On November 7, 2018, physicians on social media rallied around the hashtag “#ThisIsOurLane in response to the National Rifle Association (NRA), which earlier that day had tweeted, “Someone should tell self-important anti-gun doctors to stay in their lane.” Among those rallying were physician leaders with upwards of 53,000 followers, and they used their significant platform to advocate for health policy change.
While #ThisIsOurLane may be the most public example of physicians using social media to promote an agenda, there is another one burgeoning within the fringes of Instagram: the “medical student influencer.” Tags like “#medstudentlife, #residentphysician and #medblog” yield thousands of examples of medical students and residents leveraging their soon-to-be profession to market not only their “personal brand” in an effort to gain followers, but also products on behalf of companies that pay them upwards of $100 for each post. These accounts are well-curated with carefully arranged photos of scrubs, coffee, textbooks and anatomy models, and are geared toward the consumer who wants to experience the “glamorous” world of medicine.
Those who work in medicine know this is not an accurate depiction of clerkship, residency, and professional practice. Not shown in these posts is the lengthy training process, the massive financial investment, the difficult and often heartbreaking patient encounters, or what it’s really like being bedside in an OR, standing and watching for hours. While some influencers may argue that they use their platforms to help mentor pre-medical students and shed light on the training experience, we would argue that this is a misleading depiction of what it is to train to be a doctor.
The posts, however, don’t always end at lattes and fitted scrubs: Some are sponsored by companies trying to market products unrelated to medicine, like watches, jewellery, laptop cases, and headphones. And there are those that are more questionable—detox teas, for example, and fitness supplements. One popular diet and weight loss tea marketed by celebrities and medicine influencers alike has on their website an “ambassador” program with associated perks to the marketer, including a commission, discount codes, and complimentary products. Platforms like Linktree allow Instagram influencers to link directly to product sponsors with attached discount codes, providing a financial kickback based on the number of customers who buy the product using their codes.
What are the ethics of this practice? At a time when public mistrust in science and medicine is increasing, doctors must tread carefully online. We believe that it is unethical for physicians and physicians-in-training to be promoting or endorsing products on social media, particularly products that claim to have health benefits but lack the scientific evidence to demonstrate these claims. There is no difference between a medical student or resident using social media to market products for financial kickbacks and Dr. Oz, who is well-known for using his status to endorse—for lack of a better term—quackery. Both involve using professional status for personal and financial gain.
There is a need for specific policies and guidelines that address how medical professionals engage with for-profit companies on social media. The Canadian Federation of Medical Students has a guide for medical students for professionalism online which has excellent tips on taking ownership of what is posted online, but without any clear guidelines regarding sponsorship, interaction with private industry, and endorsements. Neither do clear guidelines exist through the Canadian Medical Protective Association, whose role is to support and protect physicians by providing legal defense, education, and risk management. The Canadian Medical Association’s code of ethics (which applies to medical students) states in article 50: “avoid promoting, as a member of the medical profession any service (except your own) or product for personal gain.” In our search, this is the only clear guideline set out by the medical profession on this matter. While medical schools cannot dictate or police how students spend their free time, they should reinforce the code of ethics and ensure students are aware of the ethical and professional boundaries of such behaviour.
With medical learners facing increasing levels of burnout, financial stressors and social isolation, it may be that becoming a social media influencer is a behaviour that serves a purpose, such as providing a social network or income at a time when people feel isolated and student debt accumulates. While we did reach out to several medical students and residents for comment, we did not receive any response. The reality is we don’t know what drives this behaviour, yet it exists across several industries and is quite lucrative.
Can we blame our learners? The most concerning feature of this practice is that medical learners are acting as vehicles for large businesses to gain access to a new marketing opportunity. Perhaps the conversation should be about how we as a medical profession should protect our medical learners from large businesses. There is a need for policies prohibiting medical professionals from engaging with for-profit companies on social media, and medical schools should ensure that learners understand the risks associated with using social media as a marketing tool. The minimal guidance provided by associations and throughout medical education on this matter leaves learners vulnerable.