A Doctor’s Face on a Billboard

After retiring from medicine, I drove across most of the southern and western United States to explore national parks and visit relatives. Every day, I would drive by billboards showing faces of physicians. I’m sure most of you have seen this type of marketing in the Pittsburgh region if not on billboards, then certainly in advertisements on television or in the newspaper.

The attractive faces I saw appeared either kind or smart or both. They fit with the other sea of faces on billboards from other businesses: automobile, insurance, funeral homes, plumbers and others. The words surrounding the physician spoke to quality in general or a perplexing specific ranking (“number one in cancer care in southwestern Pennsylvania!”). Or, the ad touted teamwork, a holistic approach, technical expertise or something else either difficult to measure or impossible for the public to find data supporting the claim.

Some of the faces I am certain were models. Most models seem to be blends of ethnic groups, attractive but not overly beautiful or handsome, and not quite human. I have wondered if these models, once opened, would turn out to be robots or aliens of some sort.

But most faces, I am sure, were actual physicians who agreed to pose. Those below the age of 60 may believe that this type of advertising is long-standing—it is not. The explosion of physician images in ads is new. When I started my career more than 30 years ago, a physician who advertised was considered unethical. So, what has changed?

The door permitting advertising by physicians opened in 1982 when the American Medical Association lost a legal battle (which went all the way to the Supreme Court) with the Federal Trade Commission regarding prohibition of advertising. Previously, the AMA considered physician advertising to be unethical and therefore prohibited. Despite the Supreme Court ruling, however, physicians surveyed in the 1980s still considered advertising as unethical. More recent opinions after the millennium echo the same position.

I don’t think those who choose a career in medicine now are so different than in the past. I suspect few medical school admissions essays state a goal to be on a billboard. And I don’t think today’s essay writers purposely hide such a goal. I am an optimist by nature—most physicians enter the profession with loftier intent.

Why do so many physicians agree to pose? While I understand one’s face on TV or enlarged to “King Kong” size on a billboard offers a fame of sorts, it is difficult to understand why this fame is admirable. Sure, a stranger may stop the physician and say, “Hey, you’re that guy on the billboard!” Should the doctor feel good about his or her fame? In the absence of other fame-worthy acts, I think most would say no. More important, will a patient trust a physician more after seeing their doctor on TV? Does the face on the ad truly demonstrate that this physician is a better physician than the competitor? Or does it simply demonstrate something more basic and less attractive related to ego? Isn’t it likely that the public views these images with skepticism, much as it views images of other marketers? And most patients would not express this skepticism to their doctor’s face. More likely, they would say “I saw you on TV!” with an enthusiastic smile that belies more critical thoughts.

To those physicians who have posed for ads, I suspect my thoughts are not a surprise to you. At the time of your photo shoot, you may have felt uncomfortable being made up or posed or scripted in some way that seemed untrue to your nature. I suspect many of you felt deep down your decision to pose left a slight stain on your diploma.

I don’t deny that in many regions, health systems compete for patients. And competition in healthcare may force aggressive marketing. My point is that what should attract new patients to a practice or system is true excellence, not a physician’s face on a billboard. Said more simply, the system or physician that markets the best should not win. The system or physician that provide the best care should.

But how do we know who is best? Measuring excellence in healthcare is difficult. Most experts would agree our understanding of how to measure healthcare quality remains poor—current measures have great limitations. And while there has been progress, most practicing physicians would judge the current state of quality measurement as poor. More work is needed.

So, in an era of competition when true comparative data on quality remain elusive, what should we do? Prior to the explosion of healthcare marketing, physicians developed a reputation through word of mouth among their patients and colleagues. This method too has limitations. Most physicians can name a colleague with many adoring patients but whose technical care is suspect.

Consider the following situation. Suppose you decided to have your knee replaced after years of debilitating degenerative arthritis. You call a close friend and mention your decision. He says, “Hey, you might go to that guy on the billboard.” Most of us would find such a recommendation laughable.

Given our choices on how to choose a physician—overt marketing, limited quality comparisons and word of mouth—what is the least informative? I believe physician images on a billboard surrounded by clever ambiguous words relay the least relevant information to the public. To my physician colleagues, my advice is simple. The next time you are asked to pose, simply say “no thank you” and spend the time saved on an effort to improve your skill as a physician, the professional you described on your medical school essay. To those not in the medical profession, I encourage you to maintain your skepticism and explore alternate options with physicians who are more focused on their patients.