S&R Blog


Doctors increasingly close doors to drug reps, while pharma cuts rank

Many physicians see detailers only with scheduled appointments. Drugmakers are responding to hard times with layoffs and a shift toward online marketing.

Source: American Medical News

The relationship between doctors and drug reps may never be the same again.

Pharmaceutical companies — battered by a sluggish drug pipeline, the looming loss of blockbuster patented drugs, an economy in recession and scrutiny of their relationships with physicians — are re-examining the value of sending drug reps into doctors’ offices. Detailers are struggling to grab a shrinking slice of physicians’ valuable time and attention while adjusting to new drug industry rules banning freebies such as pens and notepads.

At its peak in 2007, the American pharmaceutical industry fielded 102,000 sales reps, said Chris Wright, managing principal for the consulting firm ZS Associates’ U.S. Pharmaceuticals Practice. Drugmakers have slashed the number to 92,000 since then, and ZS projects the number will fall to 75,000 by 2012 at the latest, saving the industry $3.6 billion.

Pharma’s return on investment in its sales force has plummeted. For every 100 reps who visit a practice, 37 place their products in the office’s sample cabinet, and only 20 speak to a physician in person, said the New York-based consulting group TNS Healthcare. Profit per drug rep visit fell 23% from 2004 to 2005, said a February PricewaterhouseCoopers report on pharma’s future.

“The old sales model is broken now, and who knows how it will look in the future,” said Peter H. Nalen, president of Compass Healthcare Communications, an online drug marketer in Princeton, N.J. “What’s happening is that pharmaceutical companies are realizing there are other ways to reach the doctor instead of banging on the door of the doctor who just doesn’t want to talk to you.”

1 in 4 doctors works in a practice that refuses to see drug reps.

The time squeeze and the new drug industry rules are “changing the landscape quite dramatically,” Nalen said. Another troubling sign for drugmakers: More than a third of medical schools require drug reps to have appointments before seeing physicians or residents, according to the American Medical Student Assn.’s 2008 PharmFree Scorecard. The Assn. of American Medical Colleges recommended the by-appointment-only policy in May 2008.

While most physicians still have positive views of detailers and drugmakers, those sentiments are cooling.

About one in four physicians works in a practice that refuses to see drug reps. Of doctors who do see reps, about 40% will meet with detailers only with scheduled appointments. The by-appointment-only figure jumped 23% during the last six months of 2008, according to a survey of more than 227,000 medical practices representing 640,000 physicians that was released in February.

The survey, conducted by the doctor-profiling firm SK&A Information Services Inc., did not seek to determine why some physicians are giving drug reps the cold shoulder. But physicians and pharmaceutical industry consultants say doctors have felt besieged by the number of reps visiting their offices and taking up precious time in an era of declining payment.

Last year saw a slight drop in a measure of the quality of detailers’ relationships with doctors, based on a TNS survey of more than 1,500 doctors. And negative word-of-mouth about pharma rose sharply among physicians — this so-called market-resistance index jumped 62% in the last year, TNS said.

Controversies over the drugs marketed as Vioxx (rofecoxib), Avandia (rosiglitazone) and Vytorin (ezetimbe and simvastatin) appear to be making doctors more skeptical of drugmakers as an information source, said Jerome L. Avorn, MD, professor of medicine at Harvard Medical School in Massachusetts.

“Doctors are increasingly concerned that the sales pitches from drug reps are not giving them the full story,” said Dr. Avorn, author of the 2004 book, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs.

Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said in a statement that detailing visits are good for doctors and patients. “Interactions between physicians and pharmaceutical company representatives benefit patient care through the exchange of information about new medicines, new uses of medicines, the latest clinical data, appropriate dosing and emerging safety issues.”
Interacting with detailers

For every physician, it seems, there is a different way to handle drug reps.

Charles E. Crutchfield III, MD, is a dermatologist with a high-volume practice in Eagan, Minn., a suburb of Minneapolis. Though five to 10 reps visit his office daily, he strictly limits detailers to one five-minute session a week and requires that the rep provide lunch for his staff.

More than a third of med schools require drug reps to make appointments.

“The reps know they are not allowed to disturb me when I am seeing patients,” Dr. Crutchfield said. “If they do bring samples, I have a nurse who will bring the pad back to me so I can sign it. I will not see or talk to reps when I’m in clinic.”

Ari Silver-Isenstadt, MD, persuaded the four other doctors and office staff in his Baltimore pediatrics practice to adopt, in January 2008, a “no soliciting” policy for drug reps. Dr. Silver-Isenstadt is a member of the National Physicians Alliance, whose Unbranded Doctor Campaign urges physicians to refuse industry gifts and stop seeing drug reps.

Despite the new survey figures showing that doctors are cooling to drug reps, he said physicians should be more aggressively addressing the conflict of interest detailers pose.

“More than half of us doctors still just have a feeding frenzy of reps in our offices,” he said. “We should be ashamed of ourselves for allowing such an intertwining of our patients’ best interests with the convenience and niceties of drug reps.”

Not all doctors share Dr. Silver-Isenstadt’s hard-line view.

Most are simply pressed for time. Drug companies are trying to reach out to doctors via the Web, experts said. About 45,000 doctors meet with detailers using online video, and 300,000 physicians say they are open to doing so, said a September 2008 study from Manhattan Research, a drug marketing research firm.

Visits by drug reps will not disappear entirely, experts said. Rather, the sales force that survives the layoffs will be better trained and have a greater depth of clinical and scientific knowledge.

Detailers “reach the customer in a way that other promotional techniques do not,” said Wright, of the ZS Associates consulting firm. “And for many of these doctors, the choices they make about what to prescribe are worth a considerable amount of money.

“When that’s on the table, it makes sense to send a highly trained person to make sure the doctor knows about the medicine before making those choices.

Kevin B. O’Reilly – American Medical News

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7 Comments so far
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[…] This post was mentioned on Twitter by srcomblog, David Watts. David Watts said: Doctors increasingly close doors to drug reps, while pharma cuts rank: http://bit.ly/79HcUg (via @srcomblog) #in […]

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David:
Thanks for your comments regarding this article. I don’t believe the issue was singularly focused on better trained reps although it seems to me that the pharma industry has marginalized the value of reps as a valuable information source. Rather, I believ e the focus and intent of the author is to point out that in too many cases, pharma reps have lost their relationship with prescibers because of a hole host of things that pharma has done — held back data, mis-informed physicians, and in many instances, reps who simply “parrot” what marketing wants them to say. This has destroyed the believability and trust of many of the companies in our industry and unfortunately painted ALL of us with the same brush. Good luck in your job search and hope you conitnue to help your physicians learn how to have better patient outcomes as a result of your selling and education efforts.

Comment by srcomblog

Social comments and analytics for this post…

This post was mentioned on Twitter by srcomblog: Doctors increasingly close doors to drug reps, while pharma cuts rank: http://bit.ly/79HcUg

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It would be interesting to have the commentary of physicians who still embrace the interaction with reps to balance it out.
Having been a Pharmaceutical rep for 9 years, I have some biased views.
As one of those affected by a lay off in May, 2009, I personally believe the statement about better-trained reps is erroneous. Many times, the good reps who represent their companies and the industry well (knowledge, service, etc) may not be top performers. Right now, the people most likely to survive a lay off are those with the highest sales (though actual pharmaceutical sales per rep is an unscientific process at best).

Comment by DanaW

[…] post on PyschCentral, not highly. In what clearly wasn’t a good year for pharma in terms of reputation, Dr. Fink highlights why she will “no longer see any drug reps.” I didn’t want to […]

Pingback by What do physicians really think about Big Pharma? « S&R Blog

Ah, This is exactly what I was looking for! Clears up
several misnomers I’ve heard

Comment by HCG Diet Mansfield

I’m a medical representative from Sri Lanka and new to the field. The main thing that I don’t like in this industry is the way the doctors treat us medical representatives. I sometimes get really offended by the way they talk and sometimes they treat us like dogs and they condemn the job we do. Just because they are doctors is it fair for them to treat us like that?

Comment by Lauran




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