The New Detail: Creating Value

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Preserving access for representatives with physicians and creating win-win relationships are two major challenges facing the industry, but opportunities exist for creative people committed to healthcare and the value of medicine. The new reality of medical practice is that time is a very limited commodity. Today’s practice managers track physician productivity. Because patient visits equal cash flow, time not spent in the pursuit of seeing more patients or doing something with patients is viewed as a wasted opportunity. “At the HMO where I practice, I must continually justify my employment in terms of the number of patients seen or procedures performed,” says B. Eliot Cole, M.D., MPA, executive director of the American Society of Pain Educators. “This oversight of my time is despite the fact that I have been able to detect serious misbehavior and lower plan risk, in one case, by simply changing from medications that did not work to ones that did, which saved my plan $60,000 annually for a single patient. The time I spend counseling those charged with making critical plan decisions also doesn’t count financially. “Where does that leave the pharmaceutical representative who desperately wants to meet with me?” Dr. Cole continues. “Most likely out in the lobby or in the office of the pharmaceutical plan manager, but not in my office talking with me. And I am not unusual. My colleagues across all disciplines and in all practice settings are facing the same time-constraint issues.” Because the time physicians spend must be productive, they continually ask: Is this meeting with a sales rep worth reduced revenue for the plan? Should time be taken from seeing more patients or should I give up very limited break time? Will the quality of the experience exceed expectations? These are not irrelevant questions or concerns; they are a blueprint for the successful representative. Smart reps will take the time to do their homework so they know the physicians they are calling on — and the field in which they toil — well enough to get past the label on the shingle. “Other physicians and I live to help our patients, therefore making us more effective physicians must be the objective for the pharmaceutical representative,” Dr. Cole says. Improving the Visit He offers the following suggestions for improving the sales rep/physician relationship: • Identify what physicians want to hear about the product and how it can be used to help their patients right now, and tailor this information to the practice. “Few of us are interested in hearing about studies that bear no applicable information to our practice styles,” Dr. Cole says. “Most of us are not interested in learning just that the product works. We already are aware of that; after all, we let you into our offices because we know the FDA determined your product is safe and efficacious, and it has gone through rigorous clinical trials.” • Get to the point without tricks or misleading information: How do physicians use the medication? Which are the better candidates? “Reps need to speak to how their medication is better than the one a physician already is using,” Dr. Cole says. “It is helpful to surprise us occasionally by giving us new information about the context in which the product is being used. Give us value beyond the product itself.” • Provide the scientific materials on the broader nature of the mechanism of action, showing that the product has wider utility or works through some complex biophysiological mechanism. “Merely providing information from the package insert, which we have already read, in a nice leave behind is not worth our time,” he says. • Provide information from a national or international conference that a physician could not attend. “Knowing what events a physician attends and providing data from the event, which might perhaps give the physician a new treatment option for his or her next patient, is definitely over the top,” Dr. Cole says. • Fill the physician’s knowledge gap with information about something he or she really doesn’t know, or perhaps doesn’t even realize he or she doesn’t know. “This interaction would increase the reps’ value so it would be worth missing lunch, delay the start of a very busy day, or even induce a physician to stay a little later,” he says. Value Starts with the Right Training Most often, pharmaceutical representatives are trained from within their own companies. But it makes significantly more sense for representatives to be trained by the actual physicians in a specific practice area. The idea of pharmaceutical sales representatives trained in specific practice areas offers more than just another detailing piece, a box of donuts, a nice pen, or a few starter coupons for the physician’s next five patients. “The good news is that this is being done in my specialty, pain management,” Dr. Cole says. “Recently, the American Society of Pain Educators, which I helped found because I recognized these needs, partnered with one leading pharmaceutical company to offer Certified Pain Representative (CPR) training. The intent of this program is to prepare selected pharmaceutical representatives to meet with pain practitioners who come from such different backgrounds as anesthesiology, neurology, orthopedics, physical medicine and rehabilitation, psychiatry, and others.” Dr. Cole says rather than talking about their products, these specially trained CPRs are able to weave the story of their medication and its role into the overall practice of pain medicine. They understand the differences in skill sets between pain professionals, know about the myriad pain-management organizations and societies, and appreciate the practice philosophy of each clinician. This allows CPRs to tailor their presentations and marketing approaches to bring much appreciated individualized information. CPRs deliver value beyond product and exceed the expectations of their physicians. In the end, Dr. Cole says well-prepared and well-trained pharmaceutical representatives will have a much better chance at getting face time with physicians and perhaps teach “all of us old dogs a new trick.” “For all of the bad press about detailing, the bottom line is that physicians learn much about new products from pharmaceutical representatives and need to have contact with them,” he says. “Hopefully, as we sort through the new rules, we can preserve access for sales representatives with physicians and create win-win relationships. These are challenging times, but opportunities always exist for creative people committed to healthcare and the value of medicine.”F B. Eliot Cole, M.D., MPA, is Executive Director of the American Society of Pain Educators, Montclair, N.J., a nonprofit professional organization whose mission is to improve the standards of clinical-pain practice by providing training in pain-management education and helping to establish credentialed pain educators (CPEs) as standing resources within pain practices, hospitals, healthcare systems, and long-term care facilities. For more information, visit paineducators.org. Dr. Cole also is an internationally recognized expert in pain management, professional education, biomedical ethics, and healthcare policy issues. Additionally, he serves as a consultant in Pain Management for Kaiser Permanente Medical Group in Honolulu. PharmaVOICE welcomes comments about this article. E-mail us at feedback@pharmavoice.com. For all of the bad press about detailing, the bottom line is that physicians learn much about new products from pharmaceutical representatives and need to have contact with them. In an exclusive to PharmaVOICE, B. Eliot Cole, M.D., MPA, Executive Director of the American Society of Pain Educators, discusses how sales reps can improve their interactions with physicians. It makes sense for sales representatives to be trained by the actual physicians in a specific practice area. This allows reps to tailor their presentations and marketing approaches to bring much appreciated individualized information. improving the sales rep/physician relationship Identify what physicians want to hear about. Get to the point without tricks. speak to how their medication is better than the one a physician already is using. Provide the scientific materials on the broader nature of the mechanism of action. Provide information from a national or international conference. Fill the physician’s knowledge gap with information.

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