Quality Medical Representative – A need for introspection

Pharma companies sell their products by representing them to doctors through medical representatives (MRs) and generating prescriptions. These traditional MRs remain the mainstay of a pharma company’s business generation process, even with the emergence of newer modes of connection between healthcare providers and pharma companies, such as digital and omnichannel platforms. A safe estimate of a representative’s role in the industry over a five-year period would still emphasise the importance of the repesentative, despite accounting for the projected growth of newer channels. However, this balance could be disrupted if regulatory changes, like the rapid genericisation of the market in India, were to occur.

Despite the current and future significance of an MR’s role, the quality of the average MR has been rapidly declining – a sentiment shared by both pharma executives and healthcare professionals (HCPs). While this decline may have started a few years back, COVID-19 acted as a catalyst, exacerbating the situation. This article explores various aspects related to the issue of MR quality and proposes potential solutions.

Increasing career options for graduates with undifferentiated degrees

Traditionally, graduates with degrees in B.Sc, B.Com, and D.Pharm would join as MRs. The profession also saw an influx of B.Pharm graduates due to the rapid growth in the number of pharmacy colleges. Previously, the MR position was considered one of the better career options for these undifferentiated graduates. However, this is no longer the case. Several changes in the business environment have depleted this pipeline for the pharmaceutical industry. Firstly, there is an increasing number of locally available career options such as banking/finance, IT, industry, telecom, consumer durables sales and service, and modern trade. These relatively newer job opportunities often offer comparable or even better pay than an MR job. For example, a telecom or consumer durables sales and service job may offer a similar starting salary to that of an MR. Consequently, the MR job is no longer the most financially rewarding option for these graduates. Secondly, pharma companies have significantly expanded their field force over the last decade, resulting in a demand-supply issue. In some cases, it takes up to 60 days to fill an MR vacancy in Mumbai, the most populated metro in India.

The youth’s changing priorities

Nowadays, the younger generation doesn’t solely prioritise salary when choosing a career path. The level of social acceptance associated with a job plays a more significant role in their decision-making process. Historically, an MR’s job was never highly valued socially. However, with the prevalence of social media, its impact on society has increased. Yet, a social media post for a position like ‘Executive – Customer Services’ with a modern trade retailer or telecom operator receives a more favourable social response, even if the role primarily involves customer service at a mall. In comparison, an MR’s job faces challenges regarding social acceptance.

Lack of respect and importance within organisational structure

There is a growing dissatisfaction among reps regarding their lack of respect and importance within the organisational structure. This issue hinders the industry’s ability to attract suitable candidates through positive word-of-mouth publicity.

Lack of proactiveness by large pharma companies in creating awareness about pharma-selling careers in relevant social/academic circles

Established large companies recruit only about 10-12 per cent of positions through campus recruitment of freshers. Usually, MR aspirants start their careers with smaller companies, spending approximately a year there before applying to larger firms. The ad-hoc selection process and limited resources of smaller companies often result in low-quality recruitment and induction procedures.

Most often, MR candidate sourcing occurs through line managers’ contacts in the field. Line managers almost always prefer experienced candidates over freshers, believing that an experienced rep will become productive sooner. However, relying on a pool of MRs working with smaller companies for 85 to 90 per cent of recruitment is a major limiting factor for quality recruitment, even for larger companies. One reason why large companies do not recruit from campuses or hire freshers is the higher attrition rate within the first six months of joining the profession. Many new MRs find alternative career options or become disenchanted with the MR job. Unfortunately, large pharma companies have not intervened at the campus level. Only a negligible number of companies conduct campus-level orientation programs for graduating students, and campus recruitment drives by larger companies are infrequent.

Job vs career: While a large portion of the top positions in pharma marketing/sales hierarchies are held by individuals who started as MRs, there is still a lack of visibility among reps regarding career progression and associated salaries. Improving visibility in this regard can incentivise reps to make conscious efforts toward better quality work.

Training-related issues

Classroom training: In an effort to avoid wasting money and efforts on training MRs who might leave early, pharma companies prefer to invest in training only after a rep has spent six months on the job. As a result, some MRs work in the field for as long as six to nine months without proper classroom training. This low-quality fieldwork has a lasting impact on the MR’s confidence and work orientation.

On-the-job training: Area Sales Managers (ASMs), responsible for the on-the-job training of MRs, are also experiencing a decline in quality due to several reasons:

• Lack of clarity on work expectations from ASMs: In terms of job expectations for ASMs, measurable strategy execution parameters and direct customer management are becoming more important than softer parameters like coaching MRs on scientific skills, communication, and selling techniques. This shift leads to neglect in coaching MRs on in-clinic performance parameters. You get what you ask for.

• ASMs selected from the same pool of MRs with inherent quality issues: The MR to ASM promotion process often prioritises fieldwork quantity, performance track record, and customer relationships over quality in-clinic performance, communication, and scientific flair. This leads to the promotion of MRs who excel in fieldwork but lack the ability or conviction to engage doctors with scientific content or effective in-clinic communication. While fieldwork is important, these other aspects are equally crucial.

• ASMs expected to directly generate business from doctors: With the declining quality of MRs, some companies expect ASMs to directly generate business from doctors during joint calls, undermining MRs’ development and ownership of the process.

• Lack of clarity on work expectations from ASMs: In terms of job expectations for ASMs, measurable strategy execution parameters and direct customer management are becoming more important than softer parameters like coaching MRs on scientific skills, communication, and selling techniques. This shift leads to neglect in coaching MRs on in-clinic performance parameters. You get what you ask for.

• ASMs selected from the same pool of MRs with inherent quality issues: The MR to ASM promotion process often prioritises fieldwork quantity, performance track record, and customer relationships over quality in-clinic performance, communication, and scientific flair. This leads to the promotion of MRs who excel in fieldwork but lack the ability or conviction to engage doctors with scientific content or effective in-clinic communication. While fieldwork is important, these other aspects are equally crucial.

• ASMs expected to directly generate business from doctors: With the declining quality of MRs, some companies expect ASMs to directly generate business from doctors during joint calls, undermining MRs’ development and ownership of the process.

Gender inequality

Although a large number of female candidates are choosing to become MRs, not all companies actively select them. Despite HR and organisational policies encouraging improved gender equality, many line managers tend to avoid hiring female candidates. Reasons often cited include concerns about future maternity leave and a perceived softer approach expected from female reps under sales pressure. While senior management recognises the superior communication abilities of female reps, resistance at lower-level functions is depriving the profession of this abundant talent. Increased participation of women in the profession would not only bring about positive qualitative change but also aid in cultural transformation within the industry.

Activity-engagement-based selling models

As activity/customer engagement-based selling expands, MRs are able to manage business without relying solely on classical in-clinic processes. This reduces the reps’ dependence on delivering a strong scientific pitch or executing marketing communication within a doctor’s cabin.

Lack of consistency/sharpness in product promotion

Frequent changes in marketing communications and a lack of sharpness in strategies discourage MRs from settling into a consistent working pattern. Strategies and communications are often changed before reps have the opportunity to gain comfort and proficiency with them.

Rollout meetings for strategies and new launches often focus on leadership addresses and high-level strategic pitches, leaving little time for reps to understand and practice scientific and marketing communications.

COVID impact

Reduced access offered by healthcare providers (HCPs) to reps during the COVID-19 pandemic led MRs to accept compromised situations for meeting with doctors. This included conducting calls in parking lots, elevators, and patient waiting areas. The acceptance of such compromised settings by MRs has led HCPs to continue these methods of granting visits to reps. However, these compromised settings do not encourage MRs to carry out their work in the desired manner, resulting in a loss of overall quality and approach to work.

What can the industry do to remedy this?

1. Improve reliance on campus/freshers recruitment. Conduct orientation programs and provide short training for potential candidates before selection.

2. Provide training to reps as soon as possible after they join the organisation.

3. Increase the starting level salaries of MRs to make the profession more attractive compared to other career options.

4. Give strong emphasis on scientific flair and communication skills during the MR to ASM promotion process.

5. Recruit more female MRs. Facilitate maternity leave and provide support for line managers to better manage female reps’ absence during maternity leave.

6. Establish stability in promotional approaches, strategies, and tactics. Minimise frequent changes.

7. Maintain a reliance on the classic in-clinic process for business generation, even with the growing trends in engagement, doctor dispensing, and digital approaches.

8. Allocate adequate time for MRs to understand and practice communication during brand launches and quarterly campaign meetings.

9. Foster respect for reps and create a positive internal organisational environment. Reps who feel safe and have high self-esteem will be more assertive in their customer interactions.

(The author has 30 years experience in Domestic Formulation Sales, Marketing and Business management)