Don't take away my samples
Editor's note: Barbara McAulay is director, client service, Healthcare Division of Total Research Corporation, Princeton, New Jersey.
Recent consolidation of pharmaceutical firms via mergers and acquisitions has greatly increased the size of some sales forces. The merger of Bristol-Myers and Squibb created the largest U.S. sales force-3500 strong. American Home Products' acquisition of A.H. Robins helped boost it pharmaceutical sales force to more than 3000. Other large companies have reacted by massive hiring programs to stay competitive and to promote new products. Merck added 700 representatives in 1989 and now ranks third with a sales force of 2700. Ciba-Geigy has more than doubled its sales force since 1987. In total, the top 20 pharmaceutical firms (in sales force size) have almost 33,000 sales representatives in the field, an increase of 18% since 1987. (Information on sales force sizes from Medical Advertising News, September 15,1990.)
With the increase in sales forces and the proliferation of co-marketing agreements, we at Total Research Corporation decided to talk to primary care physicians to see what their reaction is to these changes. If they are seeing more representatives, do they now spend less time per visit with each sales person? How widespread is co-promotion and how do primary care physicians feel about being detailed on the same product by sales representatives from more than one company?
Earlier this year, Total conducted a telephone survey among a national random sample of 360 primary care physicians to address key questions regarding pharmaceutical sales forces. In this article we review a few of the findings from this study:
- Are physicians seeing more pharmaceutical sales representatives this year? How much time do they spend with sales reps?
- How do physicians react to co-promotion?
- Which companies are calling on the same physicians?
- What services provided by pharmaceutical sales representatives do physicians value most?
Four of ten physicians report an increase since last year in the number of calls from pharmaceutical sales representatives
The impact of larger sales forces is certainly being seen in the primary care physician's office. Forty percent of physicians perceive an increase in the past year in the number of pharmaceutical sales reps trying to see them, whereas less than 10% of physicians perceive a decrease.
Net increases are seen in all demographic segments (see Figure 1), and are particularly noticeable among physicians who see 100 or more patients per week, and among younger physicians in practice 3 to 10 years.
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Smallest net increases are seen among older physicians in practice 31 or more years, general practitioners (highly correlated with older physicians), and those with more than half their practice comprised of managed care patients.
Obviously, pharmaceutical firms have been able to successfully target their sales calls to more productive physicians with long-term potential.
Competition for the physician's attention is intense
Asked which companies had called most often in the past three months, physicians cited more than thirty firms (those most frequently mentioned are shown in Figure 2). Not surprisingly, there is a strong correlation between actual sales force size and perceived frequency of calling. Of the top ten companies in sales force size, seven were among the top ten mentioned as most frequently calling. Widest coverage was attributed to Merck, Lilly, Bristol-Myers Squibb, SmithKline Beecham, Upjohn, Pfizer, Marion Merrell Dow, Johnson & Johnson, Glaxo, ParkeDavis and American Home Products.
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The typical primary care physician sees 5.82 pharmaceutical representatives a week (up from 5.15 a year ago) and spends an average of 8 minutes per call with each representative-less than one hour per week. Considering the number of companies calling and the fact that each company usually details two or more products per visit, this is a lot of information for physicians to absorb in less than an hour a week.
Co-promotion: necessary medicine?
In order to reach more physicians and to call on productive physicians more frequently, the pharmaceutical industry has increasingly used the powerful strategy of co-promotion. One of the earliest and most successful examples of co-promotion is the joint effort by Glaxo and Roche Laboratories to promote Glaxo's anti-ulcer product, Zantac.
We asked physicians about their experience with co-promotion and found that seven of ten primary care physicians had been detailed in the past year on the same brand product by sales representatives from two different companies. The reaction of more than half of these physicians (53%) was "somewhat" to "very" unfavorable; 31% were "mixed" and 15% were "somewhat" to "very" favorable. The principal complaint is that co-promotion wastes their time with redundant information. On the other hand, some physicians appreciate the increased exposure, enjoy interacting with sales representatives and welcome the opportunity to get product samples. (See Fig. 3)
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Locking horns in the doctor's office
Sales management is keenly interested in the day-to-day competitive picture in the physician's office. To provide competitive intelligence from our study, we performed a cluster analysis to determine which companies tend to call on the same physicians. Figure 4 shows various levels of physician constituencies shared by pharmaceutical companies.
The "earlier" (further to the left) two companies are connected, the more they tend to be calling on the same physicians. The connections progress in a step-wise fashion until all companies are eventually linked. Of key interest are the companies that link early on. For example, Sandoz and the J & J companies are most likely of all the companies analyzed to be calling on the same physicians. At the time of this study, Sandoz was detailing Tavist-D and J & J's Janssen was detailing Hismanal; they are likely to be going head-to-head on these antihistamines with the same physicians. Searle and Upjohn also tend to call on the same physicians, as do Pfizer and Merck.
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By combining knowledge of what products are currently being detailed with the knowledge of shared constituencies, sales management has a valuable picture of the competitive situation at the point in time when the data were gathered.
Please don't take away my samples
Six key services provided by sales representatives were evaluated by physicians in a pair-wise trade off fashion. This method of evaluation forces discrimination and yields much more telling and reliable results than rating the services one at a time.
Physicians were asked, "Suppose a sales representative's functions were limited to one area. Which of the following would you prefer the sales to provide? Product information? Or product samples?" Other choices included: "arranging seminars/professional meetings," "product information," "providing educational materials for patients," "gifts for use in the office," and "clinical trial recruitment." All possible pairs of the services were evaluated.
It is not surprising that samples are highly valued. What is surprising is the strength of preference. Samples are more than twice as important to physicians as the second-ranking service "arranging seminars/professional meetings." Providing product information ranks third, tied with patient educational materials; another surprise.
In a climate of cost-containment, pressure to devote more dollars to R&D to develop new entries, and scrutiny of pharmaceutical sales promotion by Kennedy's Senate Labor & Human Resources Committee, some pundits are predicting that sales force sizes will decrease in the 90s. The issue may not be so much the size of the sales forces but how best to utilize this very costly method of promotion. In this study, physicians' priorities were clear: Whatever you do, don't take away my samples!