Hi Dr. Dave, In my former role as a DME rep, I remember scheduling a luncheon for an office. While waiting, one of the physicians was showing a med student around the break room ("...and this is our coffee pot, with cups over here..."). The med student noticed me, and the physician had to leave for some reason, leaving me and the student alone. I introduced myself and so did the student. I asked her some light questions, like how long she'd be in the office and what speciality she was looking to study. Once I explained my role as a rep, her eyebrows furrowed and she became defensive, almost backing away from me. The defensive look then turned to condescending in terms of speech tone. I was shocked that the student would do such a 180! This has only happened a few times, with most students being very friendly and professional. I was just wondering, in your experience in med school, what was the general attitude towards medical salespeople? Are we looked at as the devil? Are med students taught that we are the scourge of medicine?
Funny, I work at a University Hospital and many med students ask me about the money once they hear I'm an ex-rep. Even had a Orthopedic Surgeon buy pizza one night just so he could get my opinion about going into Ortho sales.
I have an affiliation with only one medical school, so please don't generalize this to apply to all medical students. My experience is that my med students interact with reps with skepticism (which I think is good) but civility (which is always best). In the spirit of Cafepharma, I have to add - our office still allows drug lunches. When one has no income and huge debt, the prospect of free food is not insignificant. Is that a pharma issue or a society/medical education issue? I have my biases, but I'm curious to know what others here think.
When I was in the pharma game most of the med students looked upon us as sales whores who would do or say anything to get them to use our products. And that was an accurate perception in most cases. So I never took offense to their skeptism and condescention. Had I been in their shoes I probably would have acted the same. Don't blame the med student. Blame the companies and reps for instigating that reaction. And stop being so damn thin skinned! You are in sales afterall!
Of course, in today's medical schoool climate, where the gift of a pen or a sticky pad is considered an illegal gratuity, the drug rep is about as welcome as a tobacco sales rep. Years ago, one of my customers (a physician head of department) used to joke that some of his residents lived on bar food provided by drug and mfg. reps. And I think there were a couple times I actually was the provider of that meal.
Many of the more anti industry medical center's have one hand out for $$$ and food(sponsorships) and the other hand displaying the "stop" sign! They are full of hypocrisy. They advertise their medical centers all over the place while decrying the marketing practices of the medical device/biopharma industies. Please, educate the medical students, don't indoctrinate them. Pull the log out of your eye before you point out the splinter in in some one else's eye....
I think many doctors and fellows did find value in rep lunches and being able to discuss a study over a meal with a good rep. The meals were always modest and I have no idea why this practice is so frowned upon, especially since most offices/departments miss it. I think as long as the meal is held for educational purposes, I see nothing wrong with it. I do take issue with providing a meal that does not result in a clinical discussion. It does seem a little strange that administration at most companies and even health systems CAN and DO still have lunch with industry. It is the doctors that suffer. I know it is tough to keep up with all the new medications and labeling. I would speculate that it is possible medical errors have gone up maybe even AEs due to mixing of meds or comorbidities that should not be combined. That is just a guess. I know the Sunshine Act has scared a lot of doctors from having any interaction with industry at all and this has hurt the research enterprise.
I think a lot of good points have been raised here. I do agree with the general sentiment that to go from generally embracing the monetary resources, support and gifts from pharma to generally showing contempt for them (at least the higher profile, obvious ones) in such a short period of time has a hypocritical feel. Back to the med student issue - one of themes of the preceding comments is that teaching/research institutions accept resources from pharma while, to use a previous poster's term, indoctrinating students that interacting with pharmaceutical representatives is unacceptable. As I mentioned earlier, the students who rotate with me (usually 2-3 per year for a month at a time) are generally healthily skeptical but polite and congenial when they interact with the reps who call on me. I also always offer them the opportunity to excuse themselves when I am interacting with reps, which they rarely do. Consequently, I don't think the anti-pharma indoctrination is as fervent as in some other places. Your comments got me thinking, though - the institution with which I'm affiliated does prohibit med student interaction with reps on its campus; however, I'm not aware of any restriction that applies when they are rotating off campus with community physicians. I'm not sure why this is. Just off the radar of administration? A conscious effort to let students see a spectrum of perspectives? Avoidance of risking offending those who provide a valuable teaching resource (it is difficult to provide sufficient clinical experiences for all students without collaborating with physicians outside the university)? Thoughts? This caught my attention - can you elaborate more on the context of the meetings to which you refer? Thanks to all for your comments!
Dear Dr. Dave, You have been an excellent resource for many reps, and medical professionals. I'm a practitioner and will give some insight about why med. school students are not receptive to Reps. First, they are not respected because the medical community frowns upon them (reps). I'll give you an example, the other day a young rep came into my office with lunch. I sat down with her for an hour. She just wanted to chit-chat about really nothing. When I asked hard questions - it was a blank stare. Then the multiple studies were given as I left the lunch room. We are busy and I don't plan on spending any time with a rep. unless he or she provides me with information. Drug reps have been considered by many (not just doctors) not to give information that is not biased - more company hand-picked studies. MEDLINE search? Thank you.
With 20 years in the industry most of it in a highly technical specialty that is constantly evolving, you words do ring true. The industry has reduced the representative to a walking commercial that is void of any disease knowledge or context regarding the treatment decisions. In addition, government induced regulations won't allow a meaningful discussion that could be beneficial to the physician or patient. On the other hand there are ways that a good representative can provide value. The problem is that physicians don't take the time to find out who provides value and who doesn't. Generally one rep or a few of them anger a physician and the entire industry is banned. I accept that you have the right to run your business as you see fit and that we are guests in your office. What I have trouble with is the broad brushing and what I regard as a lack of spine when it comes to dealing with "bad" reps. It seems hurting the feelings of a bad rep is avoided at the cost of the ones that try to be professional.
To the 4/29 poster - thanks for your response. I must admit, your comments left me with some questions which I ask with genuine curiosity and respect: My understanding is that the studies that are left behind must be FDA approved for company distribution (reps here, please correct me if I'm wrong). Also, the studies are frequently published in major peer reviewed journals. I don't discount your contention that drug company funded studies merit great scrutiny for bias, so do you feel (as I do) that our peer reviewed journals and the FDA are failing to screen for this bias? When I was in training, reps were accepted, I think, because the medical community generally accepted them. Regardless of your impression of reps in general, do you see this as a continued deficiency in medical education - IE, we don't teach our students to assess things critically and possibly arrive at different conclusions than their mentors? No flippancy or offense intended, I just couldn't think of another way to ask - why did you sit with her for an hour? To the 5/4 poster, thanks also for your response. Your comments resonated with me quite a bit. Over the last 15 years, the majority of the reps I have met I perceive as decent individuals with good intentions. Those qualities do not in and of themselves make them useful to me, however, so, if I choose to see reps, my role in the relationship is to communicate effectively what I find valuable. My experience is that when I do so, good reps learn over time what they have to offer that is congruent with my definition of value and bring it, and less good reps just kind of go away after a while. I think there is another way to look at it - a lot of physicians do not see this relationship as one that should require any effort on their part, so they never get any value. I mean that as observation, not judgment. If that's one's perspective, it makes perfect sense to refuse to see all reps. Though I don't see it that way, I respect the viewpoint and have no problem with those who do not to see reps at all. You are exactly right - as an (implicitly or explicitly) invited guest, a rep should observe my respectfully conveyed rules of conduct and decorum. Unfortunately, my impression is that lack of respectful communication is a fact of life for the reps I meet. Thanks again to both of you for your posts!
First off, I want to say that I don't think I have found any blog/site/"googlesearch", etc. to be more insightful than your blog in providing open and honest feedback to a broad forum of professionals. As a pharma rep late to the game, I cannot express my appreciation enough. The pharma industry is going through a wave of new and challenging changes/regulations for all parties involved. Generics are a major presence in the industry, cost being the main attraction there. However, there is no rep., no company presence behind education or corporate support, and no push towards innovative R&D initiatives. That said, I have had an extremely difficult time understanding what it is that makes my role valid to a physician. I have spent over a year of my sales career trying to differentiate between what is scripted by corporate as value, and what my doctors want from me to add value - completely boggled. As a rep that fills in for vacant territories, I am constantly a new/foreign presence in their office, (a role that brings on an entirely separate set of challenges). My question and one that all new reps I think can benefit from is - How can I approach that initial interaction with you, the Dr., to communicate my genuine want to bring value to your practice day 1? What would your dream rep, walking into your office for the first time say? How do I peak your interest when you are swamped with patients? I can only control the controllable's. Aside from cost, I think that branded pharma still has a benefit to you and your patients. Do we all bow out and conform to the government dream of standards, or do we fight to bring value aside from generic cost to the table.
First off, I want to say that I don't think I have found any blog/site/"googlesearch", etc. to be more insightful than your blog in providing open and honest feedback to a broad forum of professionals. As a pharma rep late to the game, I cannot express my appreciation enough. The pharma industry is going through a wave of new and challenging changes/regulations for all parties involved. Generics are a major presence in the industry, cost being the main attraction there. However, there is no rep., no company presence behind education or corporate support, and no push towards innovative R&D initiatives. That said, I have had an extremely difficult time understanding what it is that makes my role valid to a physician. I have spent over a year of my sales career trying to differentiate between what is scripted by corporate as value, and what my doctors want from me to add value - completely boggled. As a rep that fills in for vacant territories, I am constantly a new/foreign presence in their office, (a role that brings on an entirely separate set of challenges). My question and one that all new reps I think can benefit from is - How can I approach that initial interaction with you, the Dr., to communicate my genuine want to bring value to your practice day 1? What would your dream rep, walking into your office for the first time say? How do I peak your interest when you are swamped with patients? I can only control the controllable's. Aside from cost, I think that branded pharma still has a benefit to you and your patients. Do we all bow out and conform to the government dream of standards, or do we fight to bring value aside from generic cost to the table.
Thanks for your post and your compliments. I'm glad you've found some useful information here. I re-posted your "first impression" question as a separate thread. Feel free to comment!
Pro Publica lists the biggest pharmaceutical companies given civil and criminal penalties for fraud in marketing of drugs, which have injured and killed hundreds of thousands. "In the last few years pharmaceutical companies have agreed to pay over $13 billion to resolve U.S. Department of Justice allegations of fraudulent marketing practices, including the promotion of medicines for uses that were not approved by the Food and Drug Administration. Here are summaries of some recent large settlements." You can even look up your doctor on their website to see how much money he has taken from pharmaceutical companies for subjecting their patients to great harm. That is a clue. http://projects.propublica.org/graphics/bigpharma
This sounds like an important subject - would you like to start a new thread under a different title/context? I didn't want to do it on your behalf in case I was missing anything about the context. Thanks for the post-
Let's be frank. The influence of money has corrupted our highest and most revered institutions that guide our nation. Big money wins elections. Big money determines most of our public politicies. It's not just the medical or pharmaceutical industries that 'pay to play'. It's become a routine business practice in America. And it's getting to the point that if you choose not to play the game, you lose. It's not so much an industry problem. It's a social problem that's only getting worse.
It's been my experience that the primary reason the resident physicians at the teaching hospitals treat the drug reps with any outward courtesy or respect is because that's generally where the free lunches and educational grants originate. Think about it. Those residents had to work their butts off to earn a seat in a medical school and maintain a high performance throughout school to earn an MD title. Plus, most had to go deep into debt to finance it all. Compare that with what it takes to peddle pharmaceuticals. The residents realize that they're going to get a one-sided story from the reps, yet have to listen to it all with a stiff upper lip while eating the free lunch and anticipating a nice educational grant for the department. That's how we humans are conditioned in this life. Not to bite the hand that feeds us. We're all guilty of it to one extent or the other.
I was a specialty rep in the industry over 20 years. After the Pens and giveaways disappeared, my local med school's ONC department called asking me for $5K to help sponsor an off campus educational event. (Kansas University Medical Center, KC, KS) I was interested and asked what access might get in return. The answer was an offended 'none'. My response was that I can support the event but need some access, any access, a journal club or something to try to generate some business. Even a simple display at the event in the back corner or something would suffice. She said no way. I was polite but said 'no way' was right. I left the industry a year or two later. The terrain had changed and my position was eliminated in a 'cost reduction' disaster. (I was the leading revenue producer for half of the US. I was also the most expensive rep between salary and bonus. BTW, when the company called and offered me my position again. I passed.) I completely changed industries and moved on to better things, less politics and less stress. Still I miss the relationships and the clients that I build trusting relationships with over the years and thrived on the science and helping folks make better decisions. In fairness, the industry needed some policing. Peace to All, Happy in Tampa
Thanks for your post. Interesting anecdote that speaks to the medical culture that is hopefully improving. I've always been fascinated that, at least in the 90s and 00s, physicians seemed equally comfortable criticizing the pharmaceutical industry and taking material resources from it.
