Cardiologists: sales reps can be key players, if��

If you read enough news reports about the macro-level changes under way in the health care industry - new economic considerations, mergers and acquisitions, shifts in power and market share - it is easy to underestimate the significance of the individual device vendor. But the move toward the creation of integrated delivery systems means that the medical device sales rep - and the service he or she provides - is preserved as a key component of the health care team.

Device sales is a service business, as more than one doctor has said when I've broached the topic of vendors. That being the case, I recently spoke at length with a number of cardiologists who agreed to give me their candid views of the sales process and the vendor-physician relationship. To be sure, pacemakers and defibrillators occupy fairly rarefied air. But the fact is that devices in specialties ranging from pain management to urology to orthopedics are moving toward increased specialization and complexity, presenting the user with new sets of variables to control. Across the board, then, the detail model of earlier days is giving way to a more integrated, consultative approach.

"The two factors that set the stage for the vendor-physician relationship are the complexity of the device and the interest of the doctor in the technology," said one cardiologist with two decades of experience at a major West Coast institution. "If you're dealing with a highly technical device, it's hard to expect the doctor to be familiar with every nuance, so naturally he or she is going to be dependent on the vendor for guidance. And a doctor who performs two procedures a month is going to tend to be less intellectually engaged than someone who performs two a week." An M.D. who has advised several device firms adds, "It is a smart rep who gets a doctor excited about his or her technology." This is particularly the case in suburban or community hospitals that have less access to the cutting edge than their academic counterparts.

Not surprisingly, the extent to which physicians look to their vendors for help varies greatly - and is a hotly debated topic in the medical community. "There are some doctors who don't understand the device at all; they're totally dependent on the rep," complained one cardiologist. "It can really be a dysfunctional relationship, requiring the vendor to be present for every step of every procedure." This situation is exacerbated as hospitals cut back on trained technicians, knowing that the reps will be manning the controls in the operating room. On the other hand, physicians at high-powered teaching institutions tend to look for a lower level of vendor consultation. "If I need information, I just call the president of the company," one frequent member of FDA advisory panels explained. Of course, few doctors exist in such a privileged position. The key is to figure out what "service" means to each customer, then tailor the approach accordingly.

It is hardly ironic that service should be such a selling point with high-tech goods. As personal computer software companies are discovering, the surest way to alienate a customer is to skimp on support. In device sales, however, cost is a new factor that is rapidly gaining significance. While it is still the individual physician who holds sway over most purchasing decisions, the move toward systemwide contracts is shifting some of that power up the administrative food chain. That trend reached its apothesis in Columbia/HCA's bid solicitation and then selection of three pacemaker suppliers for its 325 hospitals. But outside such a global move, the doctors may have more power they think. "A lot of physicians end up being more intimidated than they should be," notes one observer. A doctor at a large East Coast institution says the solution lies in the work of strong, take-charge medical directors. "Medical directors need to take a more proactive role to cost containment," he said. "They need to be scheduling interviews with vendors, really understanding product differentiation, so they can speak knowledgeably about cost issues. If they don't speak up when a decision is being made, to some extent they deserve what they get."

If there is a wide range of physician needs, doctors, for their part, report significant differences among salesmen. "Within a given region, there's a marked gap between the best and the worst reps," one doc said. What makes for a winner? The M.D.s I spoke with identified four main points:

* Determine the level of consultation a doctor desires - whether merely a periodic briefing or constant operating room presence - and then provide it consistently.

* Maintain constant stock availability and provide timely information. Whether you supply your accounts by consignment or as-needed, every product must always be available. Keep the physician up to speed on new products and developments on the horizon.

* Ensure access to your company and its resources. If there are programming and software questions, or warranty issues, the physician needs to be confident they will be taken care of without delay.

* Look out for the doctor's interests. Is there an upcoming clinical trial that dovetails with the physician's research interests (in teaching hospitals) or one that will provide the hospital with a "drawing card" to distinguish itself from local competitors?

The vendor-physician relationship is a complex one. But its challenges are not without significant reward. A vendor who successfully delivers the goods - in terms of both product and service - will be regarded as a crucial part of the medical team. As one doctor succinctly put it: "You're going to be loyal to someone who helps you look good."

Mike Kelly, a former vice president at St. Paul, Minn.-based St. Jude Medical, is a managing director of Russell Reynolds Associates, a global executive recruitment firm.

COPYRIGHT 1995 J.B. Lippincott Company
COPYRIGHT 2004 Gale Group