Erik Goldman12.01.10
The healthcare practitioner channel is one of the fastest growing, yet least understood segments of the nutraceuticals and natural products industry.
Available data suggest that sales of supplements through physicians, nurses, chiropractors and other caregivers have increased steadily at 5-10% per year for the last decade. Practitioner sales topped more than $2 billion in 2009, and while this is only a small part of the nearly $30 billion in total annual natural products sales, the 2008-2009 practitioner channel growth rate of 9% outpaced the 8% growth of the industry as a whole.
But beyond the general trends, very little is known about the attitudes, needs, preferences and behaviors of various practitioner sub-segments as they interface with the natural products industry. Marketers are awash in data about consumer attitudes and preferences, and retail cash registers are supplying a steady stream of signals about who’s buying what in the stores. But the practitioner channel does not yield its secrets so easily, and much less is known about what’s happening between doctors, patients and dietary supplements.
This is especially true of medical doctors, the most potentially valuable practitioner subgroup but also the most difficult to assess and to reach. The few practitioner market surveys available to date are characterized by gross over-representation of chiropractors, naturopaths and other “alternative” practitioners, and under-representation of MDs.
Marketers trying to develop business in the practitioner channel have had very little good intel to guide their strategies.
In an effort to better understand how practitioners—especially MDs—interface with the supplement and natural products industry, Holistic Primary Care-News for Health & Healing (HPC) recently conducted a survey of 2000 primary care doctors nationwide, randomly chosen from the publication’s mailing list. The study was conducted by Signet Research, an independent third party, and consisted of a 52-item questionnaire. The survey garnered a 9% response rate, which is robust for any market research, and phenomenal for a survey aimed at busy doctors.
HPC is uniquely positioned to gather useful, unbiased data about mainstream physicians because the publication has a controlled circulation, rather than a subscription-based circulation; it is sent free of charge to primary care practitioners, and the vast majority of the publication’s recipients are conventionally trained MDs.
Bearing in mind the limitations of any survey based on self-reporting, this study provided a wealth of important signals, many of which are good news for the industry.
In terms of basic demographics, 78% of respondents are MDs, 12% are osteopaths and the remainder represents naturopaths, chiropractors, nurses and others. Sixty-two percent are male, and the average age is 50. Nearly half practice in suburban communities, with another 37% in urban centers, the rest in rural areas. One third are in small group practice (2-10 practitioners), and another third operate solo practices. Half are fully insurance based, while 8% (and growing) have opted out of insurance altogether.
Two-thirds of the practitioners self-identified as “primarily conventional” in their practice style; a robust 29% identified as “integrative/mixed” and 7% identified as fully “holistic.”
Here’s the good part: nearly 80% of the total cohort and three-quarters of the MDs are incorporating modalities from holistic or “alternative” medicine into their practices, with nutrition counseling, stress management and functional medicine being most common. Nearly all of these doctors—the “Conventionals” and the “Integrative/Holistic” types alike—are having discussions with patients about supplements and natural products. Close to half are having such discussions several times per day.
Nearly 80% are also recommending or “prescribing” some types of supplements to patients, and 62% agreed with the statement that, “Diseases and conditions can be treated or ameliorated with the use of dietary supplements and/or natural products.” That’s remarkable given that DSHEA prohibits nutraceutical companies from making any statements regarding treatment of disease states, and that the vast majority of respondents are MDs! Can you imagine how low those numbers would have been 10 years ago? So, no, contrary to the attitude held by many in our industry, doctors do not intrinsically hate supplements. In fact, our data suggest that many of them are fairly fond of supplements and natural products, and they are willing to recommend—or even sell—products they trust.
Close to 90% are taking some sort of dietary supplements themselves. It is interesting to note that the supplement categories the doctors are most comfortable recommending to their patients correlated very closely with the supplement categories they are most likely to be taking for their own health and well-being.
This underlines a very important point: doctors are consumers, and well-educated, health-conscious, high-earning ones, at that!
One of the best ways to win physicians as advocates and influencers—and bear in mind that each of our respondents sees an average of 18 patients per day—is to convince them of the value of your products for their own personal health. The more familiar a physician is with a particular product or brand, the more comfortable he or she will be in recommending it to his/her patients.
This holds not only for supplements, but for foods and other natural products as well. A substantial number of our respondents are buying organic and eco-friendly products. In short, today’s physicians—including many medical doctors—share in the LOHAS (lifestyles of health & sustainability) values. Even very conventional practitioners recognize the importance of good nutrition in preventing and treating common chronic disorders, and they are incorporating nutrition and other elements of holistic medicine into their lives and their practices.
But doctors do have some reservations and hesitations about supplements. Understandably, respondents indicated that quality assurance and safety were major determinants in their willingness to “prescribe” or in some cases sell particular products.
Roughly one-third of the respondents say they’ve seen a serious adverse reaction associated with supplement use. What’s really interesting about this is that few of the doctors who say they saw an adverse event reported it to either the FDA or the product manufacturer(s) as is mandated by the new Adverse Events Reporting (AER) regulations.
MDs and non-MDs were pretty much equivalent in their lack of reporting. The industry and the government have a lot of work to do in promoting the importance of AER to practitioners, if we ever hope to gain an accurate picture of supplement safety.
The survey is showing us a lot about healthcare practitioners: we now have reliable figures on how many physicians routinely recommend supplements to patients, and which specific categories of products they’re comfortable (and less comfortable) recommending.
We have a good bead on how many doctors dispense (i.e., sell) supplements and natural products in their offices, as well as how many are considering doing so in the future. We also gained insight into why doctors who do not dispense are choosing not to do so— some of the reasons were quite surprising.
We learned a lot about the differences and similarities between MDs and non-MD practitioners, between those who take insurance versus those who’ve opted out, and between those who self-identify as “holistic,” versus those who see themselves as “conventional.” We know who’s looking for new revenue streams and fresh practice models, and what sort of options they’re considering.
What’s very clear is that the medical community has heard the public’s call for greater emphasis on nutrition and prevention. While organized medicine has been historically slow to answer that call, a great number of individual practitioners are making major steps to meet their patients’ needs.
Today’s primary care physicians are a lot more open-minded and willing to engage with nutraceuticals and natural products than they were 10 or 20 years ago. It’s high time that we as an industry challenge our own longstanding beliefs and dogmas about physicians: that they are “the enemy;” that they don’t care about nutrition; that they cannot and will not ever embrace supplements.
It’s true that some doctors are still hostile, and many more are wary of nutrition-based alternatives. It is equally true that mainstream medical organizations and institutions like the American Medical Association often impede the evolution of holistic medicine. But it is important to realize that these organizations and institutions do not necessarily represent the views and needs of many physicians in the trenches whose “best interests” they claim to serve.
While we clearly need to do a lot more bridge-building between the natural products world and the medical community, our survey shows that the vast majority of physicians are open to nutrition-based solutions. One of the most promising signals was the fact that 75% of respondents say they want more education in dietary and lifestyle-based interventions. Sixty percent—and this includes the MDs—specifically indicated a desire for more education about the role of dietary supplements in clinical practice.
Companies with safe, effective products backed by good science and strong quality assurance have a real opportunity to win the hearts and minds of today’s physicians—as consumers, as advocates, and in some cases, as points of sale. The primary care community wants to learn. They’re listening. The question is will you step in and teach them?
Editor’s Note: Holistic Primary Care’s new, “Primary Care Physicians & Holistic Medicine: Transition, Transformation, Opportunity—An Executive Report from Holistic Primary Care’s 2010 Physicians’ Survey,” is a comprehensive analysis of physician attitudes, practice patterns and personal experience with holistic nutrition-based medicine, nutraceuticals and natural products. It is the first survey of its kind to assess a large and representative sampling of conventionally trained medical doctors across the U.S. The full report, complete with charts, graphs and a detailed analysis, is available for purchase at www.holisticprimarycare.net, or contact editor Erik Goldman at 212-406-8957 or erik@holisticprimarycare.net.
