- Constraint
- Physicians need to reach patients but face a structural bind: call from the hospital desk phone (geographically tethered) or call from their personal cell (exposes their personal number permanently — no boundary, no audit trail, safety risk). Most choose neither. The call doesn't happen. And when they do call from a cell phone, patients see 'Unknown Caller' and don't answer. Twilio required verifying access to the outbound phone number before letting us display it as caller ID — the legitimate path, but slower. We found a vendor that let us set any caller ID without verifying ownership. I knew that approach would never pass hospital IT security review. But I also knew hospital IT would likely never approve the product at all — it lets physicians make outbound calls using their office number from a personal cell phone, geographically liberating the number from the hospital phone system. No security team green-lights that on paper. The only path to institutional adoption was to get physicians using it first — build critical mass, and make approval a fait accompli rather than a request.
- Decision
- Took the shortcut — used a vendor that didn't require caller ID verification — because the legitimate path would never get approved. Hospital IT wouldn't pre-approve a product that lets physicians use their office number from a personal cell phone. The only way through was around: ship to physicians directly, build critical mass, and let institutional approval follow adoption instead of preceding it. Built the HIPAA compliance policy and Epic Haiku integration to give hospital IT a documented basis to clear the product once it was already in use.
- Outcome Established the identity layer Dialer scaled on. Nine years after I left Doximity, the product is still the #1 ranked telehealth platform by health system CIOs — five years running, beating Microsoft Teams and Zoom. Doximity now conducts 300,000+ voice and video visits per average weekday across 200+ health systems, reaching ~45% of U.S. physicians with paid enterprise licenses. Five direct competitors tried to build a physician-focused Dialer and failed. Pickup rates 3x higher than competitors — patients see the office number, not 'spam risk.' The architecture held.
- Why it matters
- When the call connects, a lab result gets communicated tonight instead of next week. A post-discharge follow-up reaches the patient before a complication sends them back to the ER. A physician who gets a biopsy result at 7pm can call from home — the patient sees the office number and answers, the personal boundary stays intact, and the diagnosis doesn't wait until morning. The first sign it was working wasn't a metric: medical residents I'd gone to undergrad with told me they were getting more sleep at night — they could call patients from home with the office number instead of staying at the hospital to use the desk phone. At Transcarent, the problem changed from trust to scale: how to make that same trust work across four clinical programs at once.
