Healthy Skepticism Library item: 1600

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Publication type: Journal Article

Berliner N.
Customized Detailing through Physician Categorization
2005 Apr;

Full text:

Overt and underlying motivators drive every action we take in life. You cross the street because there is something on the other side that you want or believe that you need. Similarly, your customers make prescribing choices based on different motivators. The better you understand your customers’
motivators, the easier it becomes to convince them of your ideas, and resultantly to sell to them. Having detailed thousands of physicians over the years, and in fact being one myself, I have grappled with how to categorize doctors in order to better understand what motivates them to take action, particularly the action of prescribing one medication vs. another.
I’ve come up with a fairly simple paradigm of motivators, consisting of 4 major categories and 2 subcategories. The system allows you to neatly fit all your doctors into a model that will help you to better customize your detailing approach.

The categories are based on what motivates doctors to prescribe a given medication, and the subcategories are based on their attitudes toward pharmaceutical representatives and drug companies. Before getting into specifics, I’ll emphasize that whether you ultimately use my system, a version of my system that you modify, or one that you devise yourself, it is important to have some system, and to utilize it with every one of your doctors. Doing so will get you in the habit of customizing every single detail that you do, and this process will eventually become second nature to you.

My four major categories for what motivates physicians are:

1. Concern for Patients
2. Objective Scientific Data
3. Money
4. Miscellaneous Agendas

The two “attitude toward reps” subcategories are:

A Pharma friendly
B. Pharma resistant

Let’s discuss the personality traits of the 4 categories of physicians and how they fit into the 2 subcategories. By doing this, we will be able to better customize selling techniques for each of your physicians.

1. “Patient Driven” These are the “warm and fuzzy” doctors who feel that they care about their patients above all else. They take the Hippocratic oath very seriously. They often do pro bono work, and feel that their role as physician implies an obligation of service and dedication. They evoke the image of the elderly general practitioner who was all too happy to make house calls. They are often religious and may be from multi-generation physician families and/or affluent backgrounds. These doctors are often resentful and leery of “big pharma”, which they see as a heartless entity that they feel overcharges their “victimized” patients. So their subcategory in this system is most often “Pharma resistant”. When you present this type of doctor with objective data, he or she will often reject that information because “nothing is more important than my years of personal experience with my patients”. They will also counter your objective data by telling you that they have “unique” patients to which your “homogenized, generic” data does not apply, because “No two patients are exactly alike”.

How should you approach “Patient Driven” customers? The first rule, which in fact applies to all your customers, is: Align, align, align. If the customer feels that you are on his or her side to begin with, the rest of your work will fall more easily into place. So show the doctor that your top priority is “the patients”. Just by saying things such as “the people that you care for” rather than “the types of cases that you see” can be very advantageous with these “warm and fuzzy” customers. Acknowledge the special or even “unique” aspect of this customer’s practice. Try to break down the barrier between these doctors and the pharma industry by offering patient driven educational materials and discount coupons. Emphasize how your company is sensitive to the needs of indigent people. Show how you and your company can team up with these customers to offer better and more economical care to their top priority, their patients. Doing this will position you more as a partnering colleague than as a salesperson.

2. “Data Driven” These doctors see themselves as thought leading, academic, and state-of-the-art intellectuals, and some of them may actually be right!
They are often snobby, and may view other people, including their patients and their drug reps, as intellectually inferior to them. Many of these customers are actually “legends in their own minds”, who hide behind the guise of high intellect, so some of them may actually be among the least bright of your customers! These people tend to be visually oriented; they like to see articles and graphic materials from their reps. They like statistics and “evidence-based” medicine. What they don’t like is to be told anecdotes, “spin”, and other unsubstantiated “information”. They are generally well organized, less spontaneous and friendly than other people, and may have little or no sense of humor. Their attitude towards reps are often highly individualized, based on whether or not the doctor feels that the rep in question is an organized, fact-driven, no-nonsense person.

So, again, alignment with the customer is essential; remember that you can’t realign someone’s thinking until that person feels some that there is some common ground between you. Base your detailing with these customers on recent articles. Keep small talk to a minimum. Think “business meeting” when you detail these doctors. These customers are very opinionated and will see you as a waste of their time if you don’t show them what they perceive as “the goods”.

3. “Money Driven” Many physicians, and people in general, view financial gain as one of the biggest, if not the biggest, motivator in their lives.
Everyone likes to feel appreciated and recognized for what they feel that they accomplish, and money is the most tangible proof of that appreciation and recognition. For several years now, physicians as a group have felt under-appreciated, with much of that “no respect” being directly tied into plummeting incomes. Why is this generation of doctors making less money than their predecessors? Put extremely briefly, lower reimbursement from managed care entities, higher malpractice rates, and rising business costs are among the major culprits. The managed care system has, in essence, reduced doctors to hourly employees with no traditional employment benefits, or any control over the pricing of their services. Doctors have historically had the reputation of being mediocre at best, business people. The stock market tech crash in the late 1990’s didn’t help any, and apparently hit physicians particularly hard.

In an attempt to reverse this shrinking income trend, doctors have adopted a few different strategies. The most common one has been to simply work more, a natural thing to do . The doctors who have chosen this route often become more miserable than ever! They are more likely to think of patients as numbers, and they come to resent the patients who take “too much time”, and drug reps who they perceive as wasting their now more precious than ever time. They spend less time with their families than they previously had.
These doctors are more likely to think of patients as potential litigants.
They are often tired, edgy, and generally “fed-up”.

Another strategy that has recently evolved is for some doctors to follow their passions and try to make supplemental income by doing so. I know physicians who have recently, in their spare time, pursued successful projects such as opening a winery, starting a gourmet bakery, and even becoming a stand-up comedian.

Some physicians expand their medical practices by selling OTC products such as vitamins, skin creams, or other items that usually are related to their particular specialty. Other physicians expand their careers by testifying as expert witnesses, becoming pharmaceutical speakers, joining managed care entities, or conducting research studies.

Finally, there are doctors who have come to the conclusion that they could do better for themselves by leaving the practice of medicine altogether.
From a purely financial point of view, many of them actually have a pretty good point. They perceive the combination of shrinking income, high level of exposure to law suits, and decreased appreciation from demanding patients as sufficient motivation to leave the profession.

What do these “money driven” physicians think of drug reps and the pharmaceutical industry? Some of these customers are pharma resistant if only because they see themselves as so busy scrambling to make more money that they tend to view it as an imposition to see drug reps. Also, if the doctor sees your medications as competition for his or her products or services, you’ve obviously got a problem. If the overworked “mill” doctor thinks that 5 minutes with you is just going to delay her by another 5 minutes with no benefit to her, that’s another challenge. So you’ve got to show these customers the value to them of your products (“What’s in it for
me?”) For instance, if your product has a better side effect profile than the competition’s product, then the doctor will not have to answer as many phone calls by prescribing your product. So find a way to be perceived as a partner to these doctors rather than as a burden that they seek to avoid.
These doctors will see you if you can show how your products can make the patients’ lives better, and resultantly improve the doctor’s own life in some way.

Some money driven doctors are actually pharma friendly. They see pharmaceutical companies as financially successful, a status to which they too aspire or have achieved. They may align with pharma out of their disdain for managed care and the insurance industry. They also may identify with and respect pharma’s entrepreneurial nature and commitment to research. You should compliment these physicians for their entrepreneurship, with emphasis on how their patients are so fortunate to have such a forward thinking doctor! Partner with the physician by showing that your products help the patients, the physician, and, resultantly, the “bottom line” of the practice.

4. “Miscellaneous Agendas” Most reps can describe at least one customer who is an enigma: the doctor who cannot be figured out. He or she does not easily fit into categories, has no apparent or predictable pattern of prescribing, and is often a peculiar person in general. Moods from detail to detail are unpredictable in this category of doctor, which I alternately call the “GOK docs” (God only knows!). Reps never know what to expect from these customers, and resultantly tend to avoid them, sometimes without even realizing it.

Often these customers have unknown, or even covert agendas. It can be fruitless to expend time trying to figure out such agendas, but it might be worth a try. Examples include customers who have a grudge or infatuation with a particular pharmaceutical company or have made or lost money on a pharmaceutical stock, customers who are dating a drug rep, and customers who may have family problems, personality disorders or even substance and other mental health issues.

These doctors may be pharma friendly or hostile, and may even fluctuate in their opinion for no apparent reason. They represent a challenge, but if you figure them out, it can be well worth your effort. Try asking about the special or unique aspect of his or her practice. The practice may have nothing unique about it at all, but the question is flattering and the customer’s answer may offer insights that can help you detail that individual more effectively. You might try mentioning something unique or interesting about yourself to this type of customer and see if you get back a response which provides some insight.
You may have to “cut your losses” with some of these customers who are unpredictable and draining, particularly if they don’t write your product regardless of what you do.

In summary, categorizing your customers will help to organize and customize your detailing in order to maximize your sales. Good luck!

Neil Berliner, M.D. is a national pharmaceutical speaker, author and representative trainer. His new book, “The Mini-Franchise: A Business Model for Pharmaceutical Sales” will be available in November, 2005. Dr. Berliner is available for training projects and can be reached at reptrainer.com.