Ep. 211 | The Ethical Concerns around Influencer MarketingThe influencer industry is booming and projected to reach $15 billion by 2022. With 92% of people stating that they trust recommendations from friends and family over any other type of advertising, it’s easy to see why more brands are building relationships with influencers.

But should you, as a physician, venture into that space?

This week on the Dr. Marketing Tips podcast, Jennifer and Corey break down the rise of influencer marketing, how physicians are using it to their advantage, and the potentially murky waters and pitfalls involved in treading into the influencer realm. 

Tune in to discover: 

  • What influencer marketing is
  • The current controversy surrounding influence marketing physicians
  • Potential risks and dangers of engaging in influencer marketing
  • Influencer marketing best practices
  • How influencing physicians can help self-police one another

References:

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Transcript Notes

Speaker 1: Dr. Marketing Tips. Paging Dr. Marketing Tips. Dr. Marketing Tips, you’re needed in the marketing department.

Speaker 2: Welcome to the Dr. Marketing Tips podcast, your prescription to the answers you seek to grow your medical practice easier, better, and faster. This show is all about connecting practice administrators and medical marketing professionals with peers working in practices, learning from experiences, making mistakes and sharing successes. Let’s get started.

Jennifer: Hey there. Welcome to the Dr. Marketing Tips podcast. I am Jennifer.

Corey: I’m Corey.

Jennifer: Today, we are going to talk about influencer marketing, and physicians who are influencers on social media channels, among a bunch of other stuff around this idea of influencing.

Jennifer: This came to us after a article came out in a Tribune newspaper, the Orlando Sentinel, in December of 2019, so for purposes of this recording, just this past month. The article is talking about a physician who works for the AdventHealth systems who was recently reprimanded for inappropriate posting on social media. Either it was just plain out inappropriate or inappropriate in the eyes of the social media policy for AdventHealth.

Jennifer: We talk about social media and physicians using social media as a vehicle for marketing all the time. We can go back and forth whether or not what this doctor said warrants being reprimanded like that or not, but I think the deeper discussion is that this physician, who is a resident, who grew up using social media, has developed a following that puts him in the category of being an influencer.

Jennifer: In fact, he has over 100,000 followers, I think, on Instagram, and he’s right there on Twitter. He has also got a side hustle where he sells supplements, and basically sells supplements and uses his channels in influencer marketing to push those supplements to the rave community, the rave electronic dance community. He pushes this whole supplement that goes to them using his influencing channels. So I think the conversation today is really about social media, but then the rise of influencer marketing.

Corey: Yeah. Specifically, I think we also need to mention, when it comes to physicians or nurses, other healthcare professionals, when they’re advertising, that’s something that’s been called white coat marketing. That’s a term that’s starting to be thrown around. It’s actually being thrown around in some lawsuits, specifically in the pharmaceutical space, because they had something very similar to this resident.

Corey: It’s important just to say, as part of this conversation, I wanted to share some stats from the Digital Marketing Institute, because influencers, we’ve all heard of them. It might be something that you see a teenager doing, and you just brush that off, and you’re like, “Oh, that’s silly. Whatever.” But the statistics are really startling. I just wanted to share some of those with you.

Corey: 70% of teens trust influencers more than celebrities. 86% of women use social media for purchasing. That means that if they’re following some of these influencers, they have a direct impact on their purchasing decisions. 49% of consumers depend on influencer recommendations, which is insane.

Corey: You can see where this conversation is heading, that if someone that is in the public and has trust, like a physician is, he’s created some sort of a supplement or whatever for the rave community, people that are following him, obvious they are going to trust him. If he’s a member of their community, their tribe, all of a sudden, well yeah, it makes sense to buy from him, right? That’s where there’s this ethical and moral dilemma, I think, that’s bubbling to the surface here.

Jennifer: No, absolutely. It begs the question, should doctors be in the influencer space? I think, yeah, they can be in the influencer space, but it’s about should they be able to walk that fine line of peddling goods and services versus providing information. In doing so, are they breaking HIPAA or Stark or any other regulations that are out there that are set that guide their profession? I think it’s a much deeper conversation than how many followers can he get, and should he be on social media.

Corey: Right. Yeah, no, absolutely. I think that there’s a difference too. I’m going to play devil’s advocate a little bit, but I think there’s a difference too between saying he can hawk these products or not.

Corey: If he’s on there, and he’s saying, like one of the quotes from the article was he said, “I watched my patient code and die right in front of me… Solid day.” That’s something that the hospital system or the employer may not be okay with, but at the same time, he didn’t violate HIPAA when he did that, and he has this big following, and they’re following him for a reason. Is it okay to say that? I don’t know. I don’t think I would share that, personally.

Jennifer: Well, I also think the question is, is it in poor taste, or is it questionable taste, is it good taste.

Corey: Sure.

Jennifer: Go back to that. He watched patient code and die in front of him. This is in 2012. This is going to air in 2020. He’s only now a resident, so how old was this guy? What was his maturity level back in 2012?

Jennifer: Fast forward to something he wrote just a couple months ago. It says, “Just did my first death pronouncement. Opening a dead person’s eyes and staring into them is the most insane thing ever.” He put that on Twitter, and he’s got 100,000 followers on Twitter. Is that in good taste, or is it just against the policy, and that’s why he got reprimanded?

Corey: Right, right. I would say definitely not in good taste. Then again, it crosses a very different sort of threshold when it goes from that to, “Oh, by the way, you should buy these supplement pills, because they’re the best thing ever.”

Jennifer: That’s exactly it. He spent years, at the same time he’s going to medical school, building his following, because this is a natural progression for somebody of his age. His followers are young too. So is it okay or not okay that he started a side hustle, whether it’s to pay down his medical bill costs, or just to get him into this next realm of influencer marketing. Is it okay that he started this side hustle? I don’t know the answer, but …

Corey: Right. Yeah. You’re starting to see that more and more, obviously with how expensive med school is and everything, but these students are actually moonlighting as influencers. Actually, we follow some of them on the Dr. Marketing Tips Instagram too. You can see when they’re these carefully curated posts, where they’ll just have the notebooks ever so slightly, and a cup of artisan coffee, and it feels …

Corey: We’re marketers, so we see it, and we know that is a staged photo. But to another resident who doesn’t know, or just let’s say a mom in suburbia somewhere, she may follow her family practitioner thinking that this is a good way to really get to know them in a way that I don’t have time to otherwise. Then all of a sudden, three months down the line, that practitioner may share something that promotes, I was reading an article, even something like Lululemon as sportswear or gym wear. That mom could be influenced by said practitioner to go and then buy Lululemon. Is that okay, because that doesn’t relate to health care specifically, but she’s still using her platform and her clout to influence a purchase decision.

Jennifer: Yeah. I read the same article. They are talking about Lululemon clothing, watches, vacations, all kinds of things that are just being sold through influencer networks, but this was specifically these types of things through influencers that happen to be physicians at the same time. They happen to be wearing white coats.

Jennifer: We have somebody that we’re close with on our team whose daughter is an influencer on Instagram. She’s a 15 year old girl who has a large following, and has clothing companies and makeup companies sending her free product in exchange for her going on Instagram and talking about that free product. It’s an entire new world out there. This next generation of doctors that are coming through, they’re still young people, regardless of whether they’re wearing a white coat or not, and they’re still being influenced by these types of trends that are coming through.

Corey: They’ve grown up with all of this technology in the palm of their hand just like everybody else. This is the world that we live in now, right?

Jennifer: Absolutely. This whole white coat marketing and medical professionals as influencers, the bigger question is is it ethical. The trend is that regulators have actually been looking into the practice of physicians and providers who are marketing products, like the supplements that this example from the Orlando Sentinel said, marketing those products directly to patients.

Jennifer: Now, most of the lawsuits out there and the case studies refer to the pharmaceutical space, but you’ve got multiple lawsuits in the last handful of years where pharmaceutical companies have had their hand slapped at the way that they’re marketing to physicians, and then in turn marketing to patients out there in the marketplace.

Jennifer: There’s all kinds of potential pitfalls and muddy waters that you’re walking through as it relates to influencer marketing, and potential Stark violations and kickback provisions. So I think that before a physician out there even treads into the space related to influencer marketing, there’s a legal conversation that needs to be taking place about kickbacks and about Stark violations.

Corey: Yeah, if a physician or someone related to the physician, like a family member, if they have some sort of financial relationship with an entity, like one of these businesses or whatever, then that gets really muddy really quick, because that can be construed to be a kickback violation of some sort.

Jennifer: Yeah. The kickbacks are really muddy water.

Corey: Yeah, absolutely. We all know that the physician, you’re not supposed to refer patients to the entities if it’s a designated health service and everything like that, but how, if you are posting something that doesn’t really relate but it kind of does, is that still a violation? That’s where we are now is we just don’t know the answer.

Jennifer: Absolutely. We won’t know the answer until there’s enough case studies out there and enough legal opinion on the issue itself. I think it goes back to does it pass the stink test? It’s not so much is it within the rules or outside of the rules, but is it right or wrong. That’s where we need our medical professionals to really walk the walk, I think.

Corey: Right. The thing is too is it’s hard to prove, specifically when it comes to, let’s say, referrals for example. It’s hard to prove that this product or service or a post or whatever is specifically soliciting referrals. That’s a whole ‘nother level. If it’s not just a purchase decision, but what if it’s a referral decision? Then it gets really muddy, because there’s no way to really prove that one way or the other. Then there’s no way to enforce a penalty either.

Corey: Hey, guys. Corey here, cohost of the Dr. Marketing Tips podcast. I wanted to interrupt this episode just for a minute to tell you about Insight Training Solutions.

Corey: Insight Training Solutions is an ongoing employee engagement and training platform for your medical practice, meaning employees can log on and take these medical practice specific trainings whenever and wherever they are. Each training is meant to increase employee engagement, improve practice reputation, and develop some patient service mindsets, if we’re being honest, something that we all know some of the employees may lack, not calling anybody out by name.

Corey: One of the cool things about Insight Training Solutions is they’re always developing new content. They just released 10 Steps to a Phenomenal Patient Experience where you’ll learn how to create a phenomenal patient experience, strengthen job security, and discover customer service secrets for your entire team. This course is in addition to the other ones they already have, which include Communication Across Generations, and How to Understand Today’s Multigenerational Workforce, and How to Develop Overall Patient Experience. This is another course, The New Approach To Customer Service. We’ve also got 8 Ways to Wow Patients.

Corey: You can sign up for a free trial to see what everything is about at insighttrainingsolutions.io. That’s insighttrainingsolutions.io, or just Google Insight Training Solutions. You’ll be glad you did.

Jennifer: That’s a really interesting point. As you’re saying that, I’m thinking about how I know this stuff works, influencer marketing, because even if you break it down to the way that we do patient testimonials, how many times have you heard that a patient testimonial for a doctor has influenced a purchasing decision to come into that practice? Just because you had a patient talking about their positive experience with that physician, that other people have been influenced in the purchasing decision to also come in and schedule an appointment. It’s not a direct influence relationship, but it is absolutely influencer marketing.

Corey: Yep, exactly. Like I said, at the moment, there’s no repercussions for that. There’s nothing wrong with that. It’s not illegal. It’s not wrong. It’s effective. It’s just an interesting conversation, because there’s a new way to market that didn’t exist 20 years ago.

Jennifer: Absolutely. Then as this new generation of healthcare providers and patients are coming into the system, the question comes up. Is this what we can expect? Because in general the industry needs to evolve. That’s because patients have evolved. Our expectations have evolved. So naturally this is a conversation that’s going to need to be taking place sooner rather than later, because it’s coming into the practices.

Jennifer: I was doing some research. There’s a doctor, Michael Richardson, MD. He’s a board certified family physician and medical director in Boston. He serves on the Massachusetts Academy of Family Physicians, board of directors. He said in a September article opinion piece on the AAFP website that physicians using social media should be doing so more in the interest of deepening doctor patient relationships versus trying to hawk goods.

Jennifer: What he’s saying is, “Look. I went into family medicine so that I could make a difference within families, and I could spend time with my patients. Social media is another opportunity for me to deepen that relationship with my patients.” Not saying deepen a relationship like violating HIPPA or anything like that, but a chance for the patient to get to know the doctor a little bit more, and the doctor to get to know the patient a little bit more by using social media as another form of communication. That’s a totally different way of looking at influencing marketing.

Corey: Yeah, absolutely. Because, again, he’s not trying to hawk any sort of goods. He’s just saying that this is an avenue where you can get to know me, whereas our time in the office is so tight now. Going from appointment to appointment, I think the average appointment is between 10 and 20 minutes, and depending on what specialty, it can even be less than that.

Corey: Outside of the exam room, then a lot times the providers are doing paperwork or doing other things that their employer or the payers are asking them to do. So he’s saying that, well maybe social media is a way that we can reestablish this relationship, and at the same time distinguish ourselves from some of these online health influencers. It’s a really interesting thought.

Corey: Again, to play devil’s advocate, I would say the other side of the coin is, well that’s great. Or maybe I don’t have to go on social media at all if I could just spend more time with patients, but where is that time going to come from? If I’m already working nine or 10 hours a day, and I’ve got to do X, Y and Z, and I’ve got to dictate, and I’ve got to run from office to office, there’s no time. As nice as this sounds, what am I supposed to do? My hands are tied.

Jennifer: I think that right there you make an interesting point. I think if we were to look at this physician, Dr. Richardson, if we were to look him up, I’m going to make a presumption that he’s a little bit older, and he’s not a first generation adopter of social media.

Jennifer: Fast forward that to Dr. Austin Chiang, who is a Harvard trained gastroenterologists at Jefferson Health, Thomas Jefferson University Hospitals in Philadelphia. He was recently appointed as the institution’s first chief medical social media officer.

Jennifer: This physician is 33 years old, was appointed to this brand new role, and is also recognized for starting a nonprofit organization called the Association For Healthcare Social Media, where he got together with 15 other influencer physicians on Instagram, and started this nonprofit so that they could provide best practices for physicians using social media in the influencer space.

Jennifer: He’s the guy who said, “Look. The first year I was in college, I was on Facebook, because it was the first year it came out was when I was an undergrad. I’m familiar with MySpace and YouTube and everything that came before it.” He goes into this whole thing of talking about …

Jennifer: There’s a great podcast episode that JAMA puts out where he’s talking about this new association and his role at Jefferson. We’ll link to that in the show notes. He’s talking about self-policing influencers self-policing one another. They had this whole #VerifyHealthcare campaign that they put out there because just because somebody is wearing a white coat doesn’t mean, as a consumer or as a patient, you should automatically be trusting them.

Jennifer: There’s so many instances of physicians using social media to talk about something that maybe hasn’t gotten full FDA approval yet, or hasn’t gone through the entire scientific discovery, and so it isn’t necessarily recommended for prime time, but because your potential patients and those of us laymen are seeing discussions taking place on social media, we’re taking it as being a proper treatment plan, or something that we should be asking our physicians about. That’s not necessarily the case. This whole #VerifyHealthcare campaign is the concept that, as providers, that you need to be policing one another until the rules are set.

Corey: I love that idea. I think that, in theory, that’s awesome. However, in practice, the average, again, let’s just say 22 year old female who’s on Instagram, and she happens to follow, let’s say, her OB GYN or whatever, or just an influencer in the space, she’s not going to look for the Verify Healthcare campaign. She’s not even going to know that that’s a thing that exists or that she should be on the lookout for. What she’s going to look for is something that she can identify with and that she trusts. Then if they mention a product or a service or a treatment, she’s going to say, “Oh, maybe that’s for me.” Again, I think that’s a really great idea, but in practice that’s going to be really hard to implement.

Jennifer: I think that you just referenced a young woman or a mom researching or following her gynecologist, right? That’s not where I see the issue really being. Maybe, but I see the issue being when a 45 year old or 50 year old woman is following their plastic surgeon, or a 15 year old is following their parents who happen to be following a plastic surgeon, or you’re comparing yourself to this Kardashian culture, and this culture of, “Let me worry about today. Let me look Instagram ready.” It’s those influencers out there who are putting filters on, or changing their body types or doing whatever. Then you have these young impressionable individuals or older impressionable individuals-

Corey: Yeah, I was going to say.

Jennifer: … who then now go to their plastic surgeon and say [crosstalk 00:22:26], “I want to look like this.”

Jennifer: It’s this whole Generation Wealth. There’s a great Amazon movie that came out over the holidays that is chronicling the obsession of wealth, and the fact that you know the names of the Kardashians more than you know the names of your neighbors. It’s this perfect storm all colliding at once, as we have physicians coming of age in a social media world, as we have influencing marketing hitting something like $28 billion expected in 2020, and you’ve got very impressionable individuals now comparing themselves to what the next person has, and they’re using social media to make those comparisons.

Jennifer: For the very first time in the history of our society, we are faced with troubles that we’ve never been faced with before. It begs the question, is it ethical for our physicians, and our elected leaders, and our leaders in general, to use that space to have a side hustle, or to promote fame instead of promote education?

Jennifer: I don’t know the answer to it, but it’s something definitely to watch. As marketers, I think it’s critical for us to be part of this conversation, because so many of these doctors out there are going to be asking us to do certain things, and we need to be able to answer those questions and push back a little bit when they’re asking us to help market them or take them down a certain avenue, because we see it all the time.

Corey: Yeah, absolutely. It’s an interesting debate on free speech versus what’s ethical and what really matters. I remember even, I don’t know, two or three years ago when sometimes we would go to talk to clients, and we would discuss rolling out a social media channel, and they would turn their heads and scoff at that, because they said, “Social media, it’s just for kids. That’s below me. That’s stupid. I don’t want to do anything like that.” I remember specifically one doc that we worked with saying, “That’s below me. That’s stupid.”

Corey: It’s just interesting that now we’re looking at this new generation of doctors that have grown up using this stuff, relying on it, and like you said, they are coming to us as marketers, and to our listeners as well, and asking them what to do. The answer of what to do is different today than it was even two years ago.

Jennifer: It truly is. As somebody who was an elected official for eight years, who was often cited for my use of social media, I have been through having, in a very small amount, the opportunity to influence large amounts of people with my opinions, or to put new opinions out there. I can tell you, more often than not, I would be asked to put information out there to the public, and had to be very cautious in the way that I did it, specifically because I know it would influence people one way or another.

Jennifer: That’s why there were laws put in place about what we could and could not say. It was just walking a fine line, because the laws are older than the technology and the platform itself. So it takes time to catch up. Through mistakes, somebody is going to make mistakes out there, and that’s how the laws are going to get updated. We just need to make sure we’re not the ones making the mistake, and that our listeners and clients aren’t the ones making the mistake.

Jennifer: I think at the end of this, to wrap it all up, that we’ll put some of these articles in the show notes, but I think this is one of those things that our listeners need to start thinking about. We need to make sure that we’re very clear about how we’re going to use social media to influence decisions of potential patients, but at the same time not get ourselves into trouble.

Corey: Yeah, absolutely. I would add to that that just like with any other sort of advertising, marketing, words and images matter. You’re not just trying to get more likes and more clicks, there’s an actual person on the other side of this thing, and that’s a potential patient. Even if it’s not a potential patient, it’s another human being. The things that we’re saying and posting can make a difference to them, whether we know it or not. So it’s important to pay attention to what we’re saying, how we’re saying it, why we’re saying it, when we’re saying it. It just goes round and round.

Jennifer: It does. If you want more on what we think’s going to happen with social media in 2020, go back and listen to our social engagement episode and our top 20 list, because we talk a lot about where we think social media and reputation management is going. I would add a 21st thing, and that would be this influencer marketing and how it’s going to impact healthcare in this year ahead. I think that’s a good place to wrap up. With that, I’m Jennifer.

Corey: I’m Corey.

Jennifer: We’ll see you next time on the Dr. Marketing Tips podcast. Thanks for coming.

Corey: Thanks, guys.

Speaker 2: Thanks for listening to the Dr. Marketing Tips.com podcast. If there’s anything from today’s show you want to learn more about, check out drmarketingtips.com for our podcast resource center with all the notes, links, and goodies we mentioned during the show.

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