Last year, I wrote about the rules of engagement that Dr. Jason Evans posted in his office to clarify his expectations for pharmaceutical representatives. Dr. Evans has been in practice for seven years this July. He usually sees one sales rep at lunch for 20 minutes and one to three reps in his clinic’s sample room for two to three minutes each. I interviewed Dr. Evans on these rules, which were published in the March 2006 issue of Family Practice Management.
Jane Chin: What was happening that led you to post your “list of rules” in the first place?
Jason Evans: We had had an influx of new reps and a couple of seasoned reps who were really rubbing me the wrong way. I felt like I was talking to used-car salespeople in many cases. I’ve never been to sales school, but it felt like tactics were being used with me. I see the same techniques used in DTC ads, but when used against me, they insulted my intelligence and wasted my time.
I was offered trinkets that had nothing to do with providing my patients with quality care or getting them back to see me, but instead increased the overhead of their companies, thereby increasing the costs of their drugs to my patients. They told me that they needed to talk to me above all of my partners, which I later found out was because my prescribing habits were being profiled, and I was deemed “ripe for the picking.” This made me feel targeted, paranoid and suspicious.
Some reps spent time in the lunchroom talking about anything but their drug, and then as I was getting up to leave, they would launch into a hurried spiel about their three drugs. They would bad-mouth their competitors’ drugs and their competitors’ reps. My personal pet peeve was when they would scold me about how long it had been since they had seen me, implying that I owed them my time. These tactics made me think negatively about them, and, by extension, their drugs.
What was the general feedback from reps about these rules? How do you enforce these rules in your office?
The feedback was good. I do not know if everyone really felt positively about it, or if some did not want to upset me. More importantly, the reps’ behavior improved. I posted these rules as an alternative to banning reps altogether. I never wanted a situation where one rep is banned but another can talk to me. One of the seasoned reps thought the list was a good idea for young, new reps, but he was one of the worst offenders.
Over these past five years, how do you think doctors’ perceptions of interacting with pharma reps have changed?
I don’t think I can speak for doctors in general. However, it seems as though the level of discourse has changed at my office. We have discussions now about where their drugs fit into my practice in the world of managed care, prior authorizations, multiple competitors and generic alternatives. We seem to spend less time on trivial discussions. They seem to recognize that our time is valuable and belongs to us and our patients – not to them. This makes us more likely to want to give them some of our time.
Do you think reps rely as much on lunch appointments to get time with physicians as they used to? Has the frequency of lunches remained the same?
I think those are both the same question and I think the answer is yes. That is still their best chance at our office to talk to several of us for more than two minutes. In the sample room they get enough time for a slogan, but in the lunchroom there is time for a message.
You may know that the industry association PhRMA first installed a code in 2002 that put boundaries around spending on physicians – have you noticed any difference in your interactions with reps as a result of the PhRMA code?
Not much. I didn’t accept extravagant spending before that. While there are fewer offers of the kinds of things that were banned under the code, that really hasn’t changed the interactions that I have with them. Before the code was implemented, my wife would tolerate an industry sales pitch or medical speaker while we both enjoyed a nice dinner, with the kids at a babysitter’s. Now that spouses are not invited, I get a nice dinner if I go, but saddle my wife with the kids a little longer. Therefore, I don’t go to those anymore and I don’t miss them.