Wow. Um. OK.

I'll sit back and see what kinds of responses you get!

What editor doesn't like a little controversy? ;-)

Mike Fulkerson Wow. Um. Nah. But others can follow Gunther if they want.

Gunter Wessels,Ph.D.,M.B.A. Thanks for the comment Mike. I'll register that as a "No" from you. I lean toward a qualified "Yes" and the discussion is aimed at digging out the core of the salesperson value-add in MedDevice.

Rob Osborne Sales or Account Management?

Allan Russell Gunter...if you need to ask a question like that then it's time to call it a day mate

Come on guys. Med Devices are often high involvement with many purchasing criteria to be considered before an organiation buys. Does one really think that any hospital knows everything about a DaVinci robot before buying. My hospitals undergo extensive training on these from the sales and support staff. They need and appreciate this help. Granted, if your selling pharma or scalpels this isn't as relevant, but even then doctors want updates on cutting edge innovations. As long as we offer innovation, we will be needed. When that stops, we won't.

Gunter Wessels,Ph.D.,M.B.A. Great comment Steven! So, salespeople are indispensable because they are educators. We agree. Your comment points out a deeper hurt though: customers don't fully understand the product, nor do they don't fully understand their own operation. The MedDevice Salesperson steps into the breach and clarifies the situation, as a subject matter expert and consultant?

Gunter Wessels,Ph.D.,M.B.A. Rob, I'm trying to drill into the core of what makes MedDevice salespeople indispensable. Account managers are in my definition part of the sales team.

Arlen Meyers, MD, MBA My view from the operating room:
1. I feel like I have less and less say in what devices appear in the operating room. Consequently, I need education because I can't always rely on the OR staff, like travelers, techs, etc, to know how to make things work.
2. Like any other product or service, whether liaison or sales, some know more about their product than others.
3. My primary need is to get the case done the way I want to do it. I don't care who is in the OR as long as they know something about the equipment, product updates, work arounds when something goes wrong, and show up when I need them.

Great question. After over 30 years of working with/ in the medical device industry, I think the question is not so much whether sales reps are needed but whether a company has the correct "type" of sales rep.

For 25 years, I worked for a medical device company dealing with urologic implants and procedures. The ideal sales candidate provided a blend of technical and sales skills; that person was able to give technical, device-related advice intraoperatively but was also able to discover a need and close on a sales opportunity. Needless to say, especially 30 years ago, finding that sales person with the medical/ clinical knowledge plus focused sales skills was not easy. At times the make-up of our sales force was noticably bi-polar with some reps being the hard-nosed, PSS, salesperson while the others were more medical techies and usually came from earlier medical backgrounds (nurses, PAs, NPs, etc.). Depending on upper management directives, the company, during certain time periods, actually employed two types of individuals......the sales rep who stuck to basics of sales calls, office visits, and managing accounts vs. the clinical consultant in the operating room who knew the product inside-and-out, could answer the medical/ technical questions and could troubleshoot as needed intra- and post-operatively. But ultimately, this dual sales force concept was recognized as costly with many duplicated functions and cross-overs.

Now, it seems that there are more reps available who have both technical and sales backgrounds......the once fledgling medical device industry has grown significantly and vocational needs/ definitions have been clarified. It appears to be easier for medical device companies to find that blended sales rep with both strong selling skills and technical know-how.

Mike Fulkerson Asking for a discussion starting with "...do we really need medical device reps" was what lost me at the start.

I pride myself in being indispensable.

Dr. Meyers has valid points. But I believe the rep should have an in depth knowledge of the equipment they are selling, training and using in any enviroment or you should not be there.

So yes, medical device reps are very important to the team.

No hard feelings Gunter.

Wendell Thoene Whether you are working with individual physicians, or institutions, the best way to get your message to your customer is by way of a warm body in front of them. Which is especially important if your goal is to close a sale.

I am new to LinkedIn and this is my first comment. Thanks for having me! I specialize in Adult Reconstruction and need custom equipment on a regular basis. I agree with Dr. Meyers comments. I spend a percentage of my time outside the OR defending the equipment I feel to be necessary for an acceptable outcome. Those on the business side of medicine seem to focus on cost savings and discounting the quality and longevity of the outcome. Being a practitioner in a more rural area, my sales representative wears many hats and is an integral part of surgical preparation. Not only do I expect the representative to know his product line and the competitions, he must provide regular in-service trainings, maintain an appropriate inventory of standard components, and frequently makes trips to the regional airport in the middle of the night to pick up custom equipment for urgent procedures. I have a great sales representative and I would not be as effective without him. Thanks for listening, Brad Ray, M.D.

Arlen Meyers, MD, MBA When it comes to who gets to use what and when in the OR, there are three competing interests: the surgeon, the hospital and the company selling the device. When it comes to orthopedic and cardiovascular devices, the stakes are substantial. One of the main reasons healthcare costs so much in the US is because our prices are higher. Our prices are higher for any number of political, social, economic and healthcare policy reasons.

The future challenge will be to come up with a system that provides the value (not a blank check) to satisfy a predetermined benchmark (not whatever anyone wants) given the available resources (that will be constrained)

Clifford Thornton It can be used as a competitive advantage if your salespeople are effective. Lack of one can put your image at risk and then the losses of accounts because of this will make your cost-savings irrelevant. As Dr. Ray pointed out, these are often not just sales reps, but can be a part of your operations -- supporting logistic matters.

There's just a high psychological value of transferring product information with another human being, face-to-face. People make the products, run the company, make ethical decisions, etc. The buyer wants to see the face of the company and who they're dealing with.

If I was a patient receiving a heart device, I would hope the hospital and that device vendor have a close and strong working relationship.

Plus, if you are smart, you want to understand your customers, you want feedback on your existing products and want to know about current problems. You won't get that by customers reading a product description on your website or viewing a training video on your website. You can create a customer blog on your website, but you may not get as much or as honest feedback as a sales person can collect for you. The sales person should be your critical link to the customer.

With technology evolving at a faster pace and hence processes and ways of running an OR or diagnostics department ever evolving, the key value-add of your sales-person should be to anticipate a customer's next move. You want to address their needs or concern before they migrate to a competitor. And how do you do that-- you keep in constant contact with that customer and build trust with them. And with trust-- the customer will say to that vendor-- I need this....as opposed to them shopping around and inviting everyone of your competitors to respond to their RFP. Of course they still have to perform their due diligence, but given that your product is at least of equal utility, if not better, you have a good chance of winning out from that relationship.

An effective sales-rep today needs to be a sales-closer, business analyst, market analyst, educator, and problem-solver all-in-one. If you have a sales-person in your organization who is not flexible, who is not enhancing your relationship with the customer, who is not regularly bringing back and communicating feedback or who is not engaged with the product or who ignores team conference calls, etc.-- then you should be questioning if they are adding the adequate value. Everyone is being asked to fill multiple roles, so your sales people should be no different.

My two cents.

Gunter Wessels,Ph.D.,M.B.A. Great comments so far!! I'm humbled by the collective wisdom here. But , what about "mature products?" Those devices that aren't necessarily new, or are part of the standard of care--do they need active representation? How do reps add value there?

My complements to Gunter for attracting so much of individual/collective attention and responses!

I firmly believe that, each year with technological evolutions and revolutions, most of the devices trigger new generations, and in turn, automatically leads/needs someone representing the manufacturer to explain, enlighten the professionals to understand compatibility and integration with the other devices.

I am a financial executive and just walking into the healthcare industry, met a few representatives during my visits to various locations. I am highly impressed and amazed with their knowledge of their products and also appreciate their patience and energy levels in finding the time of busy professionals and then pleasantly and effectively communicating. My sincere complements to all!

Arlen Meyers, MD, MBA Doctors who are clinical drop outs are exploring other career opportunities. There are several ways docs can add value in the field working with or for medical device companies.
Given the changes in how medical devices are bought, sold and serviced, where do you see the biggest opportunities for clinicians who are interested in working with you?

Having worked on the provider side for 14 years I would say YES. For the most part providers direct their attention inward toward patients staff and physicians. They need clarity on medical devises, use, value and cost. Medical devise account or sales rep can play a huge role in educating their customers and solving real world problems of cost in use and reimbursement issues. Just a thought

Nick Rutsis Good medical device salespeople are "experts" in the products they sell. Selling is different than it used to be in that good salespeople have to understand and eloquently discuss medical economics as they relate the to the products they are selling. Sales reps often have to sell the idea to customers of paying more for a product up front that will eventually lower overall costs. This is the classic argument of acquisition costs v.s. outcomes. Acquisition costs impact budgets immediately while outcomes tend to affect long term planning budgets that often include things such as hospital re-admissions. Physicians that may be sold on a more expensive product because it makes patient management easier in their offices won't necessarily receive a friendly hearing from hospital purchasing people. More expensive products that make patients feel better will often have the same reception from purchasing and administration. Medical device salespeople that have the skill sets to navigate through these tortuous and conflicting values are very important. Successfully selling the value proposition to both sides is coveted skill.

This is a really interesting discussion.
I do agree with most of the posts here, but there also is the general environment where we work: we all have seen Drs fed up with the sales reps waiting in line to catch them, and turning back to the OR either by lack of time or interest? Or giving them 2 minutes of their time?
What is the added value here? Could we imagine another way of proceeding (web based information, video calls?).
The legal environment might also be a feature you need to take into consideration. Here in France there is a new law to be implemented that would restraint access to Drs for manufacturers. The idea is to allow only "group meetings" - including all the staff- and not face to face meetings any more. Now the questions turns into a different one: how to get (if possible) an access to the entire staff? Providing there are thousands of manufacturer, if you are amongst the big 15 providers, no problem, but what if you are a smaller one?
Although I have also been a rep for several years, my feeling is that the system must somehow move to something else: lack of time from all sides, cost reduction, can we still sell innovative medical devices like we did 30 years ago?

Great dialogue here, Gunter. My thoughts...Device costs continue to rise and "cost of sales" is approaching 50% of SG&A for many MedTech companies. I wonder if the healthcare system can sustain itself with the traditional sales rep model or if there is an alternative delivery model that provides services truly needed but allows for more efficient and cost effective delivery of care. I recall a statement by a top IDN chief who commented, "if a doc tells me (they) need the rep in the OR to perform the procedure, then we are having a different conversation..."

Wendell Thoene I am responding to Arthur Goodrich's comments. The problem with hospitals and their keeping up to date with new technology and procedures is almost an oxymoron. If it were not for sales reps, and government regulation, I fear that they would still be listening for patient chest sounds through a wooden tube.

Michael Stoia Interesting that no one has addressed cost savings. I have saved individual hospitals over a million dollars each in my career. A GREAT salesperson take the consultive-business partner relationship to another creative level. There is more than just producing a Gpo confined quote, the GREAT ones go beyond this straight jacket and add so much more value short & long term. All of the gate keepers who are attempting to erect barriers to entry right now fail to realize this and in the end will cost their institutions a lot of money as a result ! A GREAT rep drives down cost per procedure while providing ALL of the other intagibles previously identified.

Hmmmm... As Arlen mentioned... salespeople play a role in helping the OR assist the surgeon in terms of operating efficiency with the use of new products, etc. Certain new tech roll out require sales/tech teams for teaching, etc.

Having reps troll the OR to sell physicians on converting to a knock off or me-too product is no longer very useful. Many of these decisions are now being made far above my pay grade and unless a group of surgeons has significant pull they are not going to be able to gain the attention of the folks in purchasing unless the value proposition of switching is strong.

The sales team needs to be more technologically innovative and well spoken from an operational efficiency prospective. They need to be able to teach the staff and thus serve a dual function for their organization and the organization or institution where the product is utilized. Then they are providing a valuable purpose. If they are trolling the halls looking to take me to dinner to convince me to utilize their knock-off ---> #fail.

Jim Dulaney The value that a well trained rep brings in representing highly technical products is well established in this discussion. One aspect that has not been mentioned is the day to day service that is provided by many reps (specifically ortho). These reps are responsible for managing inventory and instruments on a daily/weekly basis. If these reps were no longer providing this service, most hospitals would be forced to hire more employees to take on that responsibility.

Hats off to Gunter for asking such a thought provoking question.

Most sales reps that I have worked with will tell you that once you have established a high base of business, maintaining that business is often more difficult than securing new business. At the end of the day, most people still buy from people who they trust. Companies need skilled, highly trained professionals who can develop that trust and who can then transition relationships into lasting partnerships. This goes beyond the boundaries of whether a product is "mature" or new.

Rob Osborne Jim D., interesting comment about Sales professionals managing inventory on a daily/weekly basis. Really? Skills required to manage inventory (materials management - attention to detail, supply/demand balancing, performing inventory movement transaction likes goods receipts) are very different than selling skills (relationship management, understanding the customers technical challenges and facilitating technical solution development, public-speaking/presentation skills, deal-closing skills), not to mention the differences in compensation between the inventory management roles and sales roles.

I happen to be in a great Med Device industry that allows the end recipient to choose their brand. Almost all of our Sales/Account Managers themselves are recipients of the technology, to be able to speak to it's effectiveness personally. We do not sell a new product, it has been on the market for 30 years, but the industry as a whole is only 7% penetrated into the available market. All that to say that I believe that since Medical Devices will be implanted, or used as part of a life-enhancing surgery, sales need to be focused on the human aspect, and no one is closer to the end user than sales or account managers. Candidates will have not just technical questions, but personal ones as well, and if salespeople are able to speak on that personal level, which they should be able to, then it empowers the candidate as they become a recipient, and erases a majority of concerns.

Heather Thompson We could call them physician support reps. (heh)

Jim Dulaney Rob O., You are absolutely correct that the skills involved in managing inventory & managing a sales process are very different. The best sales organizations have an effective operations/inventory team managing inventory & instruments for their entire region, but this team does not routinely interface directly with the customer. The reality is that most of the ortho reps are in the same hospitals on a daily & weekly basis. They are held accountable by the hospital staff and surgeons to have the appropriate instruments and implants for each case that they are involved in. The most successful reps that I know work in their sales territories as if it is their own business.They are intimately involved with the inventory management because knowing which equipment to have available for each individual case is part of the technical service that he/she is expected to provide. It is at that point that the ops team gets involved, but the sales rep is usually the point person.

Nick Rutsis Dr. Myers says that there are three competing interests; the surgeon (or other specialist such as an invasive cardiologist), the hospital and the company selling the product. He is absolutely right and there are a lot of moving parts to this equation. It takes a highly disciplined sales rep to make all the moving parts work together, and it is usually not an overnight achievement. The surgeon's main interest is to achieve good patient outcomes, the hospital's is to spend as little money as possible on devices and the rep's is to sell the product. Of course, all will say their main interest is better patient outcomes, but each entity has their own interests at heart. I know a bioethicist who loves to study this stuff! If a device costs more than the hospital currently pays, they will often try to block its use. If the doctor's argument is that the patient will do better, the hospital pretty much says "prove it." Reps that provide studies as proof statements of outcomes often fall flat on real lack of evidence. The truth is that a lot of these "studies" are company sponsored, so even though they might show some positive evidence, it probably would not be considered real science. Also, paying a higher up front cost with the notion that future patient medical costs for a patient will be lower is not easy to prove. Part of the problem is that non-medical people in purchasing departments often approve or block the use of more expensive products and they are not incentivized to do anything except save money.

Jim Bloom Gunter great question. OrthoDirectUSA is proving that hospitals and ASC's don't need reps. We can train the hospital staff to do the same thing as a rep and reduce their costs significantly! Ortho co.'s are playing defense and just trying to maintain the business that they have. Papers are coming out now that the new implants aren't any better than the old ones. The market is becoming commoditized and it is long overdue!

Allan Russell Jim,
who will bring in the new products mate...your hospital??what about your
funds from your bank account?-no not likely eh brother!!....if you dont
fund the future with todays products you just have todays products
tomorrow-and if I retire in a few years time with still todays products
I'll be a bit miffed and so will you- we will have let society down badly
too-we need reps to fund the future...geddit!?!?
think of the big picture Jim-and pull your head in laddie!!

Arlen Meyers, MD, MBA Is there a software solution out there that tracks implant buys, utilization, costs, charges,etc and combines that information with clinical outcomes data?

Gunter Wessels,Ph.D.,M.B.A. Arlen,
Yes there is a very nice one called Invivolink. They're an early stage firm based in Nashville. John Bass is the COO and they track outcomes, implants and their clinical indications, cost, charges, and coding for billing. Surgeons are the primary driver of the adoption of this because it increases their ability to participate in bundled payment schemes, and ensures that the right sets are available and clinically and cost appropriate.

John Joyce An excellent question especially as we enter the era of evidenced based medicine, which incidentally one would have thought was or always should have been a criteria for making treatment choices. It would seem that the role of the salesman really is that of the persistent child or the seeker of favors from the deity in each instance getting attention for the favor sought is a function of dogged repetition. The salesmen serves as one of the repetitive mechanisms aligning her/himself with industry advertising and promotion and scientific and professional documentation and popular media coverage in which latter group would be traditional radio/tv/magazines/newspapers as well as the net and social media. With the proliferation of intensely personal information terminals such as the various phones, pads and tablets targeting medical device decision makers by these means reduces the relative effectiveness of the other sales message sources for after all the sales message is essentially a presentation of the evidence for the superiority of the device in question in ameliorating or curing the infirmity in question. One has only to note the rejection, ostensibly, of the now old time methods of gifting,wining and dining as legitimate techniques because they run afoul of the Medicare guidelines prohibiting providers from being remunerated for decisions affecting the dispensation of US Treasury funds. What it will come down to will be the judgement of device manufacturers as to the most effective way to achieve sales. I believe that there will always be a role for salespeople even if that role devolves to one akin to the town crier strolling the darkened streets of medical commerce crying out Hear Ye.

Curtis L. With over 24 years of invasive surgical sales management experience, in over 37 types of surgical procedures, it is critical that i kept abreast of the most cost effective medical supplies & devices that would meet the needs of the surgeon and their nurses, while helping to reduce costs in surgery. I am considered a much trusted advisor, mentor who is ethically sound, as to support a postive patient outcome. Helping with the reduction of spend management, identifying the cost of procedures, product standardization through the C-Level logistical chain both vertically & Horizontally, utilizing the team approach gives me the ability to be highly effective in providing much needed information in the latest "Widget" that is rapidly developing in todays market place. Absoultely they are needed, but there are also to many reps that are not properly trained, and fail to fuflill their position to the best of their abilities.

Curtis Lilieholm IV,PA,CPS

Arlen Meyers, MD, MBA Given the changing demands and roles discussed here, if you were designing a curriculum at medical device sales training school, what would be the learning objectives, competencies and curriculum your would propose for students?

Gunter Wessels,Ph.D.,M.B.A. Curtis: keep on keeping on! Great comment!
Arlen: The curriculum would be:
1. Evidence Based Medicine--fundamentals and how to properly discuss clinical information with clinicians and medical policy leaders
2. Operational management--Department operations, resources, cost-accounting for a procedure, patient flow and related workflow.
3. Business Acumen--Contracting, supply chain management, negotiation, liability and occupational hazard considerations, and basic finance of provider operations; i.e. Revenues, Reimbursements, and Regulations in departments, hospitals, and alternate sites.

We have a learning path and multi-phase curriculum in this domain.

Curtis L. 1st Introduction into the Operating Room, Sterile Field, Scope of the O.R.
Surgical Rotation

2nd An crash course of the human anatomy with a 80% requirement to pass
each test

3rd To become an expert on the particular medical device, so that this
person would be able to be a resource to the "Surgical Team", in every
aspect of the "Widgets Function"

4th To follow through and understand that the surgeon is pulled in many
directions are their nurses, to know when to interject and when not too.

5th To follow ethical behavior, to treat every patient as if it were their
own family member

6th To travel with other experienced senior people from that organization
so they may be mentored in a positive way as to bring wisdom to their
talents

7th To understand the condition of Acute & Sub-Acute care facilities in
the market place today, that heath care is out of money, to be committed in
bringing true value to the table every single time they walk in the
organization.


8th To understand the process of each organization, to be able to explain
the features and benefit's to the C-Level logistically through the food
chain. To follow up and make sure that everyone is on the same page.


9th To over promise and over deliver every single time in what they
promise.



Our jobs are to educate & provide information, in service and guide
through new endeavors pre-sale & post sale and follow up are critical. If
their are issues to take corrective action and locate the root cause of the
issue at hand, and resolve it!

It's a great question and one that most device company leaders are forecasting to answer at some point - or at least a modified version. With the awareness today among healthcare facilities and the focus on transparency, construct pricing, etc., the goal of price integrity within a device company will be tough to achieve longterm. Most educated leaders of Supply Chain, etc within the HCF have heard and probably dwelled on the term rep-less O.R. It's more than just a buzzword phrase now.

It's also a question likely to strike a nerve in the rep that is hustling everyday to build and maintain relationships, as well as consult in the cases where needed. But, the reality is that there are already a large amount of products in most rep's bags that can already be drop shipped as mailbox money to the rep. There are also accounts in a given territory that depend on the rep to facilitate the case, along with accounts that manage the process themselves.

Not to take anything away from the reps that are truly needed for the case - myself and our team are those reps, but will there be a day where the HCF's at least stock their own trays?

A good question is when will there be a solution provided to the HCF that provides them the luxury to have their staff trained to do the majority of what they're not doing today? Probably a similar question asked by someone just before the groups started capitalizing on the need for vendor credentialing.......$$$

Arlen Meyers, MD, MBA Now that software can detect device malfunction in patients, is there a role for reps/salesman/clinical liaisons to work with docs to address the problems?

Curtis L. I think like everything else computers and software have there strengths
and weakness's, Over my last 24 years i have scene to many instances of
what the software was suppose to do vs. what it did not do. If we take
humans out of the equation or sales reps that can trouble shoot this sort
of request when it occurs, i think the surgeon, patient and organization
are well served. Just a thought!




Regards,





Curtis Lilieholm IV

I think mature products in mature markets need more “sales” attention than cutting edge technologies. I have a cousin that is a ‘salesman” for Morton Salt. You don’t get much more mature than a commodity market like salt, but without sales representation they would lose revenue. If you lose revenue you have less to invest in new technology. Without new technology....... you are dead in the market.

Jim Bloom in response to Allan Russell's comment. Allan do you know that currently 75% of all orthopedic implants being used today are off patent. There has been no really significant improvements in implant longevity or design in the last 20 years. Swedish joint registry proves that.I'm not saying to eliminate med device sales reps, but their relevancy is diminishing quickly. Doctors go to meetings to learn of the new technologies. And by the way, there is this new thing in your country called the Internet that these doctors are gaining information.

Curtis L. Jim

I can NOT disagree with you anymore strongly then this. Hip/Knee implants are constantly being reinvented and they have a failure rate too! Do you really think Orthapedic surgeons have the time in their day to sit on the internet and research the latest on implants, NO! They barely have enough time to make rounds after surgery! They rely on reps to bring them the latest changes, recalls, and other feature and benifits that come with such a wide variety of choices, and i might add the cost structure from one company compared to another is extremely significant. This goes back to what i was saying earlier, its one of our jobs to educate our surgeons and nurses, as well as the logistical chain, so the organization can make the best choice possible.

Gunter Wessels,Ph.D.,M.B.A. Curtis, I like the interchange and you and Jim have good points. However, it appears that the core or your argument stems from Surgeons' time poverty and needs. Shouldn't they pay for the reps then? Patients and payers are buying the doctors' expertise, which includes the selection of the implant. If docs are unable to determine the best ones without salespeople, doesn't the cost add belong to them? Maybe hospitals should pay for reps, since the reps are doing inventory management, and alerting everyone to recalls etc, and since they're not staffing the OR purchasing department with people who are up-to-date, the cost is theirs to carry? My question is, how do Reps make the process of care more efficient and offset the cost per case? How do reps create value for the system; do good reps recommend the most cost-effective implant as a general rule? I know that pharmaceutical reps do not... I tend to believe that you do that, but I'd like to know how you would articulate that compelling value proposition.

Gunter Wessels,Ph.D.,M.B.A. Brad, I'm an outspoken critic of vendor credentialing in its current form, where a third party charges reps for access to its client hospitals. The hospital/ASC has the responsibility to monitor who goes where, and outsourcing that function has some appeal, but these organizations are possibly violating numerous employment, federal and local laws. The practice persists nonetheless, but largely because it's a nuisance fee that gets charged. Representative credentialing is silly; we don't credential registry nurses, or LVNs etc. Other professional credentialing process have merit because they're mandated by law, but because reps don't have licenses the potential to have personal, professional, and privacy rights violated is great. Furthermore, because there's a pay-to-play aspect of this, and rep-registrars are not safe-harbor qualified organizations, they may be afoul of anti-inducement laws.

Gunther What would you propose as the alternative to sell new surgical products?

Gunter tell us about what you did as a sales person. Were you ever in the OR in a complex case where a surgeon turned around , looked you straight in the eye and asked you a critical question about your equipment that was being used - a question that you needed to know exactly what he/she was talking about, for the betterment of the case outcome, and a question that you needed to know what the issue(s) were, and how best to directly answer it.
I have been in the OR environment and on the other side of the industry standing at a detail table with a pharma product. We need the former. The later - a more elaborate case needs to be made for supporting a rep in some of those environments.
The answer to your question is yes.
dk

John Joyce Given the constant influx of non-credentialed visitors to hospitals the value of rep health certification in reducing infective risk is questionable even in the OR.

Curtis L. Acute care facilities in the North East tend to be not for profit, they
tend to promote from with in, in many instances they simply have the wrong
people at the helm, or people that are in non medical roles making
decisions or bringing influence to a field they no little about. Typically
reps are commissioned based so in essence the Hospital is paying for the
representative would you not agree? Health care is changing dramatically,
competition is not only much required but needed to drive waste out of the
system, margins for companies are also eroding, I tend to believe that reps
that are "worth their salts" have a passion to introduce the most
"appropriate" implant for a particular surgeon for that particular case,
because the most positive outcome is a direct reflection on the surgeon,
hospital and obviously the patients outcome. I hope the above adds insight
to your question, and yes good reps do look constantly for ways to bring
value to the surgeon, hospital & patient, because when they fail to do this
there is a competitor looking to replace them. While the system is not
perfect, if we take a step back and review the advances in medicine,
education, information & development is our best vehicle for health care.
And yes there are to many reps just pushing product which they no little to
nothing about and are just in it for the sales, but they tend to be short
terms reps, which run through a revolving door of career changes.




Curtis Lilieholm IV,PA,CPS

Curtis L. While i think the credentialing process is become another expense that has
promoted a business that makes little sense with no governing agency, it is
imperative before any rep who enters the O.R. is up to date on all their
vaccination's to ensure that they do not pass something on to a patient
while they are on the table. This can simply be done by the reps providing
their necessary vaccines and medical reports to the O.R. so they may be
cleared prior to admission. To me this is a "No brain er"

The consultative sales representative that brings value to the customers by understanding their business is a proven concept across industries, even for mature products. This is especially true in medical, with a tradition of hands on training and in-service. Abuse occurs when scrubbed in reps upgrade a clinician mid-procedure avoiding price negotiations. Training content and type of training is critical to the performance of a well educated consultative sales organization. People still buy from people, but what are the topics you want your sales people to be discussing with potential customers ? How you approach this and educate to this may be worthy of investment.

Arlen Meyers, MD, MBA I'm more concerned about doctors transmitting infections (not-vaccinated, don't wash their hands) than periodic visitors to the OR.
Also, should patients be required to give approval for non-healthcare professionals in the OR?

Arlen Meyers, MD, MBA As someone who was involved with the early development of surgical lasers and some other complicated pieces of surgical equipment, I value the contributions from knowledgeable and professional industry partners. I don't care what you call yourselves, I appreciate your being there to help me get the case done in the right way.

Do we need the medical device market?The answer I would give is yes!How would you have a medical device market without medsales? but we need well trained medical device sales people,business developers and also good problem solvers, we need more multifuctional people beyond just sales especially in countries with deep financial crisis, like the one I live..

Gunter Wessels,Ph.D.,M.B.A. Michael, you can get a lot of impact with clinical educators and corporate accounts in some segments. I'll make more direct recommendations privately.

Gunter Wessels,Ph.D.,M.B.A. Dan:
Yes I've been there behind the red line, in the OR selling spine implants and sets, other OR equipment, tables, and more. Now I have the privilege of advising companies, groups, IDNs, policy makers, and health systems sometimes at the national level in the U.S. and abroad.
I believe in and see value in sales effort, especially when we all understand that our customer is at some level the health system--and by extension ourselves as consumers. As MedDevice salespeople with a future, we have got to make the system more efficient and more effective. If we don't do that, our time is short.
The best salespeople integrate the clinical value prop, with the operational gains and financial performance of the solution. A balanced, and real, and valued outcome. They sell the impact of their products and solutions at all levels of consideration, and can articulate how the device reduces cost for the health system. That starts with the doctor, but it can't be just good for the doctor, and his/her preference despite the cost to the hospital, ASC or health system.

This question actually brings up a fundamental mindset. Needed by whom?

Are the goals aligned? If the common need for all parties (physician, nurse, administrator, taxpayer, Med-device rep, etc.) iare aligned around the best total value to the patient - and the rep contributes value toward that goal...they are needed.

If the Med Device rep is simply focused on their own commissions or exclusively on advancing the company's interest regardless of actual value toward patient care...the rep is probably creating waste or drag on the system...and not needed.

The rep may be needed for income for his family or needed by the company to increase sales...but I would argue that in the long run, the system will spit them out unless they provide a legitimate value and are needed by ALL the parties...especially the patient.

This question sounds like it started in the Finance department about the time that comp plans are being reviewed...

I find myself raising money for some med device businesses that have not yet sold anything. I often ask myself "Can this company sell its products?" and "Do they know what it takes to sell their products?" To my mind it is always about people who can do the selling. Call him/her what you like, but I think you will always have to have the person who can work out how to sell the product and enjoys doing so. It is intriguing to see these responses because it helps me to picture the kind of person the company needs to appreciate, cultivate and attract if it truly wants to achieve the sales projected in the plan.

Thank you Gunter for asking this question.

Nick Rutsis Many years ago when Siemens owned Pacesetter Systems, (Siemens Pacesetter, now St. Jude Medical) I was in management and learned some interesting things about state run health systems, which really do not need sales reps. Only contract people are involved since capitalism does not really exist in those systems. Trade with Cuba was prohibited, so Siemens pacemakers were sold to an entity in Canada and then re-sold to Cuba. There was no service provided, only products. I remember an order of about 500 pacemakers that was sent from Siemens in Sweden to Warsaw, Poland with no service component. They were interested in the lowest possible price and the most basic pacemaker. This was the only order that would be placed for an entire year and when the stockpile ran out, it was too bad for anyone who needed a device. I don't know if Poland had a private market back then. I also have a cardiologist friend who ran the public health cardiology program in northern England. He was able to order more sophisticated products, and service was included, however, he had a dollar budget that he could not exceed, and when the inventory was depleted, patients had to wait until devices could be reordered under a new budget. There was and still is a private market in England. That, my friends, is how the socialized world receives medical care.

Joseph Ticer, MBA, CWCMS In many cases, buyers have so many choices in the medical device market, the time spent simply sifting through options would be time prohibitive. One of my close professional associates is a buyer in the software industry and conducts training sessions on the value of relationships with vendors and sales associates. Price negotiations are a minor subset of the relationship that is focused more on partnership.

Sales professionals and management teams need to upgrading skills with their sales teams on a continual basis. Value proposition from sales professionals needs to expand if we are to continue to bring forth resources as a professional group. More focus is being placed on certification programs within medical device markets which provide a clearinghouse for professinal marketing and sales efforts.

Paul J. Morse A Brilliant & Hard Working Manager said....many times,
"Nothing Happens Until Something Gets Sold!"

Gunter Wessels,Ph.D.,M.B.A. Just by way of redirecting here...I'm a capitalist, am for capitalism, and most people here are the same. Therefore, the question is about where Salespeople add the most value. Nobody believes we're going to cease having MedDevice salespeople, but I do believe that the value is migrating as many cogent comments above also indicate.
As I've observed we agreed that:
1. Salespeople add value by educating clinicians
2. Salespeople add value by aiding in logistics and kit availability, sometimes taking over responsibility for delivery of supplies on a just-in-time basis thereby insuring the success of the case and protecting the provider's interests.
3. Salespeople add value by interpreting the needs of the customer organization and making knowledgable recommendations to clinicians and managers.
4. Salespeople add value by promoting novel, innovative, complex, and sometimes skill-dependent leading edge products and showing providers how to use them safely, properly, and effectively to realize a clinical benefit.

On the negative side:
1. Salespeople do not add value if they're simply stocking parts
2. Salespeople do not add value if they're recommending something that is higher priced and has a suitable lower-cost substitute.
3. Salespeople do not add value if they don't know their product and don't know the clinical parameters of the cases their devices are involved in.

Does that capture it? We have a few other things to point out about the value of sales, but that's for another time.

Simon Williamson Hi Gunter,
Whether medical products are mature or brand new, high tech or have a basic functionality the role of the Medical Sales Person in my mind is to 'Add-Value'. I believe they should adopt Account Management principles and view their region holistically but the value is best felt when the timing is aligned with their customers decision making process.
Through having an extensive knowledge of the product, market and customer, the sales person should be walking alongside the customer seemlessly and if it is forced, the result is obvious, Contrived and of no value.
All the best

John Joyce There are devices and there are devices. Some stand alone and act directly on the patient and those should become accessible to patient choice when the evidence envisioned for evidence based medicine is vetted and published. Point at hand: there is a simple non-invasive test equivalent in cardiac disease burden evaluation to laboratory administered coronary angiography. A web literate patient could easily evaluate the two modalities and select the one preferred. As the former test is NEW and affordable and the latter ENTRENCHED and an established source of income the patient will have a hard time stumbling on the new option. This scenario is not a new one but the more evidence becomes available the more the consumer will become involved and that should really be good for the health care marketplace. For this category of device I see the salesman for the evidentiary device winner winning the day and enthusiastically making calls where a warm reception awaits but for second tier devices the salesman might as well stay home.
Yes but....

Bill Harlan In reading the above comments out side the OR without properly trained reps. there will be no new products introduced to the market.
Many if not most new ideas introduced in the market come from small companies that can't produce enough product to fill the pipeline for a large inventory for a major manufacturer or distributer.
Small companies need Independent Sales Reps to introduce their new products and ideas so they can produce enough revenue to 1) sell the company 2) to increase production.
Without small companies there will be little or no new products in the market

What kind of question is that??? Of course we DO need Med Device Sales people! These people do sell stuff so we could have our salaries paid, and our companies have the necessary resources for us to build new stuff and improve the existing stuff to strive and stay competitive! Great example: IBM, Motorola (not medical devices, but good examples): both had many leading innovations and very neat ideas ahead of their time - and a very, very strong technical teams, however sheer lack of marketing prowess just killed those ideas, products, and developments. Apple picked them up and got stinkin' rich.

Urs Mattes For me the answer is a big YES. Why? A sales person is not only selling products, our sales persons bring value for the surgeon and hospitals, be it that they support the surgeon at the OR, or helping the hospital with consignments, or bringing the latest literature to the surgeon, training nurses how to use the instruments in the right sequence, etc etc. If a company in orthopaedic in China would not do this, no sales whatsoever. No website, no blog, no app can replace a qualified sales person. Beside, the human aspect comes also into play. Most doctors are not robots and they like to interact with people rather than websites and brochures and whatever is written. The question for me, however is what medical device products do need a sales person. For highly technical products such as orthopedics and cardiovacsular, no doubt, we need sales people, but maybe not for products which do not require much support. The answer for these products is most likely a no.

John Joyce Urs describes facilitators not salesmen. The "scrub nurse" duties are
required only after the ink is dry on a contract which has and will
continue to trend to impersonal number crunching after sealed bid
submission to a board. Where evidence is required to support product claims
companies will have to succeed or fail on impersonal performance and cost
metrics. Sales as the art of persuasion is morphing into the art of
presenting and herding statistics.

Urs Mattes John, you did not read the word China. The world here is different.

Nothing sells itself

Paul J. Morse Nothing happens in the High Tech Device market until something gets SOLD!

Jim Bloom ...or maybe its gets purchased instead of sold!

Paul J. Morse Commodity items get purchased. Advanced technologies that drive markets get sold. Sitting in a cubical waiting for the phone to ring or eletronic demand to show up doesn't get it!

John Joyce True but I give you Amazon.com etc. where sales data is accessed by the
customer who closes the deal without a sales person involved. Not so
far-fetched a process for medical products.

I believe that there will be no need for sales reps in the future. Look at all the online ordering of those "Me To" products that can be accomplished. Companies like Smiths Medical, Cardinal, O&M, and Teleflex will be operating on such razor thin margins they will not be able to afford a field sales organization. There possibly might be some specialty devices that will need to be detailed, but a catheter, HME, syringes, I.V. tubing, trach tube etc, the margins have been eroded away with GPO's, and competition.

I know with the lack of time some doctors have to pick up the latest innovations in the news, they appreciate an occasional fax, or email from their salesman on the latest technology. A good salesman always knows what their customers needs are, and are always on the lookout for new devices to find solutions to those needs. I enjoy highlighting articles in certain parts and making personal notes on the sheets that relates to their situation. This makes our relationship more personal and gives me something to talk aboout with them on my next visit.
On the mature products, sometimes there are items added to improve the product. Example - pediatric trach tubes, pretty common eh? Well, there is a new pediatric oxygen flow meter that attaches to the trach that helps measure oxygen actually entering tracheostomy at the end of tube.
So even if trach tubes are pretty common and long running, the applications attached to them are why you need a salesman. They update you based on uses of the product. I hope that answers your question?

This is a really good question that should continually be asked by management. My opinion is that we will always need MedDevice salespeople...the only question is what type and how many. The answer will also be influenced by the country in which we are doing business. The answer is dictated by the sales equation, e.g., how is the product specified and purchased. As we all know, the equation changes depending where the product is in its lifecycle and who is making the purchasing decision.

Medical devices are made up of products that range from commodities to highly differentiated offerings. A key differentiator is whether or not the product or product portfolio is physician or departmental specificied or if the product is purchasing or consumer specified . Products were decisions are made by purchasing based only upon price can only justify MedDevice salespeople if the product portfolio in its totallity can, based upon a bundle of products, financial justify/support a MedDevice salesforce other than key account/national account managers. Highly differentiated medical devices that are physician or department specified generally require and can financially support a MedDevice salesforce. A good case study is MedTronic...they analyzed the shift of their vast cardiovascular products offering form physician specification to purchasing (institutional). In turn, they combined their various CV medical devices units and combined their multiple specialty CV salesforces under a single cardiovascular salesforce. However, they maintained specialty MedDevice sales organizations for their newer, non CV product offerings.

The United States serves as a good example for this discussion. As I state in "Multi Trillion Dollar U.S. HEALTHCARE TO 2020 Gold Rush", provider reimbursement, organizational structures, and care delivery will be significantly changed by 2020. Various care management models and organizational structures will materialize. Physicians will increasingly move from private practice to group and hospital practices - especially as older physicians retire. The trend will continue towards highly integrated healthcare systems to increase negotiating power with payers. As a result, physician influence in a number of product areas will migrate to the institutional purchaser. Examples include cardiac devices, point of care diagnostics, endoscopic devices, clinical laboratory tests, energy based devices, catheter abalation devices, etc. Further, some will shift from physician to consumer choice, e.g., insuling pumps and drug delivery devices, body coutouring implants (other than breast implants which are already patient specified).

In summary, new differentiated products will require MedDevice salesforces, commodity products will have to be bundled and less salespeople will be required...and the type of training they receive will be different.

I hope this contributes to the groups' thinking.

Good sales reps have learned to think in terms of customer's needs. They explain things in terms that the end user can appreciate. They not only provide customers with info, they also act as a project manager to keep a sales process going. Sales reps also provide thier principles with info on the perspective customer.

When the customer is buying a mature product, sales reps keep customers happy and make sure that communications are going both directions. They also use the visit as a opportunity to see what else the customer may need or what is coming down the pipe next. Good sales reps provide value.

John Joyce A salesman can lead a horse to water but digital marketing will make him drink.

I agree with Paul Settle, I have observed similar phenomenon in our company. In medical devices industry the successful sales person needs possess both skills- sales and technical/clinical. It is not easy to find the right candidate. Many clinical folks are not business oriented and not motivated by money so to structure compensation correctly may be a challenge too.
Our organization had few clinical folks who successfully transitioned to sales and some who not. Regulatory environment may have an impact on this as well.

Nadine Lepick Hi Gunter, This has been a great discussion so far.
I'm always impressed with the top sales reps and how they do their jobs. They are there for the doctors when needed AND they bring back great insight about the use of the products to share with their staff at HQ. Without that, no one sitting behind a desk or monitoring a website is going to collect the same information/comments from the medical staff.

I had a great conversation with a marketer from a multi-billion dollar company recently who said that they often send someone-could be from sales-just to talk to potential customers to chat. It was surprising the kinds of information they came up with. When the collected comments were shared with production, marketing and sales and other execs, it completely changed the way they sold to these customers in the future. They learned how they do their jobs, what they liked or not liked about a product.

I agree Mr. Clarke, there is no conduit of information without your sales contact going out there.

This is a great discussion. Obviously, with the evolution of Healthcare Reform over the coming years, our commercial approach is going have to change in most companies, whether we are responsible for sophisticated Medical Devices, Pharmaceuticals, or Commodity Medical Supplies.

Ultimately, if we aren't "selling" to end users clinicians, we are going to still be "selling" to Contract Managers, Formulary Committees, GPO's, IDN's, and whatever other touchpoints are necessary to support our corporate and product value propositions, so as to maintain and/or support the growth of our products. I have to believe, that corporate relationship building / managing will always have a place in our medical economy.

Luis Nieto Extraordinary question. It poses a number of things to consider and the he who dares to actually think it through will really benefit.

I was talking to my sales and marketing managers a couple of months ago and I said that I thought we would sell just as much if we went rep-less.

My comment was frowned upon at first, but after further analysis we realized we understood we needed to make sure every rep was adding value in a regular basis.

Our industry (particulary the sales function) has a supreme lack of processes, This is true for the largest and most diversified player in the field as it is for a recent start-up. So it is complicated to define and measure value adding activities for the sales reps. It can be done, some of the times with their help and some of times in spite of their very well founded objections.

These are my five cents.

Do we really need innovation? That is really your question. Without sales people driving sales on new products, even if in a given industry the impact is marginal, sales people make one product/company stronger than a lesser cometitor.

Joel Oster I truly believe it depends on the device(s) you represent. As mentioned with commodities, probably not since pricing is usually the primary driver. However as Mahesh so aptly stated, with a highly technological product or one that requires updates etc., a good rep and be a huge asset and really help drive utilization which in turn drives sales and grows market share which can only help your company's and customer's ROI.

Urs Mattes I have seen in our industry, orthopedics, that sales people were able to bring ideas back from the OR to improve existing products because they were intimately familiar with the operation as such and could discuss the critical issues with the surgeon. This will never happen on the internet. Even though I am in favour of social media, I think we should be very realistic and not fall into the same trap as we did with the internet companies downfall where valuations were done on clicks. Nothing sales itself and sales people will always exist. Most surgeons trust humans more than websites.

Yes, medical device sales people is a must have if you ever expect your product to grow. Selling in all aspects has evolved to relationship selling which can only be created and developed on a face to face with the customer. Communicating value proposition is effective when customer interact with the face behind the product or service. In this age, as customers become more aware and demanding, we cannot do without sales representatives.

It is more market specific. I have my business in Middle East, where the sales rep could make a difference. The customer in this part of the world is looking out for someone who he thinks knows the product well & can guide him in choosing the right product. A smart rep could add value to the company, to add to it a moronic rep could even kill your market....

Chris Dahm Provocative and potentially "riot-inciting" question. I think that is probably what the credentialing agencies are trying to create on behalf of affilitated hospitals. So go ahead and try to do it with a catalog or a website. It might work in theory with commodity items used on a daily basis. But the clinicians still need to know how to use their new equipment so my expertise would still be needed. Guess I am sounding defensive here but there seems to be this misunderstanding that reps get paid too much and thats whats adding to the cost of medical care. Actually did you know that 5% of the supply items used in a hospital account for 50% of the overall operating costs? I know from experience that those departments (OR, CCL, IR etc) do much of their inventory management manually (using stickers and note cards)! Can you imagine running a million dollar business like that?

John Joyce The more depersonalized the purchasing decision the less valuable the sales
rep. In the bad old days of wretched excess when individual docs were king
the silver tongued and lavishly hospitable reps wielded serious influence
it was a different story. Today with evidence based medicine it is simple
logic to see that evidence based product efficacy is here as well.
Purchasing decisions involve committees, Premier sized groups and closed
doors and the data is delivered digitally.

Rakesh Lehri Great comments and opinions.Thanks Gunter for attracting so much discussion on a very valid thought.
I have enjoyed my 30years working for one of the best healthcare organization ($63bn) in the world out of that two years in China training sales managers & sales people in the OR and outside on Sutures,Endo mechanical products& Hemostats.
I feel if the properly trained sales staff works like a facilitator not as sales person it will add lot of value to healthcare providers, patients and organization.Since the actions of healthcare person are focused on patients life,the healthcare provider also needs backup confidence specially when using a device or consumable products.The sales persons conviction about the product helps in building confidence for the superior outcome, be it new product or mature product.

Rob Osborne Great discussion! I would be interested in reading comments about experiences with automated high-security closed supply management cabinets? I've noticed them more an more in hospital ER rooms recently. They relieve the nursing staff of supply inventory management responsibilities and let's them focus on nursing.

Reps not only drive market share, but provide education and valuable information to the clinician in and out of the operating room. Good Sales representatives have relationships that drive revenue, and are esential in providing growth to med device companies. You should probably not be in med devices as a consultant, asking this question demonstrates your ingnorance.

Hi I'm Francisco and have been in the Medevices market more than 18 years, and let me tell you that the sales reps here in Mexico is super necessary. Why? well doctor and users like to be treated well, not just have the quality of the producto but tha constant personal attention to our clientes is well apreciated by them. Dont forget that if you do not pay attention to your client, some will. Best Regard for all of you form Mexico. Hope to hear from you soon. Bye

John Joyce "asking this question demonstrates your ingnorance. " There are no bad questions only bad answers or so it is said.
In the competitive sales arena where may be found several reps vying for business the individual persuasive ability of each perforce is less effective than the products strength, weaknesses and track record, i.e. evidence of efficacy and last but not least price or economic impact. If a company believes that emphasis should be placed on in-depth data gathering and presentation for review by impersonal purchasing entities the role of the rep devolves more to courteous messenger and if the sale is made then the rep can be a facilitator...perhaps.

Luis Nieto I am very glad to take part in this discussion. I do believe that challenging the status quo almost always results in great insights, even when we decide not to change much. It is exactly this ability to "blaspheme" that is needed from a consultant, together with a respectful tone and flexible position.

A World where we are not needed is obviously something not easy to take.

With all due respect, it is easy to see who is a rep in this forum. Worry not. I believe everyone in the organization will continue to make sure salesforce add value. Make sure you do.

Chris Dahm John, Please don't take offense to this. But I read you most recent comment a couple of times and still have no idea what you are trying to say. Personally, I struggle to keep my message simple, not leading off onto "rabbit trails" (just ask my wife) I strive try keep my presentations, followup e-mails and any such communications as simple as possible. This discussion seems to have begun going in circles so I may opt out soon. Bottom line for me is if I bring the expected results (value) to the company, then they should value me whether or not I am a direct or 1099. If you as a manager or owner lack trust or think a call report is the ultimate in control, then hire a W-2. My bias would be that since I cost them very little in overhead ahead of the sale, the 1099 idea should be an incentive. I just expect a similar value from them - not just fancy brochures and website (a totally new avenue of discussion if anyone dares)

Gunter Wessels,Ph.D.,M.B.A. We will revisit this topic soon, but thanks everyone for contributing! Great discussion, and some very good points! Viva Sales!

John Joyce I would like to suggest a corollary question: Will the emergence of
"Evidenced Based Medicine" significantly change sales strategy?

Rakesh Lehri For Med device sales people role of a facilitator is more appropriate and
surely they can help in achieving superior outcomes.Win-Win for healthcare
provider, patient & organization as well.

Arlen Meyers, MD, MBA Let's take the metal on metal hip implant recall issue. Were reps asleep at the switch? What should be their role in outcomes tracking, adverse events detection and reporting, patient v company advocacy?

Chris Dahm Bouncing off Joseph's comment . . . having reps involved in things like Kaizan events would be one of those "value-added" benefits (sorry for the cliche) the company could use to distinguish themselves. I personally have wanted to have support for such training, and others such as LEEN. Its expensive, yes, and time consuming. Personally, the reason I have not done so is that there is no tie-in so to speak with the companies (I am a 1099) focus, if that makes sense. I keep getting new brochures, some updates to the websites, and thats about it. Rather than spending time on sales meetings, new brochures, trade shows, maybe companies should shift to ideas that make their reps, and in turn, their company truly more valuable to the person on the other side of the desk. What was that Henry Ford quote - "If we are changing, we aren't improving". Seems like most companies I observe are in that rut, the one that defines insanity.

Having been in medical device sales and sales training, this is like saying my life's work is no longer necessary. So it is hard to be objective, but I will try. Sales people are necessary and wanted by most surgeons. We provide service and knowledge to the procedure and are a resource to busy surgeons for new information and new products. The drive to eliminate sales people come from the administrative and financial decision makers, who don't see our value. Our responsibility is to train our sales people how to be an operational and financial value to the non-clinicians in the hospital. When sales people develop the knowledge, skills, experience and confidence to call on Hospital Sr. Management. Perhaps their value to the hospital will improve. As Gunter said in his webinar, medical device companies need fewer, but better educated sales forces that can understand clinical evidence, operational and financial impact delivered to a higher level customer. I am afraid most VP's of sales won't acknowledge this and will stick to the same sales practices they were taught.

I have not read all the comments, but sooner or later this industry will go the way of the mortgage broker... We will wind up working for the hospital and you will need to know a number of different lines. You will then be place on salary and make 50-80K a year being and advisor with little to no commission. In addition, you will need to be licensed. trending in my brain pan... hope it's not true! :)

John Joyce A sale is a process like unto courtship, proposal, marriage and yes Virginia divorce. Our discussion often has focused on the skills necessary to keep the marriage alive but the crucial point is the making of the vow, i.e. getting the P.O. and as I have been suggesting the shape, content, and cogency of the proposal as a submission to a purchasing entity assumes more and more importance as medical funding grows more dear and draws such close public scrutiny.

Chris Dahm Ever since I have been around, there has been an ongoing effort to "rebrand" with fancy titles that I think are more to stroke the cardholders ego than to set one apart. When given the option, I just use the title "representative" and occasionally get courageous with something like "territory manager".

Simon Williamson Gunter et al, The comments are interesting and the views varied which is great however I do feel too much science is being applied to analysing this concept so in an attempt to simplify it, if an individual or group 'add-value' to another individual or group, surely there is a chance for synergy. For me the challenge is around the word 'need'! Of course there are other means to extract information and make purchases of medical equipment / devices but, does the clinician have the time or inclination to explore them fully? Sometimes, but not often. An informed and well trained representative that understands the needs and demands of today's clinicians should be seen as a partner to their patient services and one that saves them time and ultimately improves outcomes. Anything less is a hindrance.

I am working with the Orthopaedic Implant division of a well known company, wherehein I have experienced naive situations wherein our Product knowledge proves to be of utmost importance in the OR to surgeons and gives an extra edge to the Surgery in Process

Nick Woods Really interesting comments from all. Maybe the question needs more definition... Who's the "we" in "Do we really need meddevice sales people?".

A quick scan of responses suggests that physicians need more tech support and sales people agree they can provide that. So "we" physicians need reps and "we" reps agree we're essential. Yep... I can see that.

I just wonder a bit though... Do regional sales meetings start with "How have we all provided tech support this quarter?" or "Lets look at sales". Like night follows day, one would have thought that sales often come from offering good support. Taking that argument forward, better support should therefore give better sales. So, more technically able personnel should eventually trump the "journeyman" sales rep.

I think we may see some form of evolutionary "speciation" at work and an increasing split of roles into PhD superreps with high levels of technical ability, big territories and very close relationships with the clinical community... almost integrated into it in fact... and then the "organisers" who do the airport runs in the night to get the kit ready for the case and even stands there to assist the routine procedures. Total Joint companies are already well down this track. It just doesn't make economic sense for superrep to be spending time buying the cakes.

What happens to the scalpel rep though? Well, unless there is a technical need for them to explain how their particular scalpel is made from laser etched carbon fibre with impregnated moon rock, they'll morph into "account managers" with responsibility for negotiating central contracts and rarely see physicians, except to curry favour come decision time. That's my (European) read on it.

The answer is then that the collection of things the medical salesperson variously does are necessary, but a "traditional" salesperson (sorry for the huge generalisation) need not necessarily be the best way to deliver those things. And indeed those things will be different for different companies and products and procedures.

Joseph Ticer, MBA, CWCMS Like others on this conversation, I have found it both interesting and revealing. As our profession evolves to the next level, perhaps the discussion should go beyond technical competences and begin to look at the changing market space that defines medical services in general. With more and more decisions driven by cost factors and regulatory issues, there are more patients being moved out of traditional acute care environments and into subacute areas for extended care. Sales professionals should be tuned into the changes within the purchasing world as well. With a greater focus on supply chain management and lean operations, we need to be able to offset the tendencies of buyers to consolidate purchasing and move certain vital products to commodities status. As outcomes become more important to reimbursement, the ability to drive down to root cause once your product has been bundled will become more and more difficult. The future medical products sales rep may need to be able to participate in Kaizan events within the supply chain managers in order to remain an effective voice for our profession. Just a few thoughts. Thanks for your consideration.

Urs Mattes I have a number of good friends who are orthopedic and general surgeons. What I have experienced with almost all of them is a lack of time to use the internet and in particular social media. When I send them an email, it may easily take a week or even longer to get an answer and they always come back apologising for not having had time to answer faster. Conclusion from this observation is that surgeons prefer to gain information from sales representatives rather than the internet. This might be different with other specialties that have more time for reading.

Nick Rutsis Physicians also like to get together with their reps for dinner at national meetings, not because they are looking for a free dinner, but because they can discuss products and procedures for a long time without being interrupted by office staff and other things that crop up when they are around their office or the hospital. ADVAMED has made it much more difficult to entertain when physicians bring their spouses to meetings which are usually destination cities. It is very uncomfortable to take a physician to dinner and then expect them to pull out a credit card for the spouse's dinner. Things that are done as routine in other industries cannot be done in medical sales. You can't "buy" someone's business with a dinner and I have always felt that the rules imposed on the medical industry are unnecessary. Companies have always had their own rules for physician entertainment with regard to dollar limits and the appropriateness of venues. Even thought ADVAMED rules are not "mandatory", I do not know of any companies that are willing to openly violate them and face the criticism and scorn of the competition. Times have changed and I do not necessarily feel it is for the best.

Helen Hunter Without sales people we will simply be commodity businesses where hospitals can purchase through our stores, instrument sets and implant banks.

The Hospitals will therefore be fully responsible and accountable

- for all technical training,
- understanding all product design philosophies and their relevent purpose,
- surgeon education,
- nurse training,
- dedicated OR nursing staff for surgeon specialities,
- and patient outcomes.

Private Health insurers, and Government Health are making us look at our medical industry businesses differently simply by eroding our margins. Our biggest costs are our workforce, namely salespeople. What our government officials dont understand is how much our medical industries prop up private and public hospital sectors. Nor do they have any idea of the costs associated if salepeople disappear from the scene altogether.

John Joyce Great scenario! You know the surgeons, your product is within their decision making power, they use your product. Did you make the door opening initial sale? Your scenario is a rare one in the U.S. if it includes individual doctors with the power to make a buy decision for a non-approved new product coming in from the cold. If your product is in your maintaining a rolling hoop but not overcoming the inertia to get it going in the first place.

Robert Trinka, MBA People will be needed to understand the customer's needs and present the specific products and information that will best meet the customer's needs. The cost of wrong information is too high to not keep thinking, intelligent people in information chain.

Bill Harlan Do you really think costs will go down 50 % I have been a rep for almost 40 years and never have I seen a rep make that kind of money unless someone is cheating the system which would involve both sides

Jim Bloom Bill, if you look at the balance sheets of any orthopaedic company you will see that 41-57% of their cost of an implant come from sales rep commission, sales distribution, sales mgmnt and sales administration. Your background at Cardinal had a little bit thinner margins because they didn't make alot of their own products.

Nick Rutsis I read the blog. Wow! So we are going to be taking the profit motive from the companies and switch it to the physicians! I believe that the bulk of physicians are absolutely honest and want the best for their patients, but when you open the cookie jar and tempt them at a difficult economic time and eroding reimbursements, how certain can one be that they would always act in the best interest of their patients without giving a thought to their wallets?

Todd Staples, MBA This is an interesting conversation. I too have been in many OR suites where surgeons, staff, nurses, were fumbling through a package insert trying to piece together how to assemble and operate a device. Many marketing or operations people assume that Doctors and nurses come out of their professional training with the inherent wisdom to perform every new procedure and utilize every new device without the assistance or guidance of "Bob the sales rep" when in reality I think most surgeons demand that a sales rep be in the OR when they are using something for the first time at least. Highly trained, clinical sales reps are extremely valuable to a company, and represent not only themselves, but the whole organization when they walk into an OR. Nurses will commonly require a sales rep to inservice anyone even remotely likely to come into contact with the device before it is even evaluated sometimes.

Highly trained sales reps bring not only the latest devices to the surgical suite and the hospital, but they serve as a great tool for dissemination of information regarding local, regional, and national trends. I can't tell you how many surgeons I have known that would get the product part of the discussion out of the way quickly like they were studying for an exam, and then spend a significant amount of time in the procedure picking my brain about all the different ways I have seen this procedure done, how do they do this down at xyz clinic....OR staff, and surgeons especially are lifelong learners for the most part, and they take full advantage of the collective knowledge a sales rep brings into the OR.

To answer your question Gunter about mature products, and I assume you mean commodity products, I have found that a sales rep can reinforce a product positioning message, negotiate pricing and corporate agreements, and identify targets in the field where the value add message may resonate. At some point however, in the maturity life cycle when pricing levels drop to the point where the margins are very low, alternate sales channels can be utilized and a heavier burden can be placed on marketing to maintain sales growth as direct sales channels are phased out.

Jim Bloom Helen you are right on in your assessment of what hospitals will have to do when they get rid of sales reps. First of all, orthopaedic implants are becoming commoditized and secondly, nursing staffs are continually go through training of one sort or another. So the points you mention can easily be handled by a hospital, while reducing their costs by over 50%!! Go to www.orthodirectusa.com and find out that it is being done already.

One word, Relationship! Thats why we need sales reps

Nick Rutsis Agreed! It is also what some of the bean counter types in the ivory tower don't like and understand. When reps with relationships leave a company for a competitor, significant business often moves with them. People buy from people they like and trust.

Rakesh Lehri Agreed ! Relationship clubbed with sound product/procedure knowledge&
it's application.The users are professionals, not going to jeopardize their
reputation for relationships.

I believe sales representation is essential for new products, products that are in transition and custom products. But, even in cases where a product hasn’t changed in several years, I think it is good to have sales representation for maintaining the relationship with the doctors and it is quite helpful to find out what the competition is working on which you can't typically do via phone. All industries live or die on innovation and fresh ideas and one of the best resources for that information often comes from the reps in the field.

Luis Nieto Significant work is being done for reps not to take significant business when they leave for a competitor. It is just not right, unless they work on comissions only.

This is not the forum to discuss projects or breakthroughs, but it is well on its way.

Jonas Alexander I am a rep and believe obviously in my value to the OR. I couldnt agree more with the poster who noted you need both selling skills as well as clinical expertise to be effective. Another thing reps bring to the OR is new surgical techniques. The corporations we represent spend millions to advance surgery and sell the widgets which enable this advancement.

Rakesh Lehri Fully agree! In my long career with J&J I always believed that no SALE is
good unless it is a good BUY.All the reps working in med device industry
should take pride in the fact that they are helping the surgeons to bring
smile on to the faces of patients by introducing advance products &
techniques.

Antonin Cuc I agree with Dr. A. Mayers, just add that in addition to the interest of the surgeon, hospital and supliers of Medical Devices - It means the final destination is best for the patient's health as long as possible for acceptable costs. So, the risk management of patients and medical efficiency should prove a hundred times more often through methods Evidence-Based Medicine! Does anyone consistently? Yes, I solve it theoretically and practically by my patented a method S_T_A_R_S-Statistical Retrieval and Search of information to Decision Making, Czech Utility model 21532 - and I demonstrate it as a forensic judicial resolution of disputes in Court in specific cases, damage to health patient defective applications THA implants, the systemic medical errors to organize work at surgeon room, prevences for breakdown situtation, safety store of blood, functional all IT and supporting mechanical devices, preparing right surgeon plan, choice of optimal variant surgeon technology entries to hip, control phases of surgeon work and timing, interoperational using of Radiology control, adjustment workplaces to radiology safety monitoring individual patient, probable with preferency of Video-protocol of whole surgeon processing, instrumental firm set, advices of suplliers to temperature, safety for risk infects of implants and room, instructions of right using of products, adequte patients, technological conditions and skills to control cooaxiality stem and femur, technologies of solid consolidation position of components in bones, full right functional control after assembling set, finishing of surgeon work, anesthesy control, neurogical control, safety transport of patients, postoperational intensive care in postoperational Unit, life- function controllling, archiving of Health doccuments, etc. - all we could hunderd more in detail described and standardizing - and on orthopaedic digital simulator we can trained hard before act in time - after analyses of most often repeated medical errors by statistitic monitoring of orthopaedic errors and by the number from Court causes of bad injuried or died orthopaedics patients. It is thema to discuss to ask more efficiency of cooperate - surgeons - hospital - delivers of Medical Devices - and quality inspection Health and Safety controll of Acredation United expert Counsil. It coud be very cheap, but demanding! Maybe you will be patient next time too. I´m governmental expert for Health and Safety, I was injuried by "Fousse route" of stem, without radiology control, with bad postoperational care, with bad false protocol about surgeon act, with full trauma for nervus ischiadicus without reconstruction nerochirurgical in time - It could be 4 Month after trauma to solve. I met with 20 doctors in that limited time 4 month, nobody was educated enough and nobody has the skills to react right! We will be pay pobable such medical decisions with life, with injuries and with money from increases of entropy in information in linie of knowledges - surgeon, Hospital, Delivers of Medical devices, patients.

There has been a huge downsizing in the pharmaceutical salespeople by major companies. However, it'll be much tougher with the medical device salespeople. Mainly because of the nature of the product being medical devices. These products require more of a hands-on presentation and demonstrations to potential customers...unlike in the drug industry whereby iPads have known to replace and utilized to demonstrate the drug information to physicians. In this scenario salespeople are not necessarily an integral part of the sales/marketing efforts.

Gunter, sales people are necessary but the way things are structured currently many of them are improperly compensated or focused on the wrong things. Please check out my article that refers to this: http://biodesignalumni.com/2012/10/29/death-of-a-medtech-salesman/#more-1276

In short, there should be three types of reps:
* managers for commodity products

* managers for established products (hip implants, etc)

* development managers for first in class products (abbott mitraclip, etc)

All have to be clinical experts with strong relationships and the ability to build a pipeline and close sales. Beyond this, their time should be focused in areas specific to their customer needs. As alluded to in many of these posts, the customer is not necessarily the clinician.

This discussion demonstrates the clear need and range of skills required of medical device salespeople. Best thing you can do is keep them focused and fed. See www.datapharming.com for ideas.

I think it depends on what the make-up of the field team is. If you are trying to get your product sold through a big distributor, I believe you are wasting your time. These reps cherry pick the easiest products to sell. In our organization, I have gone to a hybrid sales team composed of Independent reps and direct people. Independent reps can only sell 2 additional lines which has worked out very well. Our product has to be presented to the surgeon first. We are priced higher than any competitor and we need the RIGHT salespeople to get to them. So the answer is yes but if they are not engaged you make changes to reps who are.

Having directed one of the largest med device field service groups from Detroit to Hawaii and all points north and south, and having been in high end capital equipment sales, project managment in Healthcare-Lab Sci etc. I am a firm believer the Account Exec which I think is a better description of todays technical med device sales person. The knowledge they require, the hundreds of balls they juggle, from relationship building, differenciating themselves and thier product line from a competetive arena we have never seen the likes of with all the me too`s.Pulling together the endless meetings with decision makers from end users to the C offices- Helping working within National Accounts, Working on projects (Million dollar+ stuff) Maintaining thier part of the team in the field with service technicians, field managment, sales managment service and sales support folks at HQ and the list goes on for ever. The good ones don`t sleep much and the others don`t last long. My 20 years experience has been a big YES! we need med device sales execs. PS don`t screw with thier comp plans and let them do thier jobs (same with field service) Chill on the endless reports- Let them stay in front of the customer and the scorboard will take care of itself ! Give the TPS report a rest in 2013! Best to all in the new year!
Join me andyflylow@hotmail.com

John Joyce Glimming your laid back style made me`think of the word banal as fitting
the traditional mgmt tecniques you seem to be dissing with but one letter
removed to really characterize them, namely the "b". I would follow your
lead and lets face it the scoreboard does take care of itself especially
for those on straight commission.

Jerry Dzierlinga I have been in medical sales for over 20 years and I don't know what the industry is thinking anymore. We allow hospitals, home medical and long term care facilities, to order a product and then use them on a patient without some kind of training. I think price is important but, what else do we get anymore. (( Made in China)) YES, I feel that it is important to have a sales representative visit you. Happy New Year!

I believe medical device sales reps are needed especially those with technical expertise and project management skills. As the demands on customer's time increases, they will look more to their sales reps for implementation and education of their product.

I would think the relationship is a two-way street. A well informed sales rep who can listen will naturally collect ideas from his customer for the design and manufacturing side of the equation.

Jim Bloom Half of the respondents here aren't even in the medical device sector, so why are you commenting? Bella, what the hell is your point? You didn't make one! I have worked for small and large ortho companies. The reality is that half of all sales reps from the large ortho companies are worthless because all they are are case cover guys that can't sell but know the surg. technique. Big deal! There's a doctor in the room. The real incompetence is in the corporate management!!! I have been in the industry for 24 yrs and have never met a regional VP or manager that was worth a s...t The real question is do we really need middle management that just goes out to the field to stroke doctors and ask if your going to make your numbers this month!!!!!!!!!!!!!!!!!!!!!!!!!!!

Jerry Dzierlinga I have been in the medical field for 20 years and have been in several position from sales to ownership of a few companies We have so many medical professional that look to us for our expertise in having a better understanding how the medical product works and should be used. We are the " PROFESSIONALS " when it comes to knowing our product line and how it should or not to be used. It's NOT like buying a a pair of socks and putting them on. Over the last 10 years, I am sorry to say that, I don't feel that SALES PROFESSIONAL receive the credit they are do.. As a professional in the medical field, I am doing my best to assist in helping the patient feel better and in some cases, save their lives. It is our job of a to know everything about the product and make or have the contact to sell it as well.. It's not as easy as some people think..Try and make a appointment with a someone in the medical field one day. It takes several calls and email in some cases to just get the right person then, a early morning meeting to discuss your product. Then you have to deal with the purchasing contact...That's always fun..

Medical sales is in my blood in my case and that's what it's all about for me.. Helping people live a full and comfortable life.

Have a great day!

Chris Dahm I think Jim's comment might have been directed more toward sales management in general. If so, in many ways, I can't disagree with his premise. In times past, when my numbers were not on fire, I have asked managers how others in the region are making their numbers. I honestly can't think of one time in the past 25 years, where I received something solid, something to grab onto. The best sales manager I ever had came out of quality management. His greatest gift was learning what made each rep. tick. He told me that the best managers shouldn't have to manage - if they hired the right person. They should be spending their time "developing" each rep. as an individual, as a salesperson, and in turn so goes the territory, the region and "voila!", the company. Maybe it sounds trite, cliche or mumbo-jumbo. But it works. Of course, my worst manager thought it was funny to call up and say things like "we're having a "fire-sale" - sell something or get fired". What a d-bag he was. BTW - the first manager moved on to other ventures and is now a retired,multi-millionaire. The second is off selling real estate, I believe.

Curtis L. Chris-

You could not have stated it any better! Your comments are right on target!

Best Regards,


Curt L

Joel Oster Chris- Spot on! I've been in this industry for almost 13 years, and like many of us, had my fair share of good and bad managers.

Learning the "mechanics" of selling our respective products is one thing, but as Chris so aptly pointed out, great managers understand each reps underlying motivations and develop that person's individuality to its full selling potential. Sure, our customers can buy many products on the internet without ever speaking to a rep and yes, it has become increasingly more difficult to get an appointment or even navigate the seemingly endless layers of bureaucratic BS and get to the right decision maker. But don't forget, a great rep can also develop the customer to the point where they become an invaluable resource to their business on a clinical, operational and even a patient care level.

Dave Sheppard, CMAA I wish I would have seen this string sooner. Great discussion. Even though it's a bit dated conversation, I feel the need to comment (being a life-long" Medical Device Salesman and Sales Leader. As such, I'm definitely someone that many "bean counters" would like to pay less (or get rid of). "Good products sell themselves", right ? WRONG ! I've seen many great products be unsuccessful due to poor sales execution. And, I've seen very "average" products be highly successful due to great sales execution. The difference in poor vs great sales execution is good marketing and GREAT sales people ! PERIOD ! It takes direct contact to "move the needle" in creating adoption of any product with clinicians. Phone calls and email and other marketing will not do it alone. And thank God for that ! Great sales people will always be needed. And, that's why great CEO's always understand that - and override the "bean counters" - as the "reward" for the company is way greater than the "expense" of the sales team !

Chris Dahm Several months ago, I attended a reverse expo. promoting a product that truly does save tens of thousands of dollars. In the focused atmosphere, we collected 50 "hot" leads out of the 125 attendees (pretty good ratio in light of only four hours given) But there were a lot of other reps there just droning on, not bringing much newsworthy to these folks. I'm driving three hours today, will have to buy a hotel room tonight as well, because a customer can't take the time to read the operator's manual or put the training DVD in to understand how to use the product. I didn't make thousands, or even hundreds of dollars on this sale either. We can bring value, show new innovations (as above) and support to customers. Manufacturers and end-users need to see the value in us and not
dismiss reps. as overhead.

Dave Sheppard, CMAA Chris - well stated ! Those manufacturer's who dismiss reps do so at their own peril (in my opinion) ! Good selling !

This is a great discussion. I'd say that reps are absolutely needed, but different sales models are evolving in the new healthcare environment. Physicians have less control then the did in the past, more are becoming employed or aligned in some way with their institution and there is growing sophistication in the buying process. In the future, medical device sales reps need to sell and defend value to clinical and non-clinical buyers. Companies that rely on physician relationships will struggle if they cannot quantify how they take costs out of the system. As products, especially orthopedic devices, reach the mature stage of the product life cycle, companies will look for solutions that reduce the cost of sale. In these categories, Value Buyers (clinical and non-clinical) will make 60%+ of the buying decision before even talking to a rep. These device companies must invest in efficient marketing technologies that get them into that first 60% of the decision. Let the rep focus on closing.

Chris Provines has an excellent book called Healthcare Value Selling and did a really nice webinar that outlines how to sell value. Here's the webinar: https://attendee.gotowebinar.com/recording/9074564493617936897.

I think I can put succinctly, people buy from people, this is especially true with technical systems and more so w Medical Devices

sales of mesical devices is still a person business. it is bases on pastion, relation and trust. if you have pation for your product and company, you can build relations and keep the relations this will make the rep, product and company succesful. it is that simple. we all can find proof in the industrie. relation is not buying trust it is the pastion of a sales person, show that she or he is knowing the products and the market.

Let's have the medical device industry (sales representaives) take a 1 week nationwide furlough from hospital/surgical presence. Repercussions??

Simon Williamson Yes (well...it depends), if you have empathy, awareness of your customers' needs, knowledge and skill in the succinct delivery of messaging you may just add genuine value. We have terms like Account Management, Territory Managers, Business Managers, Product Specialists etc. It doesn't matter the terminology, knowing everything about your product and being passionate about it's superiority is only half the equation.
Back to the question, yes. With the right training, maturity and skills, HCPs will continue to benefit and welcome their presence.

Jerrold Shapiro Excellent discussion started 2.5 years ago, resumed in the past few days. Does anyone know the total number of medical device sales reps in Europe, either working for a distributor or for themselves, who will sell a product made in the USA?

Jerrold
shapiro@FemMedical.com

Jonathan Boyce I agree with Allan above. Have you ever been in Surgical Theatres such as Heart transplant or a THA during a complex operation with a piece of Kit even though at the cold demo all seemed perfect but under the pressure of "doing it right" effective coaching of the Surgeon, Scrub and Junior Dr's present is essential if new skills and techniques are to be taught?

Reginaldo Hermanson M D Companies need a Salespeople like Nations need a Diplomat.
More than highly technical products, the decisions are still taken by people with human caractheristics.
We need sellers who know how to deal with people, with sensitivity, emotional intelligence and ability to reconcile divergent interests.
Technical questions can be answered by experts and product specialists and we have a lot of this kind of professional available.
Find who has the gift, the skill in dealing with people has been our main requirement when hiring a salesperson, technical skills are just the basics, the minimum expected from someone.
I hope my comment will help

Curtis L. Our surgeons, physicians, nursing, C-Level depend on Medical Device Reps, Radiology, Wound Care, Vascular, etc to educate them on the latest and greatest new skills and techniques are to be implemented and practiced correctly. Working in the Operating Room or any invasive surgical area, our medical community needs our ethics, efficacy, to bring forward cost avoidance, features, proper use of the latest device, constantly educating them as they already are swamped with patient over flow, insurance denials, family requests, urgent patient factors, it just is not prudent to have us serve as medical educators on our ever changing heath care area. No The Affordable Care Act will not work, socialized medicine has never worked in any country, which will only restrict the care our patient population will get, which is already under intense scrutiny. We need to provide the tools to our health care advocates, patients to know they are getting the very best care possible. We do NOT work at McDonalds! Our patient population must always come first!

Curt L

Good question! I got out of the factory and helped a local sales guy "push the doughnut cart" a few years ago. Big volume sales of near-commodity disposable labware. I learned more about the product on that day than 5 years in engineering.
You can't hear the voice of the customer from the other side of catalog or a computer. Good sales people keep moving but the information pipeline provides essential feedback for continuous product improvement.

Gunter Wessels,Ph.D.,M.B.A. We are seeing the value of device reps severely challenged lately. Product knowledge and application training are being handled by support personnel. Contracts are being handled at higher levels; at the facility, corporate system, network, or even health system level.
Sales organizations are shrinking somewhat as the market digests reimbursement cuts and cost reduction imperatives. Are the good old days gone?
That depends on your perspective.

Patrick makes a new point and a distinct point of potential value; product development around the sales function. That's intriguing.

Nice to see this string extending.
GW

hmmm - everything you need is on alibaba and ebay, and all you need to solve your surgical issue is one keyword search on google.com. If only it were that easy. Finding clues is one thing, but getting your problem or opportunity solved in less time and higher quality makes a sales person valuable in any industry.

As a graduate of Zimmer's Sales Academy, I felt extremely valuable in all of the trauma cases I supported during my short tenure with the company. The future of reps, however, is cloudy due to the changing nature of how we pay for health care in America.

I fear that innovation in medical devices will decline due to the widening of the pool of insured Americans without properly expanding the capacity to provide care. This decline in innovation could reduce the need for technical reps responsible for delivering new technology. As long as we value new medical products as a nation, sales reps will be essential. If we settle for products designed in the 1980s, sales reps might not be as essential.

Just a thought.

I hate to disagree, but if the hospitals were to truly have a choice, there would be no reps calling on their staff and doctors. They consider us a nuisance and worse yet, an actual cause of budgetary problems. They will always expect technical support, but they will disdain salesmen. the real problem is that the'bean counters' run the hospitals , not the clinicians. We are obsolete in their eyes.

Dave Sheppard, CMAA Adam - keep up the great work. I was told that sales representatives would be "obsolete" 25 years ago. And, yet, as I consider launching a new product in the near future - I know it would be impossible without good sales representatives ! Sales reps will always be needed in one form or another. Jim - I understand your statement about hospitals. However, they don't have a choice. They would be lost without reps from the O&M distribution rep to the orthopedic or trauma rep in the OR - they need reps.

Not necessarily, as I actually wrote an article about this previously an proposed the idea to (4) companies in healthcare, well known. I have a written plan and set of options already drafted to be able to do with disruptive change. In fact, it will save funds, and likely cause more business, besides reducing how many, how they are used, and combined with current technology, uniquely applied or re-tooled for current circumstances ::human factoring (not what most are thinking if or use or how it is starting to be applied in some hospitals, etc.... My new book about is due out in 3 weeks (Actually, it is guide/for use and written to be agile in our ever changing, but complex world that actually brings use all in the world both "closer" yet" more distant in some ways... if interested in discussing more connect with me if we are not already by send inf a request to connect at mdd333words@gmail.com if needed.

Jonathan Boyce Hey Gunter you've really got a lot of guys wound up with this one!!!

John Rooney Gunter, I liked the thread as it added a few things that my sales team needs to be excelling in. What I am most interested in for the future of the sales person being NEEDED is the economic side of the equation to Health Care Systems, Individual Clinics and their Practitioners and their teams. Our State of Healthcare in the US is making it harder for many new doctors to compete. These doctors and their teams need to have the most effective practices to keep their margins high and compete with well established practices that run either most efficiently or marginally efficient. Some older Doctors are nearing retirement and their practices may not be profitable enough for sale but provided a great lifestyle for decades as marginally run practices/businesses. With so many Hospital Systems bidding on these practices only those that excel in economic and medical sides of the equation will fetch the dollar the doctor needs to walk away after a long career of medicine with a reasonable win for a future lifestyle that matched what the career provided. Our sales teams can really differentiate themselves if they can deliver this side of the equation. That means bringing services directly to the doctors - services like Invivolink that was mentioned above. The sales people can not do this without their CEOs realizing all of this. The medical companies that take the leap to assist economically with investment here will forge mud stronger relations with the Hospital Systems, Practices, Doctors and their teams. I'd argue that if medical companies do not do this they are assuring a rough patch for the industry ahead. That isn't saying it all rests on our backs and I think you'll find the Hospital Systems and Doctors will welcome this economic assistance and dare I say give greater access long term to the companies who excel here as well as in new medical technology. The best representatives will end up at these companies over time and the CEO's new struggle is to assure this balance not just R&D in products but also in services secures the next great millennium of health Care Delivery. This industry has provided generations of Doctor and Sales person families (Grandfathers, Fathers, Sons, Grandson) who followed their father/mothers footsteps. What worked in the 60's/70's just before the first Endoscopoic Trocar came out after Catgut provide years of procedural advancement is not what the future medical industry families Grandsons/daughters of those great sales people, and doctors need to sustain this great industry forward. 2014 has been a year that our new company has begun to make a small difference in this economic and outcomes space but we have only scratched the surface. While we are only a new $4bb company we came from a household name of $000bb parent. One may argue we all waited a little too long focussing too heavily only in products. The industry needs to advance here.

Lots of opinions. It's not are Medical Salespeople needed, NO. Medical Salespeople that show value to your customer are needed.
My less than 2 cents.

Jack Zarra I feel like I am restating the obvious … but the challenge is that financial buyers will always claim that “… everyone’s device is the same …” so that low price wins. Those devices that have not yet become commodities must still be “sold”.

As a result, a good sales rep will add value two ways: they will thoroughly understand the “problem” their customer is trying to resolve and they know how their device will solve the problem. Most importantly, they will make sure their customer understands how their device exceeds their needs.

A great sales rep appreciates the financial impact of their device and makes sure their customer appreciates the value of their device.

Mark Bly John,

Amazon is selling consumer goods that we as individuals decide to buy as needed to "suit a "want"". Many of these products are our everyday items that if purchased and fail, we return them or put them on a dusty shelf somewhere if not in the trash. Aggregated or disappointed at best.

When a high tech device is needed in the hospital and choices are presented, the information cannot be effectively interpreted online to make an educated decision. The products need to be brought in, evaluated, and compared by surgeons, clinical staff, and in the supply chain.

The reps or teams are also under scrutiny to insure they have the requisite knowledge and doctors and staff are comfortable with these people supporting their efforts. If there happens to be a product failure or an applications issue during surgery, the rep is there to advise or review applications to prevent the issue in the first place. In many cases as you know from your career, failure can be catastrophic as opposed to an Amazon product.

I know you realize these potential scenarios and the steps as a part of a hospital making the best decision for the best outcome. However, your comment is understood as a point we all have heard at one point or another in recent times.

In 23 years in the business, I have seen a few companies who have tried the no rep model for commodity items. One or two device companies are still in business but have shown slow to flat sales over the past decade.

As mentioned by several in this exchange, sales are driven by effective reps who are able to communicate at all levels in the system. The message these days has become so complex but in the end, it still comes down to people buying from those they trust to provide the right information, be consistent supporters of the team, and work effectively to facilitate seamless delivery of their product.

John Rooney Mark,

Excellent points on the value of the sales team. I should have been more overt... I am PRO sales rep in this discussion. My main point was that medical companies must begin or continue to invest in economics and outcomes and provide valuable services that help the medical profession succeed in this next era of health care. Sure as sales representatives we speak this value to the OR staff and P&T committee, some reps even work the finance team straight to the CEO's ear. This will need to continue. As an industry I'd argue we haven't quite delivered here - above and around the sales representative - to the extent we will need to to survive the next several decades of change. The next 25 years of which you and I (judging by how many years you noted you've been at this) may be active in 2/3's of that time period will see tremendous pressure from the recent competitive pressure that the Affordable Care Act. These competitive changes in our payor system have only just begun to provide pain to the traditional payors and all of us down stream. It all flows down to those in that surgical suite. The services like the one Gunter shed light to and I referenced as example are going to be A (not sole) determining factor as to what companies succeed in the longer run as healthcare in the US continues to evolve and government continues to squeeze the traditional third party payors. If you and I are working for companies that can invest here to assist the medical profession - the Hospital Systems, Hospital Staff, Doctors and their staff with demonstrating economic value to the medical teams our future generations of sales reps will be around longer to provide that medical consultation on the value of the innovation out products bring at those critical moments to assist the doctor. As an industry we have excelled and proven ourselves to bring innovation that matters. Our R&D teams have this piece down for the most part. I agree that the sales representative will still always be required to demonstrate the meaningful medical value of the new innovation, including surgical suite consulting in that exact moment where the doctor has the question on how to extract the true innovative value of the surgical product at that critical moment where technical success and procedural safety are required. The doctors will want, need, our future medical innovation. They will also want, need our ability to demonstrate the economic value to their teams. I believe companies that excel in this area and invest in a balanced proportion to traditional R&D will help all of us survive this next era of health care delivery. The survivors will either create the services that assist in demonstrating the economic value or partner heavily with those that do. If my children follow my path in medical sales we will talk a lot about this balance...

I have been a sales person for medical device for only 6 months, but in my opinion, sales people are needed since there is a wide variety of different products out there, and it's very often that purchasing managers have no idea what they are looking for, neither do they have product specialists to explain them the difference between modifications of the same nelaton catheter:) Not to mention there are so many medical devices to choose from out there now, and you need to convince to buy yours and not your competitor's.

Simon Williamson Gunter, whilst I admire the volume of comments (some longer and more detailed than others), I wonder whether we actually gain anything from this discussion? The audience (members of the 'Medical Devices Group' on linked in) should barely challenge the concept of 'value-add' unless of course they work for a company where representatives are largely ineffectual. Patients should and I believe do, remain at the center of both a companies' and an HCPs focus, a salesperson should be skilled enough to provide an obvious solution to an immediate problem and be the vital cog that enables the initial and ongoing process to happen seamlessly. This is different within all of us yet the belief in 'value' and 'worth' is unhindered. So Gunter, what the goal here?!

Jack Zarra Although one might argue that the medical device market space is VERY complicated, the success of any company is directly related to making sure the right People, selling quality Products through a sustainable Process to the right Prospects.

As complicated as the market space is, this discussion has been specifically limited to ¼ of the formula … the right sales people. Buyers want to talk price … because their supply chain responsibilities are too broad too discuss the details of medical technologies. An ineffective sales rep, will always claim that he would sell more at a lower price point … and selling through a website eliminates the cost of sales aka the sales rep.

As a device becomes a commodity, they can and should be sold from a website. NEW technologies will redefine what is a medical device ... smaller, wireless, portable, remote access, better materials etc.

The medical device market space IS complicated because of the technologies, the importance of patient care, the payor source, the regulations etc

The right sales rep will always be needed to establish sustainable revenue from the sale of their medical device by understanding and managing all elements of the complicated space …

Sean Hägen Perhaps a spin on the question would be should a sales rep really be in the OR in the role of a technical advisor (I've witnessed many that are more than technical and despite policy give clinical advice). There are two distinct hats worn by many, especially leading edge technology and my opinion is there is a conflict of interest.

Nick Woods Interesting perspective Jack (and earlier Simon). The concept of "added value" as a determinant of rep usefulness is handy because it is really a function of two things: whether a company rep adds sufficient value for a company to invest in this expense and whether the customer gets enough "added value" from the rep to justify buying their goods. Works both ways doesn't it?
Maybe the extra "P", the Patient should be a consideration or even the deciding factor. If the patient benefits from a rep being involved then that's a big box ticked in the moral arguments for sales rep involvement in healthcare provision, especially if we're looking for ways to decide whether reps are essential. Of course, the implication is that if the patient doesn't benefit, the sales rep's banned..... which sounds draconian but is sort of de facto practised today by medical professionals who duck and dive to avoid the plugger, but welcome in the individual who's going to help deliver a great ACL reconstruction.
On Jack's point about deciding whether degree of commoditisation is a driver of sales rep existence, I'd love to know who decides what a commodity is. Not many companies are going to be too chuffed at the prospect of labelling their product as such...even the most obvious commodity sellers spend their waking hours hunting for points of differentiation to avoid that tag.
Finally, reverting to the "technical sales rep" discussion, I've written about the notion that the perfect sales rep for a device that is complex and obviously in need of in-field support as providing a kind of butler service, here.... http://www.medlatest.com/view-from-the-med/best-device-reps-offer-butler-service/
Whether a butler service is the luxury the name suggests or an essential component in a technology-heavy world of healthcare provision is ultimately the HCP's call and the success of such as Smith & Nephew's no frills (ie no reps) joint offering might be quite telling in this regard.

@ Sean - advice is directly related to quality of relationship a rep carries with the surgeon customer. In many ways a rep is no less than a consultant - helping surgeons use the products effectively.
Greatest Value add - to match product attributes to complicated indications, especially for solutions that comes with many variables in the form of instruments and implants - complete understanding of which is limited to few surgeon/customers only.

From a dental angle in clinical procedures yes for sure. Implants, CAD,CAM etc,,,

I think sales people are needed but a lot of medical sales these days are clinically driven so it's great to have a clinical specialist who has a sales approach. With a good Sales and Clinical team you will do best.

I think starting with the terminology "salespeople" takes people down the wrong track after all the CEO is THE salesperson in any organisation. what makes the difference is the person's skill set ,product knowledge, domain expertise, project management , communication, etc etc. Sales cycles in healthcare have long lead times and require very skilled professional business managers to negotiate their way through multiple levels of stakeholders. Its a lot more interesting than selling Soap Powder!!