With a record breaking 20.5 million people in the United States involved in direct sales in 2016, chances are that you’ve probably been targeted a time or two by a well-meaning Facebook friend who tried to sell you a so-called life changing product from a multi-level marketing company they represent. 

Perhaps you purchased the product and a few weeks later were approached again by your friend to see if you’d be interested in learning how you, too, can earn a supplemental income by becoming part of their fabulous team of independent business owners. Maybe the product was wellness related; a lifestyle you already promote daily as healthcare provider, so selling it would be second nature given your profession. As you start making a mental list of patients, friends and family members whom you could potentially sell to, you can’t help but drift off into a daydream of all of the possibilities this new venture could bring you. With the promise of incentives like financial freedom and the ability to earn luxurious trips to the Caribbean, why not give it a shot?

Unfortunately, when your a nurse practitioner or other licensed healthcare provider, selling a product through an multi-level marketing (MLM) company is not that simple and there are some serious considerations you need to make before you dive in.

Is it legal and ethical to sell to patients?

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As part of your practice you often recommend certain medications and advocate for healthy habits that you feel would be beneficial in improving a patient’s overall health. But when it comes to selling or promoting non-prescription wellness products to your patients that you’d be compensated for, it’s an entirely different story; one that raises the question of legality and ethical responsibility.

While there don’t seem to be any laws or regulations specific to advanced practice nurses on the matter, the American Medical Association’s Code of Medical Ethics actively discourages such practices, raising several legal concerns surrounding the sale and dispensing of health related products to patients and ultimately considers it to be an ethical violation. The issues addressed by the AMA arise not just when providers sell to patients out of their office but when they endorse a product that a patient can purchase elsewhere that results in the provider directly profiting from the sale; which is how most MLM companies operate.

For example, when individuals sign up to be a sales representatives for an MLM company, they’re generally not required to keep products on-hand to sale directly to consumers. Instead, they’re given their own website that features all of the items sold by the company. When the consumer accesses this website and makes a purchase, the products are sent directly from the company’s distribution center. The representative for whose website they were purchased from receives credit for the sale and is compensated accordingly. So even if a provider isn’t selling health related products out of their office directly to patients and instead is referring them to their website with the MLM company, this could be constituted as endorsing a product that a patient can purchase elsewhere that still results in the provider profiting from the sale.

Regardless of the manner in which a product is sold, the AMA states in its opinion that selling products to patients creates a financial conflict of interest and undermines the primary obligation of providers, which is to serve the interests of patients before their own. Providers are strictly prohibited from receiving compensation from pharmaceutical companies and selling a non-prescription product or service to a patient for which you’d be compensated for would be no different. Depending upon the laws for the state im which you practice in, it could be considered a kickback or fee-splitting violation. Additionally, because patients value and trust the opinion of their provider, they may willingly purchase products whether needed or not or they may feel obligated or too uncomfortable to refuse purchasing a product from you. This could ultimately erode the patient’s trust and may be considered patient exploitation.

Should you limit sales only to friends and family?

If you only plan to sell to friends and family, it’s still important to take into consideration how it may reflect on your reputation as a healthcare provider and what issues could still arise from it. Even if you don’t use your professional opinion as part of your sales strategy, friends and family members will still consider your expertise and will hold your endorsement of a wellness product to a higher standard than the average MLM sales representative. Because they know you’re a healthcare provider, they trust you wouldn’t be involved with selling something that was a hoax and thus they are likely more inclined to purchase from you. This could skew their judgement and tarnish your reputation as a healthcare provider if the product wasn’t effective or caused them undue harm. Not to mention, giving medical advice to friends and family on what products may help improve certain conditions they have may blur the lines of your relationship and it’s possible you could unknowingly establish a patient-provider relationship. If your family member or friend did have an adverse reaction to the product, there is the potential that you could be held liable.  

Wellness products have consistently seen the highest number of direct sales with over 12 million products sold in 2016. But, bear in mind that these products including essential oils, vitamins and other dietary supplements are not regulated by the FDA; meaning that they don’t have to prove safety, efficacy or disclose any side effects before selling them. Likewise, representatives selling these products aren’t required to have any training, education or other qualifications. This type of model would be unacceptable for any other type of regulated pharmaceutical or medical sales.

If you’re still adamant about selling a wellness product you’ve come to love yourself, strongly consider whether the product has any scientific validity. Review the product yourself through peer-reviewed literature and unbiased scientific resources; not just using your own usage of the product as your basis for endorsing the product. Consult with your state board to see if there are any laws that specifically prohibit you from engaging in such activity, and consider the other controversies surrounding MLM companies. Ask yourself if it’s a business model you’d support in your own practice. According to the FTC, 99% of MLM participants fail. Is 1% worth risking your reputation as a respected provider and violating ethics? Probably not.


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