My last column introduced Dr. Jason Evans’ open letter to pharmaceutical sales representatives, published in Family Practice Management (1). His letter, “How to sell pills without becoming one” reflected three themes on how representatives may best interact with physicians. Last month, I addressed the theme of communicating information with physicians. This month’s column looks at Dr. Evans’ view on how representatives could make the best use of time they have with physicians.
“Don’t give me anything to read later.”
Physicians are swamped with information. Much of that information, I suspect, comes from pharmaceutical companies. When I was a representative, I was enthusiastic with clinical reprints. I was generous with the clinical information I could hand out. However, I was never sure whether the physician got the reprints when I left them with an office staff.
Recently, at a doctor’s appointment, I saw a representative waiting patiently to speak with the doctor. As I was paying the co-pay for my visit, the representative loomed nearby. I could tell she did not get a chance to see the doctors as they were backed up with appointments. She left a reprint encased in a colorful reprint holder with the office staff. As I was leaving, I saw the office staff throw the reprint into the trash.
“Don’t expect me to spend more than 15 minutes at lunch, if I join you at all.”
I can appreciate the part about not expecting doctors to spend more than 15 minutes at a lunch that representatives provide, especially in busy practices where the doctor seems to always be behind. When I was a representative, I did not mind if a physician could only spend a few minutes of a lunch hour to speak with me, when I was asked to provide lunch. In fact, it was already rare for a doctor to sit down for lunch when I carried the bag years ago.
On the other hand, if lunch appointments were the only way I was able to see a doctor at all, and that doctor consistently “missed” lunch, I would feel used. Why would physicians (or office staff) expect sales representatives to bring lunch at all if they did not expect to join? Some physician offices even advertised “free lunch” for office staff as a job benefit. This probably did not help support a perception that industry interactions with physicians should be based on information exchange, not free lunches.
Dr. Evans did suggest that representatives could arrange for specialists to go to his office during lunch so that he could pick their brains. This may be a viable solution; even if the honoraria for a specialist’s lunch hour may exceed the cost of lunch alone, the probability of a physician spending time with the specialist is high, and the return may very well justify the investment. Unfortunately, the representative remains mostly passive in this situation.
“Don’t bother inviting me to evening dinner presentations.”
As more and more sales representatives crowd doctor’s offices and become described by an unflattering article as akin to “a swarm of bees”, dinner programs appeared to be a bastion of spending quality time with physicians, unfettered by interruptions and pressures of the office. Not today.
Since the voluntary PhRMA code was published and updated in the past few years, dinner program attendance has suffered. As companies justifiably stopped pay for physicians’ spouses or family members, many physicians stopped going to dinner programs. This probably helped popularize “virtual” dinner programs where physicians get information via a web cast or audio conference. Many physicians are also becoming technically savvy, and prefer to download medical information onto their PDAs.
What’s a representative to do?
According to Dr. Evans, physicians could barely afford 15 minutes for lunch, did not want to be given information to read, and did not want to be invited to dinner presentations. In the precious few minutes that physicians may actually spend with a representative, Dr. Evans did not want to be told about how much another doctor is using the drug, nor did he care to know (and I agree) on how another doctor is using the drug off-label.
Although Dr. Evan’s list is full of what not to do, he advised representatives to do the following – some of which the last column discussed:
1. Describe the Safety, Tolerability, Efficacy, Price and Simplicity of your drug (STEPS approach).
2. Do a drug cost comparison and be willing conceded to generics.
3. Give a formulary and tier status update of your drugs.
4. Show unbranded patient education materials, and without all the peripherals (pens, notepads, tchotchkes).
5. Leave samples.
As this list suggests, perhaps it is time to get back to the basics when rebuilding trust with physicians.
References
1. Jason Evans, MD. “Establishing Rules of the Road for Pharmaceutical Representatives.” American Academy of Family Physicians, Mar. 2005.