September 1, 2002
Julie E. Williamson

Julie Williamson is a freelance writer living in Arizona.

Pharmaceutical Representative

Nursing shortage hamstrings physicians' schedules, reps' calls.

Pharmaceutical sales representatives struggling to make the most of their time with physicians may find their visits are being further strained by a nationwide nursing shortage that's piling even more demands on already overloaded physicians.

According to statistics from the Chicago-based American Hospital Association, nursing shortages and staffing crises are causing a multitude of problems for hospitals, including hampered patient access to inpatient and outpatient care. Of 700 hospitals surveyed for the association's 2001 Special Workforce Survey, 17% had canceled inpatient and outpatient surgeries, 28% had cut their bed capacity and 22% had experienced longer wait times for surgeries.

When hospitals can't staff properly, they have no choice but to cut back in other areas - a result that has the greatest impact on physicians and patients, according to those in the nursing industry.

"Nurses are a critical component of quality healthcare, and physicians are certainly feeling the impact when they are no longer available to them," notes Justine Medina, practice and research director for the Washington-based American Association of Critical Care Nurses. "Physicians and nurses are a caregiving team, so when you take the nurse away, it becomes clear how that puts a real strain on a physician's workload."

The crisis isn't limited to hospitals, either. A growing number of physicians in private practices are also scrambling to fill vacant positions, often having to settle for less qualified personnel who can multi-task and do the job for less money. Some predict the widespread staffing crisis will only worsen as hospitals and physician practices compete for nurses.

One Georgia-based physician says he was unable to find a replacement after a licensed practical nurse left his practice, primarily because LPNs were in such short supply, and he couldn't afford to pay the high price for a suitable registered nurse. As a result, the physician says he is now tackling tasks that were once delegated to a nurse. "It has definitely made my job more difficult, but if I don't have anyone with the education or background to do the work, I have no choice but to do it myself," he says.

Less time for sales calls?

Just what does the staffing crisis mean for sales reps? Sources agree that really depends on the situation – and physician location.

By and large, those making sales calls with hospital-based physicians will be more likely to feel the mounting pressure than those who primarily visit clinics or independent practices. The reason, one nursing association executive explained, is that physicians who work in hospitals rely more on registered nurses than those in offices where nurse practitioners play a greater interventional role.

"I often hear from sales reps that they have more interaction with nurse practitioners who act as the conduit for information to the physician. And fortunately, nurse practitioners aren't being impacted yet in terms of the staffing crisis," says Susan Wysocki, president and chief executive officer for the Washington-based National Association of Nurse Practitioners in Women's Health. "If there's an RN in the office who reports to the nurse practitioner and that RN leaves, that may impact the flow of information to a degree, but I just don't see it being a major problem."

One pharmaceutical industry executive, who is also a nurse, indicates that some sales reps are dealing more with nurses in the health plan environment, such as in insurance companies and health maintenance organizations. That could have a negative impact if nurses decide to leave, and he adds that reps could also feel the pinch from physicians overwhelmed with paperwork and reimbursement issues.

"This pressure on the physician ultimately trickles down to the sales rep," he says. "There are more hoops to jump through now, which is just part of the sea of change that is sweeping through healthcare. That can be very frustrating for the physicians and the sales force."

Regardless of the environment sales reps find themselves in, one thing remains certain: They have to be sensitive to physicians' tight schedules if they want to be successful.

Some physicians say it's becoming increasingly difficult to squeeze sales reps in between patients, particularly since as many as 10 to 15 different representatives may wait to be seen on any given day.

"A doctor's schedule can be quite mind-numbing, so it's extremely important that they prioritize their time. It's also important that their time constraints be respected," notes Susan Pingleton, professor of medicine at the University of Kansas.

That's not to say physicians don't appreciate pharmaceutical sales forces, however. Most welcome the information and expertise that reps can provide, but become irritated when they're approached aggressively and unprofessionally. To obtain information without impeding patient care, some physicians have chosen to meet with representatives only during scheduled appointments. Others have taken it a step further, requiring payment for their time spent with sales reps.

Time-Concepts of Crestview, KY, is one company that's made a business out of improving the exchange of information between the physician and the pharmaceutical sales representative. The company, which currently has more than 50 practices and 300 physicians signed up, enables doctors to set up password-protected calendars on a monthly basis via the company's Web site, indicating times they are able to meet with reps for consults. Representatives target who they want to consult with and then schedule meetings online.

Although participating in the program is free for physicians, it comes at a price for pharmaceutical companies, which must pay $105 per consultation. One hundred dollars of that total is split evenly between Time-Concepts and the physician, with the remaining $5 going to a doctor-selected charity.

"Physicians can better enhance the exchange of pharmaceutical information while limiting interruptions during scheduled patient time," notes Robert Prichard, senior executive officer for Alliance Primary Care, one of the physician groups signed up with the Time-Concepts program.

Time-Concepts insists that pharmaceutical companies also benefit from the program because it enables them to get valuable physician feedback on their products and their reps after each visit.

Other time-strapped and overloaded physicians are turning to online detailing to learn more about the latest drugs. This method, which relies on video conferencing rather than face-to-face interaction, lets physicians electronically access real-time video detailing sessions with pharmaceutical sales reps – at a time and place most convenient for them. Because the electronic detail averages about ten minutes, reps get more out of their time with the physician and have the opportunity to access those who normally refuse to see reps.

Regardless of the method reps and physicians choose, the visit will be most productive if sales reps are organized and sensitive to physicians' needs, says Roddy Martin, service director for Boston-based AMR Research.

"The average sales rep sees approximately seven physicians a day for three to five minutes at a time. At 220 working days per year, that means reps are essentially being paid for approximately 80 hours of contact face time each year, which really puts this whole thing into perspective," he explains. "With everyone being squeezed for costs, time and other resources, it ultimately boils down to having systems and procedures in place that increase productivity and sharing of information in both directions. Sales reps' jobs aren't getting any easier, so they need to be able to use those 80 hours or so per year to their best advantage if they are to be successful." PR

Related Content: