How Drug Reps Size Up Doctors

By Sharam Ahari
Shahram Ahari is a former sales representative for Eli Lilly who left the pharmaceutical industry to become a public health advocate.  He has since completed his MPH at UC Berkeley, become a researcher at UCSF School of Pharmacy, testified before Congress and the Supreme Court, and will be graduating from UC Davis School of Medicine this summer to begin his emergency medicine residency in Rochester, NY.

Image taken from “How Drug Reps Size Up Doctors,” May 3, 2013,

For the sake of simplicity, I will translate what this data sheet means in industry terms. Its broader significance to public health and the pharmaceutical industry I’ll leave mostly to your interpretation.
First of all, the sheet catalogs the list of top 10 targets for a particular sales representative. Targets are prioritized accordingly for a number of reasons. The most common ranking metric is based on sheer prescribing volume. However, other factors come into play. Is the target a “thought-leader” – do they have an editorial role in a prominent peer-reviewed journal, or are they particularly well published?  Does the target show great resistance or susceptibility to our marketing methods?  Is the target on a hospital’s formulary committee?  All of these sway one’s “popularity” with the representative accordingly.
Second, the use of the term “target” is fairly standard despite the fact that the goal for sales representative to establish a friendship-like rapport with their clients.  It was made clear to me by a mentor that “while the doctor may be sitting with a friend, [the sales rep] is merely sitting with a client.”
Third, the graph lists whether the target is a primary care physician or a pain specialist.  In spite of selling an identical product to both types of physician, the manner in which product data is presented varies from target to target.  While there is nothing obviously wrong with that idea, it does suggest that, in the world of drug sales, how you deliver your message is more important than what the content of your message is.
Pharmaceutical sales representatives are well-trained to ferret out the reasons for a physician’s reluctance to use their product. Once identified, the goal of the drug rep is to batter that rationale until the beleaguered target alters their prescribing patterns favorably to the representative. The fourth column identifies exactly what barriers each target is putting up and it is up to the savvy yet charming representative (armed with an expense account and a multi-million dollar marketing budget) to overcome them.
There are, among doctors, the mistaken beliefs that drug representatives either provide valuable, up-to-date, objective evidence or offer only blatantly self-serving information. Neither is usually the case.  Instead, they offer reasonable yet edited information with a subtle twist so that a physician is presented only a parallax of the FDA-approved data. Typically, this means the sales representative will present the most favorable information regarding their product while juxtaposing it against their competitor’s most glaring shortcomings.  And the converse is also true: the sales representative will fail to mention his/her products’ flaws as well as their competitors’ strengths.  This is done far more pointedly when the comparison is done against the target’s medication of choice.  It should be pointed out that sales representatives receive no incentives for “educating” their targets.
The last column refers to how far along the representative is in influencing his or her targets.  Much like a 12-step program, this is an incremental behavioral modification process.  Based on the graph, Target 1 is far closer to the end of their particular “sales 12-step program” and may soon be invited to “educate” their colleagues on the merits of this sales rep’s products.  On the other hand, Target 5 is simply beginning.  It is of interest to note that Target 8’s “Decile 10” reflects how highly they rank in sheer quantity of prescriptions for this rep’s particular class of drugs.  “Good access” refers to how easy it is for the drug representative to meet with the physician.  The general rule in sales is that increased face time leads to increased sales by way of subtle rapport.