Self-distribution During COVID: Finding Your Virtual Audience
It was March 12. I remember sitting in my home office looking at the bulletin board filled with the spring/summer tour schedule for my latest documentary, DO NO HARM: Exposing the Hippocratic Hoax. It was fully booked. That's when the first cancelation came in. Then, just like dominoes, over the next two weeks every event across the country canceled.
DO NO HARM takes an in-depth look at the medical training process, a toxic cutthroat, bullying environment where doctors, impaired by sleep deprivation, are forced to care for patients. The film exposes the hidden epidemic of physician suicide, burnout, and the link to an alarming rate of medical mistakes.
I firmly believed there would be a large audience for the film. The documentary is full of important, often shocking and previously unknown information of concern to anyone who stepped foot inside a teaching hospital. I also felt it was critical for the medical community to see it to open a dialogue about how to improve a very toxic and dysfunctional medical system. To be honest, when I finished editing, I wasn't sure if any medical school or hospital would show it. In fact, one hospital administrator at NYU said they would not screen the film because they "[didn't] want to give anyone ideas."
To my surprise, many of these institutions were courageous enough to screen the film, using it to address these taboo topics. But I had no idea just how timely and relevant it would become.
The road leading up to DO NO HARM was a bumpy one. I've been fortunate to be able to make a living as a documentary filmmaker and TV producer. I've also made my share of mistakes along the way. I started my career as a TV news reporter in Southeast Texas. Then I worked as a producer for PBS in Miami, where I wrote and produced two Emmy Award-winning short documentary films. Taking what I learned at PBS, I decided to venture out on my own as an independent filmmaker and producer working on a variety of television series for The Travel Channel, HGTV, Discovery, Reelz Channel and other networks.
In 2014, the creative journey for DO NO HARM began when I read a New York Times op-ed about two young doctors who had jumped from the roof of their respective hospitals within a week of each other. I was intrigued. Doctors appear to handle life-and-death issues unaffected by stress. At least that’s the image reinforced by popular fiction and TV shows from Marcus Welby M.D. to Grey's Anatomy. What I discovered, however, was something entirely different. Physicians work grueling shifts, often 24 to 36 hours or more with no sleep. Medical students are bullied in a way that would be completely unacceptable in any other work environment. They can't or won't get mental health care for fear of jeopardizing their careers. The result is a skyrocketing number of suicides, almost twice that of the general population and often hidden by their hospitals.
I continued researching, finding studies on the link between sleep deprivation among physicians and medical mistakes. I found that preventable medical errors are the third-leading cause of death after heart disease and cancer. Yet no one was talking about it. That's when I realized this was a film that had to be made.
After shooting began, the original investor pulled financing to work on another film. Reluctantly, I was going to put the project on the back burner when Dr. Pamela Wible, who runs a suicide prevention hotline, told me, "If you make it [the film] they will come." And she was right.
At the time, with no money and only a few scenes in the can, I didn't quite know how I would be able to finish the film. That's when I turned to Kickstarter. Two successful campaigns in a year raised more than $250,000, mainly from physicians fed up with an increasingly hostile work environment. I applied for and received a Roy W. Dean Film Grant, held a fundraiser in St. Louis (where we shot many scenes) and received individual donations.
In April 2018, I showed a rough cut to 1,200 medical students at the American Medical Student Association's (AMSA) Annual Conference. The reaction was powerful, emotional and overwhelming. After that, we started receiving a lot of requests to screen the film from medical schools, hospitals and medical organizations across the country and around the world. Momentum was building even before the picture was locked.
DO NO HARM premiered in September 2018 during Suicide Awareness Month at the Angelica Film Center in New York, with two sold-out events. I appeared on the Dr. Oz show, and the film was featured in newspapers, articles, blogs and podcasts. I was able to hire an outreach coordinator and together, using social media and word-of-mouth, we began booking a film tour.
In 2019, DO NO HARM made its film festival premiere with three sold-out screenings at the Cleveland International Film Festival, home of the famed medical Cleveland Clinic, which, ironically, refused to show the film. While documentaries rely on creating a buzz at film festivals and to attract a distributor, they are also a business. I made a business decision to cut the film festival run short and focus on booking screenings and speaking engagements.
There was pressure to release the film to the general public right away on streaming services like Netflix or Amazon. But after seeing the highly emotional and often very personal responses to the film—we routinely had suicide prevention and mental health experts at each screening—I became concerned about how a medical student or physician might react watching the film alone at two in the morning after a grueling shift at work. I also saw the healing effect of watching the film as a community. These live screenings allowed administrators, students, faculty and physicians to use it as a tool to open a dialogue about how to reduce the stigma of mental health, prevent suicide and improve wellness. After more than a year on the road, and consulting with mental health professionals, I felt that the film, finally, could and should be released to the public.
By March 2020, DO NO HARM had more than 170 screenings and was booked through September. Then COVID-19 happened and the bottom dropped out. Social distancing and stay-at-home orders became the new normal.
It wasn't just the film tour that was over for the foreseeable future; the entire industry seemed to stop. No pitching new shows or shooting current projects, unless you were making social-distancing commercials. Day after day, my Facebook feed would fill with posts of horror stories from healthcare workers on the frontlines of the crisis. But there was nothing I could do. I felt paralyzed.
By the beginning of April, Zoom meetings changed the way businesses, schools and individuals communicated. I thought, Why not use this new platform and hold a virtual screening? Before long that idea evolved into a live virtual screening and panel discussion. I started editing teaser clips and began heavily promoting the event on social media and using my mailing lists. Building on our Kickstarter mailing list of about 1,000 mostly physician backers, we then started by reaching out to medical schools and hospitals in the top 20 medical centers around the country and then word-of-mouth started to spread from there. Screening the film at medical conferences also generated a lot of great leads. Four hundred forty people attended the live event and another 350 registered to view it on demand afterwards. It was truly global. People from South Africa, Ireland, Italy, London, Israel and Brazil stayed up late (or early) to participate.
It was also a financial success—so successful that I decided to have virtual screenings every Sunday during May, which is Mental Health Awareness Month, with a different topic and panel of experts each week. Many of these experts are featured in the film, while others are contacts we've developed over the years such as union reps, authors and industry leaders. With stay-at-home orders in place, all were pretty much free on Sunday nights.
The pandemic put physicians in the spotlight, justly hailing them as heroes on the frontlines of the war against COVID-19. The news is full of reports about the stress healthcare workers are under treating patients without adequate protective gear, potentially exposing themselves and their families to the virus. Healthcare workers are showing signs of PTSD and haven’t fully begun to process what they’re going through. Now after decades of being deemed unnewsworthy, physician suicides are suddenly making headlines.
All this made DO NO HARM even more socially relevant.
The conflict of making a socially relevant film that is also part of a business is something I struggled with as a filmmaker. I received many emails from people telling me I should make the film available free of charge.
Frankly, at first, I was angry. Filmmaking is a business. It's how I earn my living, just like any other small business. I also thought about the people I employ to work on the film. I thought about my graphic designer, who continually updates the website; my office assistant, who manages the screening requests; and my publicist, whose job it is to promote the film and its message. They were also adversely affected by the pandemic. The income generated from these screenings allows me to keep them employed.
In the end, I made the difficult decision to continue charging a nominal fee for the screenings. I do give away some free tickets to medical students and to others who emailed us directly who had lost someone to suicide or who had suffered some financial distress. I also donate a percentage of the revenue to charitable causes related to physician suicide and the pandemic. In this way, I feel I'm being both a responsible businessperson and an engaged citizen. The steady stream of "side chats" during the screening and panel discussion confirms that the virtual events have become more than a business venture. They're creating a safe space for people to come together during this stressful time. And, unexpectedly, it's made me feel closer to my audience than ever before.
Because of the success of the virtual screenings, I've completely revised my distribution strategy. Originally, I planned to release the film through a distributor on various streaming platforms in September after it broadcast on PBS, through NETA (National Educational Telecommunications Association). Now I'm focused on virtual screenings and developing a four-part series based on the film. Since the film has built a large following and presenting the film this way is more cost-effective, I am going to make the film available directly on my website using Vimeo on Demand, rather than via a distributor or on Amazon. And, I signed a deal with APT Worldwide to sell the film to foreign markets. That’s the plan—at least for now. It's been a wild ride for the past few months, but I'm learning that there is hope and opportunity in the virtual world.
Robyn Symon is an Emmy-winning former TV news reporter and PBS producer who has written and produced hundreds of hours of network television for Discovery, HGTV, The Travel Channel as well as several award-winning documentary films including Transformation: The Life & Legacy of Werner Erhard and Uncle Gloria: One Helluva Ride!.