DALLAS-Five years ago, Dr. Steven Selznick was a diamond in the rough.
Now he’s an emerald.
That evolution has little to do with medicine. Instead, it charts the Casselberry, Fla., DO’s success in his second career as an Amway distributor. The direct-sales giant uses jeweled titles like Emerald-Direct to recognize distributors with high sales achievements. Upper-level distributors like Dr. Selznick get there by building a customer base and earning commissions on their sales as well as those of their recruits.
While Dr. Selznick seemingly has little need for a second job, he says he needs to keep his options open. Other doctors feel the same way.
A Wall Street Journal article last year reported that an increasing number of doctors are joining Amway and other sales outlets because they believe managed care has diminished their autonomy and their incomes. And many are sparking ethical questions by selling their products to a captive audience-their patients. But none of five physicians quoted in the Journal agreed to be interviewed for this article. Dr. Selznick was supplied by Amway.
The AMA’s Council on Ethical and Judicial Affairs says the practice of peddling to patients is becoming widespread, and CEJA is disturbed by it. “Patients are vulnerable and may want to please their doctors by buying their products,” says Dr. Robert Tenery, who is chairman of CEJA.
In a report approved by the House of Delegates here, CEJA cites an unhealthy conflict of interest that arises from in-office sales, which hold “direct financial interest” for doctors but may not serve patients’ interests.
Trust is undermined whenever doctors “equate the office setting with the supermarket or bazaar,” says CEJA. Because trust is fundamental to the doctor-patient relationship, CEJA says, in-office selling “demeans the practice of medicine.” The only exception would be fund-raising that benefits the community.
AMA lawyers say patient complaints prompted CEJA to take action. Patients told of doctors peddling health-related products like vitamins and skin creams, plus non-medical goods like auto accessories and backyard produce.
CEJA addressed only non-health-related sales, though a report on health-related sales is next on the agenda. It examined the ethics of non-health-related sales first because the subject is less complicated. Health-related items pose tougher questions because nutritional supplements and the like could benefit patients, complementing the physician’s role as an advocate for patients.
Dr. Selznick sells only health-related products to his patients and insists that he maintains a demarcation between his general practice and his Amway business. Indeed, since joining Amway in 1992, he has cut his medical-practice time to 10 days a month to devote more energy to his other business.
“Corporations diversify and people stick their money in more than one stock,” he says. “As doctors, we should look at where we were five years ago and where we want to be in five years, and be aware of other opportunities.”
Dr. Selznick sells Amway’s Nutrilite line of vitamins and supplements to his patients. Sometimes they inquire about the health benefits of vitamins; other times Dr. Selznick brings up the topic. He sees no conflict in doing so.
“Prevention is part of my job, so I educate patients about nutritional supplements,” he says. “I use Nutrilite, so I make it available to my patients.” While his patients may opt to buy vitamins elsewhere, Dr. Selznick says many buy his out of trust for him as a professional.
The fundamental issue, CEJA’s Dr. Tenery notes, is that doctors hold a power position in the doctor-patient relationship. Merchandising changes that relationship to a commercial one, and doctors can have an unfair influence over patients’ choices. Trust is at stake.
Physicians, too, run a risk in selling products to patients, says Dr. Edward David, chairman of the Maine Board of Licensure in Medicine and secretary of the American College of Legal Medicine. “Conceivably, if a patient bought a product that didn’t meet his expectations, he could complain to the board on the basis of having been coerced to purchase because of the doctor’s power position.”
State medical boards have received few complaints about in-office product-peddling, and Dr. James Winn, executive VP of the Federation of State Medical Boards, says it’s still a relatively new phenomenon. He hopes the CEJA reports will aid state boards in recognizing when doctors cross the line.
The California Medical Association looked at physician-to-patient sales last year after receiving numerous inquiries from doctors. CMA’s lawyers warned physicians about possibly exposing themselves to additional malpractice action and the potential exclusion of product sales from their liability coverage.
Although Dr. Selznick’s practice still garners a six-figure income, he regards it as temporary because managed care limits his patient base. “Once my Amway income surpasses my medical,” he says, “I’ll have a choice in what to do with my career.”
Dr. Selznick defends his second career as the means to a financial security that allows him to practice medicine the way he wants. “I’m being proactive instead of sitting at medical meetings complaining about the way things are going,” he says. “You need to dig your well before you need the water.” -Amy Norton
DALLAS-Five years ago, Dr. Steven Selznick was a diamond in the rough.
Now he’s an emerald.
