Wednesday, March 31, 2010

Sales Credentialing, Just Another Brick in the Wall.

"We don't need no education, we don't need no thought control, no dark sarcasm in the classroom, teachers leave them kids alone, Hey Joint Commission, leave them kids alone."

In 2009, TSB wrote an article regarding hospitals charging salespeople for credentialing in order to gain access to the operating room. Yet, there has been a recent uproar within the industry over sales rep credentialing, meaning, salespeople must be trained and certified in understanding operating room and HIPAA protocol. This includes standards in how to behave in the O.R., being inoculated for bloodborne pathogens, respecting patient privacy, understanding aseptic technique, in addition to being knowledgeable with regards to the instruments and implants that the surgeon is using. Interestingly, there seems to be the illusion in the industry that sales people in general provide education, service and collaboration on all levels. It may be argued that the people representing the spine cartel are more apt to be educated and trained on standards when comparing them to some of the independent distributors that work on a daily basis in the operating room.

Many years ago, the salesperson played an integral role interacting with the surgeon, especially, when it came to developing new ideas into functional products or emerging technologies. Usually, the salesperson was the conduit performing due diligence before an engineering team was brought in. As the industry became saturated with commodity products, the entire strategic objective of early growth stage companies was to generate quick revenue at whatever expense there was associated with a new distributor. So who is to blame for all these ridiculous mandates? The government? The facility? The Joint Commission? The AORN? The early growth stage companies that have acted irresponsibly, placing no value on training and focusing only on revenue (TSB is excluding companies with so called emerging technologies)? Somewhere along the way we have lost all sense and sensibility. If the company you represent is required to have product liability insurance, and you are trained by the company, why should a rep be required to acquire their own insurance? Because some lawyer said so?

Some surgeons have argued that they have a sense of security when a company representative is available in the O.R..... Yet, TSB must ask the question, why would anyone want a surgeon operating on them if they did not know how to use the tools of their trade? Would Slash have been the lead guitarist for Guns N' Roses if he wasn't a virtuoso? Maybe the reason sales people need training, and surgeons need a pacifier, is because no one takes the time to get to know the nuances of a system. Could it be that many believe that a screw is a screw, and, a plate is a plate? Regardless, if there are over 500 pedicle screws, each system has its own footprint. Would you get into a 777 and take a transpacific flight if the pilot was not capable of navigating the plane without a flight instructor?

Since when did we make selling and servicing so complex? If you have common sense, you can be a valuable asset, if you don't, there's no hope. Selling is an art. Do your due diligence. Understand hospital protocol, and get to know all the key players. If you have no business in the operating room, don't be hanging around, especially when the day is starting and patients are being prepped in the pre-op area. If it is mandatory to sign in, sign in. Be respectful of the rules until you are given an invitation to the party. Your role is not only to show up for the case and make money, your job is to educate the staff on your instruments and implants. The smarter they are, the less they will depend on you, providing you with the time to make new sales calls. Don't overlook the people in central services because they are just as curious as others in understanding your instruments and implants. A little bit of attention can go a long way, especially if you are bouncing sets around from one account to another. If you are in the operating room, get to know everyone and identify the role they play during the procedure. This includes understanding the flow of the procedure and the surgeon's tendencies. The surgeon is the conductor and you are a piece to the orchestra. Lastly, the most important part of your job is to get to know all the people that make key financial decisions that could potentially effect your business or opportunities within that account. If you are going to consider yourself a businessman, then start acting like one, it just may save your a**. TSB wants to know what our readers think?

All in all it's just another brick in the wall..............


  1. I don't think it's unreasonable for a hospital to be asking reps that will have access to patient information, be in close approximately to the sterile field, and working within the OR to have to prove that they've gone through the necessary training to be competent in those situations. I've been a rep for almost ten years and have way too many times seen inexperienced reps contaminate the field, sift through patient data they don't need, and just flat out act stupid in the OR.

    Spine Cartel or not if you're sending a representative into the OR you had better trained them on these issues. This isn't a normal business...we're dealing with people's lives not selling copy machines to offices.

  2. It's interesting that the majority of device reps constantly mock pharma reps for being glorified UPS delivery people and not "real salespeople", but the one thing that big pharma does is train and train and train. The fact that a good portion of device companies do not train on simple OR protocol and other hospital aspects is a joke. The simple fact is that device companies and the distributors who carry their lines realize that a rep out of the field at a training is not making $$$ and not selling or covering a case. Thus, training is at a bare minimum.

  3. Most of the griping that I have seen on the credentialing issue stems from the new credentialing companies that hospitals are using. I have three different credentialing companies in my territory with combined charges of over 1500.00 per year. Some of the hospitals I only visit a few times a year but still have to pay 250.00 just to gain entry.

  4. I do not know if I am more pi$$ed off about having to pay the fees or not for not coming up with the idea first!

  5. How ridiculous have we become? Years ago sales people were viewed as a true asset in the OR. Now we are perceived as the enemy. In addition, if the surgeon find us as value added, why does anyone want to tax us for providing a service. I understand that we are charging for the product, but the hospital is also marking up the charge to the carrier. How ridiculous has it become that some surgeons are actually charging reps for their time to demo a product. Half of the time when you do a luncheon, it's for the staff. The surgeon could care less, especially if its another me too product.
    Just leave it to a bunch of greedy bastards. Somewhere along the way the lines were drawn, today, rather than feeling like part of the team, many of us feel like intruders. Something has to change and please no pontification on HIPAA and OR Protocol because most of us are respectful of the patient and their privacy.

  6. I don't understand how some are $85 a year for admission to 10 hospitals and other are $250 for one? What exactly am I getting for my $250? Have you actually ever tried to get these people on the phone? It is impossible. Does anyone know if the hospital is profiting of of these systems?

  7. Disclosure: I'm an MD and not a rep. Last year I was asked to go though the credentialing process to see what it is like. Conclusion: a farce. Anybody with some hands-on experience in and around the OR can answer most of the questions, and those you cannot are the ones dealing with some arcane rules and regulations. The most revealing part was that if you get a question wrong, you just go back to the start, do it again and now choose 'b' instead of 'a', and 'c' the next time, if 'b' wasn't the right answer either. So in essence anyone can pass the test as long as you have the patience to go back and forth as often as you have a wrong answer. All it does is create a false sense of security for the hospital administrators who now can hide behind the 'but he was credentialed!' argument, and a lot of money for the smart alecks who started the credentialing companies. It is part of the ever more pervasive trend that nobody wants to take responsibility for anything.

  8. It exists because it's free for the hospital and it checks some boxes for JCAHO. Pain in the rear, but only because there are so many different systems for different hospitals. I already have all the documents (supplied by my company, after proper training, or given to me by my doctor), just have to upload them. And of course pay the $$$

  9. As a seasoned medical device sales person/manager (20+ years) both corporate and distributor owner, I made damn sure our reps knew how to conduct themselves in the OR. I've made it a policy that every new sales associate understands specific OR protocol and their instrumentation prior to flying solo. The OR is NOT a training ground for reps.
    That said, I do have a problem with these Vendormate, RepTrax companies posing as benefits to the sales associate. Their inoculation demands are far reaching. Granted with the recent proliferation of TB in the US, reps and ALL of the OR staff should be screened. However, I would challenge every hospital to question their staff as to their compliance with all the inoculation demands placed on the rep. Then add the hypocrisy of charging us a hospital access fee. What percentage of the fees are paid to the hospital?
    TSB states "why would anyone want a surgeon operating on them if they did not know how to use the tools of their trade?" I've worked with some of the best most talented spine surgeons in the country. They want the rep in the room to assist the scrub tech in order to expedite the case. I'm experienced but not qualified to assist the spine surgeon.
    The point is that the sales associate is necessary to the expediency of the case. We do not want to be part of the hospital's revenue stream.

  10. As an industry executive that has worked for legacy and early growth stage companies I find a difference between how each business model is structured. Historically, legacy companies have placed a premium on sales education and training, regardless, if the company had an independent or direct distribution model. Many of these fly by night operations rarely implement a formal training program, and if so, it is usually done half-assed. The reason, some of the people running these companies never had any real sales experience within the industry. Independent Distributors would request a letter signed by yours truly stating that they were trained by the company on the product. I must admit, as embarrassed as I am, that I would sign off on a letter stating that they were formally trained. Why? Because the people running these companies are so desperate for revenue, they don't see the value in implementing these programs. It comes down to time and cost. These companies nickel and dime the programs that lend credibility to their organizations.

    Then just look at the people selling your products. The day of the sales professional is extinct, we live in a world of brokers. Everyone is looking for the deal. So maybe the hospitals do have a point in requesting credentialing, the only problem that I have is that the onus of paying for it should be absorbed by the company and not by the rep.

  11. 2:20, Thank you for your honesty.

  12. As an experienced rep myself, we used to have hospitals require us to take these same tests, for free. So, how much is the hospital getting now?? I will guarantee you the hospitals are making money off of this.

  13. Reps are just there now to protect their interests and because the surgeon feels they should be if he is putting money into their pocket. That is the plain and simple truth.

  14. Right up front I want to disclose that I head up a sales training firm that specializes in working with med device, specialty pharma and biotech companies.

    Working in the life science industries for the last 23 years, I have seen a wide variance in training. In general, pharma places a higher premium on education and on-going development than medical device. During my years in medical-device, primarily in spine, I have observed that the many device companies show little interest in training their sales force to a high degree of competency.

    I’ve witnessed companies, including start-ups with emerging technologies, reap 10X ROI from their investment in training (Kyphon, Intuitive Surgical and NuVasive). Unfortunately, I’ve also observed that as companies increase their dependence on a distributor-based sales force, there is a corresponding decrease in training of salespeople on even the basics. I can only shake my head as I watch well-financed companies launch new products into half-billion dollar plus markets and believe they can adequately train a distributor sales representative in 4 or 8 hours what it used to take OEMs 1 to 2 weeks to accomplish. One company wound up re-launching, and in the process re-training their sales force, 12 months after initial launch because they weren’t seeing adequate pull-through out in the field. I can only imagine the opportunity cost.

    We have all seen the varied results delivered by the practice of on the job training in the field as well as in the OR. The effect of this practice has led to a steady decline in the professionalism of device sales people and the respect with which our industry is held.

  15. I would have to agree 100% with James. James what is your website and contact info. Thanks.

  16. I have seen it done well and poorly. Doing it well is expensive, doing it poorly is more expensive.

    My perspective is leading me to believe that most "start-ups" hire reps based on their past and do not have resources to train a new rep.

    Companies like that are trying to use the hiring process to determine whether or not a sales rep has what they need - they do not intend to add to that person's knowledge base.

    Successful companies launch new products with a combination of people working together with different levels of knowledge quite effectively; a "product specialist" accompanies the more well connected sales manager to "close" the sale with an important customer that the sales manager is able to get a meeting with. The effective sales manager then becomes a wheel that turns and puts the customers in contact with the most expert employees that the company has for a given question/issue. This should extend all the way into reimbursement support, in-service training for the OR staff as well as case-coverage by people who are qualified to train a surgeon on a cadaver.

    There is more than one way to do this.

    Things are getting counterproductive in some areas: I know of a case where the American company wanted access to additional data that had been collected at their study centers in Europe, data that FDA wanted them to provide as a next step in the US. They can't get it.

    In other cases Reps are now being excluded from the OR altogether in some ORs in the UK.

    This is not good for anyone, is it?

  17. Per your request:

  18. I need more cowbells... I mean 'spineblogger'.

    Where are ya man- it's been 8 days!

  19. it seems that vendormate can't determine how exactly to do this process. Criteria changes with each CS rep you speak....and the CS call number is endless holds. You can leave a call back number but they won't call back. It has taken hours of staff and supervisor time to comply and later we are told it was unnecessary they really didn't need it after all. And, get this....the company doesn't even have a way to do their own digital photos. issue? We emailed the reguired digital photo.Vendormate is a good idea but poorly executed.