Get hooked on promoting nutrition in your practice.
A substantial majority of chiropractors sell nutritional supplements as part of their practices, but the success they have and the business models they follow vary greatly.1
That’s not surprising given the wide range of practice types and the varying degrees to which DCs embrace supplements, along with their different degrees of business skills and levels of comfort with sales.
There is no single sales blueprint for chiropractors and that’s good because it allows DCs to tailor models that work best for them and their patients. The following analysis will explore the most common models and questions chiropractors must consider when they get into the supplement business.
Supplements on the side
According to the Nutrition Business Journal, the size of the U.S. supplement industry is roughly $37 billion a year.
Admittedly, only a fraction of that business is done by chiropractors. But even a small share of such a vast market can be lucrative. In 2011, chiropractors sold an estimated $410 million-worth of supplements—substantial, but still $200 million less than the amount generated by the naturopathic community.
How many chiropractors sell supplements and how do they do it?
A 2011 study reported that more than 90 percent of chiropractors offered nutritional supplements to patients. Of the responding chiropractors, about 50 percent said they recommended supplements during the report of findings or the first follow-up exam, 30 percent made their recommendations after specific lab tests, and just over 15 percent advised supplements during the initial exam.
Nearly two-thirds of respondents reported that their front office staff handle the actual sales transaction while a quarter said they did it themselves. Fewer than 10 percent had a chiropractic assistant or office manager complete the sale.
Some 60 percent sold 30-day supplies to patients; 20 percent sold 60-day supplies and only 10 percent sold 90-day supplies. More than half the DCs said they followed up with patients when it was time for a refill, while nearly 20 percent said that task was handled by front office staff, with the rest delegating it to a chiropractic assistant (6 percent) or office manager (5 percent).
How much can a DC practice earn from selling supplements?
It depends on a number of factors including the size of the practice, how much emphasis it places on nutrition, and how aggressive the sales approach is, says Chris Leatherman, DC, chief sales officer at supplement manufacturer Onnit Labs.
He said he has seen practices order everything from $500 to $20,000 a month in product, but notes that “even an extra $1,000 a month will go a long way toward keeping a practice in business.”
Questions to answer
Selling supplements can be a lucrative part of your business, but if you’re thinking of starting out with them, you should answer some questions first. Namely, do you believe in supplements, are you willing to educate yourself thoroughly on them, are your patients receptive, and are you comfortable selling?
Let’s take these one by one.
Do you believe in supplements?
No medical professional should sell something he or she doesn’t believe in. The only reason to sell supplements is to help patients. Any other reason is unethical and a chiropractor who is in it solely for the money is unlikely to bring the necessary attentiveness to treat patients.
Are you willing to educate yourself and stay current?
All chiropractors are educated on nutrition as part of their training, but some embrace it more than others. Selling to patients requires committing to learning everything about the products you sell and staying current on the ever-expanding world of supplements.
Some chiropractors have a Field of Dreams notion that simply stocking and recommending supplements will be enough for sales, says Dave Preis, vice president of sales and marketing at Doctors Supplement Store, which does not manufacturer supplements but partners with DCs to sell products online.
“It doesn’t work that way. You have to have the background and be willing to educate patients on the supplements’ benefits,” he says.
Are your customers receptive?
Before selling supplements, you should gauge the interest among your patients. The patients might already be taking supplements, but probably not the right ones or ones of professional quality. They might be doing their own research, but are still looking for a credible source for counseling and advice. On the other hand, patients who are skeptical or unaware of the benefits of supplements will have to be educated.
Are you comfortable selling supplements?
Some chiropractors are simply uncomfortable selling supplements to patients, no matter how beneficial it might be for both parties. They just don’t want to introduce that element into their relationships with patients.
Self-examination is only the first part of establishing or broadening a sideline in supplements.
Selling has become more sophisticated than the days when chiropractors simply kept bottles of fish oil and vitamin D at the counter and inventory was whatever fit into the storage closet. Today, you can choose among different business models with varying degrees of effort, control, and profitability.
This was the first and simplest model and the one most DCs still practice today, to an extent, though the number that do so exclusively is dwindling. In this model, chiropractors order supplements from distributors, stock them, and sell them directly to patients during appointments.
The advantages are that the DC sets all the prices and keeps all the profits. The DC can also keep tabs on what patients are taking, and the need for refills brings patients back to the practice.
The downside is that the DC and staff do all the work. They must research what to carry, order it, find a place to store it, track inventory, handle sales, collect taxes, and remind patients when it’s time for a refill. Plus, there is the initial expense of setting up an inventory and any unsold or expired product is a loss.
Some practices supplement on-site sales with mail refills. That allows them to expand sales and service patients who don’t visit regularly or who have moved out of the area. However, it also requires keeping track of addresses and generates additional costs for packing and shipping.
Online and affiliated
Some practices set up their own online sales website, but a growing number are outsourcing sales to manufacturers (or vendors who act as brokers between practices and manufacturers).
The advantages are obvious. It frees up chiropractors from the tasks and expenses of ordering, storing, and managing their own inventory. It also can provide DCs and patients with a wider range of brands and products than a clinic could physically manage itself.
Typically, these companies build an affiliate web page with the name, logo, and design scheme of a client practice. Even the URL will contain the name of the practice. Patients can go there directly or follow a link to it off the main practice website, but it’s run by the vendor, who fills the orders, handles payments and sales tax, and mails products directly to patients.
Models vary, with many allowing practices to choose what supplements are available to patients and monitoring patients’ orders through a dashboard. Email reminders and automatic refills are also possible options. Typically, the practice gets a monthly report on sales and a check for its share of the profits.
The downside is that all this convenience comes at a price. Vendors typically don’t charge clinics for affiliation, but they do take a majority of profits from the sales, sharply reducing the potential income for practices.
For example, a vendor who sets up a website on behalf of a practice might pay about 25 percent of the retail price for supplements sold, or 50 percent of the gross profit from what patients buy. In hybrid models, you might see a practice keeping around half of the profits of onsite sales and between 20 to 30 percent of affiliate website sales.
Also, affiliated practices tend to lack control over pricing. Some vendors allow DCs to create special offers for clients, but that discount comes out of the practice’s share.
Weighing pros and cons
HealthNOW, a clinic in Sunnyvale, California, is evaluating its new online model. For years, the clinic (which was started by chiropractors but now also has an MD, an ND, and a physical therapist on staff) kept a large dispensary on site. Last year, it began working with an online dispensary that lets patients order products from a major supplement manufacturer.
Ordering is done through an affiliate page set up by the dispensary as part of HealthNOW’s website. “I feel like it’s moving us into the 21st century,” says HealthNOW co-owner Vikki Petersen, DC.
The clinic gets a 35 percent commission on products its patients order through the site and 40 percent on supplements patients order at the clinic but have delivered to their homes.
Office manager Linda Ogden says the practice is weighing the savings from outsourcing inventory, processing, and shipping against the reduced profits. Sales dipped somewhat after the switch, but have since returned to their original levels.
Some patients had to get used to the change and needed staff help to order, but the destination clinic likes that its far-flung client base can order from anywhere.
“It’s pretty hands-off. We’ve been able to take our on-site inventory way down, though we still have some here,” Ogden says. She praises the vendor for making the switch easy, including transferring patient data and setting up a dashboard that allows the clinic to see what patients order and when.
Sano Wellness Center sells a wide range of supplements, both in its 6,000- square-foot clinic in Bloomington, Minnesota, and online. It has affiliate programs with several vendors, and the practice’s website includes links to half a dozen other manufacturers, too.
Owner Christine Stueve, DPSc, PhD, ND, says she deals with this number of manufacturers to have access to the best products of each. “Supplement companies, depending on their size,
can do certain things well. But if they try to do too much, they get into trouble,” she says. “If I don’t have something that will give patients what they need, then I will seek out something that will help them.”
Dealing with many suppliers also keeps her current on new products.
“I get excited when new things come on the market,” she says, adding that she vets supplements carefully before recommending them. The online process saves her a lot of time. “It was a lot of work to keep up with all the clients,” she says.
Clinic vs. Costco
Whatever sales model you choose, you’ll have to contend with patients who think all supplements are alike and thus decline the more expensive professional brands sold by DCs in favor of discount bottles from Costco or Walgreens.
A Council for Responsible Nutrition survey found most Americans buy supplements at mass merchandisers, drugstores, supermarkets, and ware- house clubs. Price and the number of servings in a bottle are two of the top factors in their decision about what to purchase.
“These are your patients,” says Leatherman. “Why shouldn’t they get supplements from you when you have a high-quality product and can integrate it into their care?”
The inferior products sold at retailers often don’t help, which can cause patients to decide supplements don’t work and resist any further recommendations. That can affect the entire treatment program.
Sales can be outsourced, but not the responsibility to educate patients. Some will accept their DC’s recommendation without question, but many will want to know more about the supplement, how it works and why, and the evidence behind it. Odds are they’ll do their own Google research after the appointment.
“Chiropractors have to be knowledgeable and they have to be assertive with patients. Most patients like to be told what to do and they’ll do it if they trust you and understand how they’ll benefit,” Preis says.
Samples in stock
One drawback to the online model is that it depends on clients remembering to order supplements and taking the time to log onto a site. Vendors typically provide practices with cards printed with the affiliate site’s address, but cards can be lost or forgotten.
That’s why Leatherman recommends practices that choose the online model to still keep samples of their most popular supplements on hand to give out as free or discounted samples.
A 15-day supply will often be enough to show patients the benefits of the product and convince them to order more online, he says.
James F. Sweeney is a freelance writer in Cleveland. He is a former newspaper and magazine reporter and editor. He can be contacted at firstname.lastname@example.org.
1 Feeney C. 18th Annual Salary and Expense Survey. Chiropractic Economics. 2015;61(8):38.