Rise of the social media influencer in fertility care, part 2: doin’ it (professionally) for the “Gram”

Consider This

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Authors:

Darcy E. Broughton, M.D.,Serena H. Chen, M.D.,b Natalie M. Crawford, M.D., M.S.C.R.,c Eve C. Feinberg, M.D.,d Eric J. Forman, M.D., H.C.L.D.,e Natalia Grindler, M.D.,f Amanda Kallen, M.D.,g Rashmi Kudesia, M.D., M.Sc.,h Candice O’Hern Perfetto, M.D.,i Lora K. Shahine, M.D.,a Mark Trolice, M.D.,j and Kenan R. Omurtag, M.D.k 

a Pacific Northwest Fertility and IVF Specialists, Seattle, Washington; b IRMS Institute for Reproductive Medicine and Science at Saint Barnabas, Livingston, New Jersey; c Aspire Fertility, Austin, Texas; d Northwestern University, Chicago, Illinois; e Columbia University Fertility Center, New York, New York; f Conceptions, Reproductive Associates of Colorado, Denver, Colorado; g Yale Fertility Center, New Haven, Connecticut; h CCRM Houston, Houston, Texas; i Center of Reproductive Medicine, Houston, Texas; j Fertility CARE: The IVF Center, Winter Park, Florida; and k Fertility and Reproductive Medicine Center at Washington University in St. Louis, St. Louis Missouri

Darcy E. Broughton, M.D.: @Debrough27 (IG)
Serena H. Chen, M.D.: @drserenahchen (IG)
Natalie M. Crawford, M.D., M.S.C.R.:  @nataliecrawfordmd (IG)
Eve C. Feinberg, M.D.: @drevefeinberg (TW)
Eric J. Forman, M.D., H.C.L.D.: @ericformanmd (IG)
Natalia Grindler, M.D.: @nataliagrindler_md (IG)
Amanda Kallen, M.D.: @AmanadaKallen (TW)
Rashmi Kudesia, M.D., M.Sc.: @rkudesia (IG)
Candice O’Hern Perfetto, M.D.: @infertilitydrperfetto (IG)
Lora K. Shahine, M.D.: @drlorashahine (IG)
Mark Trolice, M.D.: @drmarktrolice (TW)
Kenan R. Omurtag, M.D.: @drkenanomurtagmd (IG) 

IG = Instagram, TW = Twitter.

Consider This: 

What kind of time and effort goes into your posting and commenting?

Most influencers use both topics from the lay media and from research in our field to get inspiration for posts. The majority post and respond to comments on the fly during their busy schedules. Most do not post on weekends. 

“I typically post on the fly. Occasionally I will pre-write on a topic, but I find that when I re-read it later (at the time I decide to post it) I do not like the way it sounds as much as I do when I just write on the fly.” @infertilitydrperfetto (IG)

“Typically we try to respond within several minutes. I know that if I was on the other end, I would want a response as quickly as possible and we try our best to treat patients how we would want to be treated.” @drmarktrolice (TW)

“It really varies; some weeks I’m swamped with other stuff and do basically nothing with social media. Other weeks it could be up to 3-4 hours a week, especially if I’m working on a detailed blog post. I have presented both kinds of research – simplifying scientific articles or responding to simpler materials online. I have not gotten reliable at scheduling myself out, though this is a goal for me. I typically have a topic I want to post on, and I get to it when I can. I try to respond to the majority of posts, at least with a like or heart, if not a full comment.” @rkudesia (IG)

Do you post across multiple platforms (Instagram, Facebook, Twitter, Website/Blog)?

Social media is constantly evolving and there are dozens of platforms available. When trying to utilize social media as a healthcare provider, some are more appropriate and popular, including: Facebook, Twitter and Instagram.

Facebook has been around the longest and has the most users (over 2 billion). It allows users and businesses to share photos with an associated post to connect with followers. Through Facebook, followers can “like” or comment on posts, as well as leave reviews. 

Twitter utilizes short, 140 character or less messages (can also include photos, gifs, etc.) called “tweets” to direct followers to a specific website or page.

Instagram is a platform aimed at sharing photos and/or short videos with a concise caption to connect with followers.

In addition to the above platforms, there are others that are increasing in popularity, like Pinterest (image based), YouTube (video-based), tumblr (blogging), and LinkedIn (networking).

Many SMIs post on multiple platforms, but most identify Instagram as their main posting platform and their favorite due to its versatility and dominant visual medium. Instagram has grown to be the leading social app for brand engagement. Of note, very few have applied for a verified badge and no one we interviewed had been granted one, but it’s coming. To elucidate, a “verified badge” is a check that appears next to an Instagram account's name in search and on the profile. It means Instagram has confirmed that an account is the authentic “presence of the public figure, celebrity or global brand it represents.”

“I post on Instagram. By understanding one platform really well, I believe I am able to create more appropriate content and have a better reach.” @nataliecrawfordmd (IG) 

“Instagram is so much more creative and fun with photos and allows me to write more detail about what I’m trying to say, Twitter is limiting.” @drlorashahine (IG)

“I mostly post on Instagram and Twitter.  The Twitter format is easy and a great way to do some professional networking and to find and distribute content like healthcare articles.  Instagram is more fun because it is based upon photos and graphics and seems to have less talking and dialogue.  I post on Facebook but find that the platform clumsy and not much fun…” @drserenahchen (IG) 

“Twitter is too fast. Facebook is a mess and millennials don’t appear to be using it, but it is helpful for mining local contacts and grassroots outreach efforts.  I have shifted my personal social media presence to Instagram only. It appears to be the most resilient and it is the ‘happiest place on the internet.” @drkenanomurtagmd (IG)

What posting topics garner the most interest and positive feedback from your followers? 

In general, respondents endorsed highest interest in posts containing educational content.

“…topics around LGBTQ pride garnered a ton of interest and support.

In general I notice patients responding to informational posts - why a particular procedure might be done, indications for IVF, understanding RPL, etc.” AmandaKallen (TW)  

“An increase in followers rarely come from a single post, but from a consistent posting of content in line with your message. Engagement is often highest on posts combining a good visual image with a purposeful message.” @nataliecrawfordmd (IG) 

“Diet/lifestyle and endocrine disruptor. Physician mom struggles. Honest reflections” @nataliagrindler_md (IG)

“Always a lot of interest in the specific diagnoses – especially PCOS, which is one of my focus areas. Interacting with ongoing social media campaigns helps generate new followers and engagement, particularly on Instagram.” @rkudesia (IG)

How do you feel about individual REIs or clinics posting birth announcements or pictures of children that are the product of successful infertility treatment?

Most respondents supported the posting of birth announcements or pictures of children. All noted some form of policy (some formal) requiring patient consent before posting.

“Recognizing it’s just one perspective, I view the picture of a parent with their child on a fertility page similarly to a picture of a cancer patient ringing the bell after finishing treatment. It is an image that those who just started their journey can aspire to:’I will be successful!’” @drkenanomurtagmd (IG)

“Conflicted. My practice does this a lot, and I think it is nice for previous patients and employees. But I think it can be triggering to potential patients, or those in treatment, so I think the account-holder has to decide what their goals and desired follower population is.” @rkudesia (IG)

“I try to limit baby pictures to my stories only. I think that the last thing someone who is trying to conceive or just had a miscarriage wants to see is a bunch of baby pictures. I do however, show ultrasound images of first trimester pregnancies. Follower feedback for that has been very positive. Followers comment that they love to see a success story and ultrasound images seem to hurt less than actual baby pictures.” @infertilitydrperfetto (IG) 

“I think it’s ok if they give explicit permission, I like the ‘transferverrsary.’ I think it better if patient post it and tag clinic or doctor or allow them to share.[sic]” @ericformanmd (IG)

How do you respond to negative feedback on social media? Do you ever take posts down?

Most influencers have taken down a small number of negative posts, but express that this happens rarely. Many use their followers to speak out against any naysayers. Many respondents remarked that they were surprised by how overwhelming positive the response to their social presence has been.

“I typically ignore negative comments, but I do usually leave them posted. If the comments are medically incorrect I try and correct them. Typically, my followers respond to negative commenters for me.” @infertilitydrperfetto (IG)

“…We respond in public with empathy and reach out to try to address the issue with the patient by asking them to contact a manager directly or to let us know if they want to be contacted…We apologize for the negative experience whether or not we feel at fault and try to address it promptly…” @drserenahchen (IG)

I will block people or delete comments that are not helpful to my platform. There are some people who will post harassing or hateful comments, these things are removed.” @nataliecrawfordmd (IG)

“Typically we don’t remove posts under any circumstances, because, again, we want to let our followers see what the conversation is and how we respond and react in real time. If there is a negative review that is blatantly false or misleading we will work with our marketing team to have that removed from the platform if it’s allowed. Otherwise, we will post a HIPAA-compliant response and invite the user to contact us directly and resolve the issue offline.” @drmarktrolice (TW)

Have you sought sponsorship or affiliations to monetize your social media presence? Do you display conflicts of interest or use “sponsored” where relevant?

Very few respondents have sought sponsorship or affiliation. Those that do identify sponsored posts.

“I identify sponsored posts. I am a consultant for a home sperm test so I have to be very direct about that. There is so much sponsored content out there masquerading as organic.” @drkenanomurtagmd (IG)

What advice do you have for those hoping to cultivate a social media presence in fertility medicine?

“Be yourself and do it yourself only if you want to. Being fake or not keeping up with it may be worse than no presence at all.” @ericformanmd (IG) 

“Put yourself out there, people like to see the person behind the physician. Engage with your followers and engage with those who inspire you. The platforms are not meant to be one dimensional, so if you put out content without engaging with your audience, it will never be as well received as it could.” @nataliecrawfordmd (IG)

“Once you decide to create an account, then go for it. Jump in with both feet and make a point of posting as often (I try to post every weekday) as you can. That being said, do not just post to post- if it does not fit your point of view, leave it (or just post on stories, not your feed). I think it is better to take a day off than post something irrelevant.” @infertilitydrperfetto (IG)

“Keep at it! Building a following is harder today than it was last week, which was harder than it was to do the week prior. The consistent evolving algorithms, especially on Facebook, make it harder for pages to “break through” the clutter organically. Most pages can expect less than 6% of what they post to reach their followers without “boosting” the posts. Facebook has become “pay to play” for the most part so you have to stay consistent (and a little digital advertising budget can go a long way).” @drmarktrolice (TW)

“It’s not for everyone, but don’t write it off. Experiment and put your spin on what people are already doing to make it unique.” @drkenanomurtagmd (IG)

Is having a social media account part of the job description for a reproductive endocrinologist in 2019?

Response to this question was mixed. Many endorsed that you should only pursue it if you have a strong desire to. Most feel that social media activity complements and enriches their clinical practice, but they acknowledge that effort and enthusiasm are required to be successful.

“I think you need to have your finger on the pulse of what is happening in the world both at large and in the arena of infertility. Social media is an excellent way to do both.” @drevefeinberg (TW)

“No way – it should be something someone wants to do – not a part of the job. Social media presence is important for the practice but does not have to be a part of a physician’s profile to maintain a great practice and give good patient care.” @drlorashahine (IG) 

“I think there is a lot of growth opportunity in this space. Certainly, our patient demographic is only becoming more modern and increasing conversant with technology. I acknowledge that not all physicians want to be on social media, but to those that do, I think that having a social media presence shows a level of commitment to understanding advances in technology – which is obviously an important aspect of our field.” @nataliecrawfordmd (IG)

“Not yet but it may get there! Nothing will replace good old fashioned clinical competency and bedside manner but patients also want approachable and available and friendly - which is where social media can help bolster these impressions.” @AmandaKallen (TW)

“I certainly do not think it should be part of the job description, but it is a nice addition to any CV. I also think social media does have some down sides. It takes considerable time, the occasional negative comments can be hurtful and there is a small risk of liability. If these are a major concern, then it may not be the right fit.” @infertilitydrperfetto (IG)

“I wouldn’t say it’s a requirement necessarily; however, I do think that by not being active, you are missing out on a big piece of the puzzle when it comes to marketing, communication with patients and with the larger RE professional as a whole. To be in front of the right patient at the right time with the right message, you have to be on the right platform.” @drmarktrolice (TW)

In conclusion, a digital presence online is becoming increasingly visible as an adjunct to the delivery of medical care. One recent report among spine surgeons found that absence of a website correlated with lower online reviews. That same study found that use of a social media account did not appear to influence online reviews, but it did correlate with an increased volume of feedback (1).

Another study did show an influence of social media on online reviews. A study took 102 physicians with negative online reviews, half of whom had a social media presence, and trained all 102 how to use social media. As a result, social uptake increased 90% and a resulting decreased in search position on Google of those negative reviews was noted (2).

In the future, it is possible that social media influence may be used as a domain for academic promotion. Promotion typically reflects increasing reach of scholars ascending from local to national to international influence. Historically, academic promotion and tenure committees have judged scholarly activity using publications and measures such as impact factors. Cabrera et al., make an eloquent case for the future of social media impacting promotion, as it has the inherent quality of engagement and influence, with metrics that can be easily analyzed recording distribution, dissemination and impact of posts (3). 

To aid in supporting and promoting healthcare providers on social media, a newly formed non-profit, the Association of Healthcare Social Media (AHSM) was created by fifteen leading physicians on social media. AHSM advocates for the preservation of medical integrity of online health information while developing best practices for social media use and supporting providers who desire to use social media as an educational, inspirational, or advocacy resource. Moving forward, we will undoubtedly see more physicians entering this space. Some will be able to monetize their “influencer” status in partnership with clinics, brands, or industry, which emphasizes the need for transparency of conflicts of interest. 

Fifteen years ago Fertility and Sterility dedicated six articles in one issue (Fertil Steril 2005;83:3:529-820) to the use of websites and advertising in fertility medicine. At that time, Facebook and MySpace were still niche social tools in their infancy. With time and the explosive growth of the smartphone starting in 2007, social media crossed into everyday life. Over the last decade, social media use has matured professionally and stands to grow further in our world as millennials enter their reproductive prime. Do not sleep on “influencer” networks and their prominence—their narratives will shape the messaging patients ultimately consume—and with it, our field. Do not be afraid to dive in! 

References:

  1. Donnally CJ, McCormick JR, Li DJ, Maguire JA, Barker GP, Rush AJ, Wang MY. How do physician demographics, training, social media usage, online presence, and wait times influence online physician review scores for spine surgeons? J Neurosurg Spine 2018;30:279-88.
  2. Widmer RJ, Shepard M, Aase LA, Wald JT, Pruthi S, Timimi FK.  The impact of social media on negative online physician reviews: an observational study in a large academic multispecialty practice. J Gen Intern Med 2019;34:98-101.
  3. Cabrera D, Roy D, Chisolm M. Social media scholarship and alternative metrics for academic promotion and tenure. J Am Coll Radiol 2018;15:135-41.
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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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