Meals, Medications and Meals, Medications and Market ShareMarket Share

Understanding the Tenuous Understanding the Tenuous Relationship of Physicians and Relationship of Physicians and

Pharmaceutical RepresentativesPharmaceutical Representatives

Travis C. Batts, Capt, USAF, MC

Wilford Hall Medical Center

The CaseThe Case

A physician enters his busy suburban A physician enters his busy suburban practice on the outskirts of Metro practice on the outskirts of Metro city. He sees an average of 30-50 city. He sees an average of 30-50 patients daily but finds his job patients daily but finds his job fulfilling and enjoyable. He fulfilling and enjoyable. He effortlessly glides from room to room effortlessly glides from room to room believing each patient has a unique believing each patient has a unique and dynamic problem, that only he and dynamic problem, that only he can accurately address. can accurately address.

The CaseThe Case As he leaves the exam room, the As he leaves the exam room, the

tranquility of his daily routine is abruptly tranquility of his daily routine is abruptly disrupted…………….disrupted…………….

MERCK PFIZER

ELI LILLY

SCHERING-PLOUGHBRISTOL-MYERS

GSK

DOES THIS REALLY OCCUR????????

OVERVIEWOVERVIEW

HISTORYHISTORY REPRESENTATIVE TRAININGREPRESENTATIVE TRAINING INDUSTRY STRUCTURE INDUSTRY STRUCTURE Barriers to SuccessBarriers to Success

• Product Driven vs. People DrivenProduct Driven vs. People Driven ROLESROLES CONCLUSIONCONCLUSION

HISTORYHISTORY

When did it all start?When did it all start?• Late 19Late 19thth century Eli Lilly and Squibb only national century Eli Lilly and Squibb only national

companies (manufacture >> development)companies (manufacture >> development)• 1895 diphtheria and tetanus antitoxin produced 1895 diphtheria and tetanus antitoxin produced

initially France/Germany later in New Yorkinitially France/Germany later in New York• 1906 Food and Drug Act (The Wiley Act)1906 Food and Drug Act (The Wiley Act)• 1911 U.S. v. Johnson1911 U.S. v. Johnson• 1912 Shirley Amendment1912 Shirley Amendment• WWI/WWII increased need for products but goods WWI/WWII increased need for products but goods

produced abroadproduced abroad 13 companies formed to increase production of dried plasma 13 companies formed to increase production of dried plasma

and penicillinand penicillin

• Post war expansionPost war expansion

HISTORYHISTORY

Pharmaceutical Representatives ……….Pharmaceutical Representatives ……….

Courtesy of Sylvian Cazalet

TRAININGTRAINING

Undergraduate SchoolUndergraduate School• Science vs. BusinessScience vs. Business• Foreign Language, Math, AccountingForeign Language, Math, Accounting

Postgraduate EducationPostgraduate Education• MBAMBA• MPHMPH• PhDPhD• MDMD

TRAININGTRAINING

ONCE HIRED, LET THE LEARNING BEGINONCE HIRED, LET THE LEARNING BEGIN• What is your strength?What is your strength?

Science or BusinessScience or Business

• What are your assets?What are your assets? Familiar with territoryFamiliar with territory

• RelationshipsRelationships• Knowing the lay of the landKnowing the lay of the land• Community ConnectionsCommunity Connections• ““Stickablity”Stickablity”

TRAINING- Knowing the DrugTRAINING- Knowing the Drug PharmacologyPharmacology

• Pharmacodynamics Pharmacodynamics Drugs on the BodyDrugs on the Body

• PharmacokineticsPharmacokinetics Body on the DrugsBody on the Drugs

• Time of absTime of abs• Duration of actionDuration of action• DistributionDistribution• Method of excretion Method of excretion

• PhysiologyPhysiology in the context of the pharmacology in the context of the pharmacology Disease StatesDisease States

• SymptomsSymptoms• ComplicationsComplications• CostsCosts

TIME CONSUMING

Training- Knowing How to SellTraining- Knowing How to Sell

Learn your territoryLearn your territory• The DoctorsThe Doctors• The StaffThe Staff• The Patients (patient population)The Patients (patient population)

MarketingMarketing• Travel for trainingTravel for training

ShadowingShadowing• DoctorsDoctors• RepresentativesRepresentatives

Industry StructureIndustry Structure National LevelNational Level Regional Level (Director)Regional Level (Director)

• Regulate training and testingRegulate training and testing• Dictate % market share change neededDictate % market share change needed• Predict rate of change in accordance to national Predict rate of change in accordance to national

mandatesmandates District level (Manager)District level (Manager)

• Facilitates all of the aboveFacilitates all of the above• Give Quarterly Data/Give Quarterly Data/UpdatesUpdates to Reps to Reps• Regulates Territory Regulates Territory

Territory (Pharm Rep)Territory (Pharm Rep)

Industry StructureIndustry Structure

Industry StructureIndustry Structure

How it worksHow it works• Representative learns the drugRepresentative learns the drug

New vs. Old (patent length)New vs. Old (patent length)

• Representative learns the district/territoryRepresentative learns the district/territory The Doctors, Staff, Patient PopulationThe Doctors, Staff, Patient Population

• Computer Based Prescribing InfoComputer Based Prescribing Info Queries (1-5)Queries (1-5)

• 1- few scripts of 1- few scripts of youryour drug (what he writes, why he drug (what he writes, why he writes it, and how can I make him change?)writes it, and how can I make him change?)

• 5- Heavy hitter, enjoy having him on your team 5- Heavy hitter, enjoy having him on your team (How do you keep him writing? Can he write more?)(How do you keep him writing? Can he write more?)

• 2-4- Marketing/Needs/Visits2-4- Marketing/Needs/Visits

Industry StructureIndustry Structure

Think about it like pie……..Think about it like pie……..• THE MARKET = THE PIETHE MARKET = THE PIE• You must/can SHARE the pie = You must/can SHARE the pie = market sharemarket share• The more slices of pie you have………The more slices of pie you have………

Barriers to SuccessBarriers to Success

Patent Life (20 years but decreased with R&D)Patent Life (20 years but decreased with R&D)

Source: Pharmaceutical Research and Manufacturers of America Industry Profile 2002.

Barriers to SuccessBarriers to Success

Growing Generic Drug MarketGrowing Generic Drug Market

Health Policy Prescriptions, Vol. 1, No. 9, Pacific Research Institute (Sept. 2002).

Barriers to SuccessBarriers to Success

Shift in advertisingShift in advertising

American Medical News December 25, 2006

Barriers to SuccessBarriers to Success

CompetitionCompetition• External vs. InternalExternal vs. Internal• New vs. OldNew vs. Old• Urban vs. Rural vs. SuburbanUrban vs. Rural vs. Suburban

Barriers to SuccessBarriers to Success

Laws Regulations/ReformsLaws Regulations/Reforms• Pharmaceutical, Research and Manufacturers of Pharmaceutical, Research and Manufacturers of

AmericaAmerica (PhRMA Code)(PhRMA Code) General InteractionsGeneral Interactions CMECME EntertainmentEntertainment ConsultantsConsultants Educational/Health care practice related itemsEducational/Health care practice related items

• No Free LunchNo Free Lunch• Association GuidelinesAssociation Guidelines

AMA, ACP, ACCMEAMA, ACP, ACCME

Roles of the “Actors”Roles of the “Actors” GoalsGoals

• Controlling agendaControlling agenda• Influencing outcomesInfluencing outcomes

RepresentativeRepresentative• VendorVendor• EducatorEducator• DonorDonor

PhysicianPhysician• PurchaserPurchaser• Information SeekerInformation Seeker• Recipient Recipient

Adapted from: Dramaturgal Study of Meeting… (Goffman’s Model) Somerset et al, BMJ 2001

Roles of the “Actors”Roles of the “Actors” Goffman Model Goffman Model

ExpandedExpanded• Short conversations Short conversations

dictate large amounts dictate large amounts of power/influenceof power/influence

• Effective encounters Effective encounters occur only in the occur only in the context of a context of a performanceperformance

Adapted from: Dramaturgal Study of Meeting… (Goffman’s Model) Somerset et al, BMJ 2001

The PerformanceThe Performance

Scene 1 - Scene 1 - Recognition of statusRecognition of status

Scene 2 – Scene 2 – Assessing Ability/UnderstandingAssessing Ability/Understanding Scene 3 – Scene 3 – Cost/Benefit AnalysisCost/Benefit Analysis

Scene 4 – Scene 4 – Turning Point (+, -)Turning Point (+, -)

Scene 5 - Scene 5 - Reinforce status/statureReinforce status/stature

Scene 6 - Scene 6 - ClosureClosure

Adapted from: Dramaturgal Study of Meeting… (Goffman’s Model) Somerset et al, BMJ 2001

ConclusionConclusion

Pharmaceutical industry has long history Pharmaceutical industry has long history closely tied to medical economicsclosely tied to medical economics

Understanding training that representative Understanding training that representative undergo may help in understanding their undergo may help in understanding their rolerole

Keep in mind, primary goal is market Keep in mind, primary goal is market share growthshare growth

Evaluate your performances, making sure Evaluate your performances, making sure your integrity is not compromised in the your integrity is not compromised in the interactioninteraction

Questions??????Questions??????ROCK CHALK

JAYHAWK!

ReferencesReferences Somerset et al. BMJ. Vol 323. DEC 2001Somerset et al. BMJ. Vol 323. DEC 2001 Backer E. Journal of Family Practice. SEP 2000Backer E. Journal of Family Practice. SEP 2000 Health Policy Prescription. Vol 1, No 9, (SEP 2002)Health Policy Prescription. Vol 1, No 9, (SEP 2002) Studdert et al. NEJM. Vol 351; 18Studdert et al. NEJM. Vol 351; 18 AMA New. DEC 25, 2006AMA New. DEC 25, 2006

IMAGES WERE OBTAINED FROM GOOGLE IMAGE WITH FOLLOWING IMAGES WERE OBTAINED FROM GOOGLE IMAGE WITH FOLLOWING KEY WORDS: pie, jayhawk, Shakespeare, salesman, united states, KEY WORDS: pie, jayhawk, Shakespeare, salesman, united states, pharmacologic graphpharmacologic graph