Mike Myers can remember a time when simply being a self-starter might have been enough to make someone a good hospital pharmaceutical sales rep; that time, however, is history.

Nowadays, the job goes far beyond "self."

"You can't be a lone wolf," Myers says. The regional sales director of central nervous system, specialty care, long-term care and hospital divisions for Wilmington, DE-based AstraZeneca's Philadelphia region, Myers has sold from various platforms over the years. All the while, he's watched the hospital rep's role become increasingly complicated: more coordination with others, less access to buyers. In short, reps face a more uptight hospital marketplace.

While the overall number of pharmaceutical reps has mushroomed in recent years, it is believed the number of hospital reps has stayed flat or even shrunken. The result is more pressure on hospital reps to keep their clients — and their growing number of teammates — happy.

"The hospital rep is a quarterback, like a field general. In the old days, the hospital rep was kind of seen as the Lone Ranger, and a lot of them were hired that way," Myers explains. "They were the type that would be in hospitals at 6:30 and have half of their work done by 10:00 in the morning. They'd be meeting morning rounds, in OR lounges, surgery lounges, and their day's done, or they've at least seen a lot of people."

Today, the hospital rep is more likely to encounter tougher access restrictions, tight selling rules that never existed until recently and more complex purchasing systems.

That's in addition to the greater needs of a rep's own company, Myers points out.

"Now, hospital reps have to work with many people on their own teams — medical teams, marketing, others; a lot of things are taking place," he explains. "There are some who have really adapted well to that and others who haven't."

The number of hospitals in the country has been decreasing, though the number of academic and larger hospitals primarily targeted by drug sellers has held steady, sources point out. That, along with an unmistakable decline in hospital-exclusive drugs over the last decade, has kept the number of hospital rep positions in check.

"If you look at the Glaxos and Pfizers and Mercks, they've all been around 200 to 300 hospital reps, regardless of their overall sales forces," Myers says. "The hospital rep now will be coordinating activities from several therapeutic areas in their own company to make sure it's done the way an institution wants it.

"There are a lot of hoops to go through: the P&T committee, pharmacy, material management, the joint commission," he adds. "The last thing you can do is have some rogue rep running up to the fifth floor of a hospital and leaving some samples for a non-formulary product. Generally, that doesn't happen anymore, but it will still happen."

And one rogue could cause serious ripple effects on the rest of a division.

"Everybody's screaming, 'We have to get [a certain drug] into a big hospital,' because everybody in the community does what the hospital does," Myers explains. "If there's a new cardiovascular drug and it doesn't make it onto the hospital formulary because it's not the lowest cost, all the reps in the Erie, Pennsylvania area, for example, feel it. There are bigger wins and bigger losses, and everybody knows it."

'More about price'

The pressure is compounded by a tighter squeeze from hospitals themselves, notes Deb Perl, a CNS specialist for UCB Pharma based at the Texas Medical Center in Houston.

"It used to be you could occasionally get into a conversation that involved pharmacoeconomics, but now it's pretty much straight gone to economics," she says. "If you were selling anesthesia products, you could sell based on the type of service you had or on different delivery systems. You could qualify it on other things, versus just straight price."

But as regulators and hospital buyers start looking harder at the pharmaceutical industry, "it becomes more about price," Perl says.

On top of that, getting access has become infinitely harder, industry players agree. Corporate policies can play a heavy hand, and group-purchasing deals may further restrict sales opportunities.

"It used to be anybody could come in [a given hospital], really," recalls Perl, a 10-year pharmaceutical sales veteran. "It was almost surprisingly easy how friendly and, 'Oh, and come on back!' they were. It doesn't happen anymore for the most part."

Now, some hospitals require educational materials to be cleared with facility personnel before a call on a pharmacist or other decision-maker is granted. One of Perl's former accounts also set up a "rep board," a joint committee of sales reps and pharmacy personnel, to create visitation and sales policies, she adds.

Companies shifting

More recently, Perl says she has noticed "a lot of reorganization" among her peers' companies, as drug makers try to reposition their sales forces. In at least one instance, hospital reps were being folded into a larger CNS sales force, she says.

Most drug companies, worried about sharing strategy or sales numbers, declined interviews for this article. Yet two things are clear: They're requiring better organizers and leaders in hospitals. And those people have to know how to relate better to hospitals' needs for money and time savers.

"The need [for hospitals] to cut costs is greater than ever," says Douglas Scheckelhoff, director of the division of practice leadership and management of the American Society of Health-System Pharmacists, Bethesda, MD. "Where every rep can help a hospital is understanding [group purchasing organization] contracts and understanding whatever will reduce the unit cost."

A rep must be aware of a hospital's interests to the extent that he or she now must also take into account the facility's needs to reduce errors and waste, Scheckelhoff adds.

Calling the right plays

That's where the "quarterback" concept comes in so handy, notes William Gouveia, director of pharmacy at Tufts – New England Medical Center in Boston.

"Each company should have a single rep assigned to coordinate the company's activities with the hospital's pharmacy director," Gouveia says. "Merck has done that pretty well. Pfizer still probably has about seven or eight people trying at once."

Both companies declined to be interviewed for this article.

"There's a lot more scrutiny of reps and keeping them out," Gouveia explains. "So if [reps] don't play by the rules, they'll find themselves out. The industry has to be very aware of how we scrutinize the presence of reps now."

Another piece of advice for the hospital representative:

"Take the customer's view and be a little more cautious than you have been," Gouveia says. "Carting all those lunches around, food gets left, people start jockeying for it. The patients see that and then start wondering, 'Am I paying for it?' It's getting out of hand."

Although the hospital selling milieu may have changed less than other selling venues, it clearly is a tougher place today than in the past, experts agree.

"There is obviously growing hostility between hospitals and their P&T committees on one side, and the reps on the other," says Herman Lazarus, vice president of pharmacy practice for Cardinal Health and former director of pharmacy for the medical center at the University of Alabama, Birmingham, for 25 years. "It's perceived by hospitals that [reps'] mission is to sell, regardless. Nothing else matters." PR