Health care providers increasingly are becoming social media influencers—people who promote products in their pictures to their followers—but some critics worry the practice blurs the line between harmless social media and medically unethical practices, Rebecca Jennings reports for Vox's "The Goods."

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The rise of the 'nursefluencer'

There are several factors behind why providers choose to become social media influencers, or "nursefluencers," Jennings writes.

Some do it to supplement their income, Jennings reports.

While RNs on average tend to make between $50,000 and almost $100,000 , their actual income can be much lower once adjusted for the cost of living, Jennings writes. Plus, the job has a high rate of burnout, which means not everyone is able to do it for their entire career. As a result, many nurses have turned to multilevel marketing to either supplement their incomes or provide a road out of the medical field, Jennings writes.

Katy B, an RN with 25,000 followers on Instagram, who asked to keep her last name private, said, "Most of us have a lot of student debt and are trying to stay afloat. I don't think there's anything wrong with it as long as you're being transparent about what you're doing."

Joyce Kahng, a dentist who owns her own practice and is a professor at the University of Southern California, views her @joycethedentist Instagram page as an investment. Kahng, who now has over 13,000 followers, explained that her profession as a dentist "does pay well" but "you have to work in order to be paid. It's not like a corporate job where you can call in sick. If I don't come in, every single person that I employ cannot work that day."

Another reason why providers turn to social media is to relieve stress and share with others what their lives are like as medical professionals, Jennings writes.

"It's cool when we all share our unique perspective of what it actually looks like on the human side," Katy said. She added, "We're so at risk for burnout, because we spend a lot of time taking care of other people, and I think sometimes we forget how to take care of ourselves. We have to brag about the cool things that we do!"

The ethical questions

Health care providers on social media face unique concerns, Jennings writes.

One concern involves the ethics of posting sponsored content as a medical professional.

For health care providers, leveraging your expertise as a doctor for a product can be tricky. For the most part, health care providers have deals with scrubs brands or other innocuous things, but some blur the line when it comes to what's appropriate for a health care professional to promote, Jennings writes.

For example, Mike Varshavski, a doctor in New York that goes by Doctor Mike on Instagram, has posted sponsored content for Clorox bleach, Quaker Oats, and American Express, which according to Jennings, "could create the perception that these corporations are somehow medically approved by this doctor."

As far as medications, the Federal Trade Commission has specific rules for doctor endorsements, but it doesn't answer whether doctors should promote over-the-counter medications, Jennings writes.

Arthur Caplan, founding director of New York University's Division of Medical Ethics, said, "I'm not sure [doctors] have any place [promoting over-the-counter products] other than to say, 'I'm a regular user.' I think it still undermines their professional credibility."

Another major concern for nursefluencers is HIPAA. Determining a HIPAA violation on social media is a bit of a gray area since the law existed before Instagram, Jennings writes.

Austin Chiang, a gastroenterologist and chief social media officer at Jefferson Health, said, "It's not as simple as not mentioning someone's name." He explained, "Instagram is visual, so you see a lot of procedural photos. There are certainly risks in that. There's even risks in geo-tagging or talking about a case that you're doing."

Jennings writes that every influencer she spoke to said HIPAA is one of their top concerns posting on social media.

One of them, Sarah, an RN who asked to have her last name kept private, said she's hesitant to post anything about a patient. "You can change the date, gender, or demographic, but someone from [their] work or family could recognize the case no matter how much you change about it," she said. "I would be scared to even think about posting about any of my patients" (Jennings, "The Goods," Vox, 5/10).