Ethics Consult: Can I Sell Products in My Practice?

Dear Ethics Consult, 

I own a highly regarded pediatric physical therapy practice and recently started selling pediatric-related products, both at my clinic and online. A few therapists on my team are telling me that this is considered unethical because it presents a conflict of interest.  I would like to continue doing this, as I see a lot of potential here for my business—but I don’t want to tarnish my hard-earned reputation and the goodwill I have generated with my clients over the years. Help!

—Am I In The Clear?

Dear In The Clear, 

This issue of therapists selling equipment, supplies, and products has come up frequently in the last year and a half, as the pandemic has forced many therapists in private practice to establish secondary revenue streams in addition to hands-on service provision. This issue needs to be looked at through both a regulatory and ethical lens. While my answer will focus on the ethics, the regulatory and legal perspective needs consideration as well. 

All clinicians considering selling items in their practice should check their individual state practice acts for any specific regulations that may apply. Secondly, if you work with clients who use CMS and Medicare, make sure you read the regulations they have about what they call “self-dealing.” Some cities and states may also require you to obtain a license or permit to sell items, or may have rules about whether you need to collect tax and have a resale license. And from a related vantage point, the AMA states physicians should not sell health-related products whose claims lack scientific validity, and should rely on peer-reviewed literature and unbiased scientific sources to review products.

From an ethical viewpoint, there is a difference between a therapist who exclusively sells equipment and products, as opposed to one who simultaneously offers direct service provision and equipment or products. From your letter, it sounds like you fit into both categories—you’re selling products to clients you also provide service to, and also generate online sales to people you may have no prior relationship with. 

It’s true that having a financial interest in your business—like sales of products related to therapy—while also providing therapy to clients may be perceived as a conflict of interest, as your colleagues have mentioned. There may be a conflict between the private business interests of the clinician and their professional responsibilities. 

The flip side of that argument is this: Because of your expertise in your discipline, you’re uniquely qualified and positioned to recommend to clients the “best” equipment to prevent further injury and enhance function and recovery. Failure to provide this valuable service certainly could be argued as not acting in the best interest of patients. 

What’s central to this issue is whether any financial interest in completing a transaction influences your therapeutic recommendation. That will be the determining factor in deciding whether your product sales represent a conflict of interest or not. Separating out the therapeutic practice and business interests and keeping them distinct from each other is paramount to avoiding any perception that you’re exploiting your clients for financial gain. 

There are many postures and policies you can adapt and implement in your practice so that you can proceed with a clear conscience. The best way to proceed is to be fully transparent and disclose all your connections upfront. Have clearly defined policies and procedures in your practice on this issue that are written and distributed both to your staff and to your clients. Inform all your clients of any outside business relationships that may give the appearance of a conflict of interest, and assure them that your therapeutic decisions are devoid of coercion. 

You should also make sure that the items you’re selling are necessary, fair, and reasonable according to industry standards. Choose products that align with your practice’s culture and service offerings, and that your clients are most likely to use and benefit from. You can also give your clients options of other places where they can purchase identical or similar items, and always respect and promote their freedom of choice when it comes to actually purchasing anything. 

An informed client or family member may well choose to follow a therapist’s recommendation, while fully understanding that doing so would benefit the therapist financially. In that situation, your client would have no reason to feel that they were deceived about the therapist’s financial benefit. On the other hand, a client who was unaware of the therapist’s financial interest might feel misled by the therapist’s failure to disclose that arrangement.

Gaining and maintaining the client’s trust is at the heart of any clinician-client relationship. Make sure your motivation is based not on personal gain, but what is good for the client—and then I think the opportunities are endless for a mutually beneficial relationship.

Good luck, 
Iris