Core doctors—plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists—are, as their moniker suggests, the center of the medical aesthetic industry. As physicians, they are allowed to own and operate medical spas, and their fields of expertise coincide with many of the procedures sought by those who frequent these businesses. Historically, core doctors have made a lot of money by operating medical spas along with their more traditional practices.
However, in recent years, younger core doctors, nurse injectors, and medical spa owners have courted controversy by stepping outside the role of humble healer that physicians traditionally take on, and into another role: Celebrity provider. These doctors do not hesitate to market themselves and their businesses in ways that some older physicians find gauche and undignified, and they have created a great deal of controversy in the medical community by doing so. This generation gap must be addressed, but the issues at the heart of the matter must first be understood by both sides.
Younger core doctors primarily market themselves with social media sites, such as Twitter, Instagram, and Facebook. The use of social media is a very different form of promotion than what many core doctors are used to, and it can be difficult for more traditional doctors to wrap their heads around what it is and what it does.
Because medical aesthetics has become so lucrative, it has arguably moved away from more traditional medicine. While traditional rules and traditional ethos apply, aesthetic medicine is governed in many ways by a completely different dynamic—aesthetic treatments are all voluntary, they are all cash-based, and there is a great deal of competition. Doctors are taught the Hippocratic Oath and other ethical ideals that have governed the profession for millennia. But when people choose to undergo surgery for purely cosmetic purposes, medical providers are no longer healing a patient per se, but rather providing the patient with a service that is advertised and sold on the open market. So, how do you take medical ethics that are designed to help cure disease and apply them to a competitive industry where patients shop for—and doctors sell—treatments that address patients' desire to change the way they look?
The medical aesthetics industry also intersects with technology and marketing in ways that traditional medicine does not, which has contributed to this discord. It's not entirely generational—there certainly are younger doctors who believe that the actions of some core doctors are a bit over the top, and there are older doctors who have bought into social media—but there clearly is a generational line between some of the older plastic surgeons who were trained in a time where marketing their practice, and themselves, was not as important as it is now. For many, the medicine and science behind plastic surgery has been subverted by the need for views, shares, and likes. These surgeons feel that many in plastic surgery are missing the point of what it means to be a surgeon, and that the need for celebrity has overtaken the need to practice medicine.
But in today's world, particularly among younger surgeons who have been using social media for years, the idea of not marketing yourself is unthinkable. In their world, one must adapt or die, and failure to compete in the marketplace through use of social media, video, and marketing is the easiest way to make your practice extinct. Although there have always been surgeons who are at least somewhat famous, with social media and reality television becoming ubiquitous in recent years, this has been taken to a whole new level. With social media especially, celebrity has become democratized, and physicians can become famous through sheer hustle. There are young surgeons who have become far more famous than their older counterparts purely by utilizing the social media tools at their disposal, and this has, to some extent, disrupted the established order and ruffled some feathers. So the question to be asked: Is this merely the competitive marketplace shaking itself out or has aesthetic surgery crossed the line into something more problematic that needs to be reined in? I suppose it depends on who you ask.
Streaming video of procedures has helped many core doctors make names for themselves on social media and the Internet, but this practice is understandably the source of a great deal of controversy. Recently, some prominent plastic surgery societies have begun to consider the ethical questions surrounding plastic surgeons broadcasting the procedures they perform via social media services, such as YouTube and Facebook. The doctors who stream these surgeries often say that they do this for its educational value, but these shows are also designed to raise the surgeon's profile. If the event is properly publicized, several thousand people will tune in, and sometimes a staff member will even be in the operating room with the surgeon answering questions from the video's chat function. This can lead to a great deal of income for the surgeon.
There is nothing illegal or even necessarily unethical about this but, on occasion, these videos make the surgeons and their staff members look unprofessional, especially depending on how they act during the procedure. While acting silly is almost expected from those engaging in social media today, it can be argued that medical professionals should hold themselves to a higher standard. If the purpose of the video truly is to educate rather than raise the surgeon's profile, this sort of behavior should not be highlighted.
At the same time, it is undeniable that live streaming is an effective way for a surgeon to get his or her practice's name on people's lips. It also makes prospective patients comfortable with the surgeon, provides answers to questions that many patients have, and promotes plastic surgery as a whole. And if you ask the surgeons themselves, many who live-stream can point to a direct correlation between their marketing efforts and a sharp increase in revenue.
However, while it's understandable that medical aesthetic doctors engage in marketing techniques such as these, those who make videos must make sure that they're still representing medicine in a professional manner. This is still the practice of medicine, after all. They also need to make sure that they're acting in a manner that is respectful to their patients, who often are unconscious on the operating table; it looks bad when doctors are dancing and joking while the patient is prone (yes, this has actually happened). It's easy for a surgeon to lose sight of this when he or she is performing (because a live broadcast of a surgical procedure realistically is a performance), but it is something he or she should make a point to be mindful of. This is a competitive market in which many people are utilizing unorthodox sales techniques and, while medical aesthetic professionals have to ensure that a practice remains profitable, they are still dealing with medical patients.
Crossing Ts, Dotting Is
Although this should probably go without saying, it is critically important that any surgeon or medical spa planning on conducting a social media campaign receives written consent from featured patients that thoroughly covers all HIPAA and local patient privacy laws. The forms used for this must be specifically drafted in order to address the legal minutiae of social media, so anyone planning to do this needs to be very careful to ensure that the patient understands exactly what is going to happen. This is not the sort of form that anyone can simply download off the internet. It will need to be vetted by an experienced healthcare attorney to guarantee that no legal entanglements result. (Author's note: The American Med Spa Association (AmSpa) works with a national law firm that focuses on medical aesthetic legalities and, as a member, along with a number of other great benefits, you receive a discount off of your initial consultation. To learn more: americanmedspa.org.)
Again, it's worth mentioning that when he or she signs such an agreement, the patient is consenting to having his or her likeness out there for the world to see for educational purposes, not to being a motionless prop while the surgeon or his staff members act foolish. It's not hard to imagine a scenario in which a patient would be fine with participating in a social media campaign or educational live-stream, but then appalled when he or she sees the surgeon and staff members goofing around during the promotion. The end result may not be covered by the consent form the patient originally signed.
So is it inherently bad for plastic surgeons to become social media celebrities? Isn't that the goal of marketing and public relations? It probably doesn't matter—the genie isn't going back in the bottle and the industry is going to need to figure out how to deal with it. There are numerous questions that societies should be asking themselves, particularly given the number of non-core doctors entering the industry. Any physician can establish himself as an expert by virtue of social media and internet advertising, but it can be problematic when the physicians in question are young and perhaps doing work that they aren't quite qualified to be doing. If patients are receiving misrepresentative information from these doctors—and if we've learned anything in this country in the past couple years, it's that people tend to believe what they see on television and social media—that can be extremely dangerous.
At this point, dealing with this issue seems to be about making the use of social media acceptable from an ethical standpoint. There really is no turning back; social media has become a key part of marketing for core doctors, no matter how badly some wish it weren't true, and it isn't going anywhere.
The bottom line is that the medical aesthetic industry needs to be careful—it shouldn't get too brazen with its marketing, because medical societies have much louder voices in halls of government than the medical spa industry does. A group of Northwestern Medicine authors recently proposed a code of ethics for videos, for example, and I think this is a good idea. After all, if these campaigns truly are for educational purposes, they don't need the theatrics. But at the same time, the ability of medical spas to market themselves aggressively is one thing that sets them apart and allows them to succeed in a very crowded marketplace. And the personalities of practitioners come through in social media campaigns. Often the providers become much more relatable than their surgeon counterparts. There is a delicate balance that must be struck and, if the industry is going to survive, it is imperative that we make this balancing act a priority.