Substack and LinkedIn Are OnlyFans for Intellectuals

(And that’s not a bad thing)

Ok, hear me out.

Substack and LinkedIn are OnlyFans for intellectuals and thought leaders.

Different audience, different content, same basic game:

1. Build a niche

2. Show up consistently

3. Monetize access and identity

Welcome to the Attention Economy, MD edition

(And no, I’m not encouraging anyone to take their clothes off. Let’s keep our blazers and credentials on.)

Thanks to Liv for the inspiration for this post

“Premium Access” Isn’t Just for Creators in Yoga Pants

We love to pretend that thought leadership is noble. Pure. Service-oriented.

And sure, there’s an altruistic streak to sharing what you’ve learned, opening your notes, and pulling others up the ladder. I believe in that. I do that.

But let’s be honest. This wave of physicians, founders, and knowledge workers turning to Substack, LinkedIn, and even podcasts like (NerdMDs: Efficiency Unlocked) isn’t happening purely out of charity.

We’re doing it because the traditional pathways feel broken. Because journals are too slow. Because the average conference talk gets more slide clicks than genuine traction.

We’re doing it because we want impact. And increasingly, that means building an audience.

A New Kind of Thought Work

Here’s the real shift.

Platforms like Substack and LinkedIn aren’t just tools for professional development. They’re distribution engines. They let you bypass the gatekeepers and go straight to the people you’re trying to serve or influence.

And in the process, they’re reshaping what it means to be a public intellectual, a physician leader, a startup founder.

It’s no longer just about the letters after your name. It’s about the ideas you share and how well you tell the story.

That might mean long-form essays on clinical inefficiencies.

Or punchy posts about broken EMRs.

Or spicy hot takes on the latest healthcare tech trend that forgot about actual care.

And yes, some of us are starting to charge for that work. Because deep insight has value. And because time, as I keep learning, is not infinite.

This One’s a Bit Different

This is a different kind of Substack for me. Usually I write about systems, workflows, design. The tangible stuff of making healthcare better.

But this needed to be said.

Too many of us are still writing like we’re auditioning for a panel invite. We’re careful. Polished. Sanitized. Even the spicy posts get taste-tested by some imaginary committee before they hit publish.

I think we lose something in that.

Authenticity

Urgency

Voice

Say what you’re really feeling, not what you think the other person wants to hear.

End of rant.

If this resonates, or if you’re wrestling with your own voice as a clinician or builder, subscribe to NerdMDs on Substack

Or catch the latest podcast episode of Efficiency Unlocked where we dive into what happens when you stop playing it safe

Let’s stop asking for permission and start saying something worth hearing.