Eighty thousand pharmaceutical reps crowd US waiting rooms vying for the opportunity to see physicians. Meanwhile, managed care companies require contracted physicians to churn through a growing number of patient appointments each day. And regulatory forces have removed from the marketer's toolbox many effective tactics for gaining access to doctors outside their offices. With less physician face time available, stiffer competition for each moment, and tight restrictions on access, pharma marketers find themselves hamstrung in their efforts to move product and meet aggressive sales goals.