Medical sales representatives: a neglected group of pharmaceutical workers in India: need to redefine their role in post COVID-19 world

INTRODUCTION

Medical representatives (MRs) are the only living interface between the prescribing doctors and the pharmaceutical industry. They are the integral part of the entire healthcare system. In past, their occupational duty was only to inform doctors about respective medication from that particular pharmaceutical company to which they belong. Additionally, MRs were the most efficient, and most expensive promotional channel of the pharmaceutical industry. The basic prerequisite of their job was that they could see doctors every day. In early 2020, the spread of the COVID-19 virus stopped the original way of working of MRs, how they used to do it. It was no longer possible to see a doctor face-to-face and ask or convince him to prescribe a particular medication to his patients. Field visits had to be cancelled and the MRs was condemned to work from home, using their very untypical home-office and they faced the most due to strict social distancing, lockdown measures and individual concerns.¹ Hospitals/clinics banned their entry.

Resultantly, they experienced many difficulties in their sales and marketing efforts, causing them to express burnout and lower engagement levels.² The previous study revealed an overall negative impact on MRs’ psyche and productivity with anxiety and increased burden have a medium to high impact. In order to safeguard medicine supply in future, immediate attention to sales workforce welfare is required.³

Overburdened: even before COVID-19

An MR from Indore, blamed his firm, for his death. Due to the non-accomplishment of his monthly targets assigned by the respective Company, he had attempted suicide and was found dead on a Railway track.⁴ Secretary of the Federation of Medical and Sales Representatives’ Association of India (FMRAI), said that he often hears of MRs dying in road accidents. “80% of these accidents happen in the last week of the month, implying that these were work pressure-driven suicides, “unimaginable targets are fixed by companies”.⁵

Occupational health issues associated with being a medical sales representative

There are so many potential occupational health issues: the working nature of a sales representative inhibits the opportunity for direct contact and communication between the colleagues, this can result towards the feeling of isolation and frustration; access to occupational health and rehabilitation facilities may be limited or out of reach for everyone; awareness of personal safety strategies to reduce personal risk is an essential element of salesforce training programs are unavailable; distant and frequent traveling/driving for work; and ergonomics problems may arise from long periods spent driving, and prolonged computer use.⁶

PHARMACEUTICAL INDUSTRY SCENARIO AFTER COVID-19 PANDEMIC

Currently, India allocates only 1.8% of its GDP towards healthcare while the WHO’s recommendation has been to allocate more than 5% of GDP for the industry.⁷ FMRAI, the nodal organization for MRs and sales promotion employees in the country has presented a 16-point demand to the center, the state government, and employers. There are more than 3 lacs sales promotion employees in the country and about 110,000 of them have become members of the association.⁷ They are also demanding 8-hour workday and job security and workplace vaccination. Goa state government has decided to consider workers employed in the pharmaceutical supply chain from production to retailing as frontline COVID healthcare warriors and will also be considered for priority vaccination.⁸ Pfizer Inc. reducing its US sales staff as it expects that HCPs want less physical interaction with salespeople after the COVID-19 pandemic ends and said that they are progressively transforming into a more focused and innovative biopharmaceutical firm and evolving the way they engage with HCPs in a rapidly increasing digital world.⁹

Technology redefining the role of medical sales representatives

Surveys with multiple HCPs indicate that the most beneficial outcome of interactions with pharmaceutical companies (via detailing and events) is knowledge transfer about R&D. The sales representatives has to transform from being a commoditized mouthpiece to a consulting peer to the HCP, an enabler, a research assistant for an HCP in genuinely helping identify appropriate treatments for the patients in future.¹⁰ Pharmaceutical companies adapted to the changing situation and reached doctors post-pandemic with the in-clinic detailed conversation moving from the doctor’s chamber to hallway conversations where doctors allow MRs to detail products from outside the consulting room, tabs changed to big size VA which are visible from a distant and drastic decrease in usage of LBLs and samples which use to act as quick brand reminders.¹¹ The most favored communication mediums that worked for pharmaceutical majors to reach doctors were Whatsapp calls and online video communication platforms such as Zoom and Google meet. Communication through networking sites like Twitter, Facebook, LinkedIn, Practo and Docplexus and blog/microblogs also came in handy for such communications. The survey concluded that in the upcoming years, the involvement of digital sector will be integral in the pharmaceutical industry. Hence, the industry must evolve accordingly and become more innovative and use creativity to a larger extent to engage the doctors to help them to connect with the patients.¹¹

Future of pharmaceutical companies’ communication with HCPs: hybrid model

Recently a survey was conducted by Rediffusion Healthcare, on the recent pattern of communication in post COVID-19 era. The study found that in the present time and in near future, the communication medium between doctors and pharmaceutical companies will largely depend upon the blend of physical and digital communication. The survey showed that almost 40% doctors supported the hybrid model. With patients being more concerned about their health and taking efforts in managing it themselves by purchasing devices, downloading health applications on smartphones, maximum online buying, markets need to rethink their communication channel and the mode of reaching patients will be more through digital than traditional means, said the company, which focuses on branding activities for healthcare firms. Survey report stated that forward going, the ability of companies to digitize fast, optimize the use of data analytics, and customer experience improvement will be the biggest differentiator in the industry.¹¹

Digital learning

Digital learning is the marketing of products and services using digital tools and technologies, mainly on the Internet, but also including mobile phones, display advertising, and any other digital medium.

Generally, 5 types of trainings are covered in the sales training curriculum for MRs. Module 1 includes anatomy and physiology, Module 2 includes disease process, Module 3 includes drugs used in clinical condition and advantages of molecule marketed, marketing, Module 4 includes how the therapeutic molecule will be sold based on SWOT analysis, Module 5 includes handling objections: representatives are trained on how to handle the doctors’ objections and how to reply in a dignified way without being rude, and Module 6 includes etiquette and dress code training.¹² Pharmaceutical companies, whose most expensive and valuable tool MRs’ must change their objective: from pill-pushing to value delivery.¹

Benefits of digital learning

Benefits include access tutorials from anywhere and anytime, self-directed study and provides digital record keeping facility, 24x7 available resources and immediate feedback, cost-effective- sales representative cost to the doctor is eliminated, time-saving as it eliminates the time wastage during waiting for a response from the client, ethical sales can be achieved as there are no promotional gifts will be provided, which are as such abandoned by the IFPMA code of pharmaceutical marketing practices, and live interactive e-training sessions help in the removal of nervousness and make sales representatives more confident.¹²

There are so many platforms for digital learning, which are available on the internet. They offer personalized packages according to the need and choices of the person. Not only individuals but companies are too hiring these services to train their workforce so that they can work efficiently in situations like the COVID-19. In the past, the pharmaceutical marketing arena cultivated its own inside-out look calling it communication. They misinterpreted the word communication being a one-way road, often forgetting that hammering a marketing message hardly should not be called communication. In true communication, there are two sides involved: the physician and the company, to make it an effective communication. MRs’ role is not only limited to being a loudspeaker of their marketing department, but their work was to deliver valued and valuable services to their clients such as therapeutic advice and assistance. They became accepted partners and therapeutic advisors of their clients, not only drug promoters.¹

DISCUSSION

Even after COVID-19, in upcoming years, MRs’ role will not be going to change as the “only living interface” between pharmaceutical companies and doctors, but they will not work as marketing megaphones anymore.¹ Training, education and development are the key areas for reforming the identity and role of marketing sales representatives in the future. Technological advancements are helping inside out in reforming MRs’ occupational role as only a pharmaceutical representative. Not anymore they would be considered as one of the marketing tools of the pharmaceutical companies, used for the sole purpose of reaching out to the customers. But now they are trying to create a place for themselves in business of medicine as well as in the pharmaceutical fraternity and digital learning is empowering them in this challenging task. Digital learning has the immense potential to redefine the occupational role of pharmaceutical sales representatives and it can also help in realizing the worth of this occupational sector to the pharmaceutical companies and also to the people in general so that this sector will not remain neglected anymore.

CONCLUSION

Medical sales representatives are very crucial part of the pharmaceutical supply chain but they are not getting their due recognition for their work and services. After COVID-19 pandemic, a sudden digital surge is contributing in upliftment of this particular occupation and also helping in realizing the importance of this job to the society. With the digital learning medical sales representatives can enrich their skill set and become asset to the firm they are working for.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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