Dr. Benjamin Brewer writes a bi-weekly column for the Wall Street Journal called, “The Doctor’s Office“ (subscription required). It’s a good homespun view of the small-town family practitioner (Dr. Brewer works out of Forrest, IL) and yesterday’s piece offered an important retrospective following Dr. Brewer’s decision to ”stop seeing drug company sales representatives.” I’m covering it because I think there’s change afoot here (Wyeth and Pfizer have both announced drug rep pullbacks over the last couple years), and because the issue ultimately boils down to ”samples” and an information services problem, the latter a topic I can’t put down.
Let’s put samples aside for a minute. Improved healthcare information services are going to be the defining factor in reversing our ballooning healthcare expenditures. The application thereof is worth considering and Chrysalis has placed bets in the field, specifically on HealthMedia and FWI, which owns VerusMed. HealthMedia addresses the consumer via online health-related programming and VerusMed delivers information to physicians via pharma-sponsored, objective newsletters (both digital and print). VerusMed addresses Dr. Brewer’s need for up-to-date information. Interestingly, he suggests the following:
Rather than employ a host a [sic] people to make sales calls or bring lunch for my staff, I’d like the industry to put their educational programs online and make a charitable donation each time I view new material. There is a possibility of bias in the information, as with most any form of communication or marketing. But at least with the Internet I can filter it better and won’t be as susceptible to slick in-person pitches.
The rep business is pharma’s chief advertising tool and one it won’t quickly give up. Wyeth’s and Pfizer’s recent decisions to cut back such forces notwithstanding, the below Economist chart shows the rapid rise in sales reps over the seven year period from ‘95-’02 (for the curious, Viagra was introduced in ‘98).
Note that the charted comparison is indexed to 1995 and actual reps numbered 90k in 2002 as compared to 850k doctors; the ratio of reps to docs, however, has increased two-fold. In fact, the glut of such reps has forced them to pitch their wares quickly - an average of 3.5 minutes per visit! - while competing amongst a herd of their peers (and patient flows per the 8-minute patient visit).
Many folks don’t realize that drug reps are charged with educating doctors about both new treatments and changing therapeutic protocols. It’s a sales pitch but there’s an element of ”value-added service.” Sans such detailers, as they’re called in the business, Brewer has received a surprising amount of flak in WSJ’s forum supplement to the column. In my view, though, Brewer has hit the nail on the head with online educational programs. Drug reps won’t go away, but we’re going to see more objective, better tailored, information distributed to doctors outside the purview of ”slick in-person pitches.” And many docs will be willing, I’m sure, to accept samples via similar channels.
Hey Matt,
Cool companies you mentioned that you guys have invested in.
As an aside, I can’t resist the temptation to clarify that the average Primary Care Physician (PCP) rep actually gets no where near 3.5 minutes per visit. When I did ride-withs for a top-top-5 Pharmaceutical companies in my strategy consulting gig, the average was more like 8 seconds (!). Most rep visits to PCPs are literally only a sample delivery mechanism. Back in the good ole days, before the reps arms race, PCP reps were seen as value add as you mention. But not anymore.
Specialists on the other hand are more about being on the bleeding edge of innovation. Whereas PCPs need to have a broad knowledgebase, Specialists need to know what the latest drugs are in their specialty. They need to know what the hottest and newest pills are, and so the reps really add that value-added service that you mention (these reps are also generally better trained and have a deeper life sciences background than PCP reps too). Those visits are longer — maybe near 3 minutes on average — but still pretty short.
I agree that eDetailing is definitely seen as a way to help ease the PCP rep arms race… many Pharma companies have been pushing this for some time, even requiring that doctors watch an eDetail before they can order additional samples. But change is slow. eDetailing is in particular being pushed in rural areas — areas where the reach & frequency model is too inefficient.
just my two cents…
st
Sarah:
Great perspective - thanks for sharing, and showing exactly why blogging works as a knowledge refinement/thought genesis tool.
As you suggest, I would expect PCP detailing operates differently in Forrest, IL than in the more densely populated areas I’m suspecting you visited(?). ROI is more difficult to justify, and competition less intense, so, barring eDetailing, visits lengthen. Note Dr. Brewer’s assertion that he could replace his detailers (as many as six) with one to two patient visits per day. Anway, he’s likely an outlier and your clarification is well received!
Best,
Matt