Business-to-business sales professionals typically are taught to sell to the highest-level decision-making executives they can reach. Don’t call on a purchasing agent if you can call on a manager; don’t call on a manager if you can get in to see a VP; don’t bother with the VP if you can gain access to someone at the C-level; and so forth. But the situation facing pharmaceutical salespeople is a little different. In the business world individuals’ power and influence correspond to where they reside within the corporate hierarchy. While there is a formal hierarchy in the medical profession as well, physicians’ status often is connected more to their ability to influence the beliefs and behaviors of other doctors. Practitioners who wield this kind of influence typically are referred to as thought leaders.

Thought leaders are important to pharmaceutical reps because they can dramatically influence their peers’ prescribing habits. Dan Mariani, a hospital specialist with Proctor & Gamble, has studied these influential physicians and how they operate.

“Thought leaders can be viewed as solitary physicians or considered categorically as a defined specialty,” he says. “Their influence usually can be identified by a cascading effect through local institutions and in the practices of community physicians. Thought leaders generally are disease state experts in a therapeutic area. For example, in a pyramid of influence for the osteoporosis disease state, based on specialty, rheumatologists and endocrinologists would be on top, OB/GYNs would be on the second rung and IMs/PCPs grouped at the third level. Of course there are always exceptions, but generally speaking an OB/GYN likely would seek out an endocrinologist, assuming that person was respected in the community or had an academic appointment, but not the other way around.”

Mariani notes that most thought leaders congregate around academic institutions such as teaching hospitals. For this reason, he adds, thought leaders abound in urban areas such as Boston and New York, whereas they are scarcer in rural areas.

So how can hardworking pharmaceutical reps identify the key thought leaders driving prescribing decisions in specific specialties? Mariani suggests you begin by asking the physicians in your territory to whom they refer their toughest cases. “One of the easiest ways to find out who the thought leaders are is to ask local doctors who they send their most difficult cases to,” Mariani says. “Where are the referring hubs? Usually that’s where you find the thought leaders. You also can scan journals and periodicals on a specific disease state and find out who is doing clinical research and publishing on a particular subject. They usually are sought-after speakers who do grand rounds at hospitals and lecture at symposia. For example, Mt. Sinai School of Medicine is considered one of the premier IBD study centers in the country, among other therapeutic areas. Their faculty is filled with thought leaders who publish and speak regularly.”

Identifying thought leaders is the easy part – selling to them is the real challenge. Mariani acknowledges that selling to these high-influence practitioners is not the same as making your typical office and hospital selling rounds. “You need to establish rapport up front and not babble initially about the benefits of your drug,” he says. “It is assumed these doctors are well read and up to date on their disease states, so you want to defer to their authority on the subject. They generally are more intellectual than the run-of-the-mill physician and usually more eclectic in their thought processing. Establishing a relationship is very important. You want to talk to them in a consultative manner, sprinkling your conversations with bits of technical information that establish you as a credible source of information.

“These physicians usually are interested in cutting-edge information. If you can bring this data to their attention when something new becomes available, they will appreciate it. The other key to remember is that these docs have huge egos and need to be stroked, but not in an obsequious manner. They want to be viewed as leaders in their fields and placed in venues to speak where their wisdom will shine, so if you can arrange to put them on high-profile lecture circuits there usually is a good ROI.”