There are some eye-wateringly big areas at play here, not to mention a lot of layers. So we’ll start peeling the onion by setting out four key questions.

  • What are the behavioral dynamics with the physician themselves and that of their busy medical practice?
  • How does a sales representative obtain access to the physician and work within the business model that he or she lives in today?
  • What are the obstacles that distract physicians from making a rep visit meaningful?
  • What are the dynamics and best practices that can lead to a consistently successful rep/physician engagement?

In order to understand physician behavior, it’s critical to first realize the pressure points they face in their daily practice— their business and practice irritations, frustrations, fears, even their hopes and perhaps long-lost aspirations. In short, what keeps the physician awake at night? Unfortunately, it’s probably, “Why did I choose this line of work?” Gone are the days when kindly old doctors knew every patient by name, and never worried whether they had the exact managed care plans for their office practice. Today’s physician is a different breed, working within an environment consumed with increasing pressure and stress. Patient medical coverage shifts like the wind, decreasing reimbursements, rising practice-related costs, increasing formulary constraints. The list goes on.

The tragedy is that because of the force majeure of managed care and now healthcare reform, the art of medicine is buried deep in the bureaucratic process. Today, it’s all about business. This is the environment the reps are walking into. This is the threshold they cross…if they’re lucky, that is.


Gone, too, are the days when the rep would waltz through a physician’s office door, dispensing freebies, golf trips, vacation packages and more to entice doctors to order from the company. Today, that door looks more like a brick wall. In the new business model, sales reps are more or less unwelcome in the doctor’s office—a business interruption, if you will. Everybody trusts a specialist, but a salesman? According to TNS, healthcare reps talk to a physician in person on about 20% of visits to the doctor’s office. On about 37% of visits, they wind up leaving drug samples or commercial leave-behinds. Given those daunting figures, any rep worth their salt will have to be pretty tenacious in securing an appointment. Much high-level discussion (and a lot of billable agency hours) is spent figuring out how to spin each tick of the clock into meaningful communication. And what answer have they come up with? iPads, of course!

LED-backlit display, multi-touch, accelerometer, apps, Chaps…(actually we made that last one up, but it would be an interestingly rugged addition to the Smart Cover “dyed Italian leather” line). The iPad is an instant turn on. Literally. The Wall Street Journal Health Blog recently reported that the pharma industry is caught up in an “iPad arms race.” No argument, they look cool and tee up any number of seamless interactive presentations with instant access to a plethora of online communications. But, gadgets aside, let’s talk about how much content can be relayed in well under a minute. How much pertinent, meaningful information—especially given physicians’ skepticism, fairness and balance demands, and on-label guardrails? The rep is hugely restricted, hard pressed to impress or say anything really meaningful at all during a 30-second audition. The coolness of technology only lasts so long.


So what are the dynamics of successful rep/physician engagement? What smartsolution insights can the rep bring to the conversation? A good rep is savvy, has a solid scientific aptitude, and is trained to color within the lines: Stay on label. Stay on message. So here’s an opportunity for reps to demonstrate that they have a good handle, not only on their product but also the respective disease state. To be seen as authorities, as stewards of the product and disease state, all without overstepping the bounds. That skill set, combined with creative application, can go a long way.

Keep the sales force informed about scheduled CME and unrestricted grant and commercial/sponsored programing presentations throughout the year. This proactive approach can be initiated in simple steps with provided background and supportive materials. Wouldn’t a physician really appreciate it if the rep mentioned, “Hey, did you know that Doctor X is going to be speaking on this area of medicine that you’re interested in?” Or, that a new pivotal paper has just been published.

Now the rep provides context…is part of the doctor’s professional context. Sure, the physician might know some of these things already. And in many cases, the rep may not be able to discuss off-label developments in detail. The point is that the physician’s interest will undoubtedly be piqued, extending beyond the sales pitch. So the needle starts to move from “salesman” to “valued resource.” Of course, there’s an art: not everyone can leverage all of the on-label information, know the label inside out, and weave these threads into a compelling story. Unfortunately, few reps have time to scour the literature and stay up to date on every molecule that they work on.

Here, the drug companies themselves have several opportunities to train and arm their reps—not only to deliver the finely honed, 30-second marketing message, but also imbue them with enough guidance to ensure their whole scientific resources are utilized. After all, resource is not just relaying the efficacy and safety message, it’s about understanding that the product is set within a bigger picture. If a rep does feel that he’s weak in the data—on the molecule or disease state—proactive training will allow him to learn, identify weaknesses, address them, and move on.


What would happen if the reps had a goto person—a new position, because it’s a big job—a constant source of authority, updates, and current disease state events. (This would, of course, have to be orchestrated with a firewall between commercial and medical, under close scrutiny.) Imagine, though, that the rep’s daily commute to the physician’s office could become a source of strength: Arranging schedules, ensuring adequate preparation for each and every practice. Is there a new piece of information of personal interest to the next physician? The “source” has already updated the rep on the latest and greatest. News as it happens—just as we get headlines and sports on our cell phones. It would be like having an air traffic controller, guiding these massively valuable mobile assets to safe and productive landings. Having the rep engaged and connected to so many programs— conferences, IT programs, Phase IV studies, and much more—will ultimately foster a more meaningful rep/physician interaction. The rep’s paltry 30 seconds isn’t a race against time, it’s an opportunity to reinforce the sales message and to show resourcefulness that will enhance the physician’s business.

Understanding and respecting the business model of the physician’s practice, the office structure, how it operates it, knowing the gatekeepers, is crucial to more meaningful engagement. Professional courtesy laced with professional tenacity is a potent force. It proves the rep can work, through proactive anticipation, seamlessly with the physician and his office to be able to develop and secure a successful engagement plan and see it through. Moreover, it’s a sales commitment of service to their practice.

So the message to the drug companies is this: Build access through credible information and practice-building services. Instill professional tenacity, confidence and adaptation in your reps as to how they can tap into their own resourcefulness with the tools developed. Optimize the connection between the physician and the pharma rep and the experience can get closer to a win-win, a road more successful for both.

DISCLAIMER: The Guest Commentary page allows contributors to voice their opinions on important issues that affect the industry. The views of the authors are their own and are not necessarily those of PM360 and its staff.


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