You’re So Special(ist)!

Naturopaths, chiropractors, and “alternative” MDs have been the bedrock of the practitioner channel in the dietary supplement industry for decades, and they will likely remain cornerstones of the industry for years to come. But the biggest shift—and the biggest growth in recent years—is among conventionally trained MDs.

Primary care doctors (family physicians and general internists), with their broad-based practices and emphasis on counseling patients, have been a vital part of that growth, and for many practitioner-facing supplement companies that reach out to mainstream-trained doctors, the primary care segment is the main target demographic.

Yet there is clear evidence that specialists are also interested in supplements and nutrition-based modalities. The rapid embrace of probiotics by gastroenterologists and dentists, and the interest in omega-3 fatty acids and CoQ10 among cardiologists are just a few examples. But beyond general trends, very little is known about how different specialist segments within the medical community are engaging with supplements and natural products.

For this year’s “Practitioner Survey,” Holistic Primary Care compiled data gathered from a cohort of more than 650 primary care practitioners, as well as from 125 physicians representing five distinct medical specialties: Cardiology, Gastroenterology, Obstetrics & Gynecology, Pediatrics and Dermatology/Plastic Surgery.

The data enable comparisons between primary care clinicians and specialists across measures of engagement, attitude and practice patterns. To the best of our knowledge, this survey—a collaboration between Holistic Primary Care and Capsugel—is the first to look closely at specialist engagement with dietary supplements and nutraceuticals. Missy Lowery, vice president of marketing for Capsugel, presented a first-look at the specialist data at HPC’s recent Practitioner Channel Forum.

Big Numbers
Why consider specialists, anyway? Because there are a lot of them! According to American Medical Association data, of the 624,434 U.S. physicians who spend the majority of their working time in direct patient care, more than two-thirds are specialists outside of primary care.

Each year, Americans make over 468 million office-visits to specialists. For nutraceutical companies, this is a large—and largely untapped—potential market.

In terms of total number of practitioners, Pediatrics is the largest specialty, with 55,509 active clinicians, followed by ObGyn at 40,377. They are followed by Dermatology/Plastic Surgery (28,763), Cardiology (21,819), Ophthalmology (17,943) and Gastroenterology (12,852).

Large Groups Are The Rule
The HPC/Capsugel specialist survey is based on questionnaire responses from 125 physicians, 25 from each of the following specialties: Gastroenterology, Cardiology, ObGyn, Pediatrics and Dermatology/Plastic Surgery. All respondents were at least 30 years of age, earn at least $100,000 per year, and work outside hospital/institutional settings.

In contrast to the primary care segment of the survey, in which 69% of respondents were female, the specialties are by and large still male-dominated: 74% of the specialist respondents are male; 26% female.

Greater than half (57%) of the specialists are over age 50. Nearly half (49%) earn more than $250,000 per year; this is considerably higher than the median among the primary care MDs, who make roughly $192,000 per year.

In terms of practice settings, 44% of specialists are working in large group practices. The mean number of physicians in these group practices is 21. In contrast, only 26% of the specialists are in individual private practice.

Interested, But Cautious
The best way to sum up specialist attitudes toward supplements is: interested but cautious.

Ninety-three percent of all the specialist-respondents agreed with the statement: “I believe dietary changes and nutritional interventions are a fundamental part of patient care.”

Sixty percent agreed that “Many common diseases/conditions can be treated or ameliorated with dietary supplements and nutritional interventions.”

Agreement that nutrition is an important part of patient care was high across all five specialties, and the agreement level among the specialists was more or less comparable with the levels seen among the primary care practitioners we surveyed.

Gastroenterologists showed the strongest level of agreement with the idea that supplements play a role in treatment of disease (76%). Buy-in was lowest among the cardiologists (32%); pediatricians were right in the middle at 52%.

Seventy-eight percent of all specialists agreed that “Supplements have positive benefits, but I am concerned about their quality and safety,” and 65% agreed they, “Don’t know enough about supplements to recommend a specific product or brand.”

It’s interesting that safety concerns were greatest among the dermatologists (84%), though 70% or more of respondents in each of the specialist categories had safety concerns. The primary care sector also shares concerns about quality and safety, with 80% of primary care respondents indicating agreement with that statement.

Many specialists hold to the view that good nutrition is important but that the need for supplements is minimal. Some contend that supplements cannot be a substitute for a healthy diet, and that they have little to offer people who are already eating healthfully. As one respondent put it in a written comment: “It is only a rare supplement that has any real research behind it. Most are touted by testimonials and bogus research papers.”

The most common conditions for which specialists frequently recommend supplements are: osteoporosis (43%); cardiovascular risk (33%); general health maintenance (30%); lower GI symptoms (29%); and weight management (27%). The recommendation patterns, of course, varied somewhat between types of specialists. (For a comprehensive analysis of the data, visit www.TPCForum.com and purchase the full 2015 survey report.)

Contemplating Changes
No segment of the medical community is immune to the economic turbulence affecting healthcare. While primary care doctors—being at the lower end of the medical economic spectrum—are most affected, many specialists are also feeling some degree of economic insecurity.

Nearly half of all specialist respondents are considering changes to their current practice models. Overall, gastroenterologists seem to be the happiest among the specialists; only 32% are considering changes at all. At the other end of the spectrum, 52% of the ObGyns are looking to make some changes in how they do business. By contrast, 63% of the primary care MDs/DOs are considering major changes.

As we saw among the primary care physicians, specialist views and attitudes toward supplements have not been substantially swayed one way or the other by the negative media and negative studies published over the last year.

The survey posed the following question: “Over the last year, what net effect has the published research and media coverage on nutrition, dietary supplements and natural products had on your practice patterns?”

Three-quarters (76%) of specialists said their confidence was not affected one way or the other, and 15% said they were MORE confident about using or recommending supplements than they were one year ago. Only 9% said they were less confident.

Bear in mind that this survey was fielded in early March 2015, just one month after New York Attorney General Eric Schneiderman launched a major and widely publicized regulatory attack on a number of retail herbal supplement brands.

The gastroenterologists were most likely to say their confidence was affected by the media and published research, but the attitudinal shift was in both directions, with 24% saying they are more confident, and 20% saying they’re less confident in recommending supplements.

Pediatricians were least likely to be swayed, with 88% saying the research and media has not affected their confidence one way or the other; 12% of pediatricians said they’re more confident recommending supplements than they were one year ago, and none were less confident.

By way of comparison, 54% of the primary care MDs/DOs said they were more confident, only 6% said they were less confident, and 40% said their confidence was unaffected by the media and research published in 2014.

Educational Opportunities
Keeping in mind the limitations of any questionnaire survey, the data from this first look into the specialty silos indicate that in all five of the disciplines we studied there are many clinicians who are at least open to learning about dietary supplements and nutritional products.

Summing up the findings at the Practitioner Channel Forum, Ms. Lowery noted, “More than half of specialists agree that many common diseases/conditions can be treated or ameliorated with dietary supplements and nutritional interventions. However, verbatims reveal that they primarily view dietary supplements as an adjunctive treatment, secondary to proper diet, to fill in any dietary gaps.”

She added that, “Perceived lack of scientific clinical studies and FDA regulation of the supplement industry are the biggest barriers to their use, causing some physicians to be extremely critical to their safety, quality and efficacy.”

Practitioner-facing companies that can win the confidence of medical specialists will be well positioned to capitalize on the next wave of growth within the practitioner channel.

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Erik Goldman
Holistic Primary Care

Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other heathcare professionals nationwide. He is also co-producer of the Practitioner Channel Forum, an annual executive level gathering focused on challenges and opportunities in the health practitioner channel. For more information: www.TPCForum.com