Study: Inside the Relationships between Surgeons and Medical Device Representatives
Many device reps will agree that one of the best things about their jobs are the relationships they build with their customers. Device reps spend hours in surgery with surgeons and can become an integral part of the team.
A new study looked to see how deep those relationships go.
PLoS ONE published a study to better understand this relationship and the "ethical questions about the reliance of surgeons on device reps and device companies for education and surgical assistance and practical concerns regarding existing levels of competence among OR personnel."
We've attached the study to this post so have a read when you are bored in a case or need a break from doing your weekly report. In the meantime, we've extrapolated some of the high points from the study.
The Role of the Device Rep
The study acknowledges reps perform a myriad of tasks and many are expected to be available seven days a week. Whether it is right or not, many surgeries depend on reps bringing products to the cases, and sometimes, additional products that can help surgeons if an unexpected issue arises during the case.
“This is one of the reasons why, currently, you need a rep in the operating room. . . Who’s to say who else will know when we get to surgery in the morning whether you're opening the right implants, or whether you're opening the right trays?. . It's useful to have somebody else in the room whose specific job is to have that information on hand always.” [DR1]
“When the doctor comes into the room, I can say, ‘We're ready to go with the instrumentation.’ That's one less thing he has to think about or worry about. And he has to be able to trust that I can say that with confidence.” [DR3]
“Nowadays, a device rep is in the OR for every case that you’re using his or her stuff.” [Ortho]
And If Something Unexpected Goes Wrong
“I have seen a doctor fracture a trochanter while putting in a hip replacement and look up at me and say, "Hey, do you happen to have your cables?" He had not ordered cables. . . But we made it standard practice to always bring it with us. So this is one of those situations where I get to be the hero. He's never fractured a femur before. . . . So, I run out and I get the cables, which are wrapped and sterile and outside the room and I hand it to the circulating nurse, who will open the tray and put it on the table, and the surgeon says, ‘Okay, walk me through this, I don't know how to do this.’
I'm the person in the room with the most knowledge about that device at this point. I know how to thread the wire through the jig. I know how it goes into the plate. I know how much you have to tighten it. . .”[DR1]
Know Where We Stand
This should be obvious and most reps do an excellent job understanding their role in surgery.
“They never say anything like, ‘this is where screw A is better than screw B.’ They know better than that. But if we ask them, ‘do you think this size will fit better than this?' They’ll say, ‘well, I’ve seen a lot of surgeons using this one and it seems to be working for them.’” [ENT]
And some don't:
“Some reps are following surgeons around at the hospital, sitting in the doctors’ lounge, hanging out. . . . They try to pester us: ‘Hey, what’s going on?’” [ENT]
“. . .there was actually this one pushy rep who came to our clinic and wanted us to use a new device for sinus surgery, a balloon. He somehow got the names of patients. . .He emailed me, ‘Can I come in for these cases?’. . .We refused to use his product.” [ENT]
No, You Can't Buy Me With A Turkey Sandwich
“The problem currently in my view is that we're throwing the baby out with the bath water. .. . This department once a week would have a lunch,. . .vendor sponsored. . .sandwiches for about 20 people. . . . Personally, for myself and for our residents, I found that to be an educational opportunity.
We got the chance to look at new products, to hold them and to hear the spiel. None of us is so naive as to think that these are not salesmen and they are not selling stuff . . .and if people truly believe that we can be bought with a turkey sandwich, then I think the absurdity of that speaks for itself. . . I think in today's day and age. . .we have gone so far to the opposite extreme that it makes it really difficult to even see what's new.”[RPD]
510K and Other Financial Interests
The study acknowledged that reps and companies have a clear financial interest in hiring sales reps and having them sell the most expensive products, which may not necessarily be the best choice for individual patients.
There was also concern about manufacturers making minor modifications to products, quickly getting them through the FDA process and selling them for higher costs.
“Some companies are sneaky. If a device works fine, they do a little tweak and they’ll charge more for the newer device, but then they’ll discontinue the one that worked just fine and then you’re forced to buy the new one.” [ENT]
On Perceived financial interest:
“A major company holds a conference once or twice a year; they pay the speakers $5,000,and they’re very good; they’ll provide the means necessary for the residents to travel. . . They actually invest a lot of money on education,. . .but it’s obviously one product. So if you’re educated by them, you get biased toward using their products.”[ENT]
Are Device Reps Here to Stay?
While many companies are introducing rep-less models like Smith & Nephew's Syncera, this study has shown how integral reps are to the success of a case. Whether that is right or wrong, this study shows a clear need for reps to be in cases with surgeons and staff.
“Positively, without a doubt. I think it would be a mistake to go into a surgery without the representative being there.” [DR3]
Is the need for reps because surgeons and staff have become lazy?
“I think most of the time we shouldn’t need them. The problem is that. . .after a while, that becomes the norm so nobody makes an effort to learn things properly . . .it doesn’t need to be like that. . . Very good nurses and very good techs could troubleshoot problems. So in a way, the hospital might be trying not to train their own people just because they have access to device reps. . ..In my opinion, some of our people are just not very good because of this.” [ENT]
This study opened the discussion on the relationship between surgeons and medical device representatives. While there is no doubt surgeons are in charge, the study concludes that reps have worked hard to make themselves indispensable in order to maintain influence.
As many companies move towards value-based heatlhcare initiatives, it will be interesting to see how the device rep's role changes in the future.
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