1. ACC certified industry training
Interacting With
Doctors: Rules of
Engagement
Society for Pharmaceutical and Biotech Trainers
Wednesday, June 12, 2013 4:00 p.m.-5:30 p.m.

2. Agenda
• Context of 21st
Century Care
• Building Value-Based Relationships
• Validating the Message with Sub-Specialty
Certification
• Proof of Concept

3. The changing context of medical practice
• Since 1998, physician reimbursement in the Medicare
program has not kept pace with the rising costs of
practicing medicine (SGR- BBA 1997)
• To keep pace with rising expenses, physicians have had
to see more patients in less time- primary care doctors
typically see in excess of 30 pts per day
• This means that there is less quality time for pharma
rep encounters

4. The changing context of medical practice
• In the fields of cardiology and endocrinology
over 50% of physicians are now hospital
employed
• Hospital contracts frequently limit physician
contact with pharma representatives

5. The changing context of medical practice
• Senator Grassley’s Physician Payment
Sunshine Act is implemented 8/2013
• Financial payments from industry to physicians
will be posted on a CMS website after a 45 day
review period where physicians may contest
what is reported (honoraria, meals, gifts, grants)
• Pro Publica and other media watchdog groups
will be free to digest the data and present it in
whatever format they choose

6. Bridging the Gap
• Everything begins with relationships
– First with front desk people and office managers
– Next care extenders
– Finally with physicians
• Read the tea leaves
– Is it a bad day
– How can you help?
• Know your stuff
– What does this doctor/practice need?
– How can you bring value to their patients?

7. Principles of Effective MD-Industry
Relationships
• Listen- don’t tell
• Observe- don’t sell
• When in doubt- listen
• Always remember that the common goal for
industry and physicians is providing value for
patients

8. Bringing Value to the Physician/Pharma
Relationship
• Learn the specifics of sampling for each of your
practices
– Know your product’s shelf life
– Don’t sample with soon-to-be out-of-date
pharmaceuticals
– If you think some of your previously sampled
meds are out of date, say so
– Help with accurate documentation

9. Bringing Value to the Physician/Pharma
Relationship
• Know what your physicians do
• Understand the types of patients they see
• Do your homework
– Talk shop with colleagues inside and outside
your company
– Read your doctor’s CV
– Google your doctor on line

10. Bringing Value to the Physician/Pharma
Relationship
• Know your disease process
• Know your package insert
• Know your black box warnings
• Know your drug and where it fits
• Let your doctor educate you as to how he/she
uses your product
• Never bad-mouth someone else’s drug

11. Bringing Value to the Physician/Pharma
Relationship
• Know your financial support programs for
indigent patients like the back of your hand
• Do everything in your power to facilitate the
physician in getting your drug to appropriate
patients whether they are wealthy or indigent
• If you bring value for a physician’s patients, the
physician will value you and your products

12. Patient Impact
• In spite of SGR, surging hospital employment
and the Sunshine Act, there are many
opportunities for positive relationships between
physicians and pharma professionals
• This relationship will always be a win-win if
patients are impacted positively
• The litmus test for any interaction should be: Will
this physician’s patients be healthier because of
what I do?

13. How Can You Validate Your Message ?
• Get sub-specialty certification in your product’s
disease state
– You can’t sell your product effectively without
understanding how and why physicians use it
– You can’t sell your product effectively without
a global understanding of the disease state it
treats and the other drugs in common use
• Work on your own presentation skills

16. How Can You Validate Your Message ?
• Use sub-specialty training/certification to
advance your knowledge and prove that you are
not out of your depth
• Use sub-specialty enduring materials to show
that you understand the context of use for your
product
• Have a goal to learn something new about your
product and your disease process every day

17. Why Set Standards for Pharma Rep Clinical
Knowledge?
• To improve the quality of the pharma/physician
interaction
• Increasing pressure to be efficient and effective
with rep/healthcare professional time

18. Why Standards for Pharma Rep Clinical
Knowledge?
• There is a heightened awareness of what is, and is not, appropriate
interaction
– PhRMA code
– OIG Compliance Program Guidance for Pharmaceutical
Manufacturers
– Sunshine Act
• There is wide variation in company training situations and therefore;
potential for wide variance in competency
• Heightened competitiveness in the industry worldwide

19. What about Medical Device Sales Teams?
Coalition for Best Practices in HCIR Requirements
• Mission is to streamline the healthcare industry representative (HCIR)
credentialing process for all stakeholders, while meeting the common goals
of patient safety and confidentiality, through the development of industry
recommendations and best practices
• Committed to open and ongoing dialogue between industry and health care
providers to facilitate safe and confidential patient care by ensuring
continuing access to advances in medical technology.

20. Coalition for Best Practices in HCIR
Requirements
• Members of the coalition:
– Joint Commission
– Trade and Professional Associations; Non-
profit Organization
– Individual Company (i.e., supplier, vendor,
VCO)
– Healthcare Industry Representative not
otherwise represented above
– Healthcare provider or healthcare
organization (i.e., hospital, physician group
practice)

21. AMA Research on Pharma Rep Impact
• The following slides are from a survey done by
the AMA
• The survey sampled a variety of medical
specialties

22. None
1- 3
4-6
7-10
More than 10
28.5%
39.2%
16.4%
8.2%
7.8%
How often do Sales Reps call on your practice per week?

23. How often do you actually interact with a Sales Rep per
week?
week? 1-3 times
4-6 times
7-10 times
More than 10 times
I do not interact
59.5%
24.4%
5.8%
4.5%
5.8%

24. What is the average length of time spent with a Sales Rep?
Less than 5 minutes
6-10 minutes
11-15 minutes
16-20 minutes
21 minutes or more

25. Pharma Rep has been Trained and Certified by a
Major Medical Society
No influence at all
Minor Influence
Some Influence
More Influence
Influenced Greatly
11.8%
16.3%
35.3%
21.6%
15.0%
72% said training was more
than a minor influence

26. Multiple Sources
• The following slides are from a survey done by
Publicis Touchpoints Inc in 2010 and is a Sermo
Physician Survey, “What Physicians Want”
• The survey questioned over 250 Sermo
physicians. All physician specialties were
included in the survey.

27. Survey says:
Physicians clearly respected field sales representatives who
were highly trained, experienced, and adept at having
clinical discussions that added value to their practices.

28. Clinical Studies
Physicians are hungry for clinical conversations with sales
representatives that are based on clinical studies and
evidence-based medicine (EBM).

29. Specialists
Physician respondents have a clear preference for specialty
sales representatives.

30. ACC Conducted Its Own Primary Research
Methodology:
• Conducted online survey with CardioSurve panelists
• Survey live February 9 – 28, 2011
• 160 cardiologists participated in the survey

31. 31
Satisfaction with Salesforce Knowledge
15% 46% 34% 1%3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total
Don't know Not at all satisfied 2 3 4 Extremely satisfied
• Approximately, two out of three (64%) cardiologists have indicated that sales representatives
they engage with have definite room for improvement in terms of their scientific and clinical
knowledge.

32. 32
Desired Knowledge
4%
3%
6%
27%
41%
53%
66%
68%
70%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
Not applicable
None
Other
Knowledge of the different practitioner roles in the
treatment of cardiovascular disease
Knowledge of cardiology practice needs
Cardiovascular disease state knowledge
An understanding of the goals of patient treatment
Knowledge of scientific guidelines
Awareness of clinical studies in cardiology
• It is most important for sales reps to be aware of clinical studies, scientific guidelines and the
goals of patient treatment.
Q: Which of the following qualities in terms of scientific and clinical
knowledge would be most important for an industry sales representative to
have when meeting with you? Please select all that apply. (n=160)

33. 33
Likelihood to Meet ACC Certified Sales Rep
21% 48% 29%1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Total
Don't know Much less likely Somewhat less likely
Neither more nor less likely Somewhat more likely Much more likely
The ACC is developing an "ACC certified" training program focused on cardiology scientific and clinical knowledge for industry sales and marketing individuals. A sales
representative who successfully completes the program will receive a certification from the ACC that attests to their scientific and clinical knowledge of cardiology based
on an ACC-established educational standard.
77% more likely
Q: Generally speaking, would you be more or less likely to meet with an
industry sales representative who has been ACC-certified through this
program? (n=151)
• Clearly cardiologists favor an “ACC certified” training program and three-quarters (77%) say
that they are more likely to meet with a certified industry sales representative.

34. What are medical societies doing to
assist industry partners?
• Building on their core competence and experience of
offering high quality clinical education
• Creating training to compliment company’s existing
training programs
• Working with leading companies to identify gaps in
clinical knowledge

35. What are medical societies doing to assist
industry partners and their members?
• Setting the standard for the level of knowledge
expected
• Creating unbiased clinical programs taught by
board certified physicians
• Identifying standards by specialty

36. What are medical societies doing to assist
industry partners and their members?
• Monitoring the content
• Providing access to copyrighted enduring
materials that facilitate the teaching moment
• Evaluating knowledge to assure the standard
has been met

37. Standardizing Programs Across
Specialties

38. Program structure
• The basic program and each specialty module is
broken down into the following parts:
– Pre study work
– 2-day or 2.5-day case-based classroom
teaching component including interactive
activities
– Nightly homework
– Exam
– Post-program continued access to cutting
edge information through society meetings,
periodicals and web access

39. Graduate Status
• Oversight by National Society
• Identified as meeting the standard by practicing
physican members by the “graduate”
designation
• Designated in specific disease states

40. Content Development
• Oversight by National Society
• Work Group of leading physicians from across
the US
• Experts in specific disease states

41. Faculty
• KOL’s
• Must be associated with a leading medical
school or teaching hospital
• Physicans who actually practice medicine

42. Disease State
• Focus on treatment challenges of patient-related issues
from the physician’s point of view
• Understanding:
– Diagnosis
• Tools such as guidelines, algorithm, appropriate use
criteria
– Treatment
• Decision making processes
– Management
• Comorbidities

43. 43
Class of
Recommendation
Recommendation
Level of Evidence
Discussion/Supporting
Information
Reading ACCF/AHA Guidelines

44. Case-Based
• Real life situations- participants diagnose and
treat conditions
• Breakouts
• Interactive teamwork sessions

45. Left Atrial Appendage(LAA) via TEE (Video)

46. Experiences
• Simulations
• Taped Cases
• Actual Patient Symptoms

47. Auscultation: Heart Sounds in the Initial
Assessment
Barrett MJ. Heart Songs 3.
http://www.cardiosource.org/Certified-Education/eLearning-and-Products/Heart-Songs-3.aspx. Updated
2011. Accessed June 27, 2011.

48. Attributes of an ideal disease-state
training program
For the learner:
– Curriculum is rigorous
– Information is relevant to their needs
– Provides dialogue with practicing physicians
– Improves relationships with customers
– Program delivers additional benefits upon graduation

49. Attributes of an ideal disease-state
training program
For the pharmaceutical, biotech, device
partner:
– Sales team can improve credibility with their audience
– Program can be adjusted for specific needs
– Information is relevant and up-to-date
– Travel time/cost is minimized
– Delivered by a not-for-profit Professional Medical
Society

50. Attributes of an ideal disease-state
training program
For the practicing physician:
– A sales representative that:
• Understands the disease state
• Focuses on patient needs
• Can talk about individual cases and issues
• Has been trained by a specialty society