I was following the thread of a heated conversation topic the other day, on the rapid rise of opaque physician communities, right in the SoMeDocs Facebook group, when my eyes were opened wide.

It was an anonymous post, which evolved into a discussion on the questionable (if not immoral) tactics used by the so-called leaders in this space (you can access that Facebook post here).

In that discussion, the phrase ‘MLM’ was brought up, in reference to the groups.

I was shocked. Never before had I thought of it in this way.

But the more I mulled it over, and let it soak in, the more I realized this is exactly part of what’s happening with our groups, which I once believed were effectively organizing online.

I see so many disjointed communities of physicians, quite honestly, each one claiming they’re focused on one thing or another. While some of them are respectable, and honest, others are simply taking complete advantage of physician naivete. I’ve been waiting for colleagues to speak up, and wondering when the bubble will burst.

It doesn’t appear to be happening anytime soon, and I wonder how much harm will be done once it does finally happen.

There are no clear cut rules to many of these groups that I question here, in this anonymous post (thank you so much for allowing us to vent in this way), and it seems that, if there are, they are not being enforced for everyone in the same way. I guess some of us are more “important”, or “valid” than others.

For example, my friend tried posting a business tip the other day,

in a physician business group that was there for literally physicians interested in business. It was something she had picked up along the way, in an article that was business-focused. Not only was her post erased, but she was immediately kicked out, with no warning or explanation.

I spoke to her. She was shaken up. It wasn’t her post being taken down that bothered her so much. She realized she may have broken a rule. It was getting kicked out without warning. She felt like an outlaw, when she never actually intended to be one.

Another friend of mine, a physician,

got kicked out of a different group, and was told that the admin just “didn’t have time” to deal with her. She had been working hard to advocate for physicians, but because the admin wasn’t involved financially with her effort, my friend’s comments didn’t sit well (with admin). Apparently, the comments had given my friend, and her effort, too much attention, and admin didn’t like that.

Another friend from that same group

saw several posts talking about their products and books. She immediately posted about her own creation, a product mean to help the physicians in that very group, only to get immediately shot down because you can’t “self-promote”.

I dove deeper into this issue. Asked around. How can one person self-promote, while another person get shot down? There had to be a clear and straightforward answer.

There was. Do you know what an affiliate is? The answer is in that simple little word.

Remember those times when an admin of a FB group drops a post about a conference and says they are an affiliate? It means that they make money every time we purchase a ticket. They don’t have to vet the conference in any way. But they typically promote it heavily, and often even recommend it. Audiences don’t necessarily always know that this is a paid relationship and trust these admins. Thus, the admins become “influencers”, influencing their unsuspecting colleagues, but in non-transparent ways.

Here’s the worst part:

the heaviest promotion goes to the highest bidder. The business that pays an admin the most (either the largest chunk of each signup, or the highest dollar value) typically gets the most “influence” associated with them. Meaning, the admin will work their hardest to promote them. This would typically be fine, because at the surface, it is just capitalism playing out at its best. That’s what admins want you to believe.

But here’s why it isn’t. It drives up the cost of the services and makes it expensive to exchange what many of us have built; our services, our products. Worse, it censors those of us who may not be part of this leaders’ “in” crowd.

So what we’re seeing is services that should cost much less than they do, but the price gets jacked up in order to “pay off” admins. Over time, the mass amplification of an overpriced service not only legitimizes that service, but makes it seem to others that charging that amount is ok. It makes others want to emulate the person who is overcharging. What I suspect is also happening is that when new professionals create a similar service, they overprice theirs, too, in order to competitively get shared (and because they think they can do it, if the other person could do it, too). So, in total, this is driving up costs that should be much more affordable.

Worse, the folks that overcharge seem to be banding together and muscling their way through these communities.

When we see coaches, for example,

selling their amazing, one-of-a-kind, limited time offerings, for upwards of $10,000 for services that aren’t necessarily worthy of that amount, we need to think through why admins are so adamant that we pay for them. Why is no one calling out the exorbitant fees that these doctors are charging? They’re claiming to be out to help other physicians through burnout, for example, which is admirable. But then they charge $1000 an hour and that doesn’t add up.

I’ve seen admins pushing these programs, ad nauseam. It is not lost on me that a large sum of monies is being paid to the person who is convincing others to enroll. Again, “influencing” comes into play.

I’m not sure how we solve this.

But it begins with awareness, like everything else happening right now, in medicine, where our colleagues’ vulnerability is being taken advantage of. We need to have conversations. Ask ourselves what we are being sold, and who is doing the selling. We need to call out leaders who are erasing our colleague’s comments and, quite frankly, discouraging democratic discourse. It is not a place we want to head into, as a field.

My friend (the one who was “self-promoting”) chose not to pay the affiliate, in the end. She decided she didn’t want to support the admin of the group in question because she didn’t believe in her tactics, even if it meant that the physicians who are in the group, who believe they’re in a space where open discussion and sharing is welcomed, and where they can get straight answers to their questions, won’t actually get to see her product. It meant she was hurting her potential for future success. But she was ok with that and I look up to her for that.

But the whole thing is all just a shame.