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November 1, 2007

Media docs: Practicing in the public eye

Pamela Peeke, the chief medical correspondent for nutrition and fitness for the Discovery Health cable network, made an unusual career choice a few years ago: She moved into a full-time media position.

When she did this, Peeke, MD, MPH joined a small group of high-profile physicians who serve as trusted advisers, teachers, and frequently authors, and who live in a rarified world of high public exposure.

"We are a self-selected group," Peeke says. "People who get jobs in media are inquisitive, are always learning, and are willing to be very flexible with a crazy schedule."

Media docs: A career in front of the camera

Peeke and other "media docs" have been - and in many cases, still are - practicing clinical physicians and scientists. But somewhere their career paths took a turn and they ended up in front of a camera or behind a word processor. In fact, media exposure and even working for a news outlet may be good for a doctor’s career. It can raise your profile and give you additional streams of income. In some rare cases, a media job can be lucrative enough that you can transition completely out of clinical medicine if that’s what you want.

But as Peeke and other physicians will tell you, it’s clear there is more to working in the media than showing up in the morning, reading a script, and collecting a Katie Couric-sized paycheck.

Physicians who are interested in having a public role have to learn the ground rules of journalism, consider demands on their own time, think about possible litigation issues, and navigate the delicate balance between income earned working in the media and income lost from time in the clinic or lab.

Then, of course, there’s that "it" factor.

"There’s something to be said for you either have it or you don’t," Peeke says. "You’ve got to look at your credentials and ask who else are you competing against? There’s credibility to think about. And uniqueness. Do you have a little character?"

How Peeke’s career move happened

Peeke’s transition from laboratory scientist to media celebrity began the way of so many career changes: with a phone call.

At the time, she was working as a senior research scientist at the National Institutes of Health (NIH) campus in Bethesda, Maryland, studying metabolism and nutrition issues. Before that, Peeke had spent eight years in emergency medicine and earned degrees in public health and public policy.

While she was still at the NIH, the phen/fen diet pill scandal broke. Suddenly, there was a tremendous need for credible experts to help news programs untangle the science behind the scandal.

"I was already working in a field that was incredibly hot when phen/fen hit," Peeke says. "All heck broke out with this and they needed an expert. Next thing I knew, CNN sent a reporter to my lab."

It was right then that her new career was born.

"You’re either comfortable on camera or not," Peeke says. "They put a camera in front of my face and I had three minutes. For whatever reason, I had a blast."

From there, Peeke "became pals" with the media. Suddenly, she was on the radar screen as an expert who was willing - and more than capable - to give good interviews. And, according to her, it "didn’t hurt" that she was a woman. Her early days working with CNN led to guest appearances on "Oprah," the "Today Show" and "The View."

Then, in 2002, she joined Discovery Health as the chief medical correspondent. Today, she is deeply involved in Discovery Health’s National Body Challenge, an eight-week fitness and weight-loss challenge sponsored every year by the network. She also speaks at events, writes for radio and print outlets associated with Discovery Health, authors books for the network, and represents Discovery Health as a keynote speaker and panelist at different events.

She even continues to see patients on a "very limited" basis and writes her own books.

"I love to teach," she says. "I’m a teacher, and this allows me the opportunity to teach. But a lot of physicians see the glamour, and they have no idea how much work this is. It’s a lot of work."

Work/life balance for a media doc

Peeke’s schedule is definitely high impact, but working in the media doesn’t necessarily have to consume your professional life. Physicians can also write for newspapers and magazines, review content for Web sites such as iVillage, or even do radio programs. Ultimately, the question is going to come down to this: How much can you make doing this versus how much you give up in income in your practice? Perhaps more importantly, how much time are you willing to give to this second facet of your career?

Paul Donohue, MD, the author of the widely syndicated "To Your Good Health" column, also backed his way into a media job - and eventually found that writing a column took up so much time, he could no longer see patients.

Donohue, a specialist in infectious disease, had no intention of becoming a newspaper columnist, but in the late 1970s, he frequently helped the former author of the "To Your Good Health" column answer questions about infectious diseases. The column itself had been a regular syndicated feature since the 1950s.

"The previous author was located in the same area," Donohue says. "He had an editor who knew me, so when they had an infectious disease question, they called me. Then he died suddenly and they looked in the files and my name popped up."

Donohue took over the column in 1980, and for the next decade continued to see patients while also writing the column. By 1990, however, the workload was becoming too heavy.

"I stopped my practice around then, or at least I cut it back," he says.

Today, Donohue describes his work as a "nice, pleasant" job. "It takes a lot of time," he says. "It’s not hard work, but looking up all the answers takes a long time."

Donohue gets a few thousand letters every month, each posing a health-related question. He picks a few to answer every day, researches the answer and then writes a short column. His column is syndicated through King Features and appears in about 150 newspapers around the country. He receives a percentage of the income the column generates through subscriptions by individual newspapers.

While Donohue’s job is full time, Kerry Prewitt restricts his media work to an hour or so on Saturday mornings. Prewitt is part of a busy cardiology practice at St. Joseph’s Medical Center in Towson, Maryland. On the side, he is a reviewer of online patient guides for iVillage’s cardiology health center.

"There was a guy who did work for Guidant Corporation, and I worked with them on a couple projects," Prewitt says. "He put me in touch with the Web site, and they started sending me articles to review. It seemed relatively easy and it supplemented the income."

As a content reviewer, Prewitt reviews patient guides that cover a wide variety of heart-health issues. The pay isn’t much - about $50 to review a short update or $150 to review a new guide - but it doesn’t take much time either. Prewitt estimates that it takes about 20 minutes to read a guide, and he does about three a week. Overall, he estimates that it comes to an hourly rate of about $150 to $300 an hour, which is fairly standard for reviewing physicians.

"I get up Saturday, get a pot of coffee, and crank it out," he says.

In fact, Prewitt doesn’t even keep the income generated from his reviewing. He donates it to the foundation run by his cardiology group. "It’s a small way to contribute to a charitable cause," he says.

The risks of media exposure

Is there any risk involved with media exposure? This is a question doctors must ask themselves before they establish relationships with media. In today’s highly litigious environment, even simple medical advice can potentially open a physician to malpractice lawsuits. This threat is greater for higher-visibility physicians, if only because there is the perception they have more money or rich corporations backing them up.

Because of this omnipresent threat - and because typical malpractice insurance doesn’t cover against advice dispensed in public - Peeke recommends that all doctors who are working in the public arena take precautions.

"You have to be careful about this," she says. "What if someone listens to me and I say, ’Take XYZ,’ and they take it and get sick. They might sue me. It’s never happened to me, but I’ve seen it happen."

Peeke says that a doctor should call his malpractice insurer to see what it recommends and maybe even have a conversation with an entertainment lawyer "about your precise role and how you’re identified on TV."

However, not all physicians who work in the public eye agree. Even though malpractice doesn’t cover their work, both Prewitt and Donohue see no threat in dispensing medical information in public forums.

"I don’t make diagnoses by mail," says Donohue, "And I truly hedge on my advice. I say you should confirm everything with your own doctor. I’m not telling anyone to do anything dangerous."

Indeed, the information usually dispensed by doctors is often available from government agencies. There are, however, interesting situations that might arise whenever a doctor interacts with the public.

In the course of answering one letter, Donohue casually remarked that he considered the knee "an evolutionary mistake." He was surprised to find out that his comment generated significant backlash among people who do not believe in evolution, and letters poured into his office.

"They were really ranting at me," he says. "It was such an innocent remark, but people were really up in arms."

When medicine and journalism collide

Donohue’s brush with controversy may have been innocent, but it serves to highlight a larger truth: The practice of journalism has rules and patterns unique to itself, and when it comes to health-care reporting, ethics are exceedingly important. Because of their education and experience, doctors are trusted figures, and having a public audience magnifies the impact of their words many times over.

According to specialists in health-care journalism, doctors who transition into the media - even in small ways - will suddenly confront a new set of ethical challenges. Among the most obvious are companies that want to cash in on your credibility by paying you to promote a product. This is the kind of thing that, while tempting, leads to the perception that you can’t be trusted.

In fact, any appearance of impropriety can cause serious damage to your credibility. The larger the audience, the greater the damage. For a physician like Peeke, with a national following, it’s a bad idea to even hold stock in pharmaceutical and medical device companies because these are the same companies she might someday report on.

Outside of financial relationships, there are other issues that must be confronted. In clinical practice, physicians generally learn treatment protocols that work best for them. Similarly, many doctors prefer certain surgical techniques to others and are unabashed supporters of these techniques. One obvious example is the interventional cardiologist who favors angioplasty and stenting over bypass surgery.

However, quality health-care journalism requires that these sorts of biases do not seep into the reporting.

"The transition from clinical practice to being a reporter should not be a smooth transition," says Gary Schwitzer, an associate professor and director of graduate studies for the master’s program of health journalism at the University of Minnesota. "A physician is trained in an entirely different area, and there is not an automatic overlap."

According to Schwitzer, there are two major areas where physician journalists tend to have problems. The first is known as "advocacy journalism." This occurs when a doctor goes into a story with an agenda and ignores evidence that might contradict an original bias.

"In the last few years, it’s been very fashionable for doctors to go into television or write columns in newspapers, but a lot of it is promotional and the public doesn’t know that," says Trudy Lieberman, the president of the board of the Association for Health Care Journalists.

This includes physicians who have financial relationships with pharmaceutical companies or hospitals. To be a responsible member of the media, it is important that these ties are either disclosed or you sever your ties with any health-care corporations.

Peeke says, "I have a rule that I’ll never be a spokesperson for anything. You’ve got to know the consequences."

The second challenge facing doctors in the media is the medical equivalent of "gotcha!" reporting. This happens when news stories are based on single studies or inadequate evidence and heavily hyped. The vast majority of the public has no idea how medical practices and standards are developed. They don’t understand how clinical trials work or why it often takes years for the medical establishment to adjust to new information.

"A lot of physician journalists become enamored of the newest, brightest thing in health care without reporting important questions of cost and benefit," says Schwitzer. "A lot of the folks I see on TV fall into a trap of things that seem to make good TV but don’t do the important grunt work of, ’Where is the evidence? Is it going to work? Who has access?’"

This situation is perhaps worst in broadcast, where the average network news health story runs 90 seconds. At the local level, the average story runs only 75 seconds.

Do you have the passion?

The decision to pursue a sideline career, or even a career change, in media might be driven by a lot of things, but money shouldn’t be the leading one.

It’s hard to find salary reports for medical correspondents, but it’s safe to say that for every multimillion-dollar, national network contract, there are many relatively poorly paid positions.

"Never, ever, ever do media for the money," Peeke says. "People are misinformed when it comes to this. You’ll get paid well if you’re doing well and if you’re national. But the bottom line is you don’t do this to get rich. You do it to augment who you are. You’ve got to do a passion check. If there’s no passion, it’s going to be a hard sell."

At least in the beginning, it’s going to require some selling. Media is not an easy industry to break into, even for physicians. At first, this means you will likely be offering information for free to television stations or writing articles without the guarantee of publication or pay.

Donohue says: "If you want to break into syndication, start with a local newspaper and see how your work is reviewed. Then market it to one of the larger newspaper syndicates."

If, however, you are the type of doctor who thrives on public exposure and who is sensitive to the unique demands of the media, being a "media doc" can be richly rewarding.

"When it comes to the media, you have to think on your feet because you never know what’s going to happen," Peeke says. "The bottom line is, is it fun and can you fit it in with being a physician?"



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