The Death of the Mirror-Image Sales Force - Thank Goodness

The US pharmaceutical industry is now admitting that its traditional sales model is not working. Its customers, the physicians, do not like the model, and are showing signs of intolerance, while the field-based sales forces are becoming frustrated by physician attitudes towards them and a growing lack of access. Relations between the physicians and the pharmaceutical industry are being severely tested. The industry clearly needs to make changes to its model for communicating with physicians.

The challenge is that for many years the industry has been deploying a so-called "mirror image" model, and that there are now so many sales representatives calling on physicians, that there are sometimes more pharmaceutical sales representatives than patients in a physician's waiting room.

So what is a 'mirror image" sales force, and what are its origins?

A typical sales force calling on Primary Care physicians, for example, will typically consist of 500 sales representatives. Those 500 representatives will each have a target universe of approximately 200 physicians on whom they are meant to call. Unfortunately, as pharmaceutical management from major pharmaceutical companies increasingly competed for "share of voice" among those target physicians, they were compelled to find ways of getting their reps in front of the target physicians even more frequently. They realized that with one sales representative could only call on a physician a limited number of times each year, and that that representative only got a limited amount of time with the physician to talk about the two or three products that were to be promoted. Furthermore, by the time that representative was back in the office talking with the physician the next time, there had been such a gap, and so many of their competitors had been there speaking with the physician in-between, that that physician had frequently forgotten about the products. They were certainly not "top of mind", and that was reflected in prescription performance, or lack thereof. The 'mirror image" sales force concept was, therefore, introduced, and became increasingly popular from around 1995 through 2005. A mirror-image sales force is one that calls on the same universe of physicians as the original sales force but, theoretically details a different set of products to that detailed by the original sales force. However, there are always one, two or more key brands that are detailed by both sales forces. From two mirror sales force, companies introduced a third, and a forth and more, so that certain companies had as many as six or eight mirrors all calling on the same universe of physicians.

This is what started to "kill the goose that had been laying the golden egg". The mirrors killed the relationship between the physicians and the pharmaceutical companies. This was all done at a time when Managed Care was having such a dramatic impact on the professional lives of physicians. Physicians, and particularly those in Primary Care, were required to work harder and see more patients, just maintain the same level of income that they were earning some years ago. Take this dynamic, and place it alongside the fact there was concurrently an increasing number of pharmaceutical sales representatives, and an increasing number from the same company, trying to call on the physicians at times when those physicians wanted/needed to focus on seeing patients. It was clearly a recipe for disaster. And that is what has happened and is happening. It is becoming an unmitigated disaster. More and more physicians are either banning or severely limiting access to pharmaceutical sales representatives.

So what can be done to improve the relations between pharmaceutical companies and physicians while concurrently addressing the pharmaceutical industry's need to reduce costs and increase productivity. ? How can the industry achieve more with less, particularly when there continues to be a need for pharmaceutical companies to regularly and effectively communicate with physicians to explain their products and the benefits to the physicians' patients.

Back in the late 90's and early 2000, a company called iPhysicianNet provided the industry with a means of testing out a potential alternative solution to reduce the number of sales representatives calling on the 'so-called" target physicians". iPhysicianNet was the creator of the "Video Detailing" concept. A concept whereby physicians were provided with the technology and network connectivity to have face-to-face sales discussions with pharmaceutical sales representatives at times of convenience to the physicians. The physicians were in the driving seat, and appeared to be perfectly happy to engage in monthly video detailing sessions with representatives of many of the major pharmaceutical companies. On average such video detailing sessions lasted in excess of seven minutes, and two or three products were detailed in each session.

Companies who deployed the iPhysicianNet video detailing system reported very good results in prescription increases and attractive ROIs. However, the vast majority of those companies saw the iPhysicianNet video detailing service as a means or "augmenting" the activities of their field sales forces, and not as a means of testing a future where they may need to downsize the field sales teams, and adopt a means of more effectively communicating with physicians with less representatives.

Unfortunately, the iPhysicianNet business model proved to be too capital intensive. Maybe the company was just too far ahead of its time. In those days, many physicians did not have access to or use of a computer (that was strictly reserved for the billing area). Also, broadband (Cable, DSL) connectivity/internet access was not widely available. iPhysicianNet was therefore forced to provide physicians with a PC an ISDN telecommunications connection, and internet access. There was, therefore, a major cost hurdle just to install a physician (in excess of $4,000), and an ongoing substantial cost for ISDN usage. As a consequence, iPhysicianNet was forced to close its doors in 2003, and did an orderly wind down.

Since 2003 broadband connectively has become widely available, and physician owned and used of PCs is far more widespread. However, since that time, conditions have continued to worsen for pharmaceutical companies. In fact conditions are distinctly worse. The major pharmaceutical companies, whose patents, pipelines, and profits are drying up, are being forced to undertake quite drastic downsizing measure, and relations between physicians and the industry are probably at an all time low.

This is the time that the industry needs to take another look at video detailing. Historically, a video sales representative has been able to cover a territory of 500 - 600 physicians as compared to the typical field sales/office calling representative that has had a territory of just 150-200 physicians and in some instances much smaller where companies have adopted a "micro-territory" modus operandi. With video sales representatives being able to cover such a substantially higher number of physicians than the field-based sales representatives, the industry has a clear means of doing more with less. Just as an example, for every 100 field-based representatives calling on a total of 20,000 physicians, just 40 or less video representatives would be required to cover the same universe.

The pharmaceutical industry has the opportunity to reduce costs, enhance productivity and profitability, while concurrently improving relations with the physician community via eDetailing and adding video reps to their existing sales force profiles.

By: Colby Wright Pharmaceutical Sales Force Development Expert. Changing the way we do business.

Pharmaceutical eDetailing, Physician Community

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