TikTok spine surgery: Dr. Chester Donnally's winning formula

Alan Condon -  

Almost two years after completing a spine surgery fellowship at Rothman Orthopaedic Institute in Philadelphia, Chester Donnally, MD, is making a name for himself both in and outside of the operating room.

The spine surgeon, who practices at Texas Spine Consultants in Addison, has built a substantial following on various social media platforms, including Instagram and YouTube, but TikTok is where he has seen the most success. His blueprint has been to use videos to educate patients about spine surgery and provide an inside look into what life is like for a surgeon in the operating room.

Since August, when Dr. Donnally began posting videos on TikTok, he has accumulated more than 27,000 followers, with a recent video on cervical disc replacement exceeding 1 million views. Thousands of people comment on his TikTok videos, and some of them have become patients.

Dr. Donnally spoke to Becker's Spine Review about building his brand on TikTok, tips for surgeons using social media and the technologies he's most excited about in spine surgery.

Question: How did you begin using TikTok to build your brand? Are you impressed with the attention your spine surgery videos have attracted?

Dr. Chester Donnally: I started doing TikTok videos after advice from Matthew Harb, MD, a total joint surgeon my age who I became friends with on social media a few years ago. He told me about the success he was having recently doing educational TikTok videos. There are a lot of adults on the platform; it’s not just for teens. Once I started posting videos, I got a lot of comments. Many of them were from actual patients who had "X" spine surgery, "Y" disc replacements or injections for pain. Many posts have thousands of comments from people discussing their spine surgeries. Some of those people had good outcomes, some had bad outcomes, and others wanted to know if a certain procedure was indicated in the cervical or lumbar spine, for example. I have several videos with over 1 million views. In just the last 30 days I have had over 20,000 video "shares" that reach those with some connection to spine surgery.

On LinkedIn, Instagram and Facebook, I'm trying to target other medical providers — spine surgeons, physical therapists, hospital staff, etc. But TikTok is the only platform where I'm interacting directly with patients. I've been pretty surprised by the number of new patients I get from TikTok alone. Direct marketing to patients was never my goal. I feel like that's more for derm or plastics. Social media was just something technologically easy for me and fun to do.

Q: How do you measure the referrals you get from TikTok at your practice?

CD: A lot of times, under "referrals," patients will check "internet," but while I'm talking to them later, they'll almost bashfully mention that they found me on TikTok, or even that I actually responded to one of their comments on TikTok. I've had a dozen patients drive six hours from Louisiana or Oklahoma to visit me. I actually have one video on TikTok and another on YouTube that shows where people have flown from to have surgery here in Dallas.

Q: What advice do you have for other surgeons looking to develop their brand on social media? What are the dos and don'ts? 

CD: First of all, you have to make sure you're compliant and have patients sign waivers. Whenever I post something, the patients are almost always three to six months out of surgery. One recommendation I have for surgeons is: avoid posting MRI images from post-op day one or even a couple of weeks after surgery for multiple reasons. Can you imagine how bad it would be if you posted your fluoroscopic images one day after surgery and the patient had a complication? Also, anyone can have pretty intra-op images, but it's the post-op outcomes that should be shared if using newer techniques. Showing an intra-op X-ray of a single-position surgery is neat, but proving the patient did well with three-to-six-month post-op images and a signed consent is more powerful and more truthful. 

I see two big problems with posting too soon: First, you don't know how the patient did clinically if they're only a couple of days out. Now you're telling people that this is a good way to do surgery without knowing the patient's outcome. Two, from a legal standpoint, what if that patient has a bad outcome and you've posted images on social media about their surgery? I've told a lot of colleagues my age range who are asking for tips on how to use social media — I tell them, don't post anything until the patient is three to six months out because it's kind of a false advertisement to say how great your intraoperative fluoros are by posting those images one day after surgery. Again, anyone can have great intraoperative fluoros; it's all about the outcome.

Q: Have you any upcoming TikTo videos we should keep an eye out for? 

CD: I have two really impressive cervical cases that I've been waiting to get far enough out. I'm looking forward to posting those soon. From a TikTok standpoint, patients love videos on disc replacements, whether it's cervical or lumbar. The interesting thing is that patients really know what they're talking about. They'll ask, "What if I have severe facet arthritis? Can this be for me?" or "Can I have this disc replacement if I have spondylolisthesis?" There are surgeons out there who might not understand the indications, so it's nice to interact with patients on the platform and they can also get the conversation going with their local doctor about why they should or shouldn't have a disc replacement or fusion.

Q: On the opposite side of the spectrum, how do you use social media to connect with other providers?

CD: LinkedIn is definitely a great place for that, and everyone has their own formula. I usually post preoperative images and then a follow-up post a few days later with the three-to-six-month outcomes. If you're not posting the pre-op MRI, you're not telling the full story, so I think that's important. I post all my images and typically tag other surgeons I know who will have comments. It's good name recognition for them to also comment. We all win. From that, I might get 60 people that comment, "Here's the surgery I would do." But there are many takeaways and insights that even I can learn from those comments. My colleagues from residencies and fellowship are all still learning, and that's a great way to hear about different techniques or hardware.

A couple days later I'll post the post-op images and let everyone know what I did a few months ago. There are always some interesting thoughts from other surgeons, such as new approaches to spine surgery or recent studies to check out. I use LinkedIn as less of a marketing tool to patients and more as an education tool for myself as well as my peers, physical therapists, chiropractors, hospital executives, OR nurses, etc. Everyone has social media these days, so we might as well try to make it somewhat educational.

Q: What trends and technologies most excite you in spine surgery?

CD: Not to sound like a broken record, but I really like robotic-navigated technology. It's definitely not all there yet — the elephant in the room is the price, around $1 million for the robot and if also an O-arm, that's another huge expense. So, it's very difficult to get this technology in an ASC at the moment. Robots are super expensive now, but there are smaller companies that are making more cost-efficient technologies. I think as the technology develops and more companies launch their own devices, the prices will come down. 

Thirty years from now, every operating room could have a robot in it. Fluoroscopy was super expensive when that first came out, and I'm sure there were those who wanted to just stick with the anatomy and intra-op single shot X-rays. From a surgeon's standpoint, we're all concerned about our health and the longevity of our careers and robots decrease radiation exposure for us. Unfortunately, I think every spine surgeon knows at least three other spine surgeons who have had some type of cancer. Is that because of all the fluoro or X-ray we're using? Possibly. Robotic technology greatly reduces the radiation exposure to the surgeon and OR staff, which is hugely important.

Q: Outside of the size and cost, what other drawbacks do you see with robots? How do you see the technology developing 10 years from now?

CD: To use a spine robot today, you are kind of committing to doing a fusion. If we're all saying we should do less fusions, why are we making more technology to perform fusions? I think there's a thought that at some point robots will help with decompressions and perhaps when that happens, surgeons will lose jobs or have their prices slashed as the robots will be able to do them faster and more efficiently! But I think what we should be focusing on is determining who needs fusions and if there are other motion-sparing technologies we can use instead.

Q: What do you hope to achieve professionally and personally in the next five years?

CD: For me, I focus on my three pillars: Spine, local community and family. I want to be a leader in my specialty. I'm not aiming to be Alex Vaccaro, MD, PhD, the best-looking and most famous spine surgeon in the world, ever. But it'd be nice to be recognized as a leader in my field and for my friends to believe that I'm doing great things for spine surgery.

From a nonsurgical standpoint, I also want to be a leader in my community. I practice in the same area I went to elementary school, middle school, high school and college in (Dallas). I know these people I operate on. Many of my patients are my parents' friends, so I'm already a figurehead in the community as one of the spine surgeons they know and trust.

The third is being a great role model for my family. That means not going to every speaking engagement, not going to every spine course, not doing every consulting agreement and flying all across the country. Missing those definitely take a hit on your ancillary life, but family life is also very important to me. So I focus on those three things and hopefully take little steps each week to make an impact.

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