The Complicated Dance of Doctors and Drug Representatives

For many years now, pharmaceutical companies have relied on drug representatives to persuade doctors to prescribe their products. Why? Because it worked. In 2007 there were 102,000 drug reps in the field, buying lunch, delivering samples and angling for five minutes of face time with a doctor. But, as industry rules for gift exchange have changed and doctors’ time has become even more limited, this marketing model has begun to fall apart and big pharma is retrenching. Industry watchers expect a 25% reduction in the number of drug reps in circulation; recent layoffs in most of the major pharmaceutical companies are validating this projection.

But, that still leaves 75,000 or so eager young men and women idling in your waiting room, if you choose to see drug representatives. (About one in four doctors do not see reps.) What should you do?

There are plenty of reasons to simply say no to drug reps. First, they can take up your clinical time and drive your office staff a bit crazy, even if they are willing to cart in donuts, sandwiches and chef salads to grease the wheels. But perhaps more importantly and insidiously, drug reps are master sales people, shined up with a veneer of useful clinical information. Rest assured that before any drug representative sets foot in your office, she or he has studied an enormous amount of data about your prescribing patterns, including how much influence sample acceptance has on your willingness to favor their company’s drugs. The drug rep knows exactly what you may need to hear to be persuaded to increase your use of their preferred products, based on both prescribing data and field testing. Plus, the rep has been meticulously trained in how to maximize the utility of their drugs and downplay any potentially negative issues surrounding them as well.

In the face of this roundly negative information, why anyone would entertain the notion of dealing with drug reps? Because they also bring some positives to your practice. The samples they supply can make a real difference in some practices. You can try out a medication without asking the patient to invest in a prescription. You can box up a prescription’s worth of the medication for that patient who simply can’t afford it otherwise or who will probably not get around to getting the prescription filled but may be willing to take medication that you place in their hands.

Although drug reps are trained to shine the best light on their products, they can also provide useful information that saves you time learning about the products. They keep you apprised of what’s in the pipeline, why their drug is better than a competitor and how doctors are using and evaluating effectiveness.

Should you or shouldn’t you make yourself available to drug reps?

Here are some suggestions for structuring the relationship to your benefit.
1. See representatives by appointment only. Frankly, you are doing them a favor. It’s a terrible waste of time to hang around hoping to get a few minutes of your time. Everybody wins if you guarantee five minutes at a time that’s convenient for you.
2. Recognize that some of what they say to you is crafted by their knowledge of your prescribing patterns. Ask them to share that knowledge with you; you’ll at least learn something about yourself.
3. Listen to the spiel and the info with the awareness that their first job is to persuade you to use their product. Use their information as a stepping stone to gathering your own information.
4. Accept samples if they will help your patients but be aware that the drug company is trying to make you feel obligated to favor their products. Don’t think of samples as gifts that must somehow be reciprocated; they’re sales tools, pure and simple.
5. Don’t accept the lunches and other freebies; it appears inappropriate even if you are not actually swayed by these tactics.

Above all, pay attention to your own prescribing habits. Are they in fact habits or are you keeping up with the literature and adapting based on clinical evidence and patient need? Be sure you know more than the drug rep knows about how and why you prescribe.

Susan Brissette
SB Cass Associates
East Nassau, New York

1. O’Reilly, Kevin, “Doctors increasingly close doors to drug reps while pharma cuts ranks”, March 23, 2009, American Medical News, http://www.ama-assn.org/amednews/2009/03/23/prl10323.htm
2. Ibid.