For years, the Internet has been shifting from an information repository to a network of individuals who communicate with each other. Web 2.0 is the term that describes that trend. It not only includes social networking sites, such as MySpace, Facebook, and LinkedIn, but also sites that depend on users for content - YouTube and Wikipedia, for example. Businesses, like Amazon, also build and interact with communities of customers on their sites. Blogging and micro-blogging (like Twitter), both of which are forms of web journaling, are the newest Web 2.0 developments.
The data shows social networking is huge. Facebook, for example, claims to have 175 million users, half of whom are in college. The fastest growing segment of Facebook users, in fact, is age 30 and older. YouTube says 10 hours of video are uploaded to its site every minute, primarily by 18- to 34-year olds, although its demographic reaches as high as 55 years. And MySpace has more than 110 million users, age 18 and older.
Physicians, of course, are no strangers to social media outlets on the Internet. According to a Manhattan Research report on the pharmaceutical and healthcare market, nearly 60 percent of doctors in the U.S. participate in physician online communities like Sermo and Medscape Physician Connect.
Insiders like Michael Maher, the director of client services at Greater Than One, a public relations agency for the healthcare industry, see social networking as a way to recruit physicians to clinical trials and find doctors interested in testing new equipment. In February 2009, surgeons at Henry Ford Hospital in Detroit used Twitter in the operating room to relay minute-by-minute updates on a cancer removal procedure "to let people know that a tumor can be removed without taking the entire kidney," lead surgeon Craig Rogers, MD, told CNN.
Epocrates Market Research company recently surveyed 606 clinicians and found while only 34 percent of them were part of a social networking site, spending one hour or less on the site per day, the story was different for the 900 medical students and residents it surveyed. Of this group, 75 percent spend anywhere from four to 10 hours a week social networking. Another survey, conducted by Manhattan Research, found 508,000 physicians now post and view online videos; 300,000 physicians report using blogs, and 80,000 physicians say they participate in online communities with other physicians.
Philippa Kennealy is among the social media pioneers. After practicing family medicine for nine years, she earned a master’s degree in public health and followed a career path that led to becoming the CEO of Santa Monica UCLA Medical Center. When her entrepreneurial itch flared again, she joined an Internet start-up company until it imploded in the dot.com bust. Today she is president of The Entrepreneurial MD in Los Angeles, coaching fellow physicians to build successful businesses and thriving practices.
Social media is a cornerstone of the networking tools she recommends and uses. She writes a blog and promotes her clients as @pippak on Twitter. She also maintains two Facebook pages and a LinkedIn profile. She is starting to bump into other physicians at these venues daily. Likewise, Ted Eytan, MD, a family physician in Washington, D.C., who maintains a blog on his own Web site and interacts via Twitter, says he receives a few networking queries a month from colleagues who stumble onto his existence via these sites. "The fact that they take the time to visit my page and reach out shows quite a bit more effort and creates a connection that is deeper than just an email address," he says
Ironically, the motivation driving millions of Americans to join LinkedIn, Facebook, and Twitter hasn’t exactly caught fire in the job search arena yet. Instead, job networking still belongs mostly to recruiters, who pound these venues looking for physicians to engage with them.
The Association of Staff Physician Recruiters’ (ASPR) latest findings reveal roughly 30 percent of all doctor recruitment stems from some form of Web technology or online job board. That means 70 percent of hires still rely on traditional search methods. Indeed, ASPR president, Brett Walker, says direct mail pieces, career job fairs, and help wanted ads remain valid.
In fact, cold mailing resumes gets a two-to-four percent response rate from physicians compared to email, fax, and phone contacts which get a much lower response at The Doctor Job recruiting firm in Altamonte Springs, Florida. "Right now, typically older physicians do most of the hiring in this marketplace," says vice president of sales Britt Reints. "To be a successful physician, you have to be very focused on the medicine, obviously. They [hiring physicians] don’t spend a lot of extra time learning to use technologies that aren’t crucial to the practice of medicine."
She’s speaking for today, however. "Physicians have been a little slower to adapt. But I’ll tell you straight out - that’s going to change," says Steven Levy, MD, an ophthalmologist who traded his practice to be the president of The Acoma Group, an executive search, coaching, and candidate development firm in Ridgefield, Connecticut. After all, facilities like Southwestern Vermont Medical Center have their own Facebook page and an interactive site complete with YouTube-style videos that can be used to introduce viewers to the community and as a way for communications director Kevin Robinson to show physicians the hospital is open to new dialogue channels.
Expect recruiters to continue pushing in this direction as they, of course, don’t want a one-sided equation. Making contacts online beats random gatherings of resumes emailed in from a job board, says Matthew Dillingham, the vice president of strategy and client services at Houston-based MedTouch, which develops Web-based solutions for health care. "What I see happening is people starting to use LinkedIn and similar sites to get references from other people, because you’re much more likely to interview someone you have some sort of relationship with," he says. "You meet someone at a conference in San Francisco, they live in Washington state, and you’re looking for a doctor in Texas. They happen to meet someone from Texas at another conference in Florida, and they recommend that person to you. It’s a huge network of people that you trust. I can see this taking the place of a lot of these job boards, unless those job boards evolve into being more social networking style Web sites."
Robinson agrees. "You’re not necessarily looking for a neurologist. You’re looking for a neurologist who matches your institutional culture. Social media allows you to evaluate each other," he says. "Hospitals are looking for quality physicians who want to be in certain places. It will be a whole lot easier to find them through social media sites going forward than resumes."
For Jason Scott, the director of physician relations at Lake Cumberland Regional Hospital in Somerset, Kentucky, it’s a toss-up whether he prefers the time or dollar savings the hospital enjoys from his social media recruiting efforts. "Old school recruiting, for lack of a better term, is to call physicians, try to convince them over the phone this is a great opportunity, then have them come for a site visit, and we figure it out along the way," he says. "I do everything in reverse. The site visit is a validation of everything we’ve covered previously." Pre-screening his candidates for a personality match saves hours of wasted time on campus tours that go nowhere and approximately $3,000 in travel expenses per fruitless physician visit.
"Every physician has a decent CV. I’ve never had a reference disqualify a candidate yet. I need to know what this doctor’s values are, I want to know their personality," Scott says. "If it’s a physician who will be in a political environment, does he have the personality to go out there and meet and greet with referring physicians? You can’t put that on a CV. I want to know a physician’s posture and how he uses language to present himself." He is eager for the day doctors begin sending him video CVs - miniature movie productions, if you will - highlighting their skills. So far, he’s received only one, but was very impressed by the effort, and immediately wished the doctor could upload it to LinkedIn where it would get more exposure in the industry.
The moral of the story: The goal for all of these job search routes should be to paint yourself as sufficiently compelling and qualified, says Kennealy. "You want to tell organizations your skills and talents and how they will benefit the group. All of these tools are part of a marketing strategy - plain and basic marketing."
Daniel Anzaldua, MD, a young internist who works locum tenens jobs, compares Facebook to a phone book. "It’s how I reach someone I want to talk to," he says. Anzaldua is only on the site once a week, but Krystal Tomei, MD, a neurosurgery resident in New Jersey, says she visits her social networking site daily. "A lot of my friends have moved around the country and this is a good way to stay in touch," says Tomei, who started using Facebook while in medical school. "It’s a social outlet," she says.
It can also be a professional one. In recent years, scores of networking sites have been created by and for physicians as a way for colleagues to share stories, give opinions, or simply blow off steam. Examples include: Ozmosis.com, Sermo.com (developed by the American Medical Association), Healtheva.com, DoctorsHangout.com, StudentDoctor.net, DoctorVG (www.doctor.vg/register.php), DoctorsNetworking.com, Relaxdoc.com, Tiromed.com, ClinicalVillage.com, MedicSpeak.com, SocialMD.com, and iMedExchange.com.
Specific physician groups have also been created on Facebook. For example, Nevada Osteopaths, the Christian Medical Society, Phoenix’s Mercy Gilbert Medical Center, and Tidewater Physicians Multispecialty Group are all looking for "friends." Christopher Schaeffer, MD, an internist who works in Amherst, New York, says he once tried to set up a Facebook group specifically for teaching physicians, "but I didn’t get a single response."
Here are the most common mass market sites to which most physicians gravitate.
Social media mavens rate LinkedIn as the most important networking site for any profession. The profile templates prompt users for their career and educational histories, current job title, and Web site links. Users invite each other to connect profiles, and thus have access to their colleagues’ links as well, essentially building a spider web of people with whom to communicate. There’s even a section to forward job opportunities among a network of connected users. Robinson recommends LinkedIn for physicians with private practices who are looking to make a career change or to spread their practice’s reputation; everyone should maintain a listing here, Kennealy says, for the simple fact it’s searchable by Google. Should a recruiter want to know more about Levy, for instance, typing "Steven Levy" in the browser leads to the LinkedIn profile page, where it lists that he graduated from The Ohio State University College of Medicine, has been an adjunct professor of anatomy and physiology at Sacred Heart University, and is currently searching for hospital CEOs for two acute care hospitals.
In a nutshell, it replaces the need for the physician to maintain an individual Web site, consultants say. Taking just a few minutes a day to post in a physician-only group or answer general healthcare questions can demonstrate knowledge and communication skills as effectively as entries on a formal blog. "It’s a critical site for raw networking," Levy says.
That’s why he suggests new users begin by filling out their profile template completely. Don’t forget to include contact information. "You’d be surprised how many people leave out an email address," he says. Then use the invitation button to start inviting colleagues to connect to you. If you’re reaching out to a stranger, Levy suggests personalizing the canned line the program provides to persuade this person to consider you a valuable addition to his group.
Next, participate in the topics network members throw out for consideration. "You don’t have to write a three paragraph response to everything," says Levy. "A few intelligent sentences will do it. It’s more important to contribute consistently.
"If you want to join a desirable group practice, or if you look to locate in a competitive area in a specialty that is well-represented there, the more you need to demonstrate your business acumen and build relationships," he says.
Facebook’s atmosphere is more casual and personal than LinkedIn’s, with opportunities for members to post photo albums and videos, write public notes to each other, and download applications including games and virtual pets. Connecting to other Facebook users has coined its own term in the popular lexicon: friending.
Kennealy advises serious networkers to select a professional headshot as their official photo as opposed to an artsy shot of half a face peeking out from behind a poodle or your childhood mugshot sitting under the Christmas tree. When filling out the profile template, it’s acceptable to list your birth date but not advisable to say the year.
Twitter is what experts call a microblogging site. Users send out notes to the folks they’ve connected to (it’s called "following" in this arena) in tight 140-character message spurts. If this were golf, blogging is the long game, Twitter concentrates on putting. Pressed to choose between Facebook and Twitter, Kennealy urges job searching doctors to jump on Twitter.
Once again, you will be asked to fill out a profile about yourself, the prompt for a Web page is an excellent place to plug in your LinkedIn profile URL so the curious will click for a more rounded look at your credentials. The first step after opening an account is to determine which recruiters you want to follow as well as the executives of any hospital, group, or pharmaceutical companies you may be targeting for a position. As you follow their announcements throughout the day, take the opportunity to build relationships by commenting on their "tweets" (messages) and don’t be shy about sharing relevant medical information and opinions yourself.
Do refrain, though, from a common mistake Kennealy sees at Twitter, which is chattering aimlessly about everything you see, hear, and think throughout your day. "I have no interest in whether you ate a burrito for lunch," she says, "but if you have a link to an interesting article on what’s new in the surveillance of Vitamin D levels in the body, that’s going to pique my interest in you a lot more. You look savvy and presentable."
Last July, a study conducted by the University of Florida and published in JAMA (Journal of General Internal Medicine) sent a ripple through the profession. Researchers looked up more than 800 of the school’s medical students and residents by name on Facebook and found nearly half of them had pages, yet only 37 percent had activated security features that limited access to their page only to friends and family. The rest of the medical students had pages open for view to any Facebook visitor. Of these, more an half had provided lifestyle information, including sexual orientation, dating relationships, and political opinions. There were photos, too - of residents and medical students drinking heavily, cross-dressing, posing with a dead raccoon, even wearing a lab coat labeled "Kevorkian Medical Clinic." Some had joined Facebook groups, including "Physicians looking for trophy wives in training" and PIMP (Party of Important Male Physicians).
So, if social networking has its advantages, what’s the downside? Simply put, it’s content. Posting inappropriate or questionable material on a social networking site may damage your professional reputation and give an employer or recruiter a negative impression of you.
Or does it?
"Physicians entering the workforce today are the first to be impacted by their social networking habits at job interviews," says Bob DeRoode, a managing partner of PracticeMatch, a St. Louis recruiting firm. Yet, in reality, recruiters and employers say they are unlikely to check candidates’ social networking pages. ASPR’s Walker, who also serves as the director of physician recruiting for Clarian Health System in Indianapolis, says he can’t even access these sites if he wanted to. "Corporations are really cracking down on what kind of Internet activity can be done at work," he says. "I can’t get on Facebook from my office computer even to check out candidates."
Googling, however, is a different matter. Candidates’ names are often Googled, according to Hannah Welsh, a recruiter with Avant Company and a member of the National Association of Physician Recruiters Internet Committee. Googling, however, is not always a bad thing. "Often what turns up on a Google search is an applicant’s published papers or recent speaking engagements," she says.
Of course, not everything is positive. DeRoode says his company regularly Googles candidates and, "We’ve seen applicants who have been named in lawsuits, patient complaints, even criminal investigations," he says. Walker says his recruiters once found a candidate wanted for tax evasion, but those instances are rare. "We don’t Google every candidate," Walker says. "I tell my recruiters to trust their gut instincts. If a candidate’s facts don’t add up, then they should check."
It’s while Googling that a candidate’s social networking activity can pop up. Again, that seems to happen rarely. Welsh says it has only happened twice in her experience and, "Even if I had found something on the page, it would be just one factor in the hiring equation," she says. "You have to weigh what you find on a social networking site against the candidate’s other qualifications."
Les Rosen, an attorney and the president of Employment Screening Resources, says employers were also young once, and they understand that social networking is today’s equivalent of the kind of talk students once engaged in around school lockers. "What hospital is going to think every physician they interview is a perfect angel?" he says. "I think it’s fine to have fun while you’re young, but use common sense when you post anything online."
Walker agrees social networking posts aren’t always considered when hiring. "If you begin to factor in personal photos and comments made while candidates are young," says Walker, "then Barack Obama might have been disqualified from running for office because of his early experimentation with drugs. I don’t think any of us want to be held to that kind of standard."
There are a couple of red flags, however, that, if found on a social networking page, may make an employer back away. "You want to avoid making any type of racial or ethnic slur, and you don’t want to bad mouth a previous employer," says Walker. Those are considered by most recruiters and employers as deal-breakers. And if a Google search turns up drug use, fraud, or a felony conviction, then an employer is likely going to discount the candidate.
There is another factor to keep in mind as well - employers who Google and check out social networking sites are limited by federal hiring and employment guidelines. "It’s the same when you interview a candidate," says Walker. "There are limits on what you can ask an applicant, and those same guidelines apply to what you find online."
Rosen, the attorney, agrees. "Right now, there is no case law to regulate how employers use social networking pages," but employers shouldn’t assume that everything online is fair game, he says. "If they are going to use information from the Internet to make a hiring decision, they should have a written policy in place as to when and how this information is used." To avoid any appearance of discrimination based on what’s found on a social networking page, Rosen suggests an employer not even conduct such a search until he or she is ready to make an offer. Even then, the employer should ask the candidate for consent before conducting the search, he says.
So, posting tasteless comments online may not necessarily prevent you from getting a job, but it may risk your professional reputation.
After the University of Florida study was released last year, a follow-up story appeared in its College of Medicine’s newsletter, The Insider, which said researchers had not been trying to discourage Facebook use but to make students aware of the demands of a professional persona. There is some evidence, say the researchers, that students are beginning to understand the potential impact of what they post. Said one researcher in The Insider piece: "Reactions that we got back [from the study]seemed to show a strong age effect. Surprisingly, younger kids - mostly adolescents - said that this was ’old news’ and that many adults had already made this obvious. Even better than this good news, many college-aged and professional students have said that they have really thought hard about what they put on their pages now."
Anzaldua, the locum tenens internist, says he has always been careful about posting photos or anything else on his network page. "Professional people are held to higher standards by the community," he says, and while he believes users are entitled to a private life on network sites, he knows it doesn’t always work that way. "You can’t be cavalier about what you post."
Tomei, the neurosurgery resident, however, believes photos on a social networking site should be taken in context. If she views a friend’s Mexican vacation photos, for example, and one photo shows her friend with a Margarita in hand, Tomei says she sees nothing wrong with that.
Schaeffer says he has a photo of himself holding a beer on his Facebook page, but he’s in no rush to take it down because his page is secure. "No one is going to see it except my family and friends," he says.
There’s no question that using security features on a networking site is key if you want to keep your private life private, says Rosen. "It’s like closing the drapes to your home. Why invite a problem? Don’t make your page easy to see."
Tomei says she uses every security feature on Facebook. "It’s not even searchable by Google," she says. And the UF study found the closer students are to graduation, the more likely they are to use those settings. While 64 percent of medical students had public Facebook accounts, only 12 percent of resident physicians did.
Malorie Lucich, with Facebook’s public relations team, says there are a number of ways users can keep their information private by editing the privacy settings. "One of these options includes friend lists, which allow users to control which people can see certain content," she says. Facebook also has a group of customer service representatives who police content and follow up on abuse reports.
Other social networking pages, however, may not offer the same level of security. YouTube, for example, can be viewed by anyone, including patients, and there is no way to secure your video if you post it. That’s why it’s a good idea to check your social networking sites to see what kind of security features they offer - before you decide what to post.
According to Marc Bowles, with the Dallas-based search firm Delta Companies, any picture that’s placed on a private page is fine, but if it is open for public view, then realize the photo will be interpreted by others and maybe not in the way you envision. "If you’re looking for a job in an area with a strong Christian base and a photo shows you with a beer in your hand, it may affect your employment opportunities there," says Bowles.
And while it’s not very likely patients will find you on a secured social networking site, if patients do find you and feel uncomfortable with your photographs, political views, sexual orientation, or anything else, they’re likely to either leave your practice or complain to an employer, who could either discipline or dismiss you.
According to Rosen, "An employer can’t use the information from a social networking site to discriminate against you, but he or she can tell their employees not to use a site or to use the privacy setting if they do, says Rosen.
The bottom line, says Bowles, is physicians who post content on social networking sites have to weigh the risks against the rewards. "This is a job that’s based largely on your reputation. Think about what you’re building with your patients." Even if you’re okay with what you’re posting, understand that it may still not be a cultural fit if it’s used professionally. You don’t know how patients live their lives or what their perspective is," says Bowles. "Remember that what’s on your Website, that’s who you are."
Both Julie Sturgeon and Karen Edwards are regular contributors to UO.