Kim is a newly promoted specialty sales representative in her company’s gastroenterology division. She’s been working diligently in her new territory for almost two months now, and once again finds herself leaving Dr. Walker’s office feeling that this job is more challenging than she anticipated. Dr. Walker’s nurse indicated that the doctor would not have time to meet with Kim today, but Kim would be welcome to check the sample closet. Kim, eager to turn her sample closet visit into a successful hallway detail, was excited to see Dr. Walker making her way down the hallway to pick up some samples for a patient waiting in treatment room 2. As Dr. Walker retrieved the samples, Kim quickly summarized the most recent clinical data regarding her company’s proton pump inhibitor, and even managed to ask Dr. Walker to consider the product for her next PPI patient. Without a word, Dr. Walker smiled and walked back down the hall to treatment room 2. Dr. Walker, one of Kim’s highest-potential prescribers, is no different from most of the gastroenterologists Kim calls on: busy, hard to see and difficult to interest in Kim’s key product. Although she spent three successful years selling to primary care physicians, Kim is finding that success with gastroenterologists will not come so easily to her.

Kim is confronted with a significant career challenge. Some of the questions she asks herself: “Why are gastroenterologists so hard to see?” “Why do so many of my target docs seem reluctant to engage in conversation about my product?” “What makes gastroenterologists so much more challenging for me than their primary care counterparts?” For Kim, as for any sales representative in her situation, the value of gaining a thorough understanding of gastroenterologists is becoming readily apparent. Understanding the ins and outs of gastroenterology is the first step toward building a successful relationship with the physicians who practice it. In order to fully understand practicing gastroenterologists, sales representatives who call on them must educate themselves about the training and education gastroenterologists receive, what they do day-to-day, what differentiates them from primary care physicians, current trends in diagnosis and treatment of gastrointestinal disorders, and best practices for engaging and successfully partnering with gastroenterologists in the interest of maximizing patient care.

A busy specialty

One reason why Kim and her fellow gastroenterology reps may have a difficult time accessing their target physicians is that the limited numbers of gastroenterologists practicing in the United States today are in high demand. According to the Chicago-based American Medical Association, there are currently about 9,300 office-based gastroenterologists, less than 1,000 hospital-based gastroenterologists and about 1,000 gastroenterologists in residency programs throughout the country. By contrast, there are nearly three times as many sales representatives selling to gastroenterologists as there are gastroenterologists. When you combine the number of reps trying to gain access with over 20 million patient visits per year, it’s no surprise that sales representatives often find themselves lacking face time with this busy specialty.

Training for gastroenterologists

A gastroenterologist is a physician specially trained in the management of disorders of the digestive system. Gastroenterology is a subspecialty of internal medicine, and as such, trainees first complete a three-year residency program in internal medicine prior to admission to a gastroenterology residency program. Gastroenterology training programs are usually at least three years in duration and include training in an outpatient setting, as well as in the hospital, on the diagnosis and management of gastrointestinal diseases. Additionally, about 30% of this experience consists of clinical training in hepatic diseases. Liver disease has become an increasingly important component of the practice of gastroenterology. Gastroenterologists in training also develop procedural skills in order to perform certain diagnostic and therapeutic procedures. These include understanding when a procedure is indicated, potential complications and the interpretation of results. The development of fiber optic endoscopes has revolutionized the work of gastroenterologists in recent years. An endoscope allows the physician to view much of the gastrointestinal tract and to take samples for laboratory analysis. Gastroenterologists in residency commonly practice performing such endoscopic procedures as sigmoidoscopy (examination of the rectum and sigmoid colon) and colonoscopy (examination of the colon). An understanding of nutrition and obesity is also necessary for the gastroenterologist in training.

Upon completion of a specialty training program, the gastroenterologist emerges as a very different physician, despite the specialty’s close ties to internal medicine. Gastroenterologists possess a level of expertise in the diagnosis of digestive disorders and an ability to differentiate among similar disorders that is well beyond that of a primary care physician. In their training and clinical practice, they have developed the ability to interpret diagnostic studies of the digestive system and to implement the most effective treatment plan. Their advanced training, in-depth knowledge, procedural skill and practical expertise make gastroenterologists the ideal physicians to assume long-term care and follow-up for patients with chronic gastrointestinal diseases.

The gastroenterologist in practice

Most patients are referred to a gastroenterologist by their primary care physician. Because many gastrointestinal disorders have similar symptoms, it is often difficult for a primary care physician to make the proper diagnosis. As a result, some patients may have been misdiagnosed by a primary care physician, and come to the gastroenterologist in hopes of finally bringing their symptoms under control. Some of the disorders gastroenterologists diagnose and treat include inflammatory bowel disease, peptic ulcer disease, gastroesophageal reflux disease, Crohn’s disease and cancers of the digestive system. The digestive tract has the highest incidence of cancer of any organ system of the body. In fact, 24% of cancer deaths in the United States are due to gastrointestinal cancers, clearly illustrating the obligation of gastroenterologists to understand the management of cancer. The practicing gastroenterologist, like most specialty physicians, is challenged by a constant need to stay abreast of current trends in diagnosis and management. There has been a remarkable increase in the body of knowledge in gastroenterology in recent years. New diagnostic criteria and therapeutic approaches in the areas of inflammatory bowel disease, peptic ulcer disease and nutrition are just a sampling of how the specialty is constantly evolving.

Office-based gastroenterologists spend the majority of their time seeing patients in the office. They may also spend a significant portion of their time performing endoscopic procedures and interpreting the results, and may spend some time in the hospital, seeing and treating patients on an inpatient basis. When it comes to patient care, gastroenterologists are often cast in the role of consultant for the referring physician, as well as other specialties involved in a patient’s treatment. Because care of the patient with gastrointestinal disease often requires a multidisciplinary approach, gastroenterologists must work together with other specialties in the best interest of the patient. Referring physicians, surgeons, pathologists, oncologists and radiologists are just a few of the other members who might make up a multidisciplinary team charged with the care of a patient with a digestive disease. The gastroenterologist is responsible for leading this team and effectively overseeing the overall care of the patient. As an example of how a gastroenterologist might work with other specialties, consider the patient who requires surgery. Surgery is the preferred treatment for some gastrointestinal disorders, such as colon cancer. In this case, the gastroenterologist makes the diagnosis and recommendation for surgery, and then refers the patient to a surgeon who performs the procedure. The gastroenterologist then assumes responsibility for the patient’s long-term postoperative care.

Succeeding with gastroenterologists

Kim and other reps that call on gastroenterologists can distinguish themselves by paying attention to and addressing the subtleties that make these physicians unique. Gastroenterologists are always looking for new information on treatments. Due to the complexities of the cases they are confronted with, gastroenterologists are thirsty for knowledge. They are curious about new treatment approaches, dosage strengths that are being utilized, and studies that are underway or have recently been completed. To address this appropriately, it is important for representatives to have a system in place to continually provide quick information on studies, through either reprints in their possession or dissemination from the home office’s medical department. Knowing any special disease state interests that specific customers may have will enable you to continually look for and provide this new or different information. Knowing that this specialty numbers around 10,000 in the United States, sales reps must anticipate a great deal of competition for the doctor’s time. For Kim, separating herself from the other representatives the doctor sees can be accomplished through diligent research efforts and the ability to successfully articulate the right mix of information.

Gastroenterologists treat many conditions that have similar symptoms, making diagnosis of a specific disease very difficult. How can Kim provide information that assists in the diagnosis? Does her company provide any information on disease state diagnosis, possibly in the form of patient education? If so, she must make sure that her customers are familiar with this information and recognize it as valuable. Another approach would be to utilize the company’s resources. Is there someone in the home office of Kim’s company who is an expert on the disease state and could speak to a gastroenterologist over the phone or meet with the physician at an upcoming medical convention? Is the company currently conducting any research that would be of interest to customers? If Kim’s company is involved in this type of research, she should let her customers know what is going on and how they can find out more about it.

For Kim and other sales representatives in her situation, becoming educated on the specialty will provide the foundation for success. Recognizing and addressing the differences that make this specialty unique will allow for developing successful long-term partnerships with gastroenterologists.