The first half of 2010 has been brutal for pharmaceutical sales representatives. There are hordes of former pharma sales representatives on the street, seeking new job opportunities. Many try to seek higher ground in the medical device industry, often with limited success.

There is a persistent stigma that pharmaceutical sales representatives cannot succeed as medical device reps. Some of the perceptions that contribute to this are:

1. Pharmaceutical reps “don’t really sell”. They market, message, cater and get signatures, but don’t really close.

2. Many work in pods, rather than having territories of their own. Although they say they want to be responsible for their own business, they are not prepared for the reality.

3. Their numbers and awards are inflated. As a result, their sense of their own selling abilities is too.

4. They are used to being pampered with high base salaries and generous coverage of business expenses. Although they say they want to be more entrepreneurial and accountable, they find it much harder than expected and lack long-term commitment.

Some of the sharpest, ambitious pharmaceutical reps can make the transition. These reps often have less than 4 years in pharma sales and have blown out their numbers.

It is important to understand that although device and pharma sales are both medical, when transitioning, a pharma rep may still have to pay their dues as an associate before rising into a full sales role. Sometimes this can be tough to swallow for tenured reps.

I have observed that more former pharma reps transition into the relationship-heavy specialties of total joints, trauma and spine. My guess is that there are more similarities in the call cycle, and reps more often use clinical data in order to persuade the surgeon to switch. In specialties or with products that require more hunting over a larger number of accounts or managing a more complex capital sales cycle, the resistance to pharmaceutical reps is even greater.

The best advice I can offer for any pharmaceutical rep trying to break into the device industry is not to assume your medical sales background has prepared you at all. Many pharma reps are very good with territory analysis and management, for example, but all that careful routing goes right out the window when a surgeon calls with an urgent need.

There may be a few things that will cross-over but it is best to assume nothing. To cross-over, you will have to go the extra mile: be better prepared, be more knowledgeable, do more homework, have better results and references than everyone you are interviewing against. Then again, that is just a good game plan for anyone who wants to break into medical device sales.

My windows are open on this bright, cool morning. Outside, the breeze rustles the leaves of the aspens in my yard.

Eight weeks ago today, I fractured my tibia skiing. As I sit in my kitchen writing, my right leg is stretched out to the side, foot resting on another chair.  I have a cold pack strapped to my knee. Someday soon, I hope to achieve a full range of motion again. This week, I will try to walk again.

My injury, surgery and recovery have given me an opportunity to cross over to the other side of the medical device industry, as a patient. The care I have received throughout this time, from nurses, my surgeon, the anesthesiologist, the physician assistant at the emergency room and my physical therapist, has been nothing short of terrific. I have tremendous respect for their knowledge, skill and dedication to helping me recover.

I have been as diligent as possible about following their advice. I have learned a lot about my body’s ability to heal and need for movement. My desire to be healthy and active again is insatiable.

During this challenging experience, I’ve encountered first hand products from many companies in the medical device industry. When I saw my surgeon for my 6 week check-up, he looked at me in surprise when I asked him if the buttress plate screwed to my tibia was from Synthes. He said it was. I imagine, and frankly hope, there was a company representative in the operating room when I had my surgery, who was well-trained and well-prepared with back-ups and alternatives, should they have been needed. This unknown person has also impacted the quality of care I’ve received.

The morning of my surgery, my surgeon stopped by to see me in pre-op. He was fresh from a good night’s sleep and clearly excited about operating. He had been planning and preparing for the different possibilities he might encounter. After all, surgery is what he had trained and worked so hard to do, through many years of medical school, residency and a fellowship. Medical device sales representatives, as well as those aspiring to the industry, often express a similar level of excitement about surgery.

I can appreciate enthusiasm for surgery, and I understand how such passion can contribute to a better surgical outcome, but these emotions are in stark contrast to my feelings at that time as a patient. Pain, fear, even despair would be the best words to describe how I felt in those first days surrounding my accident and surgery.

During this time, and since then, there have been moments of compassion that have been as important to me as any medical intervention. In particular, I think back to the physician assistant in the emergency room, who rubbed my arm and reassured me after I began shaking when the shock and reality of surgery and a long recovery hit home.

Sales people are measured by their ability to grow business, and to achieve and exceed a quota. Somewhere in this equation for success, there must be room for compassion. I think the best companies and sales representatives in the industry find a way to balance these two contrasting priorities. They live up to the full responsibility of their roles when they are thoroughly trained, current on the latest techniques and products, provide excellent service and support to their customers, and are well-prepared for every surgery. The final element of exercising compassion as a medical device sales representative is never loosing sight of the patient’s well-being. I hope that the sales representative who may have covered my surgery had this in mind.

One of the sales managers  I have worked closely with over the last few years refers to this as “doing right by the customer”, and in turn, the patient. Although it is not a formal metric, at the end of the day it is how he judges whether a representative is successful or not. If a sales representative “does right”, growth will follow. A lot of business is won and lost based on the level of commitment sales representatives demonstrate toward their customers.

I am suggesting that compassion toward the patient should be one of the major reference points a sales person uses to guide their decision making and their behavior. Some sales people I have spoken to in the industry use the following question to remind themselves of this:

“What if the patient on the table was my parent, spouse or child?”

I think this question should be part of the criteria for every product developed, marketed and sold in the industry.

What would happen if companies did find a way to measure the compassion their sales representatives demonstrated toward their customers and their customers’ patients, in addition to measuring growth in revenue? What you measure, you can improve. What would be the associated impact on the company’s bottom line? I am betting they would find there is as strong a correlation between compassion and results as any other metric they use. Although it may be hard to measure, compassion is an imperative for long-term success in medical device sales.

This post is otherwise known as… “How to Stay Out of Trouble in the Operating Room.”

Joseph Lister, a British surgeon, established the founding principles of aseptic technique in the Lancet in 1867. Before then, surgeons did not wash their hands before operating or disinfect their surgical instruments. (Shudder.) In case you’ve ever sat up late at night pondering the origins of the word “Listerine,” you will be ecstatic to finally know it is named after this important surgeon.

Fast forward to today. Surgeons now scrupulously defend against infections by strict adherence to modern aseptic technique. Although we know much more about how to prevent infections, the battle against microbes in on-going. The Centers for Disease Control estimates that hospital acquired infections occur in about 1% of the 27 million surgical procedures performed each year. Annually, about 8,000 patient deaths result from such surgical site infections.

If you become a sales representative in the operating room, you will have to undergoing training in O.R. protocol, so that you will not create havoc in the operating room by  contaminating the sterile field.

Here are a few basics:

1) The sterile field is the designated area which is “free of bugs that can infect people“.

2) The sterile field can include can include surfaces, instruments, even people. Once a surgeon, tech or nurse is “scrubbed in” (hands washed, adorned in sterile garb), then he or she is part of the sterile field. This means if you touch them, you compromise sterility.

3) The sterile field has a vertical dimension that is important to be aware of, as is illustrated so nicely in this picture. This means the “air space” above the sterile areas should not be violated. Doing so, by reaching over a tray of sterile instruments for example, could ignite World War III- or at a minimum make everyone in the operating room very grumpy with you.

One thing should be abundantly clear by now… contaminating the sterile field is a sure way to get on the wrong side of surgeons and surgical staff.

Some advice for staying out of trouble:

1) In the operating room, if it is blue (or maybe minty green) stay the heck away from it, by a good 12 inches or more. Absolutely do not touch it. It would be a good idea not to turn your back on it either.

2) If you think the sterile field has been compromised, tell the circulator immediately.

Hopefully, reading this will help you stay out of trouble, but the responsibility is really all yours to ensure you conform to proper O.R. Protocol. It is essential for the safety of the patient. To learn more, check out these additional resources:

According to the FDA, a medical device is “an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:

• recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them,
• intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or
• intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of it’s primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.” http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/ClassifyYourDevice/ucm051512.htm

They make is sound rather complicated, but basically it is anything that is not a drug that is used to treat, diagnose or affect the human body. The gamut includes everything from tongue depressors, to MRI machines, to hip implants. Medical devices are separated into 3 categories or classes by the FDA: “Class I includes devices with the lowest risk and Class III includes those with the greatest risk.”

Why does this matter if you are a medical device sales rep or marketer?

You could say that the classes in some way correlate to the level of product knowledge and skill required by the sales representative or marketer, as well as the level of responsibility and commitment required. Class III medical devices, subject to the most stringent review and controls, are designated as such because the failure of these products could seriously injure a patient or perhaps even lead to their death. Surgical implants of all varieties fall into this category. Whenever there is an incident of injury or, heaven forbid, death attributable to a medical device, a formal report called an MDR must be completed and submitted to the FDA. Of course, the regulatory system has numerous safeguards intended to prevent unsafe products from ever being sold. Still, even with safe products, things can go wrong.

It is worth stopping to think about a moment, isn’t it?

It really takes the idea of a “consultative approach” to a whole new level, doesn’t it?

Being a sales representative in the O.R. is exciting and rewarding, but it also comes with tremendous responsibility, to the patient, the surgeons and their staff. To recommend the right product for the particular need. To always be more than prepared. To uphold the highest ethical standards.

If you decide to pursue medical device sales or marketing, especially if you are dealing with Class III devices, be sure to keep this in perspective. It is not like selling any other product. Have respect for the learning curve. There is a lot to learn when you first get into the industry in order to be an effective representative, and more you must continue to learn to keep your knowledge current and skills sharp as you progress in your career.

Back in February, I wrote about how my trip to the hospital and subsequent recovery had given me great appreciation for the great work healthcare professionals do.

Well, I’ve had another opportunity to do so again, this time in a way even more closely connected to the world of medical devices, specifically orthopedics.

About 2 weeks ago, I had a little skiing accident. Or that is what I thought it was, and everyone else did to. Apparently, I was pretty stoic when I should have been hysterical. The ski patrol said, “Eh, it’s probably a bad bump, but you should have a few pictures taken just in case.” They thought my bulging bursa was pretty cool. Maybe the fact that I could not bear any weight on my right leg should have been a clue for us all.

I was really really hoping it was nothing more than a bump, but the xrays at the urgent care proved otherwise. And back to the local ER I went. On the way, I called Linvatec’s distributor for Colorado. “Who are the good orthopedic surgeons in town?” I was really glad I had someone I could call to find out.

Fortunately, one of the surgeons he mentioned was on call. There was some debate about whether I should go into surgery that night. I had a fantastic PA and the same nurse I’d had before when I had visited for pneumonia. I asked about their frequent flyers club- I think I am eligible. In the end, I was sent home with some pain meds and plans for surgery early the following week.

I have a tibial plateau fracture. When I wasn’t covering my eyes, I watched with the foggy images of my  bones on the computer screen in my surgeon’s office a few days later. He moved though the CT images, speculating on areas of concern. For all the amazing technology that is available, it is interesting that CT scans and xrays provide images that still leave so much to interpretation.

My PCL seemed to have pulled loose, but it was uncertain as to whether he would have to reattach it with a screw or if it could be recaptured by the hunk of bone it seemed to be attached to. The condition of my meniscus and other ligaments seemed unknown.

The existence of these uncertainties intrigued me. The mystery of it. One that could not be solved without cutting into my leg and peering inside. I think it is part of what makes orthopedic surgery so fascinating and exciting.

One thing reps in the industry say is that you have to be “on your game” in the operating room. Extra products and instruments, ready to support plans A, B and C, should the patient require it.

Surgery the next day was thankfully a blur. I now have a buttress plate with about 5 screws into my tibia. I was hoping at some point for a lucky break (probably a poor choice of words), for something to turn out better than expected rather than worse.

I got more than a few lucky breaks in the end, the first being a good surgeon. My PCL snugged back into place without a screw. My meniscus and ligaments are in reasonably good shape.

I have an insatiable desire to walk, even run, because I am feeling pretty darn good again, now 2 weeks post surgery. But I don’t dare, not yet. It would be against doctor’s orders. But I will again someday soon, and for that I am very, very grateful.

ConMed Linvatec has launched a new careers website. Sales positions are highlighted through a series of videos of sales representatives sharing their personal perspectives on working for the company.

Another great part of the website is the page on Community Action. There is a long tradition of the company and employees giving back to the community.

I realized today it has been about 3 years since I started this blog. My first post was in November 2006.

While I am not one of the prolific most bloggers, I try to make my posts useful and interesting. I hope that there has been some beneficial information shared here, for both those looking to break into medical device sales, as well as industry veterans. Thank you to those of you who have taken time to comment and contribute your perspectives.

Here are some of my favorite posts (if I may say so)…

For Neophytes:
1. How to Get Experience When You Don’t Have Any 3/17/08

2. Becoming A Sales Associate – Fast Track Opportunity for Growth 10/23/08

3. A Day in the Life of an Electrosurgery Rep 7/15/09

For Everyone:
1. Ten Truths from Rookie of the Year 4/26/07

2. Pocket Guide to the O.R. 3/12/08

3. 212 Club 8/08/08

The Interviews:
1. Sonny Crockett’s Great Year 12/14/07

2. Athletes in Medical Device Sales 5/30/07

3. The Rookie of the Year Interviews
NOM 3/13/08
2007 7/21/08
2008 7/17/09

If you have a favorite, or something you’d like me to consider writing about, let me know!

When I talk to candidates, one reason they often mention for wanting to be in medical device sales is the demographics of the aging baby boomers. The reasoning goes that because baby boomers are staying active longer, by jogging, playing sports etc, they are putting more wear-and-tear on their joints. Hence, increased demand for Sports Medicine repairs.

This is true, but there are several other factors driving demand for such products. Unfortunately, the so-called obesity epidemic also increases demand. Extra weight puts a lot of extra stress on joints.

Another contributor to increased demand is the intensity with which athletes engage in, specialize and train for sports from a younger and younger age. Thank you to the candidate who brought the following information and article to my attention:

While I was on my ride-along a few weeks ago, there were quite a few new terms I learned about electrosurgery. Here is an explanation of electrosurgery on Wikipedia. As noted here, “electrosurgery is usually used to refer to a quite different method than electrocautery”.

I myself have made the mistake of describing electrosurgery as “cauterizing”, but no more! Raquel said it is common for hospital staff to refer to electrosurgical units as the “cautery” or “bovie” unit. Since she was properly trained in the correct terms, when she refers to the “electrosurgical unit”, it sometimes results in looks of confusion from the staff.

Essentially, electrosurgery is the use of energy to cut (like a scalpel) and coagulate. Electrosurgery helps limit blood loss while making precise cuts, as described on the Wikipedia page. For this reason, electrosurgery has a very wide range of applications in many different specialties. On Conmed units, a higher “blend” means more coagulation.

Another new term I learned was thermal necrosis. Some tissue may become necrotic (dead) at the electrosurgical site, evidenced by black spots. Although the goal should be to minimize this as much as possible, Raquel said that she has spoken to some doctors that think the black spots are good because it tells them that “it’s done”. Woo.

Before Raquel espouses her product’s ability to reduce thermal necrosis compared to competitive products, she is sure to find out what matters to the doctor and what the doctor interprets as a good result. She also noted the importance of finding the right surgeon who cares about electrosurgery and will champion her product.

Today, I’ll have an opportunity to interview the latest Rookie of the Year. He is someone who from his first interview showed that he was “hungry”. It’s a quality that people talk a lot about, but what exactly does it mean? I hope that our conversation today will shed some light on it.

From my perspective, true hunger for success includes the willingness to take responsibility for preparing yourself for the next step in your career, not just asking someone to “give you a shot.”

(Read comments below for the interview… read from the bottom up)