[meta] Let’s talk about subreddit content, midlevels, and moderation.

A few times a year, we meddit moderators like to have a meta thread to discuss general moderation trends, content issues, and to invite feedback from the community about moderation. These threads help us get a feel for what the community enjoys about the subreddit and what they'd like to see change.

It's been a little while since our last one, so I'm sure there's a lot to talk about. Let's start with some stats:

We have eight moderators for this subreddit of ~228000 subscribers, a ratio of roughly 1:28,500. In 2019 so far, we've performed a collective 5320 moderation actions exclusive of discussions in modmail. This amounts to almost exactly 50 moderation actions per day. Being generous and assuming each takes about one minute to read in context, judge, action, and document, that's 50 minutes of moderating required between us in a 24-hour period. March 2019 was our busiest month ever in terms of traffic and moderation and that continues a trend of increasing traffic each month this year.

In terms of content, I think we need to start with the issue of this community's approach to midlevels. I believe that this is a pretty USA-centric problem, and so I'm not bringing much experience to the discussion here, but this has definitely been a recurrent issue on this subreddit.

This subreddit was founded to be a 'lounge' for medical professionals but has standards of civility that effectively amount to "if you wouldn't say it to a new colleague you're just meeting in the break room, don't say it here". Since the last meta thread, and probably even before then, we've been seeing a significant increase in sweeping disparaging remarks putting down entire groups of healthcare professionals. This is typically aimed at mid-levels (PAs, NPs, CRNAs, etc) from doctors and medical students. I have been approached privately and on the subreddit by a number of midlevels who feel that this atmosphere makes it very difficult for them to participate in the subreddit and who are increasingly viewing meddit as an unpleasant place to visit.

I don't have the pleasure of being a part of a system where increasing midlevel autonomy is a hot topic or a 'threat', but I think that the tone of this subreddit with respect to these topics has certainly become increasingly toxic. This is, of course, on a background of the subreddit nearly doubling in size over the last year and globally polarised polemic becoming an increasingly common method of default communication. At the moment, we moderators have to balance censorship with civility, and regardless of our approach, we will be upsetting someone. Our steering approach has often been deliberately quite heavy-handed on this professional subreddit but we do recognise that this subreddit exists primarily for the benefit of the users, not the moderators, and to a certain extent we should tailor our moderation strategy around that.

So, that's the main reason this post exists. We'd like to hear your (constructive) thoughts on whether we should be more overt in prohibiting and removing content that is disparaging to midlevels (and where the lines should be, or whether it's best to leave it in our nebulous but hopefully capable hands), or whether the best plan is to trust the community to police itself with upvotes and downvotes alone. It would be really helpful if you could provide links to examples with your posts if possible to help us quantify the problem.

In other news, we are still seeing a fair amount of politics creeping into this subreddit. We've been removing content that is not explicitly and primarily related to the practice of medicine but, as with everything we do, there are people who feel that we allow too much and those that feel that we censor too much. What's the consensus on that recently in terms of community feeling?

We've been able to run a few AMAs this year and are looking for more. If you're an interesting person (sorry, 99% of you) and want the undying adoration of a quarter million people, get in touch.

Lastly, any and all other suggestions or comments are welcome here. This post will remain stickied for one week and we moderators will try to reply to things on a daily basis. As always, this is a subreddit that relies entirely on international volunteers with full-time day jobs, night jobs, and on-calls to moderate in their spare time and we couldn't make this subreddit work without our moderation team's efforts. If you've got a suggestion – or if you'd like to genuinely offer your help to the team (bearing in mind it can take up about a full hour each week), send us a modmail. If you've got a long history of good posts in meddit, we can even pay you in salt.