There’s no denying the appeal of physicians-only online chat rooms like Sermo and Medscape Physician Connect.

Most physicians fly solo or work in small groups and yearn for the camaraderie and social networking that pervaded their lives in the form of grand rounds, curbside consults and related banter during medical school and residency.

Besides, where else can you ask 100,000 colleagues what they’d do with your patient who likes to eat dirt or the one complaining of postcoital nausea?

Physicians pay nothing to join the sites, which make money by charging Big Pharma for the right to sit behind the one-way mirror and observe the unfettered chatter.

More recently, the sites have broadened their financial models.

For example last fall, Sermo announced a deal with Bloomberg that allows subscribing analysts and investors to post questions directly to the physician community about drugs , devices and trends.

For its part, Medscape offers paying customers access to tag clouds that track keywords hot off the keyboards of its physicians. The frequently used words can be sliced and diced by specialty, zip code, age and so forth.

“These are… aggressive and high-prescribing physicians, which makes them valuable to the pharma community,” Manhattan Research’s Erika Fishman told Newsweek.

Still, some worry about where sites like this must draw a line. Should they be required to notify authorities about the physician who claims that beetle juice works wonders for arthritis or the one who crosses a line on patient confidentiality?

Sermo CEO Daniel Palestrant says so far it hasn’t been a problem. “Physicians self-police incredibly well,” he said. Sermo has given the boot to only 3 physicians so far due to inappropriate behavior.