Healthy Skepticism Library item: 1048

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Skidmore S.
Medical Partners gives reps access to doctors: For a fee, company manages sales visits
The Florida Times-Union 2003 Apr 11

Full text:

The well-groomed, suitcase-toting salesman squeezed into the chair nex
to you in the doctor’s waiting room isn’t sick, but he wants to see the
doctor as much as you do. So much so that he might pay for his visit
too.
The growing number of pharmaceutical sales representatives — an
estimated one for every 4.7 physicians — are each competing for
doctors’ increasingly limited time.
Face-to-face sales calls are the primary function of their job, but
under a new service being offered by a Jacksonville-based startup
Medical Partners, reps may now pay for access.
The physician visit is one of the most popular marketing tools in
medicine and is a multibillion-dollar marketing expense for the behemoth
pharmaceutical industry. During the visit, sales reps detail the
benefits of their product by offering new information, samples, research
or by simply answering doctors’ questions with the hope of swaying
prescribing habits in their company’s favor.
But the borders of the industry standards are changing, and now the
business tactics are following.
“Up until five or six years ago [reps] had carte blanche with doctors,”
said Sam Hinson, a former pharmaceutical rep and director of business
development for Medical Partners. “They had an unlimited expense account
for doctors and open access to meet with them. Then most of the seats
[in the waiting room] were taken up by sales reps rather than patients,
so a lot [of practices] limited, restricted or eliminated it
completely.”
The company launched in November of 2002 to help physicians manage the
growing number of pharmaceutical representatives trying to get in the
door: There are more than double the number of reps in 2001 than in
1996.
Medical Partners is not the first company to use fees as a management
tool for representative visits. The Polyclinic, a busy Seattle medical
practice, charges reps $30 for one hour’s access; and for $200, reps get
eight hours but no guarantee of time with a physician. Queen’s City
Physicians in Cincinnati created a subsidiary, Physician’s Access, to
charge drug companies $65 for a 10-minute meeting. And Time-Concepts, a
Crestview, Ky., company gives physicians a $50 payment for a 10-minute
visit.
In response to the volume of visitors, some physicians and clinics limit
the number or type of visit, but a handful charge directly for their
time used by a rep or have companies like Medical Partners do it for
them.
For a fee, the company schedules everything from the staple five-minute,
face-to-face meetings with the doctor to occasional symposiums or
programs involving multiple physicians. Physicians contract with the
company and agree only to see reps scheduled by Medical Partners. Reps
who want to see physicians log in online, set up their appointment and
pay a fee. For a five-minute time slot, the rep pays $35; $20 of this
goes to the physician. Physicians can keep the money or choose for it to
go to a charity or other group. Physicians agree to make their best
effort to meet with the rep in a timely matter.
This new twist on the relationship between pharmaceutical companies and
physicians puts doctors in the spotlight typically reserved for the drug
companies.
The pharmaceutical industry’s infamous perks — a lunch, a pen, any
tchotchke left behind to separate their name from the pack — are
standard practice. But in the past few years when this tactic appeared
to become occasionally excessive, the American Medical Association and
pharmaceutical trade group PhRMA clarified guidelines and launched an
educational campaign on acceptable relationships between physicians and
reps.
AMA has had long-standing recommendations to avoid pharmaceutical
industry influence on medicine but launched its efforts as a reminder of
the importance of the guidelines. According to the AMA it became clear
that exorbitant gifts, trips and other perks were becoming more
commonplace, and the association wanted to avoid any possible conflicts
of interest. PhRMA endorsed the recommendations for its members as well.
Guidelines recommend physicians only accept gifts or other services or
goods of modest value and only if they relate to the practice and have
no strings attached.
But when it comes to actual payment for visits, the American Medical
Association guidelines prohibit cash payments. And in all the gray areas
of pharmaceutical influence, this issue remains a clear black and white
one to Leonard Morse, chair of the Council on Ethical and Judicial
Affairs for the AMA.
“Genuine services receive compensation, but in this situation it is the
rep who offers the service, namely the education of the physician,” said
Leonard Morse. “Doctors are not compensated for education.”
The several pharmaceutical companies contacted stood behind PhRMA’s
position but declined to comment directly. But several reps said their
companies will not reimburse them if they use services such as Medical Partners.
“Sales representatives are technically trained, and it is not only a
chance for a sales pitch, it’s a chance for asking technical questions,”
said Jeff Trewhitt, spokesman for PhRMA. “Doctors should want to get
this information.”
But some doctors argue the educational information is a ruse for
marketing in most cases.
“I do not get my medical education from a pharmaceutical rep that has an
accounting degree, they do not have a Ph.D. in pharmacology, they do not
have a medical degree,” said Oscar Rodas, a Jacksonville internal
medicine physician. “I don’t rely on them for my education.”
He said in most cases the meetings are primarily giving the reps a
chance to market their products, but he does not see a conflict of
interest in these arrangements.
“At least with the physicians I know, none of us have ever been
influenced by something a drug company does in our prescribing habits.
… Ultimately, we make our decision based on how a patient will react
to a treatment, and we are responsible for that,” Rodas said.
His clinic has tried for years to schedule reps with some success, but
it still has anywhere from eight to 10 reps drop in each day, which is
an interruption to business. Rodas said he has been approached by
several groups for this arrangement and is likely to sign up with
Medical Partners because he feels the arrangement compensates for the
time he spends with reps.
Medical Partners said it intentionally kept the fee lower so financial
gain would not be an incentive for physicians. However, by charging a
fee, the company said there may be more respect for the importance of
the meeting.
As a former rep himself, Hinson said much of the educational and drug
efficacy information that can be given in a visit is often overlooked
because the benefit of a rep visit is outweighed by the resulting
disruption to the office. The professional interaction has been lost
when reps spend hours waiting to talk to a physician or only drop off
samples but he hopes his company can help rebuild the benefit of the
relationship.
“Once they see the value in it — they’ll embrace it. I’m confident in
that,” Hinson said.
Pharmaceutical reps contacted were prohibited by company policy to speak
with the Times-Union.
Medical Partners is running its trial program now. The company has
signed up 10 to 12 physicians so far and it will be ready to start its
program at the beginning of May with 40 physicians.
Following the trial here, the company hopes to expand in Florida.