Physicians Flock to Bluesky, Hoping to Leave X Behind

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Many compare it to the early days of Twitter

by
Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today

November 19, 2024

In the wake of the presidential election, physicians have been flocking to the social media platform Bluesky, asserting there’s now a critical mass of medical professionals engaging on the site.

Many told MedPage Today that Bluesky resembles X (formerly Twitter) in its early days, when they considered it a place for sharing and discussing medical science.

“Bluesky reminds me of what Twitter felt like circa 2018 or 2019 or early in the pandemic,” Nick Mark, MD, a critical care physician in Seattle who is active on Bluesky, told MedPage Today. “Less hateful, less political, and more just medical professionals talking about medical stuff.”

“All along, I thought Bluesky was the best alternative, but it was hard to get enough people to go over there, to have enough conversations to make it an interesting replacement,” said Kyle Swanson, MD, a neurosurgeon in Milwaukee who signed up for Bluesky months ago. “But with the election … I think a lot of people who were on the fence” decided to make the switch.

Seth Trueger, MD, MPH, an emergency physician in Chicago who joined Bluesky in October 2023, told MedPage Today that “the trajectory seems promising especially for physicians as the network has grown a ton, and journals and professional societies have started joining. This gives me some optimism as the best part of medtwitter to me was always the mix of professional (sharing articles) and personal (networking, friendships).”

On Tuesday, Bluesky crossed 20 million users, adding more than a million users a day for the past few days, according to site CEO Jay Graber. That number continues to grow.

Despite that growth, the site is run by a team of just 20 employees, Graber said. That number is up from the six employees who launched the site in February 2023, which was at that time invitation-only. It remained that way for a year, until February 2024, “to give us time to grow the network responsibly and build our Trust & Safety team,” Graber said in her post.

Bluesky was initially financed with a grant from Twitter when it was run by founder Jack Dorsey, according to the New York Times. Bluesky then went on to raise $23 million in venture funding from private investors, the Times reported.

Bluesky is an open platform, so users aren’t “trapped in a single algorithm controlled by a small group of people,” a Bluesky employee named Rose said in a video post. “You’re no longer tied to a dominant algorithm that promotes either the most polarizing posts and/or the biggest brands.”

Graber also said Bluesky is an “open ecosystem with an API [application programming interface] that is guaranteed always to be open to developers.”

One of the key features of Bluesky is its “starter packs,” which allow users to batch-follow lists compiled by other users. Swanson has been curating lists of medical professionals, and is currently up to six installments. His pinned post is one of the first that comes up when a user searches #medsky, which is the equivalent of #medtwitter.

“As soon as they introduced the starter pack thing, I realized the power of it,” Swanson said. “Not only is it a list, but it’s also a quick and handy way to share it, and a super quick way for people to follow-all. It allows you to get that critical mass.”

Swanson is now flooded with requests daily to be added to his starter packs. “It’s been helpful for bringing back people who used to be very active on medtwitter but have fallen away,” he said.

He added that blueskydirectory.com allows users to search for different starter packs, so they can easily choose subjects that interest them. The site also features help with starting your own Bluesky feeds.

Joel Topf, MD, a nephrologist in Detroit, said it “feels like Twitter circa 2014, lots of engagement, good discussion, no ads, no right-wing conspiracy, no anti-vaxxers,” but he did point out it doesn’t allow for multi-person direct messages, nor does it have polls “which are fun ways to talk to your audience and get engagement.”

Still, physicians agreed that Bluesky is a much friendlier, less hostile place than X.

“Over on X, the amount of harassment from anti-vaccine activists and RFK Jr. fans is intolerable,” Gavin Yamey, MD, MPH, a professor in Durham, North Carolina, told MedPage Today. “As a Jewish doctor, the antisemitic hatred was extremely unpleasant. One thing I value so far on Bluesky is that there’s no tolerance for trolls — the community shuts them down quickly.”

Trueger said Bluesky “has some structural elements that help keep the harassment and antagonism down. Blocking makes it so even people watching can’t chase the whole thread.”

He added that there are blocklists that people make, and any user can subscribe, meaning it will block everyone on the list for that user as well.

“The downside is it can be a bit of an ‘echo chamber’ (as many critics are claiming) which is true to a point, but every platform and network has elements of that,” Trueger said. “X has certainly become an echo chamber in a number of ways, and I don’t need to ‘debate’ with anti-vaxxers, etc.”

Nick Sawyer, MD, an emergency physician in Sacramento, California, said X has been transformed “into an environment of extreme political polarization, where disinformation and hate replaced fact-based discussions and the free exchange of ideas.”

“I’ll never understand how harassment and death threats have become an accepted societal norm in recent years,” Sawyer told MedPage Today. “This clearly contradicts the intent of the First Amendment. People who want to discuss issues of actual scientific debate can do so on Bluesky without facing nonsensical arguments such as the false assertion that COVID vaccines cause AIDS. Those on X not only disregard the truth, but also actively suppress it. Bluesky gave us our voices back.”