Sales reps in the OR..PO Day 115

We've all seen them; smartly dressed young professional types pulling a rolling suitcase, standing aside at the reception desk in our doctor's office. They look like they are waiting for an audience with the Queen. Suddenly the door to the inner sanctum opens and the doctor's assistant nods for them to follow and they disappear.

Generally you have just seen a pharmaceutical representative making a "call" on a physician. Their job is simple and straightforward; they educate the doctor about their products, provide samples, leave coupons to be shared with patients starting on the new drug, share a couple fresh jokes with usually a medical derivation, and occasionally arrange a free lunch for doctor and/or staff, although such monetary compensation is frowned upon these days.

What we, the patients, usually don't see takes place in the operating room. In addition to the surgeon, the OR fills up with ancillary people there to support the surgeon and the patient. You might recognize the anesthesiologist, the scrub nurse who assists the doctor with sterile procedures and instruments, a circulating nurse who is responsible for the non-sterile jobs on the periphery of the scene, a holding room nurse who brought the patient in and the recovery nurse who takes the patient out. Off to one side is a professional looking salesman type, most likely dressed in operating room scrubs but not quite dressed as if to "scrub in." He is a Medical Devices Sales Representative.

He has developed a friendly rapport with the surgeon who has come to respect the agent's knowledge about the artificial devices used in so many surgeries today. Not only is he there to deliver the artificial knee, hip or shoulder that will be used today, he has very likely been in on the decision of what to use, what size is required and what "issues" might show up in this patient. He is now in the operating room to offer support to the nurses in arranging instruments according to when and howthey will be needed and "provide guidance during unexpected events and equipment failures."  Wow, he sounds like someone you really want to be there!

The problem is that he is "expensive." He is usually well compensated by the devise manufacturer both in salary and sales commissions. Yes, he is a salesman. He is not there to encourage the surgeon to comparison shop or try the equivalent of Consumer Reports "Best Buy"prosthesis. He is there to promote his product. And in this day when hospitals are having to reduce overhead, he is being looked at as a way to reduce costs. In many joint replacement procedures the device is the most expensive item on the list of charges in the bill. The one big advantage third-world-reduced-cost-surgical-destinations have is that the prosthetic device they utilize will often cost one tenth of the US manufactured  joint.

Hospitals are beginning to see the merit in creating a regular staff position, a liaison between the surgeon and the device manufacturers. This person would be responsible for inventorying the equipment needed, assuring its sterility, shopping around to get the best prices, all the while being well versed in the vagaries of the equipment and how to use it. Even knowing hospitals are thinking about it has caused manufacturers to reduce their sales staffs.

I don't know how to think about this potential change. It's kind of like when Allen Shepard realized his space ship was built by the lowest bidders on government contracts. If you remove the profit incentive will you have the same dedication and work ethic? Will the manufacturers have the same desire to educate and inform? Will the surgeon have the same expertise available to him? I hope so.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically.