Doctors give drug reps less time

Changes in the industry put limits on pharmaceutical company employees

They hang out in hallways, hoping to snatch just two minutes with a doctor. They stock supply closets with drug samples and know the latest medical research inside and out.

But pharmaceutical sales representatives, once welcomed by doctors as the bearers of golf outings and days at the spa, have been pushed by many physicians to the margins of their practices.

At Wilmington Health Associates, drug reps aren't allowed to pitch their drugs to doctors who are signing for samples.

"Our rule is that if you want to sit down and chat with a doctor, you can do it at lunchtime when a doctor has time," said Michelle Jones, a family doctor in the practice who sees five to 10 reps a day. "Surprisingly, they understand."

Drug reps haven't become any less attractive, intelligent or persuasive. But over the past five to 10 years, a changing health-care industry has disrupted the way they do their jobs.

That's good news for critics who contend that any freebies from drug reps, no matter how small, affect the way doctors write prescriptions and potentially drive up the nation's health-care costs.

To be sure, drug companies' finances are still healthy, although they have recently faltered. The world's five largest pharmaceutical companies generated $36 billion in profits last year. Drug reps still took home average compensation of $89,600 in 2005, according to Hay Group, a management consulting firm.

Their jobs are just tougher and less glamorous than they were.

Drug reps' role is to know the latest research about their own products and their competitors', to communicate that information to physicians and to encourage the use of their companies' drugs. However, much of their daily grind can involve delivering drug samples, branded giveaways and food to doctors' offices.

Not all have science backgrounds, but they receive weeks of intensive training that can help them chat with doctors and answer their questions.

New ethical guidelines adopted by the drug industry in 2002 limit drug reps to providing educational programs over lunch or dinner. Freebies must be minimal and related to patient care.

Some doctors were willing to make time for drug reps when talking about drugs meant going fishing or to a hockey game.

"The problem with reps now is they don't have that carrot they can dangle," said Eric Challgren, a Raleigh dermatologist who attended NBA playoff games with drug reps as a medical resident.

Greg Gibbons, a family doctor in Cary, never felt right about accepting the tickets and outings proffered in his early years of practicing. He'd be happier if today's reps also stopped bringing "doo-dads" such as dolls labeled with drug names or walnuts meant to illustrate the size of the prostate. "I don't think many doctors like them that much," he said. "Pens and pads of paper, that's all we need."

Precious time

Drug companies also have created a logjam at doctors' offices. The volume of salespeople vying for time with doctors has surged, even as physicians have more demands on their time.

There are about 100,000 drug reps in the United States, up from 35,000 in 1995, according to Hay Group. Although companies used to assign a single rep to market drugs to a particular doctor, the largest now have several reps calling on physicians about similar therapies.

On Jan. 1, Family Medical Associates in Raleigh is laying down the law: no more loitering in the hallways for half an hour; no more than one visit per month, per rep; and if the medical practice needs samples between visits, the staff will call.