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Healthcare Market considerations for Eliminating Pharmaceutical Sales Representatives

June 3rd, 2010 Leave a comment Go to comments

There has been considerable debate about the role of pharmaceutical sales representatives in the evolving new healthcare market.  Do they have any role, what is it, and are they worth keeping around at all? It is clear that the market has had enough of the sample dropping reps specializing in the social, relationship building, access gaining tactics like “lunch and learns” and “dine and dashes” that contribute little to physician education.  I believe that despite some of these questionable tactics of the past, pharmaceutical sales representatives have played a far bigger role in physician education about drug treatment options than most physicians, other healthcare professionals, and certainly academics would want to admit.   I’ve always wanted to do a package insert test of doctors who regularly see pharmaceutical sales reps verses those who do not.

This is more than a debate about what information is now available on the internet and the potential for distance learning.  It is about timely awareness and comprehension of treatment options and best practices.  It is about knowing how to use a drug correctly, in the right patients and knowing about potential side effects and adverse reactions that might occur.

It is nearly impossible to stay current merely by having access to the internet, despite what some websites might want you to believe.  Besides, how many hours per day can physicians commit to  staying current (remember it is not just drugs they have to be current about)?  CME requirements to maintain  a medical license vary by state but range from about 20 hours to 50 hours per year.  Not a lot of hours considering the pace of science, technology, and advances in medicine today.  Also, keep in mind that many physicians earn a good share of their CME credits by attending conventions and conferences (subsidized and often sponsored by the pharmaceutical industry).  So what’s my point?

Take the rep out of the picture.  How do physicians find out about new treatments?  The newspaper and television most likely. Who educates physicians about new drug treatments?  The local medical school? Most towns and cities don’t have one.  At the local hospital monthly grand rounds?  Which disease or product treatments are covered this month, by whom? In a year’s worth of grand rounds do they cover everything a physician needs to know about drug therapies? The physician waits to hear from an expert at the next conference? What if the topic isn’t covered?  The textbook on their shelf? When was that written and more importantly, when did it finally get published? How many medical journals are physicians skimming through to stay current? When were those articles actually written? Who is writing the articles?  People who have done work with the drug (hopefully they weren’t paid by the pharmaceutical company to do the clinical trial because they would be biased) or another “expert” who has merely read some articles and summarized a bunch of studies about the new drug?

While I agree that some of the sales tactics of the past contributed little to educating physicians, the collective drug education impact of the industry should not be completely dismissed.  There is a need and role that could and should be filled.  If the healthcare market feels there is no role for pharmaceutical sales representatives in physician education,  then the healthcare market and academics in particular, must be ready to accept the responsibility for providing better alternatives for physician education (there are more than 600,000 physicians in the US) than putting stuff on the web or just going to meetings and conferences to passively learn about new drug treatments. It will be especially challenging to reach the more rurally based physicians and those who can barely keep up with the minimums of CME credits because of their workloads or financial constraints of their practices.

Few societies, medical organizations, CME providers, or even medical schools have stepped up to do mass market education (especially about a particular drug).  Even those that are doing CME are not doing it on a mass market basis (ensuring that they get to most physicians) and few are doing CME without funding from the pharmaceutical industry.

So my point is, if there is a role for pharmaceutical sales representatives in the evolving new healthcare market it is to be a credible source of scientific and medical information that can help physicians stay current with best practice treatment options.  These are not traditional sales roles (you don’t get paid a bonus or commission) but more therapeutic area experts who know the literature, know all the drug treatment options for a disease, and can speak knowledgeably and objectively about competitive products as well as their own company’s products.

mike@pharmareform.com

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  • Mario Cavallini

    Mike, you call for “therapeutic area experts who know the literature, know all the drug treatment options for a disease, and can speak knowledgeably and objectively about competitive products as well as their own company’s products.” How is that different from the nonpromotional staff found at pharmaceutical companies who are typically called medical science liaisons?

  • http://www.pharmareform.com Mike Wokasch

    Mario,
    You are correct assuming two premises:
    1) the MSLs have a high level of scientific and medical expertise
    2) they are perceived by those they call on as being credible sources of scientific and medical information.

    Unfortunately, the industry has not always maintained these standards, sometimes deploying MSLs as nothing more than glorified sales people or using them as a safe harbor for “off-label” promotion.

    The other difference from what I am suggesting is that MSLs are frequently deployed in medical school settings and targeted at specialists and key opinion leaders and not the more rural or mass market primary care audience where I believe the information need and challenges of staying current are greatest.

    Thanks for your comment and question. mike@pharmareform.com

  • Jack

    This article assumes sales reps spend most or the majority of their time educating or speaking to physicians about things such as package inserts, clinical trials, and other high level medical information. The truth is, a very small portion of a drug reps time is discussing these high level medical discoveries. The majoirty of drug reps time is spent building relationship with key staff and physicians as well as detailing off of marketing pieces that are very biased to the favor of that particular drug and company. Do drug reps have any value…? Absolutely. The REAL question is and the one you have failed to properly address here… do they have vale that constitutes the cost they bring to the healthcare syatem which is 150K per rep. per year. My answer is a strong and definite absolutely not for a multitude of factual and credible reasons which I will not go into here. Thanks for writing on the subject.

  • Howard

    Mike – I guess this is being a bit ‘Devil’s Advocate’ but without a bonus or other incentive what would you suggest as alternative to motivate these guys (I’m assuming one needs a sales-type mentality to want to pursue this sort of role)?

  • Rori

    The need for redundant reps has vanished, especially with common “me-too” drugs that are mature in their life cycle. As more complex drugs enter the market, greater confusion with managed care, and less money in reimbursement, the value of reps will come in clincal education combined with assisting doctors and their staff in navigating this complex climate. The pod style selling did little to add value, this contracture in the market will hopefully allow fewer reps to be a resource once again.

  • http://www.pharmareform.com Mike Wokasch

    Jack,
    In this and in several of my previous posts you’ll note that I do not believe the traditional pharmaceutical sales rep model or profile is working nor will it work in the evolving new healthcare market. The traditional pharmaceutical sales model clearly moved away from physician education about company products (in the context of promotion) to a lot of other activities, including those you mention.

    The point I was trying to make in this post is that even with what some might suggest was of marginal or nominal educational value with regards to educating physicians (even if it was done in the context of product promotion), the medical community has a long way to go to fill the void that would be left by eliminating pharmaceutical sales representatives completely. This is especially true for new products and for healthcare providers in rural areas and areas where access to continuing medical education and peer to peer discussions may not be as robust as it might be in and around large medical centers. As the science and medicine evolve to include the complexities of personalized medicine, companion diagnostics, and increasingly sophisticated delivery systems, one of the options is for pharmaceutical companies to consider the scientific and medical expertise alternative to the current sales model.
    mike@pharmareform.com

  • http://www.pharmareform.com Mike Wokasch

    Howard,
    Good point, thank you. Maybe that is another one of the biggest differences between what I am proposing and the traditional sales model. I would suggest you don’t need and probably wouldn’t want a “sales-type mentality ” for these scientific and medical expertise type roles. I also believe there are many well qualified people for these positions who are driven by different personal motivators that are less financially oriented. I also want to clarify that these people could participate in corporate bonus programs and incentives stock option plans. Most research scientists in pharmaceutical companies as an example may participate in bonus programs that have corporate revenues along with other factors but they are usually not tied directly to sales for products in their area of research. As an example for expectations and potential motivators for this group I would suggest encouraging and nurturing these individuals to become nationally or internationally recognized by the medical community as an expert in a particular disease or product area.
    mike@pharmareform.com

  • http://www.pharmareform.com Mike Wokasch

    Rori,
    Well said. Thank you. mike@pharmareform.com

  • Eric

    Mike,

    I appreciate your article. Well written. I agree with your premise on the ever-changing role of the rep. However, being a Libertarian, I have always wondered why the government has any business regulating the sales of private companies. Do you have any thoughts on this?

  • http://www.pharmareform.com Mike Wokasch

    Eric,
    Seems like nobody wants government intervention until something goes wrong (think BP oil spill). Without government regulation of what pharmaceutical sales reps say and do (go back to the “say whatever it takes to make a sale” snake oil sales man of the 1800’s) more people would almost certainly be exposed to worthless, ineffective treatments when they could have gotten something that might have worked and more importantly, more patients would be exposed to potentially life threatening adverse reactions that they might not even be aware of (all prescription drugs have side effects and some have more serious adverse reactions than others).

    While I believe most pharmaceutical sales people are well intentioned, there have been a sufficient number of cases litigated in the courts and investigated by the Department of Justice to demonstrate that pharmaceutical companies in deploying and training their sales people haven’t always played by the rules. I would like to believe that regulation is unnecessary, but history has demonstrated that regulating what pharmaceutical sales people say and do to sell prescription drugs is in the best interest of patients.
    mike@pharmareform.com