Before we begin these are my personal views and don’t necessarily reflect the views of my employer. Whilst researching pharmaceutical sales force recently I realised that I couldn’t find one positive piece of reporting on this highly important part of the pharmaceutical business. And please remember that it is a business, and that drugs are developed ultimately to be sold. It follows that many positives have resulted from this fact such as drug awareness sites, patient forums which in turn have led to greater patient empowerment and better products to meet this new and sophisticated educated consumer base.
So where has this bad press come from and why is it important? Firstly we don’t want to come to a point where only big brand drugs are found in doctor surgeries, patients deserve to have the best possible treatments. An example of this being the Pfizer Bextra incident where they were fined $2.3 billion for fraudulent off label marketing and kickbacks but to be fair $102 million of this went to the six whistle-blower’s. The thing to note about the Pfizer case is firstly it was caught and secondly it was found that both the marketing and sales teams of the Bextra campaign were at fault as well as upper management not just the pharmaceutical reps. It also heightened the mistrust of the pharmaceutical industry by the medical sector.
There is also the misconception that pharmaceutical sales force are becoming defunct, take Novartis as an example, announcing cuts in US sales and marketing teams in April 2010, a week later they announced expansion of their sales force in China. We also have reports that sales calls by pharmaceutical reps are down but this does not mean much if the face to face meetings figures are not reported or the sales figures themselves! Calls SHOULD get longer and less people called once you have built a solid client base, so I do not feel these figures allow us to gauge whether a sales campaign is working or not working.
The other misconception is that sales force are just the pharmaceutical reps; however the term sales force actually applies to sales and marketing within a sales team. When I ask my clients about their sales teams and marketing, in this case the social media marketing; the general feeling is that social media marketing is definitely important but it should add to the sales strategy NOT replace it. I feel it actually goes further than this, social media should also complement and be tailored to existing offline sales and marketing techniques. Taking into account demographics, therapeutics areas, culture’s and surveying both patients and HCPs to really find out what their preferences and overall needs are. It is in this way a sale can and should become personalised too. This would be the natural progression.
Social media aims to be as human as possible, which makes perfect sense; this is its very essence, to connect, to pass on information, to engage other humans, to give other human’s something useful, something they need. How then do we substitute human beings in our sales campaigns? Can social media substitute humans and human relationships? A marketer will say yes, a seller will say no and I am a seller.
Social media is obviously an important part of the sales and marketing campaign but so are human beings, you leave your essence, your personality in the social media campaign to connect with other humans because humans are your key consumer. Logic would then dictate that the natural progression would lead to humans on the phone to further engage and build rapport with other humans and finally long lasting relationships through phone work and face to face meetings. Rapport is not the same as engaging. You ENGAGE someone’s attention by them reading a blog or an article on your website; you build RAPPORT between two human beings. Rapport is a human action, a subconscious communication between two beings when they connect on some level.
Is it right to deny doctor’s the right to a human connection, after all they value the human relationship with their patients and their patients trust. In this way a pharmaceutical rep and doctor could also have the same type of relationship where all the physician stands to gain is customer service and the best possible information and treatment for their patients.
And yet it is sometimes the doctors themselves who do not want this relationship as we have seen with the now famous ZS Associate report stating that only 58% of doctors in the U.S. were rep accessible in 2009 falling by 20% from the previous year. Astoundingly a survey in 2009 by TNS Global shows that things aren’t so bleak in the EU with 70% of physicians in the UK agreeing that physician education via sales force is important. Admittedly these figures are from 2009 but this report does indicate that EU doctors are far more receptive to visits and sales force information than their U.S. counterparts. The report also indicates that pharmaceutical reps should know their market and product inside and out.
So where did it go wrong, doctor’s tend to be mistrustful of pharmaceutical companies as a whole, so it is up the rep’s to build that trust as they become the face of their company. The majority of physicians agree as does the EFPIA Code that medical reps are a valuable source of information so this just leaves sales techniques. From experience if more than one person calls a prospective client during a campaign or a client is called too much, that client is less likely to be receptive to that company, this could be another reason for the drops in rep accessible physicians.
In the U.S. there is 1 rep for every 6.3 physicians this is an extremely high number. It is simply too much for an account managed sales industry. In the UK pharmaceutical sales calls are governed by the EFPIA Code. This is where problems arise when the code is interpreted to mean you can only call a physician a certain number of times. What happens is that a rep will use up their number and another rep will jump in to call the same physician, a kiss of death to any campaign or rapport building exercise and to be honest annoying to anybody receiving these calls. All that needs to be used here is common sense perhaps keeping the same person on the same zip code and if you must hand over to a new rep leave a responsible length of time between switches.
I feel the pharmaceutical industry is listening to physicians and after the economic downturn we did see companies merging sales force teams or splitting massive sales departments and delegating them to brand or therapeutic area. With this hurdle jumped pharmaceutical companies can finally build rapport and trust with physicians because in the end it is the patient that will benefit from this relationship. This is not to say that physicians cannot find their own sources of information and do not gain a lot from e detailing. But it makes sense to check every source possible and it would stand that a pharmaceutical rep would be another excellent source of information.
Once the rapport, the human relationship, is built with a rep physicians ultimately have more control over the number of calls and visits they receive. If a physician is only dealing with one rep, then it would stand that all drugs from that brand will go through them. When they see one rep they are more likely to have frank discussions about efficacy, as the rep will not risk destroying a long lasting relationship with misinformation. They also have more power over the information and treatments for their patients, if there is a better drug out there shouldn’t the physician know about it? And who better than a rep who knows the brand inside out to give them the necessary information. This relationship of connecting doctors with pharmaceutical companies is actually a highly important one which physicians can use to their advantage.
If a physician is really clued up they could use these long lasting relationships to gain better prices. The physician could tell them the current prices they are paying for drugs and find out which context to take e detailling information from other companies. It will be in this way that healthy competition is built between companies and clinical trial data or e detailling starts to presented in different ways, as doctors demand more transparency through their reps. But then again you don’t know each other now, do you……..
As a former sales rep, sales manager, and brand manager at a major pharma company, I’m pretty sensitive to this debate and have feelings about it that are probably different than many in the industry…also, probably different than some of what’s in this post. While I agree with a lot, there are a few points that I’d debate.
First, this quote:
“And yet it is sometimes the doctors themselves who do not want this relationship as we have seen with the now famous ZS Associate report stating that only 58% of doctors in the U.S. were rep accessible in 2009 falling by 20% from the previous year. Astoundingly a survey in 2009 by TNS Global shows that things aren’t so bleak in the EU with 70% of physicians in the UK agreeing that physician education via sales force is important.”
The conclusion was this: ” this report does indicate that EU doctors are far more receptive to visits and sales force information than their U.S. counterparts.”
I’m not sure I agree with this. These stats are measuring two completely different things. If you asked US doctors whether or not education via the sales force is important, I would bet that you’d get a similar percentage as the UK study. However, perhaps US doctors don’t think that this education is worth giving up extra visits or time with patients.
This is the problem. In order to spend time with reps, doctors have to give up time with patients. They get paid based on seeing patients, not reps. Unfortunately, that’s the system. So, it’s a simple equation. Is the value that reps bring worth more than both what the physician would earn in the same period of time seeing patients? OR is it more valuable than spending extra time with the same number of patients?
In general, the answer is probably no. Most reps don’t bring this value. They either don’t offer anything new that the physician doesn’t know, they can’t handle the in depth questions that physicians want answered, or they can’t talk about the topics that physicians want to discuss (because of off-label discussion rules). Of course, there are some exception out there. I’ve worked with many of them. However, they aren’t the majority. The majority of reps are focused on the traditional sales-marketing model of pharma: frequency and reach. You tell you key message to as many to doctors and as many times as you can. That’s different from aiding them with questions about their practice or helping them understand a specific part of a disease state or new data. It’s repeating a marketing message that the doctor has heard countless times. Yes, perhaps this sells drugs in the short-term, but it’s not a long-term model and that’s why it breaks down.
Sales reps represent (in the coldest terms possible) an enormous fixed cost for pharma companies. If you count each like a piece of equipment you can deploy (told you it was cold), then you quickly realize that the cost is around $200k per year per rep. This includes salary, benefits, car, local spending, meetings, etc. $200k is a pretty good number (probably low in some areas).
I completely agree with the assertion that reps need to forge better relationships with physicians, but their leadership teams have to get comfortable that every call can’t consist of them saying the same thing, the same 5 bullet points. I know that most reps would be all for this and those that don’t like this idea are probably a good place to start your cuts.
Jonathan Richman
Dose of Digital
Jon many thanks for your incite in this matter. It really does help when ex industry or industry come forward who have had experience in the sales side of pharma and understand that it’s a business.
As to your views well I feel they are placing all the blame with the reps. As a seller and a good one at that I know that there will be reps out there who know their products inside and out. There is no way a physician can be a specialist in every drug they prescribe in every therapeutic area and keep up to date with every market change pertaining to the pharmaceutical sector.
I will however concede the point that there are sellers out there that use pitches but they must learn somewhere but having run teams and floors in the past once again I must disagree and say once you have learnt you do not use a pitch on a peice of paper and every single sales team will have their own strategy and methodology.
Therefore we have experienced sellers who do not know medicine inside and out but who do know more about their brand. As to the off label discussions Jon we both know there are ways around it and more often than not it is the doctors prescribing these usages in some cases for years which is another discussion altogether. Which is not to say I have an opinon on this FOR THE MOMENT.
Wouldn’t it therefore be of use to have experienced reps who could perhaps talk this point out and advise as to what the drug will or won’t react well with? Shouldn’t a doctor recognise if a rep “knows their stuff” and if so don’t their patients deserve to have that doctor make time to find out as much info as possible about the drugs they are prescribing.
I respect the medical profession but the I also respect the people they treat. I know these people aren’t the people with as loud a voice as physicians, so I’ll say it for them. This piece was written to hopefully open some form of dialogue between pharma and physicians and explain what could happen once it is open, the piece is not a criticism rather an analysis of what could be stopping this dialogue. I hope it will be received as such….
I don’t mean to place all the blame on the reps… in many cases, they’re simply following orders (i.e., from the marketing teams and senior sales leadership). Usually, they don’t have much input on what they do and what they are supposed to talk about.
Here’s the big fact about pharma sales and why a big part of your argument isn’t working for me:
The VAST majority of drugs that are promoted by sales teams are established drugs that have been around for more than 3 years. There are very few new drugs introduced each year…about 20 in the US. Most sales reps these days will NEVER launch a new product. There is also very little in new, meaningful data on existing products (that is also legal to talk about). Therefore, most reps will never really be educating a doctor about their products. For established products, I’m worried about any doctor that knows less about it, how it works in the body, what it interacts with, the biological actions, and recent data compared to a sales rep. Take the number one drug in the world, Lipitor. Is there a single doctor in the world that doesn’t know everything about this drug?
The reason reps continue to talk to doctors about it is to convince them to continue using it instead of competitors or to start using it instead of competitors. Again, the VAST majority of doctors have already made up their minds, know the data, have interpreted using their own views, and have made a decision about what to use. No sales rep is going to change that. So, they aren’t really answering questions for doctors that the doctor didn’t know. I’ve made and been on thousands of sales calls and the percentage that involved a question about a product from a doctor is easily below 1%.
My point only is to say that we need to be honest about what reps do in the real world. It’s no fault of their own and there are exceptions, but as a general rule, I believe the above is true. Having said that, if companies believe that continuing to tell doctors the same message over and over keeps them using their products, then they should continue doing this. It’s perfectly fine. I have no problem with this other than I don’t think it’s very effective. However, let’s not pretend that most sales reps (and what their marketing teams instruct them to do) are doing more than what they actually do.
Jon I don’t think it is realistic to say all reps do not know as much as their clients. I am a sales manager and have also run floors as well as consulted on sales campaigns and know that there will always be sellers that outsell the others. This is how they gain the promotions and exceed targets as we both have and do. And to do this yoy nust know your market.
But that aside I am so glad you commented Jon as you have given such a great incite into the world of pharma reps which lot’s of people have no idea of by the way. As a seller I have learnt over many years to recognise frustration in another. And that is what I felt from your frank comments. The disillusionment of being in a sales sector strangulated by regulations and red tape. And all this will leave is a characterless vacuum, with no artistic license and sales is an art Jon and I can tell you carte blanche I would not have worked in such an atmosphere.
With no creativity in sales you become am customer service rep with set answers for the usual questions because I as a seller Jon I do know the sectors of the pharmaceutical businesses I work in, inside and out. I have sold within the pharmaceutical sector for many years and know that new drugs and devices do get approved, and that drugs are still sold and if it was as easy as sending an email out to sell them we would all be millionaires, so I have to disagree on your all reps are not clued up on their sector. I also know that each sales team and company sales strategy is different as much as I recognise the bored and stifled seller within you.
I feel if your sales manager had educated their staff properly the clients would have been more open to speaking with them of course, this goes without saying, no client will listen to someone that is not on their level. So it sounds like you had separate reps on the phones handing over leads to field reps (always a kiss of death) . Obviously an experienced seller will be the best person to have on the phone, and it lends a rapport until they set up the meetings. And to have so many sellers know so little well this is just high turnover, if you have been in a role for many years you will start to take in the sector and information.
I do feel your comments are extremely important Jon in kick starting a movement within pharmaceutical sales to bridge the gap between company and physician and I really do hope that many people will read your comments and make the change in this important part ot the pharmaceutical supply chain.
To conclude I hope the pharmaceutical industry takes these pointers and asks themselves this:
If I have a vendor before me giving a presentation and I start to realise that they have no idea what they are talking about, should that vendor expect a $100,000 contract?
What can we be doing to give our clients the same service that we ourselves as the providers expect?
Very inciteful Jon….
I personally agree that the notion of completely eliminating sales forces in preference of technology is impractical and impossible. There is nothing that replaces that human interaction. There is no technology that can encourage a HCP to speak about an issue, challenge. Technology can’t build relationship with office staff and learn details relevant to the success/failure of your product in a physician’s office.
There’s no doubt we created our own demise. I’ve said, for years, that the pharmaceutical industry needed to reduce the size of its sales force. I never thought my position would be one of those eliminated, and it carries a scarlet letter, a feeling I’m not good enough for an industry I love and defend.
All fingers are pointing to small, nimble, specialized sales forces in the future. However, what experts recommend – clinical, business savvy, hybrid medical liaison/rep – seem to be pipe dreams currently. Having experienced a lay off myself and seeing many friends go through them as well, it seems the clinical reps who recognize the need to do more than parlay 3 core marketing messages and a close are the ones most likely to be laid off.
We rely way too much on metrics and KPIs to predict how a territory should perform based upon collective information. We all know that each territory is intrinsically different, and each will have its own unique challenges/benefits that can affect outcomes tremendously.
My career has seen 4 product launches and 5 device launches. Two of the products were first in class, new molecular entities. Launching Byetta/Symlin and actually educating physicians on the hormones (that they didn’t learn about in med school) was a breath of fresh air. Laying down the physiologic rationale for using the products was amazing, and then Merck launched Januvia, GSK had the NEJM article published regarding Avandia, and all of our efforts benefited our competition by allowing them to seize upon our efforts and the opportunity Dr. Nissen’s meta-analysis created.
I started in the field in 2000. I exited in 2009. It was a completely different world. Access changed, more products were on Prior Authorizations, more generic competition, less trust in the industry and in clinical data.
My biggest concern is that many of our executives who ultimately craft the direction we take in sales/marketing are not intimately familiar with the conditions in the field. Yes, I’ll be the brazen one to say it, reps have to falsify calls to survive the KPI’s handed down. No rep can consistently see 8-10 physicians/day.
The institution of 2 rounds of PhRMA codes have changed the playing field. The new breed of physicians entering the medical field are more focused on their families and less focused on making their practices their #1 priority – it leaves less opportunity to engage them after hours.
The pharmaceutical industry has traditionally hired people like themselves for sales positions. People are drawn to like people. Sales people tend to be highly social, competitive, slightly self-centered (in a good way to drive success). HCPs tend to be the grown-up version of the studious kid in high school that everyone wanted to bum homework from (yes, I was that nerdy kid, too). We need to focus more on putting the representative in front of the HCP that they want to see, want to engage/interact with, and focus less on who we like.
We need HCPs in marketing/brand departments to help drive appropriate campaigns, messages and media through which to reach their colleagues – not just market research and test messages.
We need to recognize collectively that the field representatives may be one of the biggest assets a company has currently – they can be a huge wealth of information pertinent to advancing our products/business. We just need to give them the opportunity to candidly share what it’s really like without fear of being rogue and possibly losing their position to someone more willing to “play the game” and not ruffle feathers.
Dana many thanks for your pointers, both you and Jon have given excellent points of view and incites into the world of pharmaceutical sales. I don’t really think I can add to your synopsis nor would I want to. I feel what you have brought to the table is a very realistic opinion and well structured view of a seasoned pharmaceutical seller who as I would expect knows their subject inside out. I also agree that the most important part of this is the fact that the relationship between a rep and physician is of the utmost importance and cannot be replaced. I knew when I wrote this post that of would not be popular that is to say it would not get the responses my social media tweets and posts receive. I am now trying to think of ways go get more people talking about this important subject. The question is how, it is far to big to ignore, these relationships could change clinical trials, e detailling, the way patients are treated world wide, social media, info released post market, all marketing and drug info world wide, the possibilities of this simple relationship are limitless…
I agree with your opinion, which is “social media should also complement and be tailored to existing offline sales and marketing techniques.”
Social media is just useful media like TV, newspaper, or Phone. That’s powerful, but it doesn’t mean social media replace human.
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Sales force is still the most effective sales source. We just need better sales people.
На солько я помню это уже было где-то на сайте, может кто-то предложит другое решение
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