Social Media Use by American Association of Hip and Knee Surgeons Members

Abstract

Introduction:

Social media offers physicians marketing opportunities previously unavailable. We sought to evaluate social media use and its correlation with public rankings among Association of Hip and Knee Surgeons members.

Methods:

A list of members and demographics was collected. Social media sites were reviewed for each surgeon, and a score was calculated based on active use. The US News and World Report (NWR) was used to determine rating and number of reviews. The Spearman correlation coefficient and independent samples t-test were used to measure correlation and compare means between the groups, respectively.

Results:

A total of 2436 members were analyzed. The average social media score was 4.14. The average US NWR score was 4.25. A strong correlation was observed between social media and US NWR scores (r = 0.74, P < 0.01) but not with the number of reviews (r = 0.40, P = 0.17). A strong association with US NWR rating (r = 0.74, P = 0.04) and a weak correlation with the total number of reviews (r = 0.61, P = 0.06) were found.

Conclusions:

Social media use is correlated with US NWR scores. Association of Hip and Knee Surgeons members may be underutilizing social media for the promotion of their practices. Future studies are needed to evaluate whether it affects patient volume and outcomes.

Currently, approximately 72% of the US population reports using social media.¹ Physician review websites (PRWs), such as US News and World Report (NWR), offer patients the opportunity to easily share feedback on their medical care experience. Owing to their public nature, reviews can have a notable effect on a physician's practice, both positive and negative. In addition, physicians can use social media platforms such as Facebook, Instagram, LinkedIn, X, and YouTube to disseminate information, promote their practice, and access a larger patient population.

Although PRWs offer a safe and streamlined modality for patients to provide feedback, they are not a validated measure of assessing physician competency. A 2014 review of 2,185 online ratings of orthopaedic surgeons found that scheduling ease, time spent with patients, short wait time, surgeon proficiency and knowledge, and bedside manner contributed to higher ratings.² It is equally important for patients to share negative reviews as well, such as long wait time and poor bedside manner; however, false claims and factors outside of surgeon control can be particularly damaging to a practice and affect a physician's practice.³ As a result, physicians have an opportunity to use social media as a way to connect with patients and establish a relationship before the initial clinic encounter.

Owing to the largely elective nature of hip and knee arthroplasty, adult reconstructive surgeons have the ability and necessity to advocate for their practices with modern methods. A 2019 review of 145 American Association of Hip and Knee Surgeons (AAHKS) members from Florida showed that surgeons with a social media presence had a higher number of total ratings on Healthgrades and Vitals; shorter wait time; and more care philosophy descriptions, personal statements, and Castle Connolly awards for excellence in medicine; however, age, academic degree, institution, graduation year, website, and overall rating were not correlated with social media use.⁴ This study explored the implications of social media use in a surgeon population where only AAHKS members in a single state were included in the analysis.

The purpose of this study was to evaluate social media use among AAHKS members and investigate whether there was a correlation between social media usage and publicly available rankings and publicly available reviews. To our knowledge, no other study has investigated the utilization of social media among a national cohort of hip and knee surgeons. We generated a social media score based on nonacademic versus academic use and presence of profiles on specific platforms. We hypothesized that having a higher social media score would increase a physician's overall rating on US NWR. In addition, we expected that more recent residency graduates would have an increased number of reviews.

Methods

Physician Selection

Members of the American Academy of Hip and Knee Surgeons included in this study were identified through the AAHKS website, using the “Find a Doctor” feature. Inclusion required membership in AAHKS and registration of the surgeon's practice address with the AAHKS. The date of retrieval was June 22, 2022. IRB approval was not required for this study because we used a publicly available database.

Quantifying Social Media Utilization

After selection, Google searches were used to determine a surgeon's social media usage and develop a social media score. Each member was searched on Google in the following format: “First Name, Last Name, Degree, Social Media Platform.” The social media platform points queried were Facebook, Instagram, X, LinkedIn, and YouTube, in addition to whether the surgeons had a professional or institutional website.

Points were given to quantify social media usage. A surgeon was awarded 2 points per active, personal social media platform (Facebook, X, or Instagram) that served to promote themselves professionally. They were awarded 1 point for each institutionally managed social media account that promoted them directly, and they were also awarded an additional point for active YouTube accounts and LinkedIn pages. They were further awarded 1 point if they had a personal website that promoted themselves or their practice. Personal social media accounts that did not serve to promote the surgeon or their practices were awarded no points. Total social media score was calculated as a sum of all social media usage, both institutional and personal. Personal social media score was calculated as a sum of an individual's website, Facebook, X, YouTube, LinkedIn, and Instagram accounts. Accounts required active posting within the past year to be counted. All accounts (except LinkedIn) were verified as professional accounts used for promotion of business and accessible to the public without having to “friend” or “follow” to access content. Private LinkedIn accounts required joining a physician's network to view their content. This score was generated for the purpose of this study and based on the methods in a study by Narain et al, which investigated social media use among shoulder and elbow surgeons (5). They calculated an overall score for each surgeon [0-7] using the total number of active accounts across various platforms to more objectively assess social media presence.

Using the AAHKS website and various social media sources, demographic variables were obtained including sex, state of practice, type of practice (nonacademic versus academic), and member status (candidate versus fellow versus military member).

US News and World Report Reviews

Additional Google searches were conducted to find the studied surgeons on the US NWR website. All surgeons were identified. The total number of reviews and the number of reviews in the past 12 months were recorded. The US NWR has several subcategories in which surgeons are rated, which include “Thoroughness of Examination, Ability to Answer Questions, Clarity of Instructions, Provider's Follow-Up, Amount of Time with Patient, Provider's Attitude, Perceived Outcomes, Patient Loyalty, and General Feedback." These subcategories are reported as integer values (^1-5) and consider variables such as the time since the review and the source of the review. Given the overall ratings reported by the US NWR, an average of the available subcategory scores was reported as the overall average rating for a surgeon.

Data Analyses

Social media score and US NWR variables were compared using the Spearman correlation coefficient. Demographic characteristics and social media usage were compared with independent samples t-tests to compare means between the groups. Statistical significance was defined as P < 0.05.

Results

A total of 2,436 members of the AAHKS met inclusion criteria. 1158 (47.1%) were in academic practices while 1221 (50.1%) were in primarily private practices. In addition, of the members included, 12 (0.4%) were in active duty military and practiced in military treatment facilities. 34 members (1.4%) were retired. Regarding sex, 2384 (97.9%) were men compared with 52 (2.1%) who were women (Table 1).

Table 1.

Demographic Information

	Count	Percent (%)
Men	2384	97.9
Women	52	2.1
Academic	1158	47.5
Private	1221	50.1
Retired	34	1.4
Military	12	0.5

Regarding the specific social media platforms physicians used, professional websites were the most commonly used platform, with 2365 members (97.1%) having either an institutional or professional website promoting them. The next most commonly used platform was institutional Facebook pages (1,701 members or 69.8%), followed by LinkedIn (1,676 members or 68.8%), institutional X accounts (1,283 members or 52.7%), Instagram pages (1,135 members or 46.6%), and YouTube (997 members or 40.9%). Personal Facebook pages, X accounts, and Instagram accounts were the least used platforms by AAHKS members, with only 208 members or 8.5%, 201 members or 8.3%, and 57 members or 2.3% usage, respectively (Table 2).

Table 2.

Usage Across Social Media Platforms

	Professional Website	Personal Facebook	Institutional Facebook	Personal Twitter	Institutional Twitter	YouTube	Personal Instagram	Institutional Instagram	LinkedIn
Total users	2365	208	1701	201	1283	997	57	1135	1676
Percent usage	97.1%	8.5%	69.8%	8.3%	52.7%	40.9%	2.3%	46.6%	68.8%

Surgeons with primarily academic practices had higher average social media scores (4.98) compared with their nonacademic counterparts (3.46), which was statistically significant (P < 0.01; Table 3). Private practice physicians achieved a personal media score of 2.21 compared with academic physicians with a score of 2.77. Despite having higher social media scores, however, academic physicians tend to be reviewed less often and less favorably on US NWR.

Table 3.

Account Type Comparison

	Academic	International	Military	Private	Retired
Average of social media scores	4.98	2.36	3.67	3.47	0.56
Average of number of reviews	128.10	144.00	81.50	174.60	89.25
Average of weighted average	4.18	3.20	4.40	4.31	4.03
Average of personal media scores	2.77	2.09	2.50	2.21	0.56

When comparing social media scores and reviews from the US NWR with sex, we found that both social media scores between men (4.14) and women (4.06) were similar (P = 0.76) (Table 4). However, despite similar social media usage, men had markedly more reviews and higher overall scores on US NWR.

Table 4.

Gender Comparison

Values	F	M	P
Average of social media scores	4.06	4.14	P = 0.77
Average of number of reviews	106.44	152.30	P = 0.03
Average of weighted average	4.06	4.25	P = 0.04
Average of personal media scores	2.38	2.45	P = 0.71

We used the US NWR rankings for physicians as a way to objectively measure satisfaction. Overall, we found that the social media score was positively correlated with improved overall ratings on US NWR (r = 0.74, P = 0.01), but not a statistically significant association with the total number of reviews (r = 0.40, P = 0.17) (Figure 1). However, there was a strong association between personal social media scores and US NWR overall rating (r = 0.74, P = 0.04) but a weaker correlation with the total number of reviews (r = 0.61, P = 0.06), which was not statistically significant (Figure 2).

Figure 1.

Graph representing the total social media score (x-axis) versus US News and World Report rating (y-axis).

Figure 2.

Graph representing the personal media score (x-axis) versus US News and World Report rating (y-axis).

Discussion

Social media use among physicians and other healthcare practitioners has grown drastically in the past decade; however, only two-thirds of physicians use social media for professional purposes.^1,6 According to the American Medical Association, almost 80% of internet users indicated searching for information regarding physicians, treatment, or diagnoses, yielding 6.5 million health care–related queries per day.⁷ Although roughly 65% of American adults use social media, only 50% use it to obtain health information, 25% watch videos related to health issues, and 5% interact with physicians directly.⁸ This lack of social media engagement in medicine presents an opportunity for both patients and physicians to communicate in a more convenient and meaningful way. Curry et al⁹ surveyed 752 patients presenting to an orthopaedic practice and found that 51% use social media to gain insight into their condition. In addition to querying information about their disease, patients appreciate the accessibility and ease with which they can speak with their providers. Duymus et al¹⁰ studied 647 patients and found that 34.2% consulted with an orthopaedic surgeon online and 48.7% preferred platforms that allowed them to ask questions. Similarly, in a study of 450 hand surgery patients, 31% indicated that they would be interested in communicating with their physicians through social media.¹¹ As a result, orthopaedic surgeons have not only an opportunity for patient recruitment but also a chance to provide streamlined access to health care using modern technology. Although studies have investigated the effect of social media usage among various orthopaedic subspecialties, little data exist regarding its use by joint arthroplasty surgeons.⁴

Physician review websites, such as US NWR, Healthgrades, Vitals, and Google reviews, allow patients to share their experiences with physicians and learn more about their practices. Damodar et al⁴ demonstrated that increased social media usage by physicians is associated with a commensurate increase in use of PRWs by patients. In particular, AAHKS members tend to have high and frequent average ratings.¹² Although they have high evaluations on PRWs, it is unclear whether this is related to their social media presence. For simplicity, we selected US NWR as a single PRW for correlation.

The demand for total knee arthroplasty and total hip arthroplasty is projected to increase 673% and 174% from 2005 to 2030 to include 5.28 million and 572,000 procedures annually, respectively.^13,14 With an increasing lifespan and number of procedures being performed on baby boomers, the caseload of total joint arthroplasties per orthopaedic surgeon is expected to double by 2050.¹⁵ Although this presents an opportunity for increased business and patient recruitment, baby boomers may not use social media in the same capacity as younger generations. In 2014, LeRouge et al found that baby boomers (born between 1946 and 1964) were markedly more likely to use health information websites rather than smartphones or blogs and were less likely to share sensitive health information through online platforms.^16,17 Because this article was published during the early years of social media, it is unlikely that many were using these platforms for medical purposes. Therefore, their results cannot be applied with certainty to the current generation.

Interactions through social media may directly benefit a physician's practice. McNamara et al administered a questionnaire to patients undergoing elective total joint arthroplasty to investigate the effect of a surgeon's online presence on surgeon selection.¹⁸ They found that 64.3% of patients used the internet or social media to search for their surgeon. Preferred search engines included Google (94% of patients), WebMD (39%), Facebook (16%), and Healthgrades (11%); platforms recommended by patients to others included Google (74%), WebMD (35%), Facebook (17%), Instagram (8.9%), and X (6.9%). Although search engines may be used more often than social media for researching surgeons, a subset of patients use and recommend social media for health information and surgeon engagement. In addition, social media pages are often a top result in internet searches. As a result, it is important for AAHKS members to target these platforms as a modality for practice promotion and dissemination of information.

Facebook, Instagram, X, YouTube, and LinkedIn are among the most commonly used professional social media websites. Various studies have demonstrated that orthopaedic surgeons use LinkedIn (40.3 to 57.1%), followed by Facebook (15.8% to 48.8%), X (12.4 to 18.7%), YouTube (6.3 to 23.6%), and Instagram (0 to 6.3%).^19-21 More specifically, it was previously reported that AAHKS members most often use Facebook (31%), X (10.3%), Instagram (2.1%), and YouTube (51.7%) in a previous study that only included surgeons from Florida.⁴ We stratified by personal social media accounts and institutional accounts, both academic and nonacademic, and found that Facebook was the most used institutional platform (69.7%) while LinkedIn was the most used personal platform (68.7%). In addition, we found an average social media score of 4.98 for academic and 3.47 for nonacademic (P < 0.01). Because 1 point was awarded to institutional pages and 2 points were awarded for personal professional pages, the social media scores suggest that these platforms may have the greatest effect on correlation with US NWR ratings. To account for this, personal social media scores were calculated, which demonstrated similar tendencies, with private practice physicians achieving a score of 2.21 compared with academic physicians with a score of 2.77. Academic practices likely spend more monies on marketing overall when compared with private practices, which could account for the observed difference. In this study, the higher mean social media score suggests that academic practices use Facebook pages and Instagram accounts more often than private practices.

Sex may also play a role in social media use by physicians. Woitowich et al²² surveyed 577 surgeons to evaluate differences in social media usage by sex. They found that both men and women agree that social media use has increased collaborations with individuals in (178 men [70%] versus 219 women [68%], P = 0.53) and outside (152 men [59%] versus 181 women [56%], P = 0.53) their specialty and outside their institution (167 men [65%] versus 202 women [63%], P = 0.75); however, none of these results were statistically significant. In addition, they found that women were slightly less likely to report that social media increased engagement with others (26% versus 39% for men, P < 0.01). Kerzner et al²³ studied 2870 sports surgeons and found that although no notable relationship existed between sex and active online social media presence, female surgeons had a markedly higher likelihood of having active Facebook, X, or Instagram accounts. Despite previously reported differences, we found no difference between male and female joint arthroplasty surgeons and social media scores (4.14 for men and 4.06 for women, P = 0.76). Despite the social media scores being similar, however, we found that male surgeons tended to be more reviewed (152.3 reviews versus 106.4 reviews, P = 0.03) and more favorably reviewed (4.25 versus 4.06) than their female counterparts. This analysis is limited by the fact that only 52 AAHKS members (2.1%) at the time of this study were women.

Time since residency graduation date may reflect surgeon age and can affect both social media presence and average number of reviews. Among Florida AAHKS members, surgeons who graduated after 2000 had higher overall ratings on Healthgrades (4.5 versus 4.0, P < 0.0001) and Vitals (4.3 versus 4.0, P < 0.001); however, academic degree, institution, website, social media presence, number of ratings or comments, care philosophy, personal statement, or awards were not markedly associated with graduation year.⁴ Among shoulder and elbow surgeons, McCormick et al found that those who completed residency after 2000 were also more likely to use social media (40.8% versus 29.2%).²⁴ In addition, as of 2018, Florida AAHKS members in practice 1 to 10 years had statistically higher overall average ratings when compared with those in practice 11 to 20 and 20+ years (P < 0.01); however, no differences in average ratings were observed between sexes, practice types, geographic region, PRWs, or personal websites.¹¹ We found no notable correlation between the number of years since graduation from residency and the average social media score (r = 0.27), nor did we find any correlation between the average rating and time since graduation (r = 0.42).

Previous studies have evaluated social media presence and PRW ratings in orthopaedic subspecialties; however, none has investigated this association among all AAHKS members.^1-4,23 We selected US NWR as our primary PRW because it contains public rankings of all physicians in the United States, including number of reviews and breakdown by category (eg, thoroughness of physical examination, clarity, amount of time spent with patient, provider attitude, and outcomes). A meta-analysis of PRWs of orthopaedic surgeons found no correlation between number of reviews (r < 0.001) and a poor correlation between number of reviews and regional population (r = 0.199).²⁵ Triemstra et al²⁶ found a statistically significant correlation between a hospital's reputation score and overall rank, which may indicate that reputation is influenced by social media presence or that rank may affect the number of social media followers.

We found that the average US NWR score was 4.25 with an average of 151 ratings per physician. We found a strong association between social media score and US NWR score (r = 0.74, P = 0.01; Figure 1), but weak association with total number of reviews (r = 0.404, P = 0.17). However, after calculating the personal social media score and comparing that with these parameters, we found that the personal social media score also had a strong association with US NWR rating (r = 0.74, P = 0.04; Figure 2) and a weak correlation with total number of reviews, with the latter not reaching statistical significance (r = 0.613, P = 0.06). Given that the personal social media score is more representative of an individual's strive to network through social media, this suggests that members who are more active personally tend to be reviewed more and are more likely to have higher online rankings and publicly reported patient satisfaction.

This study has several limitations. First, we selected a single PRW that may not be representative of a surgeon's total online reviews across all sites although we did find US NWR pages for all surgeons evaluated. Emmert et al showed that younger women and unsatisfied patients are more likely to write reviews online, which may have skewed our results; however, given the average age of an arthroplasty patient population, it is not likely to have been affected by negative ratings alone.²⁷ Second, although we assigned points based on academic versus nonacademic, we did not verify whether the social media sites had been active within the past year. Points were also not assigned based on the number of posts and level of activity. As a result, surgeons may have had higher social media scores by solely having an account without that account being active. Finally, we created the social media score for the purpose of the study, and it has not been validated against other studies' scores. Nevertheless, this is the first study to correlate all AAHKS members' social media scores with publicly available online ratings. Future studies should evaluate multiple PRWs and consider assessing relative value units to objectively measure the effect of social media on business volume among hip and knee surgeons.

In conclusion, we found that surgeons with higher social media usage scores had higher patient review scores on US NWR's website and a trend toward a higher number of reviews. Social media remains an underutilized means for surgeons to communicate with patients, educate patients, and promote their practices.