Friday, March 30, 2007

Basics of Sales Rep Watching

Yesterday, as I was waiting in my doctor's office, at least seven pharmaceutical sales representatives came into and through the office, all within a 30-minute time span!

That's about one rep every four minutes! At that rate, my doctor could have seen about 60 reps yesterday.

To amuse myself, I carefully observed these reps in their natural habitat. It was an exhilarating experience that I urge everyone to try. The beauty of it is, you don't need any expensive equipment like binoculars. You are immersed in the same habitat as your prey -- you can even engage them in conversation.

There are a few essentials for the serious Pharma Sales Rep Watcher.

First, you must be able to spot a rep amongst the crowd. Almost invariably, sales reps are much younger and way better dressed than the typical watcher/patient. It's not likely that the seventy year-old woman with the walker is a sales rep. Don't even waste your energy observing that one!

Second, you must be able to identify the rep's employer. There aren't any written guides for this -- reps are very circumspect about revealing their identities to rep watchers (aka, "patients") who may be lurking in their territories. So, you'll have to be very observant.

Often the rep carries a canvas bag with a drug logo on it. Yesterday, I spotted two reps that I could identify this way: one was carrying a Zetia bag and the other a Lamictal bag. The first rep, therefore, worked either for Merck or Schering-Plough. The other worked for GSK.

A rep's bag, however, often is one of those bulky black boxes without any discerning logo. The only way to identify a rep carrying such a bag is to perhaps challenge your prey with a direct query such as "So, you're a drug rep. What company do you work for?"

This tactic, however, may spook your prey to fly the coop!

Another tactic to employ is to sneak into the back office as the rep intercepts the doctor and overhear the 30-second detail spiel. However, often the rep merely shoves a sample receipt in front of the doc for a signature and then high tails it out of there.

Sometimes, you will be lucky enough to spot two reps from the same company working in concert. This is a very rare thing, however. I was lucky enough to spot such a pair yesterday, although I could not determine what company they represented. One was tall and rather good looking; the other was short and dumpy. My doctor is a BIG woman; any rep that hopes to bar her progress through the back office hallway must be equal to the task!

When there are several reps in the office simultaneously, you are in for a treat! I've only seen this a few times. Yesterday was one of those times -- at one point there were 4 reps in the office at the same time. Two were sitting in the waiting room working on their notepad computers and two were in the back office hallway waiting to intercept the doctor.

The two reps sitting in the waiting room engaged in conversation, which was amiable. I am not an experienced Pharma Sales Rep Watcher, so I am not sure if this is a common thing or not.

One rep -- the Zetia rep -- was an experienced denizen of the habitat. The other -- the Lamictal rep -- was a newbie, trying to stake out her territory. The Zetia rep was very helpful and explained the procedure reps follow in this habitat, which is:
  1. If there are other reps, wait your turn just as if you were at a deli counter at the local Acme super market;
  2. Before entering the back office, the sales rep ahead of you must leave the back office;
  3. Ask the receptionist if it's OK to drop off your samples in the sample room;
  4. After dropping off your samples, wait in the hallway until you can accost the doctor;
  5. Get the doctor's signature and leave.
I saw this unfold before my eyes three times! It was a well-choreographed ballet!

The Zetia rep explained all these details to the Lamictal rep. She even pointed out where to find the sample closet. The Lamictal rep, however, flew out the door without ever dropping off any samples! Very unusual. I predict that her family will die of starvation, which, I am told, happens all too frequently in the harsh world of pharma sales reps.

When Pharma Sales Rep Watching, you should note carefully the sex of the rep and correlate that with the sex of the physician. The reason why this is important is that conventional wisdom says that sexual attraction between reps and doctors is exploited by the pharmaceutical industry (see "Sexy Reps Sell Rx").

In my case, six of the reps were female and one was male. The physician is female. This may have been a rare mis-matching and I am excited that I witnessed it!

At one point I couldn't help myself and I engaged the Zetia rep in conversation. I revealed that I was taking Zetia and Pravachol for my cholesterol and asked her if her company made a combination pill I could take. She mentioned Vytorin but wouldn't say any more. She suggested that my doctor could tell me more.

By watching pharma reps in their natural habitat, I learned a lot. For one thing, I was surprised at the camaraderie among reps. They all knew each others' names and shared experiences. I suppose, however, that these reps were not from competing companies. Still, this friendly repartee between reps belies the experience I had with reps on CafePharma (see "Banned from CafePharma!"), a notorious online pharma sales rep warren.

Which only goes to prove that in order to understand pharma sales reps, you must observe them in their natural habitats and you cannot believe everything you read on the Internet.


  1. I have yet to witness the all too rare mismatching but I will be watching. There is a game here potentially points for;
    1.Who can spot the most NFL Cheerleaders or NBA Dance Team Members?
    2. Best anecdote from a moment when attractive rep meets dumpy & frumpy doc.
    3. Brazen flirting and infatuation
    4. Obvious jealousy from the staff

  2. It's only a mis-match if your female doctor is straight. Need more data on sexual orientation to truly call this a mis-match.

  3. You overplay it a bit, but a lot of the "choreography" is dictated by the doctors, who don't want drug reps swarming around the office at will.
    And the main goal of this from the doctors' perspective is the samples. The samples allow us to have a patient try a medication without cost to see if there is benefit or side effects. Somewhat unfortunately, samples are only available for brand name drugs. At the same time, just because I try a brand name doesn't mean I can't use a chemically similar generic if the brand name works.
    The appearance of the drug reps has definitely changed, but look at salespeople at car dealerships, look at news anchors on TV. This is just a recognition of how people react to the appearance of someone trying to sell them something, and it's not just a phenomenon unique to doctors.

  4. Greg,

    Thank you for your comments.

    Yes, the elaborately choreographed ritual of the pharma sales rep is a result of evolution over a long period of time whereby the environment (eg, rules of the habitat set by physicians) shapes the behavior that -- by the principle of survival of the fittest -- eventually resides in the genetic makeup of rep species.

    Sampling, like the transmittal of sperm, is the ultimate goal of the rep. Sampling succes ensures the survival of the fittest specimens of the species. Hopefully, the doctor will play his or her proper role to ensure that the samples impregnate the most worthy of patients, thus closing the loop of rep-doctor-patient.

    As for appearance, yes, pharma sales reps, like other species in the sales kingdom, depend on displaying the proper plumage to close the deal.

    Obviously, this post was just the "basics," but thanks for bringing up these issues, which I may write about in a more advanced treatise on pharma rep watching.

  5. Anonymous11:13 AM

    I work in a health care facility, so I'm able to observe drug reps on a daily basis. I usually work in the back, but sometimes I'm required to go out front, in the wait area or near the receptionist's desk. So I've seen the beginnings, the middle, and the ends of these visits.

    I've never encountered an unpleasant drug rep. Their livlihood depends upon their professionalism and personalities. They all dress well. I'm always glad to see them as most people are so slack in their manner of dressing in an office environment, intil it's a very welcome sight to see them arrive, dressed so well and smiling.

    It is a true pleasure to see a woman in a nice suit and a man dressed in a suit, dress shirt and nice tie. I usually will compliment them on how nice they look. Many of them work on commission, so if they aren't nice, they WILL starve on be required to change their profession.

    I wish some of my co-workers were as nice and as meticulous as the drug reps and I sure wish more of them would come to work dressed like they're coming into an office environment rather than a motorcycle roadhouse, the beach or an adult nightclub (not all, but some) with their breasts hanging out of their blouses, portions of their midrifts showing, pants so tight it's evident if they're wearing thongs or bikini's because of the panty lines pressing through, or wearing pants with the material so thin the very patterns and colors of their undergarments are apparent.

    No, I'm not advocating they come to work dressed like they're going to a wedding or a formal dance, but they can do better. And because MOST of the employees at this company are female, why even bother with the display of their bodies? The only body I'm interested in is the body of my husband :-)

    I went off topic, but in closing, I say this! I wish them, the drug reps, much success because they are doing a service in introducing their particular company's products, thereby allowing more choices for doctors, which allows them to use those choices to introduce patients to other drugs that may be better. It gives patients a chance to try new drugs which may be more effective for their particular medical problem.

    I have HTN and because of the variety of medications, over the years my doctor has introduced me to various alternative medications based upon the features of one drug over anouther and has fine-tuned my HTN by trying various medications from Beta blockers to ACE inhibitors, Calcium channel blockers, etc., as well as changing from one brand to another because of certain side effects.

    If he has samples in his office of the the new prescription he is going to allow me to try, he always will give me samples along with the new prescription. This allows me time to use and assess the effects of the new medication before actually submitting the prescription to the pharmacist.

    Those samples were provided by drug reps who visited his office, and I'm thankful for these ladies and gentlemen.

  6. Anonymous12:50 PM

    No John, this is not Mom, but you made my day! You really made my day. God bless you!

    Oh! I apologize for the typographical errors in the previous post. I didn't proof-read before I sent the comment. And if you see any others in this one, please accept my apologies for them as well. I proofed, but may still have missed somethng.

  7. Don't worry about spelling! It's the thought that counts!

  8. Anonymous9:34 PM

    I enjoyed your take on observing the sales reps. But a few points: Most pharma companies require their reps to wear a name badge to identify their company (however, many probably don't wear the badge).

    Also, most reps know the competitive reps in their region--probably from the sample closet, where they try to place their drugs in the more prominent position! They're usually very convivial to the other reps. The industry is so incestuous that it's likely they've worked in the same field force in the past.

  9. Anonymous11:29 AM

    I am wondering why you are so interested in "watching" drug reps as you are sitting in your Dr's office. And just because your Dr if a female does not mean it is a "mis-match" that you saw more female reps than male. Reps are not told what Drs to target based on their sex. It's based on business. Also, just like in any other industry, reps do get along w/ each other very well and are mostly very courteous and respectful of each other, as well as the Dr's and their staff. You should try reading books or the newspaper and not CafePharma- that is the most ridiculous website going...

  10. I watch drug reps because there's not much else of interest hapenning in my doctor's waiting room! As a commentator on physician marketing, it's also my job to observe how reps behalf in doctor's offices, although I don't have any grant money to do it in a scientific fashion.

    Regarding CafePharma -- you are entitled to your opinion. But there are nuggets of information and entertaining views there that you will NEVER find reading books or newspapers!

  11. Anonymous7:14 PM

    When Drug Rep's come to the clinic requesting a signature;give 3 samples;the signature pad is signed. Then there is two maybe three differant brands of samples as well as How many given? Never does the drug Rep" complete the form. How many samples distributed to the Clinic? or which medication.He has a signature?Then he is gone.I wonder what is handed in to his boss? They never complete the paper work that they require before sample is left. MD's sign. Then poof gone..There is no receipt given back? What is the Policy of samples?

  12. Anonymous9:42 AM

    I am an employee in a large medical practice that employs approximately 45-50 employees. The doctors I work for will not even entertain the notion of seeing a drug rep unless they provide lunch for the entire staff. Out of a typical five day work week, we usually have no less than three lunches a week, but most often there is a lunch provided every single day. And I'm not talking about peanut butter and jelly sandwiches either. Quite often we get beautifully catered gourmet meals from high end catering establishments or restaurants. We get full lunches with elaborate menus from soup to nuts, including desserts and beverages. The whole 9 yards. This of course includes plastic utensils, napkins, paper plates and cups, etc.

    By the time it is all added up, I'm sure the price tag for these noontime extravaganzas is well into the thousands of dollars when you consider the fact that each rep is doing this five days a week. Every time I eat the food I ponder over the fact that this is why pharmaceutical drugs are so incredibly expensive. The entire population is paying for these free lunches. PLUS, it isn't doing my waistline any good either.

    I don't know when it became necessary for drug companies to provide this kind of ridiculous form of bribery to use their products, but it seems to me that if the drug they manufacture is a good one and works well for patients, they would not need to resort to bribery to put it across. Besides, isn't this a form of payola? Radio stations are not allowed to accept bribes, so why are doctors allowed to do it??

    I am probably being naive here. I know that drugs are a huge business and represent millions of dollars to the drug companies. They probably look at it as a mere drop in the bucket to pay for these lunches in order to bring in gigantic dollars in drug sales. I just cannot help but wonder if prices of medication would decrease significantly if these lunches were outlawed.

  13. Anonymous1:16 AM

    The pharmaceutical sales representative (rep) is not bribing the physician when he or she brings lunch. I think any physician would be deeply insulted at the idea that they're prescribing habits can be bought for a Panera sandwich! Rather than "buying their Rx," the rep is instead buying the physician's spare time.

    Physicians are paid, roughly, by the number of patients they see. Once upon a time, physicians had a lot more spare time during the day, but as a result of managed care pressures and reimbursement they have been forced to be far more efficient (aka, hustle!). So a physician is literally loosing money in the form of time he or she could be seeing another patient if they're doing anything else, or worse, some end up skimping on their time with other patients. The lunch time meeting emerged as a fair and convenient solution to this problem.

    Most everyone takes a moment to eat lunch, so reps are happy to accommodate and spend usually between no more than $8-15 per person. No, it's not PBJs, but it's definitely not caviar or lobster. Most every state bans such extravagance, as does the recently passed Physician Payment Sunshine Act. The physician and staff get to pause for a second and catch their breath, enjoy a meal and some light conversation in addition to learning about the benefits and side effects of the products they use in their practice as well as new ones.

    There are some physicians that decide for one reason or another that they don't want to see pharmaceutical reps. I respect their decision, whether it's because they're too busy, don't care to be social or feel that the industry is crooked and that they are concerned that they're being manipulated. That said, in my experience, physicians who don't meet with members of industry are behind their colleagues in terms of the latest data, new drugs and the ever-changing field of medicine.

  14. Anonymous1:17 AM

    My personal opinion is that it comes down to the individual. Yes, virtually all reps have quotas, but they are reasonable and based on the market history of an area. There are good reps and bad reps, just as there are good cops and bad cops, good waiters and bad waiters. However, the bad reps don't tend to last very long. Doctors and office staff don't waste their time with people who aren't providing them value or have a sleazy attitude. Think about your best and worst experiences while shopping. When a sales person helps you make a decision by understanding your needs, or helping you understand their product, aren't you thankful? Of course, there's always the "used car salesman" approach, "what's it going to take to get you to buy this car?!?" and nobody wants, or needs to hear that!

    To those who believe "good drugs sell themselves," I can assure you that there have been many great therapies that have, for one reason or another, sold poorly. Everything, from Mercedes, to mainframes to jet airliners must be sold, and physicians are like anyone else... they need to be reminded of things and taught new things, and there are new things for them to learn every day. I want my personal physician to meet with pharmaceutical reps. What I definitely do not want is for my doctor to meet with just ONE company's rep, and favor their medications.

    As for the price of drugs, consider the fact that this is dictated by insurance most of the time. Much of the promotional money was spent on the pharmaceutical "shwag" you used to see at your physician's office. Remember the note pads and pens? The clipboards, toys, and all manner of freebees? All of that is now gone. In fact, reps are themselves in decline. There are only a fraction of them now employed as compared with 8-10 years ago. You may think free lunch costs a lot, but compared with the over $1 Billion it now takes to bring a new drug through FDA review, it is very little.

    Thanks PharmaGuy for operating this site and providing a glimpse into an often misunderstood profession. I urge anyone out there who is intrigued by pharmaceutical sales people to go up and say hello to them. They don't bite, and quite often they're happy to talk to a patient and can be a great source of information about medications, insurance plans, pharmacy benefits and disease states. They might even invite you to share a sandwich. :)

    1. Anonymous5:57 PM

      Thank you "anonymous" SPOT ON!
      Oh and they are professionals and so they should be dressed in that matter.

  15. Anonymous12:35 AM

    Let me just set the record straight: Pharmaceutical representatives are people. They are patients, they are caregivers.
    They balance work and life. And, when they (or a family member) are dying, or suffering, many hope or pray for something that will preserve life and preserve quality of life.
    Describing them by physical characteristics and extracurricular activities is like believing you know Tom Cruise or Jared from Subway. You know what you see, you may have heard a comment or two or maybe you are close enough to see them monthly. But, given that no two reps are the same, it would be impossible to speculate what their exact motivations are for doing the job.
    "Well, they have to die sometime" is a comment I've heard countless times during my career as a "drug rep". If it's your child, parent or friend being treated by that physician, wouldn't you be hoping a rep would come in and challenge the status quo? If you think that every drug being marketed is a glorified therapy that already existed, check your knowledge base. And, then check your imagination.
    If you expect your doctor to know everything about everything, you may have unrealistic expectations. Doctors are also people who balance work/home/health. And, if you are a doctor and think that you know enough and don't need the education, it's time to hang up your stethoscope. If healthcare were as simple as a 15-45 minute visit (liberal estimate) and generic drugs, then it wouldn't be called the burden of healthcare. I'm sure you've heard the tale about the Smartest Guy in the Room.


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