Meals, Medications and Market Share: Meals, Medications and Market Share Understanding the Tenuous Relationship of Physicians and Pharmaceutical Representatives Travis C. Batts, Capt, USAF, MC Wilford Hall Medical Center


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


The Case: The Case As he leaves the exam room, the tranquility of his daily routine is abruptly disrupted……………. MERCK PFIZER ELI LILLY SCHERING-PLOUGH BRISTOL-MYERS GSK DOES THIS REALLY OCCUR????????


OVERVIEW: OVERVIEW HISTORY REPRESENTATIVE TRAINING INDUSTRY STRUCTURE Barriers to Success Product Driven vs. People Driven ROLES CONCLUSION


HISTORY: HISTORY When did it all start? Late 19th century Eli Lilly and Squibb only national companies (manufacture >> development) 1895 diphtheria and tetanus antitoxin produced initially France/Germany later in New York 1906 Food and Drug Act (The Wiley Act) 1911 U.S. v. Johnson 1912 Shirley Amendment WWI/WWII increased need for products but goods produced abroad 13 companies formed to increase production of dried plasma and penicillin Post war expansion


HISTORY: HISTORY Pharmaceutical Representatives ………. Courtesy of Sylvian Cazalet


TRAINING: TRAINING Undergraduate School Science vs. Business Foreign Language, Math, Accounting Postgraduate Education MBA MPH PhD MD


TRAINING: TRAINING ONCE HIRED, LET THE LEARNING BEGIN What is your strength? Science or Business What are your assets? Familiar with territory Relationships Knowing the lay of the land Community Connections “Stickablity”


TRAINING- Knowing the Drug: TRAINING- Knowing the Drug Pharmacology Pharmacodynamics Drugs on the Body Pharmacokinetics Body on the Drugs Time of abs Duration of action Distribution Method of excretion Physiology in the context of the pharmacology Disease States Symptoms Complications Costs TIME CONSUMING


Training- Knowing How to Sell: Training- Knowing How to Sell Learn your territory The Doctors The Staff The Patients (patient population) Marketing Travel for training Shadowing Doctors Representatives


Industry Structure: Industry Structure National Level Regional Level (Director) Regulate training and testing Dictate % market share change needed Predict rate of change in accordance to national mandates District level (Manager) Facilitates all of the above Give Quarterly Data/Updates to Reps Regulates Territory Territory (Pharm Rep)


Industry Structure: Industry Structure


Industry Structure: Industry Structure How it works Representative learns the drug New vs. Old (patent length) Representative learns the district/territory The Doctors, Staff, Patient Population Computer Based Prescribing Info Queries (1-5) 1- few scripts of your drug (what he writes, why he writes it, and how can I make him change?) 5- Heavy hitter, enjoy having him on your team (How do you keep him writing? Can he write more?) 2-4- Marketing/Needs/Visits


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


Barriers to Success: Barriers to Success Patent Life (20 years but decreased with R&D) Source: Pharmaceutical Research and Manufacturers of America Industry Profile 2002.


Barriers to Success: Barriers to Success Growing Generic Drug Market Health Policy Prescriptions, Vol. 1, No. 9, Pacific Research Institute (Sept. 2002).


Barriers to Success: Barriers to Success Shift in advertising American Medical News December 25, 2006


Barriers to Success: Barriers to Success Competition External vs. Internal New vs. Old Urban vs. Rural vs. Suburban


Barriers to Success: Barriers to Success Laws Regulations/Reforms Pharmaceutical, Research and Manufacturers of America (PhRMA Code) General Interactions CME Entertainment Consultants Educational/Health care practice related items No Free Lunch Association Guidelines AMA, ACP, ACCME


Roles of the “Actors”: Roles of the “Actors” Goals Controlling agenda Influencing outcomes Representative Vendor Educator Donor Physician Purchaser Information Seeker 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 Expanded Short conversations dictate large amounts of power/influence Effective encounters occur only in the context of a performance Adapted from: Dramaturgal Study of Meeting… (Goffman’s Model) Somerset et al, BMJ 2001


The Performance: The Performance Scene 1 - Recognition of status Scene 2 – Assessing Ability/Understanding Scene 3 – Cost/Benefit Analysis Scene 4 – Turning Point (+, -) Scene 5 - Reinforce status/stature Scene 6 - Closure Adapted from: Dramaturgal Study of Meeting… (Goffman’s Model) Somerset et al, BMJ 2001


Conclusion: Conclusion Pharmaceutical industry has long history closely tied to medical economics Understanding training that representative undergo may help in understanding their role Keep in mind, primary goal is market share growth Evaluate your performances, making sure your integrity is not compromised in the interaction


Questions??????: Questions?????? ROCK CHALK JAYHAWK!


References: References Somerset et al. BMJ. Vol 323. DEC 2001 Backer E. Journal of Family Practice. SEP 2000 Health Policy Prescription. Vol 1, No 9, (SEP 2002) Studdert et al. NEJM. Vol 351; 18 AMA New. DEC 25, 2006 IMAGES WERE OBTAINED FROM GOOGLE IMAGE WITH FOLLOWING KEY WORDS: pie, jayhawk, Shakespeare, salesman, united states, pharmacologic graph