Advice on When and How Physicians Can Speak Out If Their Opinions Differ from Their Employer

Johnson encourages physicians to scour their contracts before stepping on that soapbox. “Sometimes there are restrictions on who has the authority to speak on behalf of a hospital,” she said. “More commonly, though, there is language prohibiting a provider from portraying the hospital, medical school, or healthcare organization in an unfavorable light. Additionally, hospitals and health systems might have language in their bylaws prohibiting speaking on behalf of the hospital without the hospital’s approval or speaking in a manner that casts a negative light on the hospital.” Setting aside the contractual issues, however, it is legal for a physician to express an opinion, she says.

The venue and context in which a statement is made matters. “Statements to patients, on social media, or to medical journalists are generally higher risk, whereas a statement made at a conference—but not as an official conference speaker—may carry less risk,” said Johnson.

Dr. Holland avoids bringing up politics while practicing in the clinic or when representing his employer, Ascension Providence Hospital in Waco, Texas. “But they’ve given me leeway if I’m speaking on behalf of the Texas Medical Association,” he added.

Physicians who use social media to get a point across should exercise caution on these platforms, as should anyone. Dr. Holland maintains a robust Twitter account in which he freely expresses his thoughts on issues. “I’ve always been politically active and was so even before I went to medical school,” he said, admitting to having been quoted and “gone viral in ways that perhaps I shouldn’t have.” His advice: “Never post anything the first time you think about it.”

Dr. Wei knows of several physicians who have been targeted via social media. She is willing to take a risk for what she believes in—but not online. “I rarely post about controversial topics on my personal or professional social media accounts,” she said. “Most institutions have marketing personnel that monitor social media. Physicians must make sure that whatever they post is disclosed as not representing their organization.”

The good news is, at a time when the art of “agreeing to disagree” appears all but lost, physician activists have an opportunity to show the public how to engage and work cooperatively with others who may hold an opposing point of view. “Our job is not simply to spout opinions,” said Dr. Holland. “We need to choose our battles carefully, to be selective about what we say in public, in print, and in the media, and then be respectful no matter what.”