluate Pharma estimates that there will be over 500 mega brands in two years' time. One of the key reasons that innovation in pharma and the growth in the number of mega brands is so meaningful for Doximity is that many newer brands are launching with a digital-first strategy. That means that from the start, more of their dollars are being allocated to digital channels like ours, as opposed to traditional or in-person, which we believe will be a natural tailwind for us over the next 5-10 years as we continue to Pac-Man up this chart. Turning to how we are able to grow our share of mega brand budgets.
Looking at our two key growth vectors, this chart here is showing the number of mega brands we have worked with over time, broken out by those that buy one to two modules, three to four modules, and five-plus modules. You can see here that while we have been able to grow the number of brands that buy more modules, we still have the opportunity to scale most brands. Typically, the higher the number of modules, the higher the spend of that brand. For those brands that are more entry-level and only buy one to two modules, the average spend is roughly $500,000 per brand. For the brands that buy three to four modules, the average spend per brand increases to about $1.5 million. For those buying five-plus modules, the average spend per brand goes up to roughly $4 million.
For reference, this $4 million is nearly double what the average spend per brand was in that 5-plus module bucket two years ago. As we look ahead, with the introduction of our new point of care and peer-to-peer offerings, we expect to not only be able to get more brands into the higher module buckets, but also continue to increase the average spend per brand. All in all, we believe we still have much room for growth here. Now, the customers who have added brands and modules at the fastest clip are our top 20 customers. These customers have the largest budgets, are leading the industry's shift to digital, and have often been our partners the longest. You can see their growth with us represented here in this S-curve.
Over the past three years, we have tripled the revenue from our top 20 customers, and a lot of this growth has been led by the eight-figure customers that we work with. In fiscal 2020, we had our very first eight-figure customer, and three years later, we reached 11 eight-figure customers. Of note, these 11 eight-figure customers are all top pharma manufacturers and have strong brand diversification, buying across an average of over 15 brands each. This ability to continuously upsell our largest customers has given us a net revenue retention rate for our top 20 that is higher than our overall business at 124%. We believe that this is a strong indication of both the value these customers are receiving from our platform and the path other customers could take over time.
Moving on to our broader financials, we've experienced strong revenue growth at a 49% CAGR over the past four years, reaching $419 million in fiscal 2023. As a reminder, we sell our programs as subscriptions, and our growth is led almost entirely by customers that we already have relationships with. This bridge on the right here is showing that we typically enter a given fiscal year with around 60%-65% of our subscription-based revenue already under contract as of April 1st. The remaining 30%-35% of revenue typically comes from renewing and upselling our existing customers, and we only rely on about 5% of our revenue to come from truly new customers that we do not yet work with. Turning to our margin profile, our vertical business model has allowed us to scale very profitably.
Our non-GAAP gross profit has grown at a 50% CAGR over the past four years, consistently achieving north of 85% non-GAAP gross margins and reaching 90% in fiscal 2023. Our adjusted EBITDA has grown faster at a 107% CAGR, achieving 44% margins this past year, and our free cash flow has grown at an 87% CAGR, reaching over $170 million this past year. All measures of our profitability have grown at a faster pace than our revenue, demonstrating the inherent leverage in our business model. We believe that our high profitability is a true differentiator of Doximity and provides us some significant optionality as we continue to scale.
Speaking of scaling, we just talked about our opportunity in the last five years, and I think we're very excited today to give a long-term financial outlook. Starting with revenue, we aim to grow the business at an average CAGR of 20% over the next five years, reaching more than $1 billion by fiscal 2028. Now, there are several key assumptions behind this growth. First, as Ben mentioned, we believe the digital pie will continue to grow, and we will continue to take share with our leading ROI and first-party network. Secondly, we are leaning into new innovative modules such as peer-to-peer and point of care, that help us to unlock more of our TAM.
Thirdly, as the universe of $100 million brands continues to grow, we expect our top customers will continue to lead our growth, and we'll see an increase in the number of eight-figure customers that we work with. Diving a bit deeper here, we're going to start with the chart on the left, and this chart breaks down our path to over $1 billion by business line. We estimate that roughly 80% of our revenue in fiscal 2028 will come from our pharma and hospital customers through our current core business. This represents an average CAGR of about 14% on that piece of the pie. We believe this is very achievable, given the continued shift to digital and our ability to gain share.
Next, we estimate that roughly 15% or about $150 million, will come from our new point of care and peer-to-peer offerings. We just unlocked these new budget lines about six months ago and have already seen strong initial adoption from our customers. Additionally, as Ben had just mentioned, early ROI and engagement results are incredibly high, which we believe will be the key to aiding future growth here. Finally, we estimate that roughly 5% will come from new businesses. As Craig had mentioned, there are many adjacent opportunities available to us within our same end customers, whether it's clinical trials or rep scheduling or reimbursement support. We're excited by the potential to increase our offerings and unlock more of our clients' budgets over time.
As we continue to scale within our clients' multiple budget lines, we believe we can increase our number of eight-figure customers. You can see here on this chart on the right that just two years ago, we had just two eight-figure customers. We grew that to seven in fiscal 2022 and 11 in fiscal 2023. We look ahead, we are aiming to add an average of two to three eight-figure customers per year to reach 20-25 by fiscal 2028. To break down this 20-25 further, we think we can get most of the top 20 pharma there, say roughly 18-19 of the top 20, a few mid-tier pharma companies, and a few health systems. For reference, our largest health system today is over $5 million in revenue, growing from just $500,000 two years ago.
We have strong momentum in that part of our business as well. To summarize, between the shift to digital, the growing number of mega brands, and the new budgets we're unlocking in customers that we already have deep relationships with, we believe we are well-positioned to achieve this billion-dollar-plus target in fiscal 2028. Now growing within the same vertical provides us an opportunity to gain further leverage. As we look ahead, we are updating our long-term operating model to a sustained 85%-90% non-GAAP gross margins and an increased 45% adjusted EBITDA margins. This 45% adjusted EBITDA margin puts us at over $450 million in adjusted EBITDA by fiscal 2028, and we are looking forward to continuing to deliver the profitability that really differentiates our business model.
We have been proud to be a rule of 65 + company for each of the last three years, and we look forward to maintaining that for the long term. Now, finally, given that profitability, we are announcing a new $200 million share buyback program that we plan to execute over the next two years. With our current growing cash balance of over $840 million and our high cash-generating business, we believe we have a great opportunity here to provide value to our shareholders, while also maintaining significant optionality to invest in future growth. With that, I will open it up to Q&A and ask Nate and Jeff to join me on stage.
Just raise your hand with questions, as we get mics to you. I'll just begin the Q&A by saying that our whole leadership team has reviewed these forecasts. We are committed to being a billion-dollar company. We see many paths to getting there. With that, questions, please.
Thank you. Richard Close, Canaccord Genuity. Anna, maybe if you could go into the different budgets with pharma and, you know, just go into more detail in terms of, you know, how you access those budgets and maybe some of the newer products that you showed and what's different on those budgets?
Want to take that, Nate?
Sure, I'd be happy to start. I think what's exciting about our newer products is that they do unlock new budgets for us, and they're also multi-budget applicable. In terms of new budgets, there's sales enablement and point-of-care budgets that have been distinct from the budgets that we've formerly been able to tap into with our core products that you've seen over the past two years. If you compare the other offerings that exist within those budget categories, we're quite differentiated. These are often comparing analog solutions or very limited technology solutions compared to what our new modules are able to offer. That said, these are also appealing to marketing budgets, to the partnerships that we've had in place over the past decade, with our existing customers.
It's understandable that our existing marketing clients would also want to tap into those new product offerings. I will say that if it were not for these new products, we would not have been able to land our first $10 million customer when we did on this last earnings call. They were essential to getting that level of growth, and that's something that I think we hope to be a pattern that our other partners will follow.
Hey, guys, Stephanie Davis from, I guess, SVB at this point. Thanks for taking my question. Nate, I noticed in your demo you had separate apps for Amion and Doximity. Talk me through this. Is the integration the first step into a consolidated app and kind of collecting more eyeballs there? How are you balancing all these new product releases with still keeping a clean user interface in the app?
You highlighted a really important point. We spend a tremendous amount of time with our physicians figuring out how to minimize the time that they spend interacting with any sort of inefficiency in their workflow. Sometimes that requires having a separate app. Separate apps also help you iterate in your early years. Dialer initially was a separate app before we brought it into the mothership Doximity app. When it comes to our scheduling, there are currently workflows that make sense to have it as a separate app. Those of you may have had Facebook and Instagram on your phone, and when you have one, you're instantly signed into the other.
By bringing Amion into the fold, we're able to deploy those same sort of simultaneously signed in across all platforms, cross-link them, and move data, in fact, between the platforms, so that if I wanted to use Dialer technology to call a physician that I see in my Amion schedule, it feels seamless, even if they're using separate app install bases.
Hi, guys, Brian Peterson from Raymond James. I wanted to hit on the M&A strategy a little bit. Jeff, I think you mentioned you'd like to do more tuck-ins. You have $850 million in cash. What would you like to do in terms of adding more of the platform through M&A? Anna, on the outlook, does that 20% number, does that include incremental M&A, or is that an organic outlook?
Great, I'll take that. So, you know, Amion's been great for us. As Nate said, I think it belongs as a separate app, like a Google Cloud would be, right? You have to have separate, you know, email and docs and other things, but all integrate well. We're really pleased that we were able to, again, rewrite the full tech stack of Amion and have that fully integrated within a year, which is a sign our engineers know how to integrate these types of companies. There's a lot of companies like Amion out there that are EHR adjacent workflows that doctors have to do that have been built for them, that, you know, scheduling just isn't a priority, really, physician scheduling for the person who's running the EHR and worried about billing all day.
It's very complicated to keep track of every specialty service for a level one trauma center, being on call at all hours of all days, of all weeks. You know, it's complex stuff. We embrace the complexity, and there are a bunch of companies that do some of that sort of middleware. Obviously, we're not talking about any specifics here, but we think, again, there's a real opportunity here with Workflow as our second act to grow our physician cloud.
For clarification on the path to $1 billion, we are not assuming inorganic growth there. That's organic.
Hey, this is Vikram Kesavabhotla from Baird. I think I saw in your presentation you said that one in 12 pieces of content on the news feed now is sponsored. I think in the past, that number used to be closer to one in 14, I think you said. I'm curious if you've seen any impact on user experience or user satisfaction as you've increased the ad load. Do you think you need to continue doing that to support the growth rates that you've talked about today? Thanks.
Sure. Thanks. I'll take that. Yeah, it's a little bit higher than it used to be, but I can tell you that, as you know, one in five, one in four, without having a really negative impact on the physician experience or engagement, I think being at one in 12, we're still at the place where we think we have a lot of headroom. Jason?
Just a question on the product roadmap and the margin target. Like, as you think about a 45% EBITDA margin target, you know, you have a business that's structurally got very high margins on the gross margin perspective and kind of an EBITDA margin perspective. Like, as you think about workflow, some other applications that are there, the calculus in terms of like, hey, maybe it's worthwhile taking a step back in terms of margins because we can invest for XYZ, for an elevated growth rate long term. How do you think about maybe just take us inside what that calculus looks like?
Yeah, no, great question, Jason. You know, we thought a lot about our margins, obviously, as we put together that longer-term forecast, and the short answer is that we have an ability here to monetize workflow in a way that really none of our middleware competitors really could. The opportunity to keep that margin as high as it's been, we think, exists with multiple additional businesses. That said, we do think the core business is already running at a higher margin and will continue to run at even higher margins over time, and that will be able to allow us to maybe make lower margin acquisitions if we need to grow pieces of workflow. The overall business and the margin profile we have, it's interesting.
When you're in an industry like pharmaceuticals, they're used to having high margins, and they don't mind if their partners have high margins as well, as long as they're delivering return on investment.
Hey, Matt Shea with Needham. Thanks for putting this on today, guys. When you released the point of care module, you had discussed that maybe over the next 12-18 months, we might see more products, and you would resume that cadence that you had previously been on. What other areas for opportunity are you seeing for incremental modules, and how might you factor those into the 28 targets? Thanks.
Yeah. Thanks, Matt. It's a good question. I think Craig's slide, I think, spoke to some of that, the different axes that we can expand. Again, this digital channel between physicians and industry. I don't want to speak too specifically to product roadmap, but I will say that both Ben and Craig have done a terrific job of expanding our aperture there. Again, there's a lot of ways that we can help both sides here save time and be more efficient.
Hi, thanks for taking the question. It's Jess Tassan from Piper. Can you just help us understand how you get to the kind of 14% CAGR for the core business? How much of that is pricing, how much is market growth? Does Docs have sufficient inventory on the news feed to grow in line with the market? Just reason for asking being, you mentioned point of care was crucial to getting to that $10 million with a customer. Yeah, I just want to kind of square that feedback.
Sure. Yeah, I think I'll just start by going back to those first few slides I was talking about with our opportunity and new brands to sign up, and then how many brands we have that we could actually expand, how many modules they buy. That could look like for us. Then we certainly consider market factors. Market growth is something that's, I think, been a little bit tougher to predict. You know, obviously, we did have a massive sales normalized, and we're using the current baseline as market growth, and we're assuming that we'll be able to take share. I mean, I think Ben talks to the cookie crumbling being the tip of the iceberg for us.
We've been able to take share before that's even happened with our leading ROI, and so I think we have some really nice tailwinds in place for us to continue to take share.
Thank you. I'm Jailendra from Truist Securities. Craig talked about seven distinct sales team, you guys have, in different two buckets. Can you maybe talk about how you evaluate performance of these sales teams? I mean, it's pretty clear from the pharma side, maybe you look at the revenue they bring, to you guys, but how would the physician side, like, how you evaluate, which metrics you track, and depending on the value evaluations there?
Yeah, no, great question. Well, the short answer is, this is what we have great commercial leaders who've been with the company for years leading. We'll have quotas. That's the primary metric. In terms of access to the overall network, though, you know, my line internally is if we focus on the physicians, the profits will follow. We do focus on physicians first, and we focus on building better products that drive more engagement. I think we have ample engagement right now, so that from our point of view, in working with our commercial teams, we've established pricing that's based on return on investment of the clients, not on other metrics.
Hi, guys. Thanks. I just wanna ask about DoxGPT, and just thinking about any, like, utilization comments you can provide. Just thinking about the cost side of it, like, at some point, you know, I don't know if it's something that's of a concern right now, but, like, cost per prompt, is that something that you guys are concerned about, or is it gonna impact margins in the short term, or is there anything from that?
Pennies. Nothing.
Okay. Then utilization?
Utilization is great. We provided some, you know, data on that, thousands and thousands of prompts per week. Again, the cost per token is pennies, it's not a meaningful driver of costs.
Hey, guys, me again. I kinda wanna push back on the opposite side of your guidance. Your 20% + 14% growth in your core business, using the data that you just shared before, that there's gonna be 500 brands, like, that alone is an 8% CAGR in brands, and you're increasing penetration. How plus is that plus?
Sure. I think, you know, take a step back and look at the industry we're in, right? We're in healthcare, we're serving the pharma industry, which is just a slower industry to move. What we're focused on here is delivering durable compounding growth for the long term. From our perspective, as we think about that 14% or the overall 20%, you know, there's no doubt that the shift to digital is in play, and it's happening. It's gonna happen over the next 5-10 years and continue to do so. We are in an industry that, at the end of the day, is a regulated, slow-moving industry. That's the real bottleneck there.
All right, last question.
Hi, Stan, Berenshteyn, Wells Fargo. I'm curious, what happens when you have competing brands advertising on your platform? How do you navigate that, and does that create any natural limits on penetration?
I'll take that. We do not offer exclusivity to any brand. We coauthor all of our content. We wanna put out the most clinically balanced and relevant content. There are folks who certainly would pay us a lot to offer what they call brand blocking or exclusivity, but we don't do that. I think long term for the business, again, we wanna provide a balanced perspective. All right. With that, this room is free, but unfortunately, it does come with time limits. We're gonna have to end our Q&A here. We wanna thank everyone for joining the live broadcast. Again, I'll just say from our end, we're excited to keep building for you all and putting physicians first. Thank you.