In this episode, Griffin talks to Dr. Natalie Crawford, an accomplished REI practicing in Austin, TX. Dr. Crawford (@nataliecrawfordmd) has successfully utilized Instagram as a tool for education as well as marketing; today, she has tens of thousands of followers who turn to her for information and connection. Griffin and Dr. Crawford speak about the role social media plays in medicine, and the ways that physicians can use social media to create a connection with patients and prospects alike.

Griffin Jones: Today I’m here with Dr. Natalie Crawford. Dr. Natalie Crawford is an accomplished REI who currently practices in Austin, TX. She did her medical school studies at the University of Texas medical branch in Galveston, and she did her residency in OB/GYN at UT Southwestern, and most recently completed her fellowship in REI at University of [inaudible]. She currently lives in Austin, TX with her husband, Austin native Jason, and their two young children.

The reason why Dr. Crawford is on the show with me today is because of her several thousand Instagram followers and the way she’s been able to use social media to connect with patients and with colleagues. Dr. Crawford— Natalie— welcome to the show!

Natalie Crawford: Hi, Griffin! Thanks so much for having me here, I”m so excited to be doing this with you today and talking about the role of REI in the social media world is something I’m really passionate about.

G: You’re among the first people I’ve had on the show, you’re among the first episodes, and the reason you’re on that short list is because you and I met a few years ago on social, and at that time you were amassing some followers— I think you had a couple thousand followers, I think the last time I looked you’re at 48,000— and this is just Instagram. I’m not talking about other channels. I’m curious did that start for you. Did it start way before [glitch] and how did it unravel?

N: You’ll laugh at me. I was barely on Facebook before medical school and residency. I was a big believer in the “keep your personal and professional life separate” camp when it comes to social media. At the end of my fellowship, I have a younger sister who’s very prominent in teh tech world. She’s much younger— about 8 years younger, our ideal demographic— and she came to me one day and said, “I wish you would put more about what you do out there. As a fertility doctor, it’s fascinating, and I have no idea what you do. I’m your sister, and I have no idea about my own fertility— what I should know, when I should try to get pregnant, or any of that.” It really spoke to me, as far as something I’m passionate about, which is educating young women about their fertility and loving my job as a fertility physician, I often see women too late. They’ve already had time go by, they’ve been diagnosed with diminished ovarian reserve, and I thought this could be an avenue to reach people before they had issues to educate them, to reach more people than you can see in a day across your desk. It’s really just grown immensely; I’ve had the Instagram open for two and a half years, and I don’t really have many other platforms at the moment.

G: What was the momentum of it? Did you start putting some pictures on, like, “Hey, this is what I’m doing with my day,” you find other people on there via hashtags, I presume? How did it build up?

N: The best advice I got early was that if you’re wanting to connect with people, it’s worthless if you don’t connect back. It’s not a passive medium. You can’t just put a picture of yourself in scrubs out there and expect to get followers who you want to get, unless you’re telling a story and you’re talking back with them. Follow people on the space who inspire you. I started following early a lot other physicians, none of them were in the infertility space, but seeing what they were putting out there as far as emergency medicine, or dermatology, or plastic surgery, and how they were educating patients. I started following them and commenting and engaging with them and reaching out to them for advice. It’s slow growing, organic growth at first, I just engaged and put things out there. And then it’s crazy how even in the last six months, it’s doubled— it exponentiates once you get bigger.

G: This started as a means of satisfying your sister’s curiosity, and then it ended up being a way to just engage and promote the field and promote the ideas and research that you’ve worked on, and this is a theme that’s come up in earlier episodes with Allie [inaudible] and Rebecca Flick from Resolve, it’s something I talked to Serena Chan about a lot, which is social media, which we sometimes view as something apart, but as it becomes the way that people communicate, it just becomes part of the standard of care.

N: I completely agree. I’ve been floored by how it’s changed by your career and how much power it has. A medium that I looked as just to provide education has provided me a community, it’s provided me opportunities, it’s connected me with so many people and as you’ve mentioned before, it’s a great way to market yourself and give a voice to you in an online world that’s not just patient reviews. You’re controlling the story, and I find that patients are really drawn into the fact that the know a little bit about me before they sit down, or they’ve often read some of my stuff or they find me through the Instagram world and I think that just allows that connection to be even more meaningful.

G: Controlling the story is a very compelling reason for physicians who maybe have no interest in getting on social or haven’t thought too much about it before, because otherwise you’re leaving the story completely up to someone else’s hands. Sometimes people will say, “Why did this person say something bad about me on Google Reviews or Fertility IQ or Facebook?” I know negative reviews sometimes really bother physicians. I’ve had several clients tell me, “I can’t sleep at night when somebody leaves a negative review about me!” I hate that too, when I’ve put something out there and somebody has a difference of opinion or doesn’t appreciate it or looks at it cynically — I think we all do— but when you start to do your own storytelling, especially on social media, you start to bring out more of the people who agree with you, also. You do that all the time in so many different subsegments. You do it with women in medicine, you do it with infertility, you do it with residency and training. For the people who are concerned about the “haters,” what’s the balance been for you with positive and negative?

N: I think I’ve come to the point where I realize you can’t please everybody all of the time. That’s in your clinical practice— you’re going to get negative reviews— that’s in the online world, but if you’re putting out content you care about and you can stand behind, it doesn’t really matter as much. I definitely try to post opposing viewpoints. I don’t take down comments that are different than mine, unless they’re derogatory or leading the conversation down a path I don’t like. But my view is that everyone should have a space, and they have their opinion. I know not everybody is gonna like everything I’m doing or saying, but I’m not trying to be controversial. I’m trying to be real. I believe life in general is about connecting with people, and social media is the modern way to do so. You can connect with people who are going to be your patients, people who will never be your patients across the country who are looking for support, who are scared to go to the infertility doctor. They see you on there and you’re not that scary! Or other young women in medicine who are afraid they’ve been told they can’t do X, Y, or Z, because they won’t have a family. I find that being yourself and being a little bit vulnerable to that criticism opens you up to make better connections overall. I just take the good with the bad when it comes to that.

G: And by the way, if I left that sound bite like that, it would sound like there’s a lot of negativity in your social media feed. There’s very— I haven’t seen any haters, but I think just looking, that at everybody’s, certainly yours, the positive is so much more than the negative in terms of comments, feedback, interaction— unless we’re on Twitter talking about politics or something. For the most part, you say you’re just putting out opinions that you stand behind, viewpoints that you really believe in and have put some thought into, and maybe not everybody will like them, but for the most part, you’re connecting with people who either validate that viewpoint or benefit from it in some way.

N: I think, at least in modern social media, people have no time to engage in arguments, nor do they want to. If you’re not their cup of tea, they’re going to stop—

G: Mmmm, I don’t know if you’ve been to a hashtag of any political term on Twitter— I don’t know if I agree with that—

N: Ok, ok, you’re right— let me rephrase. The demographic I’m after who is on Instagram is often looking for inspiration over controversy. I’m not saying everybody, but who am I appealing to? Young reproductive-aged women. A lot of them are wanting to be professional in some way, a lot of them are interested in starting a family, trying to start a family, and they’re going to this space for support and inspiration. You’re right, overall I find my Instagram to be a happy place, where people are looking for each other, or trying to open their minds about different viewpoints. There’s not very much public hating happening in that space.

G: You hit a killer point in there— which is one of the things you’re doing is that when people come in to see you that have already seen you on social, they feel like they know you a bit, they feel like they can open up to you more quickly, you have a rapport with them already coming in. One of the things, when I first got into this field 4-5 years ago, I was having dinner with an REI, who’s a really great guy, he was asking me, “Griffin, these people that if I had just seen them two years earlier, I would have so many more options for being able to help them. How do I get them to come in those two years earlier?” And I’m thinking, “This! This is how you do it!” Talk a little about that— about the rapport building.

N: I always feel like infertility is a one-way street with vulnerability. You’re asking somebody to sit across from you and open up and tell you their story, which usually has some heartbreak in it. You’re just on the receiving end of that. When they’re able to feel like you’ve shared some vulnerability, if that’s on social media— it doesn’t have to be super vulnerable, just putting yourself out there is vulnerability. They see you’re there, they’ve read your writing, they feel like they’ve got a glimpse into your life also. I think it makes the relationship more meaningful from the get-go. It makes it easier to connect and get through some of those hard moments and to gain trust. I’ll interject here and say, I’m a huge believer that a pure professional page doesn’t always accomplish that goal if you’re not showing any of who you are as a person— at least in the Instagram world, people are there to get to know you as a person. If it’s super vanilla, just quotes all the time, and there’s nothing about you, you’re not going to accomplish your goal.

G: I face that fairly frequently, it’s often from a prospective client reaching out to me that just has the idea in their mind that this guy with the funny haircut and colored pants can bring us more patients on social media— they’re magic patients that will come to us if we somehow “do” Facebook or “do” Instagram. You see tons of practices using probably some— not even a marketing agency, probably a subsidiary company of the phone book, and they’re posting something on Instagram that’s a recycled image or a link they find from Google news search about infertility that day. There’s no engagement, and consequently it’s not doing anything for the, for their practice, for their rapport with patients… social media is a forest. If that tree goes down and nobody hears it, it didn’t fall. All that matters to me is how people engage. To me, you have to have scaled it. You have 48,000 followers, and on any given photo of yours, you’ve got thousands of comments and likes. Why you’re on the show is because you’ve scaled it to that level, but people don’t have to do that. If you have 300 followers, or 100 followers, but you’re connecting with them in a meaningful way, it can impact your practice and other parts of your life.

N: Griffin, I love that you said that. I totally believe there’s power in social media, and you don’t have to get to the tens of thousands of followers level to get what you’re looking for. The truth is, having a social media presence that’s engaged and real, even if it’s behind-the-scenes pictures in your office or pictures of your staff, it validates you as a modern practice. As an REI, we have very modern technology, and so being a modern practice really appeals to the generation that’s looking to come to us for care.

G: I think I can say this, I think it’s public news, but are you going to be speaking about social media and physician use of it at conference this summer?

N: I am! We can talk about that!

G: We can talk about that? All right. It’s Midwest Reproductive Symposium, it is my favorite meeting in the field. I’m a little biased to it, and I’ve spoken about social media there. I’m looking forward to coming and seeing your talk because, when I talk to other agency owners, I have a different rapport than even when I’m talking with physicians. If I’m talking with REI practice owners, they can connect to me as a business owner, they can connect to me as someone with the expertise in developing a fertility practice and acquiring new patients, but I’m still not a physician. At the end of the day, there’s that lack of peer authority to just grab somebody by the shoulders and say, “Freaking do this!” like I can with other agency owners or other business development consultants. When you’re talking with other physicians, probably getting the same objectives I get, like, “I don’t have the time, I don’t know how to use it, it’s for kids, I don’t know what I would post,” how do you get people to dip their baby toe in the water?

N: I usually try to appeal to them that most physicians in our field really do want to reach people and our job is very educational. WE will tell you we sit across from the desk, and we’re drawing diagrams and explaining how the reproductive system works. There’s a way to do that on a different level. If you have a clear objective in mind, social media isn’t as daunting as it seems— you just have to put yourself out there. The biggest thing I find with other physicians— the two barriers— are 1) time— they’re afraid of the time investment and “who will take my pictures and what pictures” and 2) this weird fear of self-promoting, “I don’t want to just be posting pictures of me all over the place and have the impression or whatever badness that comes with that.” To me, self promotion or personal branding— you’re giving a voice to yourself. You’ve worked hard as a physician to do whatever job it is you want to do. There’s no harm in trying to spread that greater. But I think that’s a kind of a problem and a barrier– ”Oh, if it’s just pictures of me, people will think I’m arrogant.” I don’t know– I’m trying to break that down. The reason why my feed is pictures of me is I believe people on social media are very lazy, and they’re scrolling their feed, and they don’t see your name but they see your picture. IF your picture is a stack of books on a table, they may not stop. If the picture’s of me, my followers know what I look like and they’ll often stop and read what I write. So versus it being self-promoting, per se, even if that’s a bad thing, it’s more of a way to capture attention, because I have a message to spread. I think that the time commitment isn’t as big as people are afraid of. It’s fearful to go into something new. I think that’s the biggest barrier, honestly.

G: I always think, “I didn’t grow up doing this,” is what people will say to me, but I didn’t necessarily grow up with it, either! I didn’t have a smartphone— even us earlier millennials are still a little bit pre-internet. But you didn’t grow up driving, either— you didn’t grow up with all these other things. In addition to how relevant it is to practicing medicine, it’s also indisposable to just running a business.And, for example, I suck at accounting. I am really bad with managerial accounts, but that doesn’t mean that I am allowed to just ignore that. I still have to learn it to a baseline to be able to help my accountants, interact with them, and be able to have conversations with my bookkeeper and make my business function and grow. There’s a certain baseline of literacy that I think now is non negotiable. 10 years ago, it might have been a nicety. But today, it seems to be part of the vernacular. I’m going to jump into that a little bit, but I also want to say you are pretty good [glitch] it doesn’t always have to be about us— if it’s our Instagram, most of the time it will be if it’s our channel, but part of the reason we met, one of the things our company does is spotlight people. We say, “Check this person out! This is what they’re doing— we like them.” It makes it a good way to connect with people that isn’t just us.

N: Yeah, I think it’s a great way to collaborate and expand your networking— your professional network and within the space in general. I know closely, I have phone conversations, and I see people that I’ve met from Instagram from our professional realm that I never would have run into or would rarely see, and now I have this connection with them. About the other thing, I don’t accept the barrier, “I don’t know how to use the tech” as a reason to not be on social media. I challenge that in all physicians, especially in our field, because the tech is always changing, even on the REI end of it. We’re always learning new skills, we’re having to keep up as things evolve. Social media is just an evolvement of how people communicate and how we reach each other. It’s just a skill that needs to be learned on some level. I like to challenge physicians when they say they just can’t/don’t want to learn that new skill. Obviously, as physicians, we can learn lots of skills.

G: I am huge on responding to people who comment on social media– I think it’s one of the most important things you can do. We do it on our social media channels, and we also do it for clinics. If someone comes on and says, “Dr. so-and-so is the greatest” or even if they comment on a post, we try to respond to every single one of those, “Hey, thanks for the kind words, hope you’re having a nice day.” Something brief, something non-PHI. You were really good about that for a long time. You’d get dozens and dozens of comments, and there would be dozens and dozens of replies from you. Now that you’ve scaled up to a level that’s a lot, are you still able to do that?

N: I think it’s still very meaningful to do that, because if people are taking the time to leave a thought on your page, to respond to it thoughtfully is meaningful and allows that connection to grow. What I try to do when I have a post, in the evening when my kids are asleep, I look back through and I certainly can’t respond to every single one of them anymore. The ones that are like hearts or thank yous, I just like. Ones that are a thought-out comment or question, I try to respond to. People who are asking for that next level of engagement or who are really commenting something meaningful, you want to foster that relationship. That’s the whole point of the social game. To ignore those comments or opportunities, they’re just lost opportunities.

G: I’m gonna jump back in to what I think is the biggest point— we’ve talked about participating in social media as part of the standard of care, part of operating a practice or business, and I want to delve in a bit deeper about why. Specifically, what I mean about it just becoming part of the vernacular, part of the way people talk. In the mid-20th century, when television and radio started taking over, Marshall McEwan coined the phrase, “The media is part of the message.” When I was scrolling through your Instagram stories today, which is another feature apart, a platform in a platform itself, and a way that people really used to spend so much of their media time. You were curating stories from other [glitch], and the fact that you curated and the fact that this platform allowed you to interact with dozens of people and get their opinions and show the way that you were then telling their story, like use the features to circle a paragraph or highlight a word, and interject your commentary with an arrow and some text— that just is the way that people communicate today! And we’re not 18 year olds. And that behavior is only aging up. So, if you’re not doing that, eventually you become the person who doesn’t know how to use the telephone, the telegraph, who doesn’t know how to use a fax machine. Eventually, you’re not a part of the conversation at all. I want you to talk a little bit about that. How communicating in this way is just the contemporary way of doing it.

N: I totally agree. I think this is just the contemporary way of communicating. I think that we’re in a unique position as REIs specifically, we have a very specific age of patient range— we have women typically aged 18-45, so we’re going to get older, and our patients who are younger now are going to age into this range, and they’re going to only be more savvy and communicate through mediums like this and other things we can’t even imagine. If you can’t be relevant to them, I don’t know how you’re going to communicate with them. I believe that staying modern in that way is really important to feel like you care about being relevant to them. I don’t think that it’s— maybe physicians in every field could argue it’s not as important for them, but I think it is for everybody, but I could hear the argument— for our field specifically, as a physician, by the time you get through your REI fellowship, you’re going to be getting to the older end of your demographic. You have to be able to look at what’s coming next to relate back to them.

G: I could spend the rest of this day on this topic I’ve partly built a career on. I think “The Ultimate Guide to Fertility Marketing,” the blog, might be enough for people if they want to delve into more of my opinions, but is there anything you’d want to conclude on this topic that I haven’t asked you that other people in our field should know or consider?

N: I’d like to say, I get asked all the time, there’s so much on social media, on Instagram and Twitter, and Facebook and blogging, it overwhelms people– do they need to do it all? The advice I got? Just start with one. Learn one platform and do it well. Learn what your voice is and what your audience is. You can expand upon it later. But I do think it can be overwhelming to try to master different things at one time. I’d just like to say, there’s no harm in saying, “I’m just gonna take this first step and learn Twitter or learn Instagram,” or whatever you think is the right medium to communicate with who you want to communicate with.

G: Everyone who’s listening should follow you on Instagram— we’re gonna link to that in the show notes. Is it @nataliecrawfordmd on Instagram?

N: Yes, that’s it.

G: You heard it here— follow and pay attention. Dr. Natalie Crawford, Austin, Texas— thanks so much for coming on Inside Reproductive Health!

N: Thanks so much, Griffin! It was a blast!