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After vaccinologist Peter Hotez, MD, was stalked at his home last week following harassment that began on Twitter, cropped up suggesting doctors and scientists were leaving the social media platform.

Doctors and public health experts have raised concerns about negative changes since billionaire Elon Musk purchased the platform. Many of them also weathered harassment for combating misinformation during the COVID-19 pandemic.

But have they actually been quitting Twitter completely?

One company that has been tracking physician engagement on social media for more than a decade reports that this doesn't appear to be the case.

Greg Matthews, CEO of HealthQuant, reported that over about the last 2 years, physician activity on Twitter has remained .

Using a sample of 100,000 physicians on Twitter, he found that the number of monthly active physician users was in the second quarter of 2023 as it was for the third quarter of 2021 (67,099 and 71,554). (He noted that the 2023 second quarter results do not yet include data from June.)

"My sense of it, through looking at the numbers and watching the feeds and doing research for clients, tells me the average doctor is not really much affected by the changes that are hitting Twitter," Matthews told MedPage Today. "The big names who acquired a public and polarizing profile during the pandemic are different from your average physician who is using it primarily to connect with other colleagues."

For instance, Twitter posts around the American Society of Clinical Oncology (ASCO) meeting -- the largest clinical cancer research meeting in the world and one that has always been a major focus of online activity among doctors -- have been on the rise for the last 3 years, Matthews said.

"Twitter has always been about who you follow and I think that's still true," Matthews said. "Most doctors tend to follow fewer accounts than the average Twitter user, and the accounts they follow tend to be other doctors. So I think they are, in a way, a little insulated from some of the other trends."

Nonetheless, the number of active physicians has trended slightly down over the last 6 to 9 months, Matthews said, and the fallout from the Hotez debacle isn't over yet. Full numbers from the second and third quarter of this year will reflect any additional changes, he added.

Engagement measured through other parameters does appear to be down somewhat, he said. While the average physician posted 15 times per month, Matthews said, that figure is down 11% over the past 2 years. In addition, the average number of physician authors was down 6% during that time.

"Doctors who are engaging may be posting a little less often than they used to, but have people really vanished from this platform or is there something more subtle going on? I think there's something more subtle going on," he said.

Indeed, physicians on Twitter interviewed by MedPage Today said that, overall, they are interacting less than they used to -- and that's largely because of the quality of the content turning up in their feeds.

"I'm still on Twitter, but very rarely interact now," Katelyn Jetelina, PhD, who runs the "Your Local Epidemiologist" newsletter on Substack that became popular during the pandemic, said in an email to MedPage Today. "I would love to still use Twitter for scientific dialogue, but it's just not constructive anymore. It's almost impossible to know who to trust and who not to trust (due to the verification system changing), it's hard to weed through the noise of pile-ons, and many other colleagues are not engaging anymore either."

Joel Topf, MD, medical director of St. Clair Nephrology Research in Michigan who was an early adopter of social media medical education -- he started a -- said the "quality of the signal on MedTwitter has gone down over the last couple of months, and it's not clear whether that's because the algorithm is not as good, or whether some good people have left the platform" or aren't tweeting as much.

Topf noted that as the quality of his "Following" feed -- the one that is personally curated -- has gone down, he's jumped over to the "For You" feed, which he describes as being weirdly addictive, but not in a good way.

"It's a lot of topical news stuff and I don't know why it's addictive, but it's similar in the way that you can lose hours in TikTok," he said. "The platform seems to be deteriorating."

That's unfortunate, he said, because there's no good alternative, and the social media medical education community -- and the public -- may be at a loss.

Jetelina said her "biggest fear is that scientific dialogue will go back to private conversations. For public health, this means the community will be largely removed from conversations, which would be a tragedy. During the pandemic, this was a huge benefit and, I believe, saved lives."

Matthews said that, overall, Twitter remains "the platform where doctors are engaging." Although sites like Mastodon have aimed to become its replacement, that hasn't happened. Mastodon's decentralized platform makes it hard to connect, and LinkedIn has a lot of physician users but it "tends to be a place where you hang out a shingle and don't really come back," he said.

He noted that Meta will be jumping into the fray with " this summer, but it remains to be seen whether it will be the app that finally pulls doctors away from Twitter.

"I think that the secret sauce of Twitter has always been that it's the easiest place to find people who have like interests and connect with them and converse with them," Matthews said. "Twitter is going to be the thing until there is something that can replace that ability to connect with people who share your interests."

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