Healthy Skepticism Library item: 11108

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

Lowes R.
What drug rep visits cost you
Medical Economics 2007 Aug 384:(15):49-51
http://www.memag.com/memag/article/articleDetail.jsp?id=443728&pageID=1&sk=&date=

Full text:

By swearing off meetings with detailers, some doctors are seeing more patients-and watching their earnings rise.

Benjamin Brewer, an FP in Forrest, IL, turned up the heat on pharmaceutical representatives by framing a simple question: Are their visits worth the patient encounters they cost a doctor?

In 2005, Brewer decided that the 15 or so drug reps-also known as detailers-who visited his office each week distracted him from patient care. So he went cold turkey, refusing to meet with them or accept their samples. Life without reps, as he recently wrote in his online column for The Wall Street Journal, has allowed him to treat a few more patients each week, and earn an extra $6,300 a year.

“I didn’t think rep visits cut into my time with patients, but a few minutes here and a few minutes there added up,” says Brewer.

It’s not just the money or the productivity at issue; it’s the overall value of detailing visits, which have faced increasing criticism in recent years. Doctors like Brewer, who find them expendable, view the samples they leave behind as an attempt to lock patients into new medications.

Not everyone sees it that way. Most of the doctors we informally surveyed welcome the attractive men and women who show up with pizzas and meds. But many have nevertheless tried to rein them in, only meeting with them during lunch hour, for example, or limiting how many can come to the office on a given day. Here’s a closer look at how some doctors deal with detailer visits.

“Reps cost us far too much money”

Nationwide, there are an estimated 90,000 to 100,000 reps; each calls on eight to 10 physician offices a day. Some practices may get only two to four visits a week. However, in 2005 and 2006, primary care physicians deemed as “heavy prescribers” were called on by an average of 29 reps a week, according to Health Strategies Group, a research firm that tracks the pharmaceutical industry.

How those visits break down hints at the possible strain on physician practice: In 2005, 85 percent were drop-ins, 5 percent were appointments, and 10 percent were lunch dates.

Hearing a drug spiel over a fajita wrap may not disrupt the schedule, but drop-ins and appointments eat up roughly 60 minutes a week, Health Strategies Group reports. If you used that extra time to see four established Medicare patients, using CPT code 99213 for an intermediate visit, you’d collect roughly $60 per visit, $240 per week, and $12,000 over 50 weeks. Subtract 50 percent for overhead, and you’d net an extra $6,000 a year-just a hair under what Brewer cleared after dropping rep visits.

Some doctors eliminate face-to-face conversations but still accept samples, a practice FP Patti Roy in Muskegon, MI, started 10 years ago that freed up a whopping three hours a week. “The staff brings me the form to sign for samples,” says Roy. “I don’t even say good morning to the reps.”

The three-doctor Acacia Family Medical Group in Salinas, CA, takes the same signature-only approach. “We’re convinced reps cost us far too much money,” says FP and group president Sumana Reddy. “I have always wondered how doctors can spend that precious time listening to a solicitation.”

Yet many physicians insist there’s little time lost, since they book the maximum number of patients and see drop-in detailers in between. That time management strategy sounds good in theory; in practice, it can derail a doctor’s schedule-and annoy patients.

“Every rep visit makes the patient wait an extra five to 10 minutes,” says pediatrician Tammi Schlichtemeier in Coppell, TX. “I often hear their frustration when they open the exam room door, only to find me talking to a rep. The question is always, ‘How much longer?’ “ To stay on track, Schlichtemeier limits detailers to 9 to 11 a.m. and 2 to 4 p.m., with no more than two per session

Why some doctors love their reps

Time constraints aside, most of the doctors we interviewed say the benefits of rep visits outweigh any disadvantages.

They’re particularly thankful for the free drugs. “Samples help a lot, especially for the significant percentage of our patients who can’t afford high-priced medicines,” says urologist Sivaprasad Madduri in Poplar Bluff, MO. In all, 78 percent of doctors accept samples, according to a recent study published in The New England Journal of Medicine.

There’s also appreciation for the product information detailers provide. “A drug I’m prescribing has been reformulated, and if I hadn’t heard this from the rep, I’m not sure there would have been an easy way to find it out,” says pediatrician Katrina Hood in Lexington, KY. New York City psychiatrist Sharon Packer credits a rep with helping to convince another specialist that a prescription he wrote for her patient had an adverse interaction with another medication.

Doctors reap other benefits. Eighty-three percent eat catered meals, according to the NEJM study. At the practice of FP Scott Jordan in White House, TN, a different rep treats the 25-member staff to lunch each day. Some doctors we interviewed see the food as an employee benefit and a productivity stimulant-nobody has to leave the office to grab a meal.

With a physician marketing budget that topped $7 billion in 2006, member firms of the Pharmaceutical Research and Manufacturers of America (known as PhRMA) shower practices with supplies-pens, notepads, staplers, exam room paper-that help keep overhead down. Patient-education materials are also a hit-ditto for golf putters and tickets to sporting events.

Then there are the intangibles. “Detailers are a wonderful community resource,” says FP Steven Kamajian in Montrose, CA. They’ve used their contacts to help him find new employees, for example. Socializing counts, too. “The few reps I see offer a break from patients-they listen to me talk,” says psychiatrist Sharon Packer.

“I got turned off being a sales target”

Despite the goodwill, the doctor-rep relationship appears to be eroding. Detailers spent 20 percent less time with doctors in 2004 than in 1999, according to Health Strategies Group. Some medical schools and academic medical centers ban samples and free lunches and admit reps only by appointment. The rationale: Freebies shouldn’t influence doctors to prescribe costly brand-name drugs when low-cost generics may be just as effective.

The pharmaceutical industry contends that modest meals don’t hinder a doctor’s ability to render independent professional judgments. And drugmakers defend samples, saying they not only help the uninsured, but also make it easier for doctors to test the efficacy of a new treatment.

Patti Roy takes the middle ground. She dispenses samples for chronic conditions only after establishing that a generic can’t do the job and sees no harm in using a sample antibiotic for an acute illness, because it doesn’t lead to a long-term prescription. But she avoids reps because she feels she is getting sales pitches, Roy says.

Benjamin Brewer agrees. “I got turned off being a sales target,” he says. He couldn’t stand drug reps tracking his every prescription with their computer software, which was more sophisticated than his EHR.

He’s doing fine, by the way, without samples. “If a patient is uninsured, I’ll prescribe a proven generic.” He also falls back on old-fashioned charity. Brewer recently saw an unemployed patient who had run out of his antidepressants and charged zero for the visit so the man could spend his scarce dollars on meds.

With extra money in his pocket as a result of his no-rep policy, Brewer finds it easier these days to be generous.