It should come as no surprise that medical students, weaned on the Web, are the most active users of the giant portal Medsite.com. But there's not much chance the Internet Goliaths will ever completely replace the role of associations or their meetings, say dot-com execs and medical society leaders. In fact, there are some services, such as advocacy, that associations do best, asserts David Grande, MD, president of the American Medical Student Association, Reston, Va. Instead of thinking competitively,Grande says nonprofits should forge partnerships with dot-coms that benefit organizations and their members.
"There is an Internet revolution going on," he says, "and it makes more sense to join it rather than fight it."
And join he did. Last year, the 50-year-old AMSA partnered with Manhattan-based Medsite.com (www.medsite.com). Ironically, Medsite was founded by a former University of Pennsylvania pre-med student and his three college buddies in 1995. AMSA is among six medical associations that have linked up with the aggressive Medsite.com, and the group is in tune with at least one philosophy Medsite.com fosters: embracing technology to deliver health care more efficiently.
"The partnership (with Medsite.com) has given us the ability to do a lot of things on the Internet that we wouldn't or couldn't have been able to afford to do ourselves," Grande says. The relationship basically involves a link on AMSA's Web site that takes the user directly to www.MedBookstore.com, where discounted books and supplies can be purchased online through password-protected registration. Like most e-commerce arrangements between for-profits and their partners, AMSA receives a revenue percentage on each transaction. Called its affiliate program, Medsite.com creates a customized link on an organization's Web site to the virtual bookstore, which is then tailored with giveaways, further discounts, and incentives particular to that group's membership.
"But beyond the nondues revenue source," Grande says, "there's a comprehensive array of benefits and services out there [on Medsite], and as an organization, we should provide whatever our members are seeking."
From the bookstore, users can click through to Medsite.com, where the full array of portal services resides--accredited CME, journals, e-mail service, personal home pages, an insurance filing function, and a registered-user money manager complete with the latest stock quotes. Medsite.com also partners with a variety of companies and universities to provide content and other e-commerce opportunities. Among them are HealthStream, Medscape.com, McGraw-Hill, WebMD, and Stanford University.
Nabbing the 'Net Generation Medsite.com is currently in a pre-IPO phase and silent on its future plans for financial growth, acquisitions, and partnerships. But John Eastman, publisher and vice president of Medsite.com, makes clear the portal's role relative to associations: It's all about e-commerce.
"We look for relationships for the long term and that starts with relationships with doctors at the beginning of their careers when they are students," Eastman says. Although he declined to provide numbers, Eastman says students are the most active group on the site. "They are driven by price, convenience, and the speed with which we fulfill orders," he says.
Backed by more than $57 million in venture capital investments in the past year, Medsite.com has been able to buy itself position and rank in the medical education field, most notably in January with the purchase of American Medical Communications, a Houston-based producer of educational courses and materials accredited by the Accreditation Council for Continuing Medical Education. Medical expertise is what Medsite.com hopes to leverage as a revenue opportunity and a community builder. But nevertheless, Eastman says, "we don't view ourselves as competitors to medical associations."
The Big Difference "Medical societies' mandate is advocacy," Eastman says, "and Medsite.com is attempting to do that as well, but we're not trying to replace live meetings. Actually, portals will enhance the ability of a medical society to help its members."
On the point of enhancement, Grande agrees. "We as an organization very much support getting future physicians to embrace technology to deliver health care more efficiently," he says.
"We (AMSA and Medsite.com) believe there a lot of ways to reduce the waste of pushing paper, and it is the younger generation that will move things along."
Advocacy, however, is where the waters part. Grande says, in his mind, he cannot square profit motives with altruism. "Nonprofits will always be the advocacy voice. There are too many conflicts of interest in trying to drive the bottom line and advance causes."
AMSA prides itself on taking up the gauntlet for the underdog. Its Web site, www.amsa.org, puts advocacy and student initiatives foremost among the multitude of choices and links, something not found on for-profit portal sites. AMSA's Standing Committee on Advocacy includes projects and activities, subcommittees, and e-mail listservs, all to forward the group's traditions and vision. The four subcommittees--Committee on Disabilities; Lesbian, Gay and Bisexual People in Medicine; Minority Affairs Committee; and Women in Medicine--push issues on the national level.
"We advocate for the underserved of this country and much of what we do would represent a loss of profit," Grande says, "so it's hard to believe for-profits would be able to do that. Social responsibility and making profits are mutually exclusive. We are advocates of patients and the public and, I suppose, a (for-profit) portal could be an advocate for its users, but not for the public."
"Comparing medical portals and associations is like comparing apples and oranges," says Barry Culman, president and CEO of Radiology.com (www.radiology.com), headquartered in Chantilly, Va., "but they're the same in that we both help the professional learn more about their occupation. What we're going after is the next generation of doctors."
Radiology.com began as a hobby for Robert Lufkin, MD, chief of head and neck radiology and professor of radiological sciences at the University of California at Los Angeles. He registered the URL in 1993, long before the Internet was a fact of mainstream life, but his sideline evolved beyond the spare time he could devote to it. Last year, he turned Radiology.com over to iWeb Corp. for corporate development, and the private, for-profit portal was officially launched at Radiological Society of North America's annual meeting in Chicago last November.
Lufkin is still very involved in his creation as editor-in-chief of JRAD, a free, peer-reviewed e-journal for radiologists that Culman considers the crown jewel of the site. It's not a replacement for RSNA's print and online journals, but another choice, according to Lufkin, who points out JRAD's international reach. "RSNA is limited to North America," he says, "but we're not." Lufkin says he's also expecting JRAD to be listed in Index Medicus by the fall, giving accreditation to the journal.
Like any for-profit portal, Radiology.com takes advantage of every opportunity to draw users (right now about 3,000 with a 30 percent monthly growth rate) to the site--relevant industry news, free e-mail, online chats, CME directory and links, Web conferencing with PowerPoint and streaming audio presentations, and most recently, archived video presentations from notables in the field (such as Nobel Prize winner Richard Ernst).
Culman explains that Radiology.com makes profits from its medical book business and from its latest innovation, a digital imaging storage and retrieval system called ImageBank. "But as we get bigger and better and raise funds, we'll also raise our brand awareness," he says. "We are planning many things."
Market Forces Will Rule "We're not meant to be a replacement for societies," Lufkin says, "but, for better or for worse, the Internet is the future, and some real live courses and societies will be impacted--but the market will decide."
Marketing strategy is Culman's domain. He also admits that Radiology.com will not likely replace RSNA, but he's targeting smaller societies as partners to link up with JRAD. In fact, on a small scale, the market is coming to him.
"Several small societies are asking if we (Radiology.com) can be their Internet infrastructure for their Web sites," Culman says. "They're asking to use our model and we want to say 'yes' eventually with the software to market to them."
For now, Culman and his staff are quite aware of the generation gap between tech-savvy younger physicians and older doctors. Often, they take their show on the road to meetings, trade shows, and conferences to give live tutorials. iWeb has redesigned the site to reduce barriers for technophobes by making it easy to navigate and for users to build their own simple Web sites, another Radiology.com feature.
"It's a battle," Culman says, "but people are slowly coming around. We especially see it when we go to the shows ourselves, and sit with the doctors at the computer, and just show them how to use it.
