Scrub Up: Debate Over Reps In Canadian Hospitals
12 CommentsBy Ed Silverman // December 10th, 2007 // 8:44 am
Should sales reps attend surgeries? Should patients be told? Those are questions being debated in Canadian hospitals after a recent article in the Canadian Medical Association Journal examined a new policy in British Columbia concerning sales reps in medical facilities.
Device reps sometimes do attend surgeries, offering docs technical advice on heart pumps, orthopedic implants and other products they sell to hospitals. But in Calgary, patients are often unaware of the practice, in part because local hospitals don’t require specific consent for a rep to attend an operation - a fact some observers find troubling, The Calgary Herald writes.
“You have to be really sensitive to people’s privacy and their right to know who’s involved with their care,” says Dr. Guido Van Rosendaal, a physician and University of Calgary health policy researcher, tells the paper. Experts say this is just one example of how the influence of device and drugmakers in hospitals reaches further than many patients realize.
The CMA journal reported that Fraser Health brought in the rules after discovering some reps were paying surgeons an honorarium or educational grant to allow them to attend surgeries, a practice that is prohibited in Calgary.
Still, the changes at Fraser Health have some observers taking a close look at what industry practices are allowed in Calgary hospitals. “There’s a larger question in terms of what really is the role of sales reps in hospitals,” Barbara Mintzes, an assistant University of British Columbia professor, who studies pharma marketing practices, tells the paper. “Are some of these promotional activities leading to less appropriate patient care?”
But the association representing Canada’s research-based pharmaceutical companies argues their reps have a role to play in medical facilities. “We’re making sure health-care professionals know the best information about prescription medications,” Russell Williams, president of Rx & D, tells the Herald.
The debate follows the new Fraser Health policy, instituted this fall, that stops reps from leaving samples of new drugs and other products at hospitals. It also bans salespeople from clinical areas such as operating rooms, unless they have permission.
The Calgary Health Region has a similar rule prohibiting reps from meeting with docs in any patient-care areas of hospitals. Reps aren’t allowed to leave free samples of new products in CHR hospitals. But Fraser Health’s policy goes further than Calgary’s, requiring vendors to receive an identification badge and “certification” when they arrive at a hospital, the paper writes. The CHR has no such central intake process for salespeople, though officials concede some reps occasionally wander into areas of the hospital where they are not allowed.
Steve Long, the CHR’s director of pharmacy integration and strategic programs, says the health region contemplated introducing such controls, but decided against it because “we don’t see there’s an issue or problem.” Calgary’s policies also differ in one other significant way: CHR hospitals don’t require explicit patient consent for a vendor to attend surgery, which is mandatory in Fraser Health hospitals.
Experts like the University of Calgary’s Van Rosendaal say local hospitals should reconsider this practice.
CHR officials say that vendors follow procedures to protect patient privacy and are only present in operating rooms to provide technical assistance. “A vendor wouldn’t be allowed into the room before a patient is draped and they talk about confidentiality,” Shanda Naylor, the CHR’s director of perioperative services, tells the Herald.
Officials with Rx & D, the association that represents the country’s 50 research-based pharma companies, say they’ve banned gifts such as buying a round of golf for a doctor. “We don’t pay for access to medical professionals,” Williams of Rx & D tells the paper. But Rx & D does permit companies to sponsor training activities for medical professionals and some Calgary doctors say they have little choice but to rely on such support for continuing medical education.
Debra Isaac, director of cardiac transplants for CHR, says sponsorships from industry allow her to hold training events where she can rent a venue, bring in speakers and even serve a meal. A session in rural Alberta, for example, might teach small-town doctors about treating heart failure. Without the industry sponsorships, Isaac said, the events wouldn’t happen. “There’s just no government funding, no hospital funding,” Isaac tells the Herald. “At this point, we’d be very limited without it.”
Experts like Mintzes say more public funding should be available to ensure continuing medical education is conducted at arm’s length from drugmakers. And she also believes industry’s self-regulation is problematic, arguing there have been cases where pharmaceutical companies paid for access to doctors, which is prohibited by Rx & D’s code.
For now, however, the Herald writes that it’s left to industry and health-care providers to find the right balance. In Calgary, health officials say they have a strong set of rules in place to govern physicians’ involvement with drugmakers.
Nathan
I have a friend who is a medical device sales rep. He is often present at surgeries. The reason is because many of the devices on the market are very complex — a doctor can’t be expected to know exactly how to “install” every different medical device on the market. In particular with orthopedics, the sales rep is present with a variety of products available so that once the patient is cut open, the best device can be chosen. Remember that the extent of an injury often isn’t known until surgery begins. What if the doctor needs a hip replacement product, and accidentally ordered a slightly incorrect model? Would you rather have a sales rep be present at the surgery that can get you the new hip pronto, or would you rather sew the patent back up, FedEx the new hip joint in, and then redo the surgery?
Choosing a joint replacement is probably a bit more complicated than choosing the MP3 player model… I’d like a true expert from the company that manufactured the joint present at my surgery.
That said, it is common courtesy to let the patient know who exactly will be in the operating room with them.
Lisa Van S
“A doctor cant be expected to know exactly how to “install” every different device on the Market”
That’s a Pretty frightening statement you made– I wouldnt consent to an inexperienced surgeon to operate on me, or any of my family members. And a Sales Rep without a medical license telling a surgeon what to do, Wow, thank God Hippa.
Dan
Agree with the premises posited in the original comment. However, one paramount variable that was not considered in this comment is the fact that the device rep., more than likely, is not a surgeon and presumably is biased towards thier own products, regardless if they are the most clinically appropriate for any particular patient, which the rep. is most likely not able to determine due to the absense of qualifications.
Yet, I agree with the statements in this post, and the statement reiterated in the original comment, which is that the patient has a right to know if a rep is allowed to be involved in any way in thier care and treatment, even if a rep. is there simply as an observer, and this awareness should be acknowledged by such a patient, as well as thier consent.
Nathan
Another thing to remember is that medical devices are often custom-made for a particular patient and hand delivered by the sales-rep to the doctor on the day of surgery. This sales-rep I know would often be called in late and night or on weekends to consult with the surgeon about particular orthopedic devices. The surgeon’s specialty is the human body. The sales-rep is a specialist in the technical ins-and-outs of the devices he or she sells. You need both in the operating room.
TOdd
Great insight Nathan - actually anytime a pacemaker is put in I can guarantee the device rep is there in surgery. Any time a implanted defib, same thing. Any ortho device - hip, knee, joint, shoulder - absolutely the same. You won’t find a doc who doesn’t want that. Great for patient outcome, lowers liability.
And if you think what the Pharma industry does is bad - take a look at devices reps. Now the good ol’ days of Pharma are good stories, but device guys are legendary. These are the guys that take you to front row football tickets, head to the bars, then take you to the strip bars. No regulation and no one knows.
So if you don’t want a doc operating on you without the specialist in the room, try to enroll in Canadian medicine. But device reps are absolutely there to stay - sorry. But I guess what you don’t know won’t hurt you - sorry to ruin the facade.
TOdd
Oh yeah, even better. When you “go to the doctor” to have your pacemaker’s settings checked, you are actually seen by the device rep. Not sure if they then see the doc (I assume so) or if this is a billable event by the physician. But call any invasive cardiology office, they schedule appt by what type of pacemaker you have and when the rep will be there.
Sometimes the industry is counted upon and held responsible - you just didn’t realize it. Again, sorry to bring that up.
Lx
Although I am not a medical device rep, I work for such a company and am closely aligned with the sales function.
On the whole, I think most would agree that surgeons are generally smart and savvy people. I don’t think that most doctors would risk their livelihood by using inferior products simply because rep buys them tickets to football games, though no doubt there are few hacks out there that would.
Many times reps are a second set of eyes in the operating room, a product expert that the surgeons can consult with if they have any questions, someone who is there to make sure the doctor has everything they need or could conceivably need should some unanticipated situation arise. The final decision is always the doctor’s, and most reps learn very quickly not to cross this line (lest they get thrown out of the operating room).
If there is a doctor reps avoid working with, it may be because their work is shoddy. Likewise, a rep with questionable ethics or who doesn’t prove their value through product knowledge and service isn’t likely to have much access to operating rooms.
I am not suggesting that there aren’t reps and companies and docs who don’t sometimes cross the line. In every profession there are the good and the bad, the ethical and the sleazy. I think it’s healthy to question and discuss these matters, and probably the patients should be notified of the reps presence. I’m just suggesting not to smear an entire group without fully understanding their contribution.
Marys
Lisa Van S, you unfortunately have very little understanding of how medical device sales and surgeries work. Believe me, you WANT the rep in there–no one, not even the most skilled surgeon in the world, knows as much about that particular device as the rep. I use to observe surgeries, and saw device reps in on surgeries. They are working in teamwork with the doc to make sure the patient has the best possible outcome.
Lisa Van S
Marys
I understand more than you think I do. Like I said earlier, I would never consent to an inexperienced surgeon to operate on me.
and as far as Sales Reps go,….just check out Cafe Pharma. The thought of one of those indiduals in an operating room with me,…makes my skin crawl.
Take medical advice from an anonymous person on a Pharma Blog,…I dont think so.
TOdd
Lisa - not a lot of device guys on CP, sorry to disappoint. That is the playground of the worst 10% of individuals in any area of life — reps, teachers, catholic priests, etc.
No you would never consent to an inexperienced surgeon — but call up the most skilled invasive cardiology office you can find. Ask about ICD or pacemaker placement and if a rep is there. Also ask who checks the settings on the pacemaker on follow up appt. You really think a skilled surgeon pulling down $7 figures is going to do the work that others can safely be trained to do?
Take medical advice from an uninformed lawsuit participant on a Pharma blog…. I don’t think so.
But, please, start to do some basic fact checking before you try to burn everyone on here. And please, call any ortho or cardiology office and get back to me — If you can find one that allows no reps in the OR — I WILL GIVE YOU $3 dollars. On the honor system no less.
KenThomasRN
As a former medical device sales rep, I was recruited because of my ability to communicate how to operate the device, educate, and the fact that I had clinical experience doing so. I have to give medical device reps their due as outstanding educators whether or not they have clinical experience with that same device. The “non-medical experienced” device reps I workded with where outstanding in their knowledge and having interviewed with other device companies specifically for operating room (robotics) and surgeons (implantable defibrillators), I was scrutinized for my experience being in an OR, hands on with similar devices, etc. I would not personally worry at all if the surgeon wanted a sales rep in the OR on his initial applications of a device. These reps “know their stuff”.
TOdd
lisa van s — no response? huh