In this theory, two prisoners are each offered the same two options: He can confess to the crime for which he's accused or remain silent. In this case, we assume that each prisoner cares more about his own personal welfare than that of his accomplice, and neither have any way of knowing what the other will do.

The deal presented is this: If one confesses and the other stays silent, the confessor will walk away a free man while the other serves a maximum sentence (say, 10 years). If both confess, each will be convicted of the more serious crime but will serve only five years. If both stay silent, they will serve just six months each for a minor charge. Each prisoner must make a choice: Betray the other (defect) or remain silent (cooperate).

The theory proposes that when everyone pursues rational self-interest (confesses) and when minimal trust exists among "players," all may end up worse off (serving some time) than if everyone acts contrary to rational self-interest (stay silent). The dilemma is that, no matter what the other does, each prisoner is better off confessing than remaining silent. But the outcome achieved when both confess is worse for them both than if they had both remained silent.

Only when one is certain that all others will cooperate – and go along with the plan that benefits all — is it safe to cooperate. In all other cases, the most prudent strategic move is to defect and choose the option that best serves self-interest. Otherwise, you lose.

A clear solution for the industry hasn't yet emerged, but it seems clear that pharma sales teams need to figure out how field representatives can consistently provide value to physicians and use their time — and company resources — wisely.

The Upside: Reps are content – and optimistic

Despite the grim signposts of the industry at large, reps indicate that they respect their current employer and are happy with where they are careerwise — either because they are content with their current position, or because they think their current role is a solid stepping-stone to specialty selling or management.

More than half of all reps (52%) named their own employer as the healthcare company they most respect. Similarly, half selected their own as the world's best sales force. Four out of 10 even predicted that their sales force will grow in the coming year.

Maybe it's because things are working well internally. Companies are supporting their sales team well; reps and managers are aligned; marketing is providing well-designed and timely materials; and training needs are, for the most part, being met.

Reps and managers indicate that they are well supported with the sales materials they get from marketing. They feel that their input is incorporated into these materials and are satisfied with how materials are rolled out. Specifically, 76% of respondents agree that their company provides sales reps with the tools and training that reflect the current selling environment.

Similarly, 70% report that marketing provides reps with the necessary resources to compete and also that management and marketing do a good job of explaining the resources they develop for the field. A full 64% of all respondents agree that sales materials are useful. When asked what makes sales materials useful, respondents said that they have an appropriate level of detail (59% of respondents) and are timely (44%).

Yet, as a group, sample suppliers don't necessarily agree, as 38% said that sales materials are useful, while 72% of trusted colleagues did so. Older reps felt better about the usefulness of sales materials (72% rated them as useful) than their younger colleagues (56% agreed). The small group of people who said they are not useful cited relevancy and "too many pieces" as reasons.

Evidently, happy reps mean happy managers. Nearly all managers (90%) rated reps' work ethic as strong, and they agreed (83%) that reps' exhibit a positive attitude. And while work ethic and positive attitude were the highest rated of all rep attributes tested with managers, most managers rated reps' skills as strong in every category tested.

So, internally, companies seem to be doing well; it's external pressures that reps blame for limiting their effectiveness.