Unfortunately for numerous residency graduates, many of the decisions regarding interactions with pharmaceutical and medical device sales forces have been put into policies. These are often parallel to the strictest of parents attempting to shelter their children from what is socially perceived as “evil” or “influential,” which in many instances has led to the development of very poor relationships when these residents come out into the real world. Much like the same children that were not allowed to make their own decisions, they either become rebellious and overdo their interactions with drug companies, or go the other way and continue to shut them out of their offices. In either case, the results tend to be more to the extremes based on the media bias and fears of scrutiny which have influenced decisions. In summary, access bans on sales reps in academia, hospital health systems or other settings have become problematic for the development of healthy partnerships with industry. It affects patient care, medical education and pharma reputation. This may have several outcomes for the long-run, including either complete restriction (i.e., no sales rep and no industry support of any kind), or a return to the relationship that helps patients and physician. Unfortunately, these policies are hurting patients’ access to new drugs and those physicians who truly want information.
The problem began when a few took advantage of this sacred relationship. Whether it’s the physicians who held their prescriptions hostage (“I won’t write your product unless I serve on an advisory board or speak at an event”) or the inexperienced sales reps who traded food for prescriptions, the problem led to a more regulated environment. Even worse is the notion that there should be rewards for being a high writer of prescriptions in the form of invitations to be a speaker on that product or that disease state, independent of the physician’s ability to perform in front of the audience, answer the important questions regarding applications of therapy, and, even more so, engaging in a constructive dialogue with colleagues without a script.
That said, there are ways to improve the physician-rep relationship. Here are some suggestions based on 15 years of working in private practice, academia and from speaking with colleagues.
Dos and Don’ts for Interactions with Sales Reps
• Stay professional. Unless the rep truly has a personal relationship with the physician, don’t discuss personal lives, ask what they did over the weekend or gossip.
• Assure that reps come in with a targeted, focused message, such as a new study, patient resources or an upcoming medical education program.
• Have them make an appointment instead of dropping in with an excuse (“I just wanted to drop off these prescriptions”).
• Suggest a meeting with a science liaison when the topic is about off-label indication. Some physicians know the limitations of what the rep can say about the drug and may just be testing the rep. If there is an interest in research, clinical trials or lecturing on the subject, the medical liaison should be the contact and not the sales rep or manager.
• Reps should let their products’ data speak for itself. Don’t compare it with other drugs unless asked, don’t speak negatively about the competitor, and don’t assume the physician will stop writing prescriptions for the competitor.
• Physicians should provide their CV, published articles or presentation slides if they express an interest in speaking. This approach takes the rep out of the discussion and reduces the risk of “jeopardizing” future prescriptions.
• Avoid all interactions with sales reps and any members of the pharmaceutical industry in public and especially within sight or earshot of patients. Reps should never say “thank you for prescribing” within earshot of patients. This actually puts the physician’s reputation at risk with the patient.
• Reps should never feed the office staff on the first visit; there should always be an initial visit with the physicians first. When a date is set for lunch, the physicians should make time to attend so that it does not seem like a catered benefit instead of a true business meeting for the office.
• The physician should not make the rep feel uncomfortable. This usually happens with the opposite sex. Remain composed, ask questions quickly, and involve other staff in the discussion when possible.
• Don’t dash out without asking one focused question, such as the physician’s current use of the drug.
• Never give in to a “commercial.” A successful sales rep will provide balanced information and stay within the label.
• Don’t risk pharma’s reputation by holding the sales rep hostage to get ahead with a personal interest in clinical trials or speaking that the physician has (“I won’t prescribe unless I sit on the advisory board or speak at an event”).
• Don’t let a rep beg for prescriptions (“I need more prescriptions to win this contest that I’m in”).
What about physicians who are difficult to see or do not usually see sales reps? Try making the appointment first. Every sales rep should always make one attempt to visit difficult-to-see physicians, whether their reason is because of restrictive policies or because they are skeptic about pharma.
In this era of where there are greater restrictions to share information with physicians, pharma must focus on creating a positive relationship. It’s much more productive than dealing with restrictions. Finally, it should be noted that the most successful thought leaders in the specialty that conduct clinical trials, that are invited to speak at conferences, and that develop consultant agreements with pharmaceutical companies, are not those who are aggressive or obnoxious in their quests. They are those who create a scientific niche or specific interest in the specialty that becomes known based on the merit of either the results or the presentation of one’s own written lecture at a CME meeting, such as the American Academy of Dermatology, American Society for Dermatological Surgery, or any local or state society meeting where an abstract is submitted without any input or influence from pharma. It is very similar to moving to Hollywood and declaring that one is an “actor” compared to “being discovered” based on hard work and the merit of one’s efforts. In short, it will be more lucrative and more prolonged to have industry come to the physician to start a relationship than for the physician to say “pick me” or “I want to work with the company” when there is nothing to show on the CV or track record to support that interest.
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