April 11, 2003
The Florida Times-Union
By Sarah Skidmore Times-Union business writer
The well-groomed, suitcase-toting salesman squeezed
into the chair next to you in the doctor's waiting
room isn't sick, but he wants to see the doctor as
much as you do. So much so that he might pay for his
The growing number of pharmaceutical sales representatives
-- an estimated one for every 4.7 physicians -- are
each competing for doctors' increasingly limited time.
Face-to-face sales calls are the primary function
of their job, but under a new service being offered
by a Jacksonville-based startup Medical Partners,
reps may now pay for access.
The physician visit is one of the most popular marketing
tools in medicine and is a multibillion-dollar marketing
expense for the behemoth pharmaceutical industry.
During the visit, sales reps detail the benefits of
their product by offering new information, samples,
research or by simply answering doctors' questions
with the hope of swaying prescribing habits in their
But the borders of the industry standards are changing,
and now the business tactics are following.
"Up until five or six years ago [reps] had carte
blanche with doctors," said Sam Hinson, a former
pharmaceutical rep and director of business development
for Medical Partners. "They had an unlimited
expense account for doctors and open access to meet
with them. Then most of the seats [in the waiting
room] were taken up by sales reps rather than patients,
so a lot [of practices] limited, restricted or eliminated
The company launched in November of 2002 to help
physicians manage the growing number of pharmaceutical
representatives trying to get in the door: There are
more than double the number of reps in 2001 than in
Medical Partners is not the first company to use
fees as a management tool for representative visits.
The Polyclinic, a busy Seattle medical practice, charges
reps $30 for one hour's access; and for $200, reps
get eight hours but no guarantee of time with a physician.
Queen's City Physicians in Cincinnati created a subsidiary,
Physician's Access, to charge drug companies $65 for
a 10-minute meeting. And Time-Concepts, a Crestview,
Ky., company gives physicians a $50 payment for a
In response to the volume of visitors, some physicians
and clinics limit the number or type of visit, but
a handful charge directly for their time used by a
rep or have companies like Medical Partners do it
For a fee, the company schedules everything from
the staple five-minute, face-to-face meetings with
the doctor to occasional symposiums or programs involving
multiple physicians. Physicians contract with the
company and agree only to see reps scheduled by Medical
Partners. Reps who want to see physicians log in online,
set up their appointment and pay a fee. For a five-minute
time slot, the rep pays $35; $20 of this goes to the
physician. Physicians can keep the money or choose
for it to go to a charity or other group. Physicians
agree to make their best effort to meet with the rep
in a timely matter. This new twist on the relationship
between pharmaceutical companies and physicians puts
doctors in the spotlight typically reserved for the
The pharmaceutical industry's infamous perks -- a
lunch, a pen, any tchotchke left behind to separate
their name from the pack -- are standard practice.
But in the past few years when this tactic appeared
to become occasionally excessive, the American Medical
Association and pharmaceutical trade group PhRMA clarified
guidelines and launched an educational campaign on
acceptable relationships between physicians and reps.
AMA has had long-standing recommendations to avoid
pharmaceutical industry influence on medicine but
launched its efforts as a reminder of the importance
of the guidelines. According to the AMA it became
clear that exorbitant gifts, trips and other perks
were becoming more commonplace, and the association
wanted to avoid any possible conflicts of interest.
PhRMA endorsed the recommendations for its members
Guidelines recommend physicians only accept gifts
or other services or goods of modest value and only
if they relate to the practice and have no strings
But when it comes to actual payment for visits, the
American Medical Association guidelines prohibit cash
payments. And in all the gray areas of pharmaceutical
influence, this issue remains a clear black and white
one to Leonard Morse, chair of the Council on Ethical
and Judicial Affairs for the AMA. "Genuine services
receive compensation, but in this situation it is
the rep who offers the service, namely the education
of the physician," said Leonard Morse. "Doctors
are not compensated for education."
The several pharmaceutical companies contacted stood
behind PhRMA's position but declined to comment directly.
But several reps said their companies will not reimburse
them if they use services such as Medical Partners.
"Sales representatives are technically trained,
and it is not only a chance for a sales pitch, it's
a chance for asking technical questions," said
Jeff Trewhitt, spokesman for PhRMA. "Doctors
should want to getthis information."
But some doctors argue the educational information
is a ruse for marketing in most cases.
"I do not get my medical education from a pharmaceutical
rep that has an accounting degree, they do not have
a Ph.D. in pharmacology, they do not have a medical
degree," said Oscar Rodas, a Jacksonville internal
medicine physician. "I don't rely on them for
He said in most cases the meetings are primarily
giving the reps a chance to market their products,
but he does not see a conflict of interest in these
"At least with the physicians I know, none of
us have ever been influenced by something a drug company
does in our prescribing habits. ... Ultimately, we
make our decision based on how a patient will react
to a treatment, and we are responsible for that,"
His clinic has tried for years to schedule reps with
some success, but it still has anywhere from eight
to 10 reps drop in each day, which is an interruption
to business. Rodas said he has been approached by
several groups for this arrangement and is likely
to sign up with Medical Partners because he feels
the arrangement compensates for the time he spends
Medical Partners said it intentionally kept the fee
lower so financial gain would not be an incentive
for physicians. However, by charging a fee, the company
said there may be more respect for the importance
of the meeting.
As a former rep himself, Hinson said much of the
educational and drug efficacy information that can
be given in a visit is often overlooked because the
benefit of a rep visit is outweighed by the resulting
disruption to the office. The professional interaction
has been lost when reps spend hours waiting to talk
to a physician or only drop off samples but he hopes
his company can help rebuild the benefit of the relationship.
"Once they see the value in it -- they'll embrace
it. I'm confident in that," Hinson said.
Pharmaceutical reps contacted were prohibited by
company policy to speak with the Times-Union.
Medical Partners is running its trial program now.
The company has signed up 10 to 12 physicians so far
and it will be ready to start its program at the beginning
of May with 40 physicians.
Following the trial here, the company hopes to expand