Healthcare’s Unsung Hero - The Medtech Sales Rep

A recent data search showed that the average medical technology sales rep earned twice as much as the average pharmaceutical rep. At first, this struck me as odd, but then I thought about how the medtech reps often contribute a significant amount of ‘hands on’ support. A great rep can both explain the technology and provide operational expertise.

When I ask physicians about the value of medtech sales reps, they initially tend to take them for granted. A typical initial response is “I don’t need them, but the staff does.” But further investigation shows that this is not an accurate assessment of the situation. After peeling back the onion a bit, it is clear these reps provide  at least three significant benefits that can be important to the physician.

The first is organizing the logistics around the procedure. The rep frequently brings necessary resources, which can include boxes of instrument  trays and specialized capital equipment. One physician told me how an orthopedic sales team transported vital instruments from Long Island to upstate New York on four hours’ notice through a ‘bucket brigade’ of drivers relaying them from car to car along the way.

The second added value is in patient services. Sales reps in the diabetes world frequently help patients master insulin pumps, implantable glucose sensors and phone-based management applications. In cardiology the reps have historically helped with programming the pacemakers and defibrillators, which was standard practice in the 1990’s. In orthopedic bracing the reps often fit the devices on the patient.

The third and most striking area is in knowledge transfer. The rep sees thousands of cases and can have a wealth of  knowledge on the use of their company’s products. They use this  vicarious experience to transmit best practices. They may artfully use phrases such as,  “I saw Dr. Reynolds make this closure step a bit simpler by using the curved instrument” or “The plastics guys use the closure glue on the epidermal layer to reduce the scarring.”  Back in the 1980’s when US Surgical introduced the surgical stapler, reps were often taking a hands-on role in the operating room teaching the physicians how to use this groundbreaking technology.

Today in atrial closure procedures the rep has typically seen hundreds more procedures than the interventional cardiologist. Thus, a procedure usually begins with a consultation between the physician and the rep, with the rep helping at critical junctures such as determining when the device is in proper position for deployment.

The most eye-opening insights come from physicians when asked the question, “Did a medtech sales rep ever save you in a case?” After a bit of soul-searching the answer usually is “Yes,” followed by an interesting story. As one surgeon described it “There are times when it is just me alone and I must figure it out. If I am stuck, which has happened, the rep who helps me get unstuck has earned access to me forever.” At these critical moments, the sales rep’s knowledge can be priceless.

One physician told an amazing story about her residency. During an extremely late case, she had been  struggling for hours to close a microvascular free flap and it was not going well. At 2:30 AM her attending surgeon turned up and helped her close. It was not until years later that she learned that the sales rep had realized her predicament and taken it upon himself to step out and call the attending surgeon at home, waking him up and bringing him in. The former resident commented that “The rep made a gutsy move, and if I had known at the time, I might have been quite annoyed. But he really made the best decision, for the patient and me.”

A hand surgeon told me about his experience moving outside his area of expertise. “While on call, a trauma patient needed a femoral nail as part of setting a fracture. This procedure was part of my training, but that was decades ago, and a broken femur should be set immediately as a procedural delay hurts the outcomes. The patient could not wait until Monday morning. The sales rep was helpful in getting the angulation on the set screw correct as I revisited my early days in general orthopedics.”

An artificial hip surgeon told me of how he had a rasp stuck in the femur and he could not get it loose. He said “I was flipping out as I did not know what to do. But then the rep suggested I put a vice grip on it and then bang on the vice grip with a hammer. And it worked!”

One of my favorite stories from a sales rep was when he was helping a resident screw a plate in place. The screw simply was not going in and the resident was getting frustrated. The rep quietly told the resident “Turn the screwdriver the other way.”

One of the best ways for a sales rep to bond with a physician is to aid in mastering a new procedure that expands the physician’s practice and income. In the interventional cardiology field Guidant sales reps helped physicians learn to open coronary arteries with balloon catheters. That procedure lifted cardiologists from glorified internists into hospital rock stars. And the physicians remember how that training guidance changed their lives (and economic status!) They can recall the name of the rep that helped them on their first cases decades later.

Value-added services can allow a rep to build a terrific bond with her physician customers. That bond with the sales rep can transcend the company she works for. A pacemaker rep can bring two-thirds of her business with her when changing companies. And that makes her a valuable employee who is well compensated for building a loyal customer base.

Depending on the product, the sales rep job can be quite demanding as a physical presence is often critical. The morning OR start times can be early with the day running long. Trauma device sales may involve weekend or late-night procedures.

When we think of the team that provides hospital care, it goes beyond the physician and hospital staff to include that anonymous unsung hero behind the curtain- the medtech sales rep. He may not be a hospital employee, but he is pivotal to many care processes running smoothly.