Doctors To Sales Reps: Go Away And Stay There!
28 CommentsBy Ed Silverman // October 13th, 2010 // 5:51 am
So how many reps visit a doctor’s office each week? A survey finds that nearly 98 percent of physicians who are accustomed to multiple visits from sales reps each week reported that the number of appearances were unchanged between June 2010 and December 2009, when the survey was last undertaken. Either way, the implication is that a rep comes knocking comes knocking every two hours.
Meanwhile, about 77 percent of all docs allow reps across the threshhold, a percentage that has actually held steady since a December 2008 survey. And almost half of the docs require reps to make an appointment, a figure that remains unchanged from December 2009, but up from 38 percent at the end of 2008. The survey of 680,000 docs was conducted by SK&A, a market research firm.
Who’s most likely to turn reps away? More than 92 percent of diagnostic radiologists, almost 92 percent of pathologists and about 91 percent of neuroradiologists have a ‘no-access’ policy, and these rates have remaind the same for the past couple of years. On the other hand, allergists and diabetes specialists have welcoming arms (see the results here).
Meanwhile, practices with fewer patients seen each day are less likely to see sales reps. For instance, nearly 29 percent of those with a daily patient volume of one to 10 people refuse reps, while those with a daily patient volume of 31 to 40 have a 13.4 percent no-access rate. Why the discrepancy? SK&A says practices with just one doc are too busy to break from patients to see reps.
At the same time, larger practices are less likely to grant access. Practices with one to two docs have a no-access rate of 13.3 percent, and practices with 10 or more docs have a no-access rate of 42.2 percent. Not surprisingly, offices owned by health systems and hospitals are tougher: these have no-access rates of 30.8 percent and 29.6 percent, respectively.
Salient point
I don’t understand this headline. 3 out of 4 docs are seeing reps. The number isn’t trending down.
industry insider
As a pathologist I would have gladly accepted samples of No-Doz from a rep when I was called into the hospital at night to do a frozen section on a surgical specimen from the operating room that should have been sent to me four hours earlier by a surgeon who should have spent less time admiring his handiwork and more time getting to the damn tumor in a timely fashion.
inside to outside
Nothing has changed…
I used to be a rep. I’m reading this article because I’m still a stakeholder in the industry, but from a much different vantage point.
It used to be, that patients sought doctors that spent time with them, understood their family, complaints, and sought out care focused on the patient. Drugs and tests and knowledge of disease have improved. But look no further than the “no-see” rates at the hmo and hosp businesses to see what it’s about more and more… making money. It used to be that making some was enough; now, it’s about making more.
20 years ago I started telling anyone who would listen: only see doc’s that see reps. They accept that they don’t know it all and take the opportunity every day to learn more, to challenge themselves. The rich ones watch their watch and liability and step on their hypocratic oath every day. Shame on you. Wake up. At a minimum- e-mail a thought leader across the states to learn something. If CME weren’t forced upon you… would you learn someting new?
Doc
Most reps simply regurgitate pre-digested marketing messages and have little to zero medical / scientific background. The vast majority spin their data to their product’s benefits and 1 in 1000 review fair balance / safety information. MDs are required to get true CME each year, pharma company reps are hardly the best source of unbiased data.
M Helm, MD
I2O
I’d argue that all of us with a pulse and respiration, and who have families (be they parents, spouse(s) or children) are stake-holders.
I have to say that your assumption that MDs who see reps are more likely to be engaged in life-long learning is just that - an assumption. My experience in the industry and later as a clinician has been that MDs who see reps are not significantly different in level of knowledge from those who don’t. Some MDs are always on top of their game, others don’t seem to have learned anything since their first year or two of medical school (and more than half of what they think they know is wrong). However, MDs who do see reps tend to give more samples, prescribe more brand name medicines (even if the generic choices available are in fact more likely to produce better outcomes), and generally provide more costly, but not necessarily better care.
There are some MDs who don’t enjoy the job, but like the money (which is really pretty silly given that for many of these bright folks, they could have made more money doing other work). I would imagine that no doctor believes that they deliver sub-par care; nevertheless, it is hard for an individual clinician to compare what they actually do to anyone else. For example, I may intend to treat all of my patients per national treatment guidelines, but the systems (or actually lack thereof) in my office may get between my intent (and perception) and the reality of the patient experience.
It is also difficult to know which bits of “knowledge” are true and correct, and which are misremembered or just plain wrong. Half-listening to a drug rep repeating what a marketing director wants an MD to remember for 15 to 60 seconds a few times a day for several different promoted brands a day is no substitute for actually keeping up with changes in medical knowledge.
A better recommendation (at least for now) on how to pick a doctor would be to ask another doctor (particularly one who was involved in some administrative capacity) who they would see for a particular problem.
DrugRep
I agree with salient point. Stupid head-line for the story. A more appropriate headline would be “Vast majority of docs welcome sales rep.”
And Doc, if you only get your drug info from CME, God help your patients(if you still have any.)
Carolyn Thomas
I too think the headline’s wonky.
In fact, drug rep visits are actually down by 20% according to the drug industry-funded website ‘Policy & Medicine’. The lobby group’s tagline is “Supporting Innovation Through Collaboration”, a CorporateSpeak phrase that is roughly translated as: “We Put Doctors On Our Payroll So They’ll Flog Our Drugs For Us”.
‘Policy & Medicine’ is quite worried about the results of an AccessMonitor™ report from ZS Associates. The study surveyed 500,000 American physicians, nurses and other drug prescribers. It also tracked both the planned and completed sales calls of 41,000 pharmaceutical representatives.
This drop is significant, because we know that doctors’ prescribing habits do change after spending time with drug reps. For example:
- Favourable change in a doctor’s prescribing habits after spending less than one minute with a sales rep: ↑16%
- Prescribing change seen after three minutes with a sales rep: ↑52%
For more numbers, along with a CorporateSpeak translation of ‘Policy & Medicine’s’ dire predictions if physicians decide not to see drug reps (like the poor doctors will have NOBODY to help educate them!), visit The Ethical Nag: Marketing Ethics For The Easily Swayed at: http://www.ethicalnag.org/2010/05/28/fewer-physicians-see-reps/
Teflon no more
Can you blame them? With multiple sales forces many major bigpharma cos still have and the doctors simply had it. Imagine any other biz with multiple sales reps selling you the same product. Joe, Mary, Sam, Peter, Paris (like in Hilton), Tod, and the other Joe take turns calling on you selling you same shovel. You listen to Joe then few days later Paris comes but since she is so gorgeous you see her then another Joe comes, then Peter and finally you break down and tell your sec, no more calls from any shovel selling company.
Of course poor reps are ordered by their co to see you 15-25 times per year each because you are such an important user of shovels. They call you supertarget. Sometimes two of them end up in your office at the same time since your best time to be seen is Tue. and Fri. at 4.30pm. Along Joe and Peter there are other reps from other shovel companies, showing up at your “best” time. So how long this will go on? Bigpharma is the ONLY biz on this or any other planet that uses multiple sales reps (usually for GP drugs) to sell same products to the very same target customer. Apparently this is changing but they still have too many reps “dealing” same drugs. You see the BP figured out that docs will more likely see 5 reps 25 times in 3 moths than one rep 25 times during the same time period.
As early as 35 years ago, Sandoz had a meeting in Basel where they brainstormed the idea of doing this biz with no reps. Conclussion; reps were needed then but would not be needed in near future. That future is now or coming very soon. Make your own conclussions if you are still in the biz. I am out and thanks God.
Teflon
Umm… Nice comment. .Sandoz is out of business dumb ass.
John S. Campana
I WAS A SALES REP. FROM 1956 THROUGH 1992. I WAS A PHARMACIST FOR SEVEN YEARS BEFORE I FELT THAT THIS WAS NOT WHAT I WANTED TO DO FOR THE REST OF MY LIFE. AS A SALES REP. I WAS ABLE TO SEE BETWEEN FIVE TO EIGHT PHYCIANS PER DAY WITHOUT A PROBLEM. I KNEW WHAT THE ADVANTAGES OF MY DRUG WAS COMPARED TO THE COMPETITION AND I STRESSED THOSE POINTS. I TRIED TO SPEND NOT MORE THAN 5 MIN. WITH EACH DOCTOR AND LEFT SAMPLES. IF YOU ARE ARE A BENEFIT TO THE DOCTOR WITH INFORMATION. HE WILL SEE YOU. YOU NEED TO HIT A HOME RUN FROM THE START. I HAVE BEEN IN THE DOCTOR’S OFFICE WHILE SOME FEMALE REP. IS TALKING TO THE DOCTOR AND THE FEW I HAVE HEARD DO NOT HAVE A LOT OF KNOWLEDGE. IF I WERE A DOCTOR, I WOULD NOT SEE ANYONE UNLESS THEY WERE OF BENEFIT TO ME. COMPANIES NEED TO HIRE PEOPLE THAT BRING OUT THE ADVANTAGES OF THEIR DRUG COMPARED TO OTHERS IN A LOGICAL MANNER IN A SHORT PEROID OF TIME.
rep
As a rep I find myself playing the role of a liaison, working between competing expectation of the physicians that I call on and those of the company that I work for.
The physicians know what I’m there for. To promote my products, as long as I can add something of value, I’m well received. Of value generally means relevant information on disease state, class of meds, clarifying competitor information, or information on the product I represent.
As far as they are concerned & I’ve expressed to quite a number of them; they have the education/background/and clinical experience to know this information inside and out better than I do, But they also have so much more to know, outside of my areas of focus. I’m generally well received with this approach, even when challenging their views on studies. (All too often, shaped by the messaging delivered by competing reps)
As for my what my company expects well lets just say it has devolved over the course of my tenure to make for a far less compelling profession. And yes, younger and more energetic is the face of the new rep in this industry. As an older rep, it reflects an institutional change, get the new in, that are naive and unaware of any other way. The shame is I enjoy interacting with the physicians I call on, even the really tough ones. It is like a puzzle to me, to find the right piece to make an impact. Cest la vie
Mkessler
Ooops….Ed Silverman is an idiot! His take and assumptions on the data couldn’t be MORE wrong
Ed Silverman
Hi Folks,
Thanks for the notes. And I’m always happy to revisit something, including headlines. My take on the data, which was largely unchanged from the last survey conducted by the firm, was that reps were no more welcome than before, although more appointments are required over the last couple of years.
Yes, on one hand, three out of four docs will see a rep, but on the other hand, roughly 25 percent will not. Headline writing is an imperfect art and some are better than others. But I attempted to capture an issue that is of concern to many people for different reasons.
And finally, to MKessler, I appreciate that you took the time to offer a remark. But as I’ve indicated to others, it’s best to engage in a constructive dialogue. If you really have greater insights, then feel free to offer them in a meaningful way.
Regards
ed
Tom Kaye
Certainly the aspect of sales and marketing play a pivotal role in new produce introduction. The operational cost now associated to the visit, the materials left behind and the benefit load of having a live body detail what has been prescript to the prescriber is very expensive. How ever this expense rarely shows on the 10K or balance sheet other than lumped into with Research and development. As we have seen in recent events, big pharma is shucking the reps right and left based on the overall ROI. It used to be that for each $1 spent the ROI was around 8-9 to one. This margin has fallen as well as the regulations affecting the supplemental rebates, rebates and 340b pricing. The downward pressure on the finances drives the compression and slightly fewer rep visits. The market savvy of big pharmacy is highly supplicated, thus targeting only high prescribers retain a desirable ROI- the family practice doctor is not a high prescriber in most cases of branded medications. The march continues.
Tom
Sandoz update
To Teflon…….
Sandoz is not out of business. It merged with Ciba and became Novartis, a highly successful organization.
The Sandoz name became their generic arm. Generics have changed the pharma business game plan. And they don’t have massive sales rep forces. Maybe Basel was ahead of the pack.
By the way, I don’t work for Novartis or Sandoz.
dacp
So, let’s see if this falls under the heading of constructive dialogue? As part of disclosure and full transperency, how much was pharmalot sold for to Cannon Communications?
Ed Silverman
Dear DACP,
Thanks for your interest, although I’m not sure how your question is relevant to the topic at hand or why you think there is some significant issue that is not being disclosed.
Here is some history: I joined The Star-Ledger of New Jersey in 1995 as a business writer and began covering the pharmaceutical industry. After doing that for a decade, I suggested a web site to track pharma and the idea percolated before Pharmalot was launched in January 2007.
I ran the site as a full-time employee of the newspaper in 2007 and 2008, but then took a buyout at the end of 2008. I subsequently joined The Pink Sheet. However, soon after, I wound up with the rights to Pharmalot, which I re-launched in October 2009 on a part-time basis with the blessing of my supervisor at Elsevier, which publishes The Pink Sheet.
Several months later, I was approached by the company that owns Canon Communications, which offered to buy Pharmalot. I agreed and joined Canon, where I am also involved in a couple of their magazines. The sale, however, was a private transaction and, accordingly, I am obligated not to disclose the details.
My tenure with Pharmalot is, in my mind, akin to riding a surfboard over different waves. Throughout this experience, I have attempted to exercise the same journalistic approach that I have always brought to my work. If you have any specific questions, please let me know. You seem to be insinuating something, but I’m not even sure of your point.
Regards
Ed
Karen Reina
I’m a medical assistant for an internist/pediatrician, and maybe he’s the exception, but we rely on reps for samples. There are more and more truly needy patients who are facing ever-increasing co-pays and restrictions on branded medications. Samples are a strategic part of our armamentarium for our patients, and we welcome reps at our door.
industry insider
Karen, samples are not just for the indigent. My dad is a retired physician who has psoriasis. The only topical that works is a product called Taclones. It costs $700/month for a 60 gram tube, and it is not covered by Medicare part D. At $8500/year that’s a lot of money, even for a retired doctor. Therefore he is grateful for the samples from his dermatologist.
PharmBoy
Why attack the author? I’ve been in this industry 25 years and have seen lots of changes with more to come. Despite constant demonization, there will continue to be drug reps. Those who see us with horns and pitchforks, at least you’ll continue to have a straw man to rail against. To those who see there are good and bad reps just like there are good and bad physicians, we will continue to work together for the benefit of the patients.
JaT
Would you say any of these are accurate?
1) Drug makers should give samples to early consumers as those are the people helping to make their post-marketing analysis. They are the people reporting anything that would require labeling adjustments.
2) Drug makers are not giving samples as a gift. They go with the hopes of creating new long-term customers.
3) Samples are a problem for people who’s insurers do not include those drugs on their formularies once the samples stop coming.
True story:
Patient goes to ER with severe pain and a kidney infection. Doctor writes prescription for a new antibiotic. Patient asks if it is expensive, being so new, because patient has very little money and has to wait for insurance reimbursement. Doctor admits it is very expensive and guesstimates an amount. Patient asks for something less costly because he didn’t have that amount. Doctor says take this or I have to admit you. Patient takes prescription, walks accross the street, and is seen by a nurse practitioner. Nurse practitioner prescribes a sulfa drug. Patient recovers on a drug that was literally pennies on the many many dollars.
What was the incentive for the doctor? Was it to provide a cure for his patient? Not if the patient stated he could not afford the cure. The insurer did have to pay for an additional visit (to the nurse practitioner), but actually saved money in the long run. And sure saved money as compared to hospitalization.
Teflon no more
To Teflon: you picked the right name for you. Teflon. Nothing sticks to your brain and you can’t even understand stuff you read. So who is dambass in this case?
ps: Sandoz when in biz by itself was one of the most enviable drug cos in the world. Unfortuantely someone came and murdered (not merged) two excellent cos CibaGeigy the other and made it into Novartis. Yes it is successful but nasty co just as Phizer et al. Recently as you saw it here on Ed’s place, Novartis joined the crooked BigPharmafia club with fine of $422M for offlabel and other crimes. I know few from that Co who deserve to be behind bars as it may happen (hopefully) in the near future.
As for current Sandoz, it is the biggest generic Co in the World and does well while the “brand” name branch Novartis bitches against generics stealing their patents etc. They distroyed the brand name Sandoz and to add insult to injury they gave that noble name Sandoz to generic company. Nothing is sacred in this biz except the loot they plunder and steal.
Yes someone must end up behind bars before we can get this biz back where it was. Ethical.
Carolyn Thomas
The subject of independent Academic Detailing - which five provinces here in Canada have embraced - hasn’t been mentioned yet. Compared to the $8 billion spent by Big Pharma on marketing to physicians, this may seem like a David and Goliath tale. But according to ‘Prescription Policy Choices’:
“Academic Detailing programs rely on credible, independent drug reviews and are usually based in medical or pharmacy schools. They employ clinicians such as physicians, pharmacists, and nurses to give prescribers reliable guidance on potential benefits and possible harms of specific drugs. In contrast, industry detailers are not required to have a medical background, and are recruited based on their sales skills.”
“Rather than forcing a physician to sort through a sea of competing promotional messages, academic detailing helps physicians to improve their prescribing based on the best available scientific evidence.
“Economic analyses of existing academic detailing programs have found them to be cost-effective. Particularly in the American setting, in which prescription drug spending is aggravated by the overuse of costly brand name drugs in lieu of appropriate generic options, academic detailing programs can recoup their costs by promoting more rational prescribing.
“Finally, as the Canadian experience suggests, as academic detailing programs grow in number, it is possible to achieve economies of scale by sharing the production and use of educational materials, training programs and data management systems. ” More on Academic Detailing at: http://www.prescriptionproject.org/tools/fact_sheets/files/0007.pdf
In the U.S., Academic Detailing programs currently exist in Maine, Vermont, Massachusetts, New York, Pennsylvania, South Carolina and the District of Columbia. Pilots are underway in Idaho and Oregon. Legislation is pending in California, Minnesota and Wisconsin.
PharmBoy
Not to sound combative, but if it’s anything like Canada’s healthcare system, I’d pass. Besides, we already played that scenario. Lilly hired only RPH and other companies hired sales people. We know how that turned out. I dig the nag site, it’s good for a chuckle.
pharmavet
I hate reps more than anyone, but with regards to the “academic” detailing of Canada, what a joke! Same job, different master. They are biased against the latest products and ONLY “sell” what saves their masters(the state) money. Generics and cost savings rule. They would always prefer bolting 4 generic antibiotics together vs a monotherapy option if the generics were even a cent cheaper from an acquisition standpoint even if the brand name product resulted in shorter lengths of stay and saved Canada money. Silo mentality that is killing our US hospitals as I type.
My other take so far from them is that they are not smoking hot like industry reps.
Let me be clear: all reps, either industry or government appartchik should be fired.
Scott
I beg to differ! Our academic detailer is a well prepared pharmacist and smoking hot. Her sales pitch is always the same: “do what ever you think is in the patient’s best interest!” She increased our use of Plavix and decreased our use of ineffective generics and Branded drugs whose safety should be carefully evaluated. She is smart and armed with excellent materials (from Harvard) that include CME. What else could you want? She works for Pennsylvania and her constituency is the older Pennsylvanian for whom lottery funds are directed. Did I say she was smoking hot!
Druggie
How can anyone think that drug reps are of value? Ugh…..
Cwdonald
Actually, what should be called into question is a physicians ability to accurately remember whether they are seeing more reps or fewer reps. Anyone who works with the audit data at the physician level know that frequently physicians dont know how many patients they prescribe a certain drug for, and even get the rank order of drugs they prescribe in a class wrong. The headline should have been so what.