Many Are (or Should Be) Called

It’s called the “Total Office Call” and was likely part of your initial pharmaceutical sales training. The main idea is that drug reps aren’t just trying to sell to physicians, but to the entire staff as well, including nurses, physician’s assistants, receptionists, etc. Since everyone in the office has the potential to impact prescribing decisions, whether directly or indirectly, they all deserve the salesperson’s attention, interest, and respect.

Nevertheless, some reps ignore this directive, and focus their attention exclusively on gaining access to and detailing physicians. “These reps don’t realize that office politics are often at work, potentially impacting their ability to gain access to the prescribers,” says Jodie Bender, president and CEO of Pharmacopy, Inc. (www.pharmacopy.com), a Pennsylvania-based pharmaceutical sales training and marketing organization. “It is impossible to tell which staff members have ‘pull,’ which ones have the doctor’s ear and which ones don’t. What if the receptionist is a relative of the doctor and you don’t know it? If you offend him or her, don’t plan on getting in to see the doctor anytime soon. What if one of the nurses is very highly respected by the doctor and influences his prescribing habits? If you don’t detail other health-care professionals, both non-prescribers and prescribers, you are missing the opportunity to influence the physician through people he knows and respects. Nurses can often be valuable proponents of your product if it makes their lives easier in some way. If it saves them time by eliminating patient calls or by reducing the managed care paperwork, they have a good reason to talk to the doctor about it.”

As Bender notes, physicians are often not the only prescribers in the office. Depending on the state, nurse practitioners (NPs) and physician’s assistants (PAs) may have their own prescriber identification number (PIN) for writing scripts or they may simply use the supervising physician’s PIN. Typically NPs and PAs will be influenced greatly by what supervising physicians prescribe, but are often in a position to make clinical recommendations that doctors will heed.

In fact, Bender says, one area where NPs and other staff members can have the greatest impact on prescribing is by conveying information to physicians about patients’ experiences with specific medications. “For example, if a nurse informs the doctor that a lot of patients are calling in with complaints about a certain drug, the doctor might conclude that it saves time for the staff to prescribe another product that does not have the same side effects and has equal efficacy,” Bender explains. “Or if the nurse complains that a certain product being prescribed is creating a lot of managed care problems because of formulary status, the doctor may well change his prescribing habits to create less work and hassle for his staff. The best reps are smart enough to explain to the nurse how the benefits of their product can help the staff without sacrificing quality of care.”

While there are plenty of reasons to dedicate attention to the nursing staff, there are also countless ways nurses who feel unappreciated can hinder pharmaceutical salespeople’s efforts. “Nurses very much appreciate being included as part of the health-care team,” Bender says. “They went through a lot of training to become a nurse, and that a salesperson would not recognize their clinical expertise is very offensive. Nurses have an excellent understanding of clinical and pharmacological information, but reps often ignore them since they don’t actually write scripts. Watch out for the disgruntled nurse who you snubbed on your last call—you may find out that she put a bug in the doctor’s ear about it!”

If up until now you’ve been giving short shrift to the other office staff members, not to worry, says Bender. You can easily begin the damage control by changing your attitude today. Just remember: the call begins as soon as you walk in the door and greet the receptionist or office manager and doesn’t end until you say goodbye to the person at the front desk and leave.