Physicians face many financial pressures. Faced with skyrocketing malpractice premiums and reduced reimbursements from government and insurance payers, doctors must serve many more patients—about 21 percent more than they did roughly eight years ago—just to maintain their income, according to the Medical Group Management Association (MGMA) Cost Survey: 2005 Reports based on 2004 data. In addition, physicians can incur more costs from violating regulations. HIPAA, for example, creates expenses for storing patient acknowledgement forms and—for many offices—lobby reconstruction. To compensate for the numerous financial drains, many doctors have refocused their time and attention on serving current patients and securing new ones.
In this time-pressured climate, meeting with pharma reps has become less of a priority. Overworked and crunched for time, many doctors see little incentive to meet with reps since the doctor-rep visit takes valuable time away from their patients. Many actually view the visit as a financial burden, if not a financial loss.
The physician's office staff represents another roadblock for reps. The staff has the time-consuming and often stressful responsibility of scheduling and managing these visits and imposing limits on visit frequency. Some offices report that they spend anywhere between five and 40 hours per week managing rep visits. To streamline this process, some pharma companies have turned to a neutral third party to assume these scheduling responsibilities. This way, doctors and staff know which reps are coming, when they are arriving, and what they are carrying in advance. This improves meeting efficiency for all parties. It takes the administrative burden off of physicians' offices and the financial burden off of doctors, who, with a set schedule to follow, can better maximize their time with patients.
Currently, many physicians' offices create deterrents to confine sales-rep activity. Seeking to balance the benefits and costs of rep visits, some practices accept only a limited number of reps (e.g., five reps per day), and then post a "no more reps today" sign after they've met their quota. Some physicians agree to see reps, but then deliberately make it so difficult to set a time to meet that most reps give up. Even reps who schedule their calls in advance may experience reluctance from office staff. Reps say they face restrictions on at least 82 percent of visits to medical offices, according to a survey conducted by Smart Practice Management. Many times these restrictions are arbitrary and disparate, vary by office and region, and are subject to frequent change. These constraints come in many forms:
Reps may never—or must—bring lunch
- Reps must have badges (or not) and/or must sign in with security, the front desk, or some other party
- Reps must stock the sample closet and document their delivery—or may never approach the closet
- Reps must be accompanied by office staff and/or avoid certain office areas entirely
- Reps may only visit on certain days or in certain time windows. About 44 percent of offices surveyed by Smart Practice Management impose this restriction, and in that group, nearly one in seven have physician-specific time windows.
The physician backlash against detailing can be costly for pharma. Some offices have banned reps altogether to save time and money.