Kevin Busto In some cases, when it concerns commodities, sales will move to inside reps and online ordering. The highly technical products, admin & purchasing better hope that reps don't leave hospitals. Granted most are intelligent people, but even the most technically able do not know it all.

I couldn't agree more Kevin. I have actually seen an upswing in facilities asking for on site assistance when setting up new items they've purchased.

Why would the Hospital want a 'rep-less' future?? Because some reps out there ruin it for everyone else ( just like the idiots at school did!) they push their way into cases they are not welcome in, they make surgeons feel obligated to use their products, they tell purchasing to order in product that a surgeon has requested (not!), basically not very professional. But luckily most if us provide excellent service, value and an expertise in the products we represent that can only be offered by a Product Sales Rep

Shiva Kumar Its not possible without rep in hospital,if they (hospital people)go for online sale it take at least 4-6 days time and if they require in emergency our reps should be there


And more thing surgeons sticks to one product or technique in more cases,even if they get new technique ,results for that technique is 99% good also they least bother to use and even they can't go for evaluation purpose also ...it takes lot of time for the surgeon to use the new technique or new device or product

Shiva Kumar Its not possible without rep in hospital,if they (hospital people)go for online sale it take at least 4-6 days time and if they require in emergency our reps should be there


And more thing surgeons sticks to one product or technique in more cases,even if they get new technique ,results for that technique is 99% good also they least bother to use and even they can't go for evaluation purpose also ...it takes lot of time for the surgeon to use the new technique or new device or product

Javier Lopez Pastor In line with Kevin point of view. Complex devices need advice and presence from the expert. Doctors are not engineers or physicists nor electronics experts.
Same for scrub nurses or even ward nurses with new or devices requiring some degree of technical knowledge. As an example, have a look to thoracic drainage (Pleur Evac, more than 40 years in the market) in ICU or many Emergency Rooms.

Andrew Kyle The "rep" is usually not vendor neutral - they push their own product lines. So that is itself a contradiction ... vendor neutral and best for the patient and facility is in my mind a better sale and more objective. We are so vendor neutral we will sell another companies products when that makes better sense for the end user.

A "rep" is like a lobbyist - someone pays for that service and it is likely the end user is paying for their salary and a top line % above that. Why not just hire the "rep" and use their expertise.

The larger companies have an advantage as they have the resources to locate as many "reps" to counter a competitor who is smaller. So that is not a fair playing field in my mind.

Why wouldn't the physician be qualified to operate the equipment... sounds more like a dependency that can be rectified by training? I doubt Mercedes provide a driver for the physician and a complex car is not too much different than a complex medical device. If the physician can master one, they certainly should and can master the complex medical device.

Carl Goosen Judging from the tall elegant females, etc I believe they will never disappear!
Carl Goosen

Change is rampant throughout healthcare, so why not the role of the device rep? But while this role is evolving, I don’t think will ever be entirely eliminated. So who will be left after this impending shakeout in the industry? If one can remain relevant through use of technology and by providing needed technical and logistical assistance, then their career will be secure. If one has relied on the old ways of riding surgeon coattails, pitting docs against contracting, and just being buddies with the right people, then there is indeed something to worry about. Always true: A bird sitting on a branch never worries what will happen if the branch breaks.

Can someone please offer a decent comment on this topic!? Jezz!

Andrew Kyle Dan - the floor is open. What is a "decent" comment that fits your viewpoint?

This is a trend that will only grow in the near future, particularly with the large conglomerate hospital monopolies. Purchasing & hospital admin is already asking "What's our price without a rep in the room?" I believe these large hospital groups will hire "cover techs" to be in the OR for implant cases.

I tend to agree with this..especially as large hospital groups expand their footprint and physicians become employees. The decision-making will increasingly reside in MM and group contracts will (already do in some areas) dominate. My concern is technological advancements, particularly those is less sophisticated areas of medicine will be lost. The cost of entry will be too high and those companies with GPO contracts and large market share have no incentive to innovate.

Jonas Alexander As healthcare reimbursement shrinks the pie gets smaller and hospitals already operating on slim margins wont be able to pay for the high priced technologies. Companies will have to lower prices thus lowering margins thus lowering money available for six figure reps.

With all change there's opportunity. Top sales reps will increase in value as will their income opportunities but they will need to move with the changes - this is true for all types of business. There is a very big difference between engineering a product and selling it. Selling products produces revenue & income to pay engineers and others. If companies can't SELL their products they will go out of business. Overselling a product or service is a short term game in any business and those reps / companies will not survive. The best companies are the one's with engineers that respect sales reps and sales reps that respect engineers.

Cathy Webb This "sales rep-less" idea has been tried a number of times by Pharma and medical device manufacturers. It has never worked.
First of all, who encourages the doctors to use the product? Who negotiates market pricing? Not all medical markets are created equal. Who performs in-services for nurses and doctors? Great products are often nuanced and require a bit of training. Sales reps who do a superlative job will even out product cost by volume. Finally, if the device or drug is a "dud" an ethical salesperson will deal honestly with the hospital/physician. Also, if a product fits a particular niche, the smart salesperson will present it that way.
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It's not easy to surgeons and nurses to work without reps, cause they are one more person to control the process, so the percentage of mistakes during the surgeries could increase. I was in situations when my "stop!" or "please, take care of" or "it's better to do it another way" saved patients extremities and, may be, patients life.

There will be situational opportunities, such as specialty hospitals that are able to standardize on certain products to reduce the role of the rep in the OR, but even that will not be a truly rep-less model. Products do not remain static, as innovation and technology drive efficiencies and efficacies, and those changes will always necessitate training, in-servicing and support for safe and effective adoption. And large teaching institutions, where there is a continual stream of new residents to train and where diverse and complex pathologies are treated will always have need for the critical support role of well-trained sales reps to support the hospital's ultimate mission of optimal patient care.

Lina Lobasova If with product marketing everything is done correctly is not necessary for sales rep "to live" in hospital.

Lina Lobasova I think that this is reasonable. I am for a long time working on Russian surgical market and can say that today I have less and less visits to final user. All questions are discussed by phone, product information is avaliable in internet. So I have some visits just to make training, if it is needed.

Trent Pierce In our setting, the operating room staff, fellows, and surgeons rely heavily on the vendor sales reps intraoperatively. Their expertise, and experience is invaluable at those times. There has been talk of technologies to put in place along the supply chain to limit, and even eliminate the need for the rep's hands to be involved in in-house consignment restock inventory. There's even been questions of reps double charging the facilities through bill-onlys, over ordering restock, and keeping the "extra" as "trunk stock" for other facilities that they service. Maybe I'm naive or just blind, but most of the reps that I deal with seem to be very honest. What I HAVE noticed, is that it isn't that they are over-ordering or double charging, but that the OR staff is not always accurate documenting charges. I have seen where there are charges for a guide wire and screws, but there were no charges documented for the IM nail and drill bits used on the case.
As far as bringing in new products...no new products will be allowed to be brought in without going through value analysis, which requires a formal request submitted by an attending physician only. These requests are not accepted from nurses, PAs, NPs, or even fellows. It is the rep's responsibility to present the physicians with the new product or upgrade. If the physician expresses an interest, THAT's when the ball starts rolling on the value analysis process. Without the rep showing what upgrades or new products are available, all advancements in intraoperative care would cease.

Trent Pierce Kevin's comment "I believe these large hospital groups will hire "cover techs" to be in the OR for implant cases." may have some validation in community hospitals, but larger facilities wouldn't be able to afford the staffing required to have all of that knowledge. Just the implant vendors that I deal with on a regular basis...I deal with ~45 vendors in different areas of surgical implants. Although I have basic knowledge of the capabilities of different product lines, it would be impossible for me to know everything about everything. I am the jack-of-all-trades-master-of-none when it comes to implants, but a rep will be able to give every detail and application of their respective product line.

Cathy Webb Good comment. I am a former vendor, and I'm working on my BSN. From my viewpoint, good reps can and should enhance the knowledge base on implantables, instruments, etc. There simply is not time for medical staff to study all the new products that are approved for use. Without the reps, a surgeon can miss out on a new product that saves time and money. Good vendors will have all this info at their fingertips and can conduct outstanding in-services for all staff members from surgery to sterile processing for reusable instruments.

Javier Lopez Pastor Thank you Trent for including an oppinion from de user´s side "jack-of-all-trades-master-of-none". Same expression in Spain. When someone requires the assistant from a expertice it is time for experts,

The last master of everything - up to mi mind - was Leonardo da Vinci.

Now, 4 ages later and due to increase of knowledge,with limited possibilities for human knows most about their profession, we can consider the assistance from others when required (experts).

I do agree the assertions that power tend to concentrate on supply and demand sides, but access to knowledge and personal skills allow the survival of all types of suppliers, in particular if they are experts and know and serve to those in need.

Jackie Lee want to follow

Richard Brautigam One of the elements that contributed to the success of New Wave Surgical was our customer facing model. We used direct and dealer reps to "pioneer" our tools to nurses and surgeons and also take ownership of introducing the tools with success stories laterally to other teams or hospitals within a group. Once the product was established inside sales and teleservice took over. On the next two ventures where I am engaged I see the same model working. In the case of these two platforms the devices are being designed to significantly reduce the time of surgery and replace more expensive tools.

Linda J. Pavlos I think what we should be discussing here is not whether it will disapear but how we can make it better! What can we do for ourselves and them?

Linda J. Pavlos Frankly its difficult to get ahold of people. How can we expedite things AND make money doing it?

Jackie Lee Yes. i think it will disappear.

As a surgical tech I certainly hope not! They are good teachers and very good at supporting us in the OR. A few bad apples have made it hard for the good reps. That's a shame.

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