Saturday, April 23, 2011

What's Going On

Over the last few months, the criticism of spine reps has intensified. Is the spine industry a mirror image of a larger epidemic effecting America? We have become our own worst enemy, a divided society, no less a divided industry. Us against them, rich against poor, business against government, the unregulated against regulation, red against blue, right against wrong. Whether our readers agree or not, there has been a blatant assault on the sales rep.  Some of it is justified. Some of it is not justified. Some of it attributed to good old A1, red, white and blue greed.  So in an effort to set the record straight for our readers, here are the facts.

Whether  management, surgeons, or hospital personnel believe it, your hard work is what makes this industry thrive.  You are the stimulus that pumps life into a company. Whether TSB has been in sales or in management, the bottom line is the infantry gets the job done.  A visit into the Korengal Valley would expose that there aren't too many generals waiting for a firefight. The publics perception is that you are all making $250K per year, drinking Bordeaux, smoking Cohiba's,  and investing in Broadway musicals,  and we all know whom we can thank for that.  People believe that most of you have banking hours, are overpaid, and are the primary reason for the escalating cost of delivering healthcare in the U.S.. Just because you did not go to medical school doesn't make you any less valuable in the food chain.  As baby boomers enter their golden years, they have been programmed demanding the fountain of youth.  They want bionic knees, hips, ankles, and spines, demanding a return to normalcy after all is said and done.  Insanity at its best.  We may be a civil society, but based on what is going on around us, not a very intelligent one.

Unlike salaried employees, sales reps are solely responsible for what they earn. Essentially, you are no different than a stock broker in that you eat what you kill.  You deal with a pernicious, apathetic, and selfish healthcare environment.  Did I miss any other adjectives? You are stonewalled by hospitals, operating rooms, nurses, doctors, and hospital administrators whom frown upon you as a necessary evil until they need something, and then they want you to drop everything you're doing to help them out, and you do it.   When did this assault begin, and whom do some of these people think they are in contributing to the escalating cost of healthcare (Do you hear me Dr. Steinmann)?  Hospitals complain about cost, yet continue to expand and build newer, bigger and better facilities.  There are new cardiac centers, children's centers, women health centers, cancer centers, and parking garages, yet no one seems to be questioning and demanding accountability on their part.  There is no excuse for the behavior that is exhibited by these people.  Unfortunately, courses in professional behavior is not taught in med school or grad school.  80% of your business comes from 20% of your accounts, because your days are spent brokering rather than selling.  Thank you corporate America and Dr. Famous for your contribution to our day. When you do have something innovative or clinically beneficial for the patient, you have to move mountains to motivate a surgeon to try it.  During the interim, the patient suffers.  On average you spend $100-$125 per week on gas (thank you speculators), in addition to tolls and parking (someone needs to pay for the construction) and you are obligated to buy a prospective customer lunch if you have any chance of getting their attention, whom no less has no problem telling you that there will be 10-15 employees attending. TSB usually tells the nurse that I will be glad to meet the surgeon one on one and buy him a sandwich. Some even have the audacity to tell you where they would like it catered from. (that's my favorite).  A shameless society.  Besides these expenses, hospitals want you to register with various vendor management services to protect the patient, a bogus rationalization.  What about your protection?  It's bad enough that hospitals are squeezing you for every penny on the dollar, but some want you to pay to play in their facility. Aren't these people embarrassed? And then you have to deal with management at your respective company.  So in an effort to set the record straight, here are the facts.

Management is in denial when it comes to market dynamics.  Some still believe the party is going on.  Publicly traded companies continue to push you to your limits by promising their Master, Wall Street, that they will continue to grow in spite of all the barriers that you face everyday in growing your business, no less the ones that you cannot control like insurances denying surgeries (can't wait for NuVasive's analyst call).  Attrition has become a norm in sales.  You're on the clock.  If you can't increase revenue in a short period of time, you're gone.  Just look at some of the companies out there.  Management is more concerned about share holders value than whether they have delivered the necessary tools so that you may be successful.  How many empty promises have been made to you?  How many product development timelines have been missed?  Yet, the game continues by increasing your quotas and demanding results.  Some companies can't even provide you with samples and marketing collaterals.   Your middle managers have grandiose expectations.  They accept whatever is spoon fed to them by the senior management team and never question the validity of any strategy let alone revenue expectations, because they cower for their jobs.  They're great at giving you a quota when they have no clue as to the demographics of your territory, or the obstacles that you are confronted with on a daily basis.  Product evaluation committees (what free market), preferred vendor lists (discrimination), vendor certifications (violation of your rights), surgeons protecting other companies turf and their own consulting agreements, if that isn't the decline of the empire, what is?  TSB wants to what's going on?  You know what Marvin Gaye once sang;

"Picket lines, and picket signs, don't punish me with your brutality, talk to me so we can see, what's going on, what's going on, what's going on,  we've got to find a way to bring some understanding today."

As a side bar to our discussion, TSB hopes our Jewish and Gentile brethren had and have a wonderful holiday season!  L'Chaim!


  1. Amen brother, but the battle must go on.

  2. All true, however there has been a decline in the pedigree of medical device sales representatives over the last decade fueling the animosity. With company after company popping up and needing to fill their sales force rosters, retreads, never-wasses, kid brothers and bonified criminals/hookers have seeped into what was once a very difficult industry to break into. Couple that with a more entitled generation coming up, (25-35 demographic) and I can begin to understand the resentment.

    But if you remove the true professional reps from the equation it all falls apart. There are many competent nurse managers and O.R. teams that can run a room with instrumentation sans representation, however, introduce new technology, ala motion restoration or perc products and the wheels come off. Mostly, though a company loses presence. They lose their advocate. The rep is, like it or not, crucial and inextricably tied to growth. But there are many pretenders still and very few that have the "juice."

    I am hopeful that there will be a correction in the market, a forest fire if you will, wherein the strong trees survive and a clearing of dead wood occurs, for companies and reps alike, even docs. I think this industry was last healthy pre-Cage Rage/Post Pedicle Screw Class Action, circa 1995-1998. Best product, best service win and only the truly innovative surgeons that really could help a device company were tapped for development.

  3. Well said, Sir. To quote the great band from your previous post:

    Rise up and take the power back, it's time that
    The fat cats had a heart attack, you know that
    Their time is coming to an end
    We have to unify and watch our flag ascend

    They will not force us
    They will stop degrading us
    They will not control us
    We will be victorious!

  4. Once again I smell some Nuvasive bashing in these posts based on the blog above,, it's just too easy to ignore I guess.

    As it relates to all of these companies, the problem isn't so much those in the field as it is the brass at the top. Everyone wants to get into management in this industry, especially in the younger companies, because they're looking for a large equity stake & a big payday when the company is acquired or sold. One of the biggest problems in the business these days is that many managers at the top don't warrant being there and have been promoted into a position because they're good at kissing ass and don't threaten the incompetent individuals at the top trying to lead these companies.

    the takeaway is that as top management continues to make promises to The Street in hopes of driving stock price, the focus of the industry has become very short sided & in turn is what has prompted much of the B.S. out there that is now going on across spine.

    So, in essence "What's Going On" is that you've got an industry too focused on short term windfalls,, which has completely lost its focus on driving patient outcomes.

  5. Wes Hand is dominating the spine market in IA....just ask Lesnar...

  6. Are you missing the point here. Surgeons and hospitals decide what to implant and how to implant. Sales reps are not responsible for patient outcomes only bridging the gap between mfg and buyer, and some are a lot better than others. This is a free market society. Income is determined by market forces. What is the issue with anyone earning 250K and who has the right to determine what another person should earn. It is no different than any other industry. I bad baseball player still makes one hell of a living as does a bad surgeon. There are huge profits in spine with no barriers to entry, hence small companies. Surgeons do not demand science or evidence as part of their decision making and provide no evidence or science for the techniques they perform. You can decide the motive. Stop looking at each other for the problems in this industry. The problem lies in the office with all the diplomas on the wall. Enjoy the fruits of your labor while they still exist. Its a great time to be in spine.

  7. So old wise one why have sales people become everyone's favorite whipping post? You call this a free market, based on what? Does it really work like a free market? if it did there wouldn't be so many barriers to selling. No one is making an issue of a salesperson making $250K except for the people making $750 to 1 mill. Ironically we're not looking at each other, we're looking at the insanity of the others in this marketplace.

  8. MM,, Aren't Globus & Nuvasive everyone's favorite whipping post on this blog, followed by sales people?

  9. Who are you calling old... Barriers to selling exist in every market and industry. Its a free market since sales people only earn what a company is willing to pay them, regardless of the barriers, as we all are aware of them. For example - Globus C level and investors understand that MSD enjoys certain priveleges as the #1 spine company - yet they choose to play in the sandbox and to pay significant wages and commissions (or guarantees) in order to increase their chances of success. If these barriers to selling were that significant, why would any company invest a nickel or attract any VC. This investment capital would flow to another industry or technology where returns are better. This is inevitable in every industry over time. I agree with the insanity just think its counterproductive to constantly point the finger.

  10. MM, good post, quite funny and true. My favorite are the fat azz office people demanding lunch to be able to set an appt to see doc and oh by the way we need to feed 20 of our fat azz office staff. Second are the cunts roaming the halls dying to catch you without your badge on or if you didn't sign in. Once I hit the lottery or before I retire, I plan on telling them to go fu$$ themselves. No doubt sales rep are treated like a piece of shit in the hospitals and doctors offices.

  11. I don't know Dr. Steinmann but reading about him online sure seems like he is a real sleezebag.

  12. And why are we being assaulted? Because people like 9:07 are allowed to work in our industry. We are hiring younger, less qualified representation because they have lower income expectations. When experience drops, so does service and further muddies the waters. Couple this with what an earlier post said about the entitlement problem and we are easy targets. If you want to succeed it's a process, earning trust and respect along the way. You want to put a punk kid who wants to drive a Range Rover in front of your customers don't be surprised when the wheels come off and your company looses all credibility in the customers eyes.

  13. let's face it, it's only a matter of time before our jobs are obseleted.

    It is impossible to point fingers as to who is at fault here. Spine pricing has always been cyclical. When the prices are driven down, we cannot afford to keep seasoned SALES reps in the rooms all day and night. They need to be out SELLING, so they can meet their #, so the company can meet their # and keep Wall st happy. This is why you are seeing 20 somethings with minimal experience covering cases. They're cheap!

    Hospitals continue to make it harder and harder for us to do business in them. Product committees, contracts, vendor credentialing, badge hawks as previously mentioned. Yet they have no idea the behind the scenes work setting up trays at midnight, inservicing, working with SPD...and still, they are the first to call you in a panic for a trauma case at 2am when a cardiac team is on call and they dont know the difference between a pedicle screw and a nail clipper

    The reality is, we have spoiled our customers. When I started doing this 10 years ago, I had guys doing scoli, acdfs, etc without me there if I couldn't make it. They knew how to do it, and the staff could handle it. Now,if you're not there at 7:35am, the phone is ringing. It really is becoming a joke

    FYI - I drive a 2004 Nissan Altima with 168k miles and a bad muffler. Does that look bad in my customer's eyes as well? who cares what car you drive

  14. Amen 10:07!

    9:07 post personifies the under educated, entitled, rubes roaming the halls. Whatever company allows this trash to represent them should be ashamed.

  15. Free market? If this was truly a free market pedicle screws now would sell for about 10 dollar a piece. Simple matter of supply and demand....

    Vendor management services? Once you pass a bogus exam, which anyone who has the patience to start again at the beginning every time he answers a badly formulated multiple choice question wrong will, two things are accomplished: 1. You now are allowed to enrich the few sleazy former colleagues who dreamt this BS up; and 2. hospital administrators can hide behind your 'qualification' any time something goes wrong. All part of the "I want the title and the bucks, but not the responsibility" mentality which is slowly suffocating society.

    Happy Egg day!

  16. 9:07 here, thanks for the comments 10:07 and 1:28, obviously you two dont have much of a sense of humor and seem to be experts on the industry, relax and get the corn cob out of your ass. Everything I said was true and if you have been in the business long enough, like me, then you know exactly what im talking about. Get your suits mentality out of corporate America and get back to reality. I have built my territory the good ol fasion way, building relationships with my docs and guess what, they use whatever I bring to them because they trust me. As for the hospitals, they could give two shits about us, so keep dreaming they are your friends, you idiots, as they are building massive additions to their already massive hospitals and continuing to nag about pricing and treating you like a piece of dirt. Happy Easter to all.

  17. Hey 11:39. Nice post. I don't know you, but I like you.

  18. I think the PEEK cages do more harm than good. Mine migrated and caused serious nerve damage.
    Who's to blame the idiot surgeon who doesn't have a clue or the dam Johnson and Johnson company.

  19. This is classic. As TSB said, we are divided on almost every level. Even this post. I tend to agree with 9:07. RELAX 10:07 and 1:28! You old timers take yourselves so serious. Divided.

  20. 9:07

    Bet your smokin' a fatty for Easter! Hangin' wit yor bitches and hoes. Keep it real bro. You're the future!

  21. we'll we'll we'll, the moment iv'e been waiting for. I happen to be the uneducated rep WITH THE RANGE's in sales, largest territory, 2 promotions, and quite frankly hardest worker. some of you just keep paying that college note off, and i'll keep taking names, get over yourselves.

  22. 8:47 I applaud you for your hard work and you deserve to make as much money as you can. I question anyone that would buy a Range Rover. It's a piece of shit with horrible resale that only people concerned about their image would buy. You should go back to college so you make better vehicle decisions.

    If you want to run your next vehicle purchase by me I would be happy to help. I am worried you are going to piss away all that hard earned money.

    I drive a 1989 Lambo Countach with Scissor doors and custom 17" rims.

  23. please enlighten us Ms. Range Rover, where do you work. Large territory and top in sales are relative.

  24. April 23 @ 907: Thanks for making all reps look and sound ignorant.

    817pm: PEEK Cages aren't made by JnJ. I find it hard to believe that a patient with a bad outcome wouldn't know that detail. My guess is you are just an ignorant rep who doesn't know your competition; are you surprised they're beating you?

  25. feed the animals!!!!!
    you all sound pathetic

  26. Being a spine rep isn't a sales job at all...its about how to handle being extorted at every corner.

  27. Spine has very much become what Vegas has alwasy been: everything has it's price in Vegas & there is no morality.

    Very fitting than that a meeting like SAS will be taking place there this week. In fact, perhaps NASS should considering holding it's annual meeting in Vegas every year. Would be VERY fitting for an industry that is largely void of morality,,

  28. I think that the traditional sales model will change even more significantly in the very near future.

    It is clear that there is significant downward price pressure by the hospitals and ultimately they will be paying 300-400 per screw in todays dollars.

    Obiously hospitals' reimbursements will continue to decline and ultimately they may be only making a mere 100% margin off the screws they "redistribute" back to the third-party payors.

    The margins in the implant world are not great as it is and only the biggest vendors are actually seeing this margin. All of the "cost" is tied up in sales/marketing and "R and D".

    Sales currently is directed a doctors. Obviously there is an enormous amount of cost associated with that often futile effort. However, ultimately it will be the hospitals that need to be "sold" on quality, low-cost implants as the majority (approx 80%) of orthopaedic surgeons will be 'owned' by the hospital within 5 to 10 yrs.

    Let's be this market, quality sales reps can be employed with a decent salary of 70,000k to 100,000k depending on the region they work. The question that a good sales rep has to ask themselves as they look at the future is, do I want to do this job at a significantly decreased salary?

    Just like hospitals building the latest and greatest W Hotel-style specialty institutes, Smart implant companies really need to reevaluate what they are spending their money on as far as R and D. I would argue that the majority of the money spent is not directed at clinically-relevant improvements in outcomes for patients. This includes the majority of consulting expenses for physician consultants. Sure, some of the expenditure goes toward clinically significant ideas and research and hopefully something truly meaningful for patients results. The minor changes that so often occur with the "latest and greatest" pedicle screws mean nothing for the patients. It is all marketing and creation of an illusion of medical advancement. This type of expense will need to be minized as well.

    Unless the implant companies want to go red, then these things have to happen. Smart companies will be the first to go that route.

  29. There's no way I would stay in spine at 70,000 - 100,000 per year. We basically are on call all the time for our customers. That alone makes it a job worth way more than your salary predictions, among other reasons.

  30. @2:27
    Savvy hospitals are getting the same premium for spine cases they were 5 years ago if they have negotiated properly with the payers (i.e. carve outs/pass throughs). The only difference today is that the insertion of me too companies (Alphatech, Globus, Innovasis, Eminent and the like) has driven the price of implants down in an effort to get into the markets with technology that is no better for the patients and often times riskier due to less R&D & mechanical testing. Many of these companies also helped give birth to the POD model that we now see running wild, anything to get a piece of the action.

    I agree that prices will continue to come down until small companies have no attraction in the market. If you cannot be part of a POD and an MSD screw costs the same as an Eminent screw then MSD is going to win that battle. Unfortunately the days of 250k are drying up quickly and those of us that are in the upper income brackets are going to have to decide if this job is worth it. I have a number in my mind that if I fall below this becomes not worth it for me anymore for the stress etc.
    If I am going to make less than my threshold, I will do it somewhere else in another environment. But for now I get paid enough to put up with the daily grind, its worth it to me.

    Whats your number?

  31. 2:27 You must have been in pharma prior to spine.

    If you're content earning $70-100K in this business you're either dumb, lazy, or incompetent,, perhaps all 3??

    Maybe you're a coverage rep?

    An average to high end sales rep in this industry should be making $200K+ easily; the top echelon reps earning well into the $300's & beyond.

    Perhaps you should be preparing your exit strategy from spine,,

  32. 4/23 11:39am
    Preach on...

    When i tell reps now that i used to have 2-3 cases going on at the same time in 2 different hospitals, they look at me in awe.

    associate rep? never heard the term at the time. Did i sweat bullets some times? Sure, but most of my accounts had staff that were trained well (by me) and surgeons that actually knew how shit worked and werent afraid to do a surgery without someone there.

  33. Too many reps these days feel "entitled" to make $250K+ when they've done nothing to BUILD the business; they're simply coverage reps or "babysitters" who can't sell shit.

    They're aware of what the Sr. rep is earning & think right away because they're simply in the O.R. that they should earn like that too. However, the reality is that they don't know they first thing about how to engage a surgeon in a conversation, let alone challenge the surgeon in a tough conversation, then close for the business. They only know how to pull sets off the case cart, point their laser point on the back table & fill out the charge sheet.


    1. Another reality is perhaps that no one has taught them how to do anything different. They could be experts at the devices they represent but don't know anything about what else is available out there. How many reps have you taught and how did you help them become as good if not better than you? It's easy to say that they are "entitled" or have "done nothing" but how many have forsaken their families, income, and pride to just be pushed out because no one provided any true guidance outside of device specifications. I'm not throwing stones! For the record; I have not trained anyone in spine yet. I'm still working on myself to be worthy of duplication and in the process doing everything I can to be of value to the Dr's and Patients I have the honor of assisting. I have had nothing provided by the company I serve other than device specs. (I'm even reading and commenting on blogs written over a year ago seeking any extra enlightenment). So, maybe it's not the reps but the system and good information available for them. Reading through these blogs is "Pathetic". Where are the professionals I thought I joined in this elite, service based community? I would love to learn from any rep from any company that is successful. Wish you and whoever reads this well..

  34. I make 75K and struggle to convert biz. Tough w PODs & long term relationships

  35. 6:33 Why would you deal w/ all of the B.S. in this industy for $75K when you could do a variety of other things, probably be treated w/ more dignity & respect, while earning twice as much?

  36. @6:33

    No shit. I would definitely not put myself through this ringer for 75K, its not worth it. My cut-off is 175k, but for that I would give much less of a shit than I do currently..LOL.

  37. 75k, thats a good month.. why is everyone mad at that???? you must of worked hard that month, most i ever made in a month was $44,000

  38. Surgeons do read this and make note of these interesting comments.

  39. @7:21

    What pearls are surgeons gleaning out of the above posts, please do tell us? That reps feel they put up with a ton of crap and they have an income threshold where that crap is not worth it?
    I would assume a surgeon has a similar threshold. Hell, everyone has a certain amount of crap they will deal with for money, its all relative to the individual!

    If I was with you right now I would give you a wedgie and stick your head in a toilet ALA swirley you nerd!

  40. 4:21

    I am a spine surgeon and have no consultancies and nor
    Do I sell implants as part of a POD.

    But I was writing to you. At this time you should be making the money you claim you make. My point is
    That those days are numbered...

    With health care dollars being limited and continued
    Decline in reimbursements there is no way for a company
    To maintain the same expense levels and stay in business.
    In private practice we have had to do this, just to stay in business and yes that includes taking cuts in pay.
    Who will be in control of the health care dollar? Hospitals.
    And they will drive implant prices down to painfully low levels for even the big companies to swallow without having to drastically reduce expenses.

  41. 7:21 What notes are you making? Is that some sort of threat? Why on earth would you care how much money we make? Are you affected by us making a decent living or do you believe you are the only one entitled to provide for your family? I know you make a lot of money and could care less; I hope you make millions. We should be on the same team as both of our incomes are in danger of going down. You come across like a little brat that doesn't know how to share. Whether you like it or not most reps work very hard and are strong advocates for the surgeons we work with.

    Go see a shrink and get over your hatred of anyone else that makes money. I promise when you release your negativity toward us your emotional well being will improve.

  42. @8:49PM

    Suuuuuure you're a spine surgeon. Give us a break, man. We aren't stupid. Well, most of us aren't.

  43. 6:55 - total douche. wish we could all be as cool as you.

  44. Will the real spine surgeon please stand up?

  45. Get over yourslves. Slow down, read, and stop taking everything as a personal attack!

    8:49 was stating facts as he sees them, and he's absolutely right. Our medical system is moving in the direction of Hospitals controlling the game, no longer surgeons. It's not about you.

    When the implant costs are forced down to where they should be (in a free market with lots of competition) there won't be enough money left for the company to keep paying you what you've gotten used to.

    Work hard. Differentiate yourself, and there will always be a place for good reps to make a decent living. The top reps will earn less, and the bad reps will hopefully get squeezed out of the industry.

  46. My company manufactures biologics on an OEM basis for a number of Ortho companies. Already seeing many hospitals trying to go direct to cut cost.

  47. Medtronic associates/case coverage junior reps make 100k BASE and that's a fact. Surgeons should respect the small company reps like LANX and realize they are getting screwed by the big guys, raping them with high prices for years and sending college kids to cover cases while the senior rep golfs. No one knows what work ethic is anymore. SPINE is done on the rep side, more money in other places in medical sales!!! Open your eyes

  48. One of the implant reps that frequent our office provided me with the address to this website in that I might have a chance to see what was being written about physician owned distributorships. I feel that they are ethically wrong by the way and are not going to withstand the court of public opinion.

    That aside, I am appalled at what is being written about us as customers. Even more disgusting is that you all seem to be more occupied with finger pointing about your relatively high income levels, than you are about elevating your value. Compensation is based upon replaceability. The reps that I respect have a great deal of knowledge about their industry, their products as well as their competitors, and a great level of clinical decision making skills and provide options to the equation of effective surgery. That said, I have no problem if they make 300k or more, as I see very few of you who could replace them. If they could be replaced for less, I have a feeling that their companies would do so in a heartbeat.

    As far as your comments about your surgeon and hospital customers, be advised that salespeople are not the only ones viewing this site. Your written thoughts will create your own self fulfilling prophecy.

  49. @ 8:39 - Are you serious? A great deal of clinical decision making skills? Remind me not to refer any patients to you. I was hoping that after medical school, residency and fellowship that a spine surgeon would be able to (and want to) make clinical decisions on their own. The last thing I would want is a rep making a clinical decision about me or one of my friends or family. Scary.

  50. 8:39

    Understood, and those of us who are in this for the long haul apologize for those new to the business venting with short sided perspectives. They are spewing these blog posts as we think surgeons really have no idea what we put up with in order to do our jobs well nor do we think they feel we share in the pressure to have every case go perfectly. When we hear bad surgeons gripe about our income by saying that we can be easily replaced as we just open boxes, it creates a sense of disrespect that some feel the need to vent about.

  51. 8:50
    The point is well taken. I think the public has absolutely no idea how many times we have been asked by a surgeon during a case to provide input about "what kind of things do you see other guys do in situations like this?"

  52. I'm a surgeon w/ a thriving practice. I have an ownership stake in several surgery centers as well as a physician specialty hospital, a PT practice, an MRI center, a POD, a neuromonitoring company, as well as a few other business ventures. I don't really care how much a rep or distributor earn because I know that I will easily trump that 5-6 times over and feel that I am very well compensated & live quite comfortably.

    I see the very good reps that I work with bringing value is a variety of ways and I do appreciate how hard many of them work & the hours that they put in to support my staff & I. I can honestly say that their preparation & diligence in havng what is needed for surgery and helping my O.R. run smoothly reduces the # of headaches I have to deal w/ on a daily basis.

    The takeaway is that this industry has been & will continue to apply Social Darwinism to the fullest extent as many of the "imitator" companies will dry up & go away as will many of the reps who don't warrant a position in the this industry.

    The best of the best will continue to thrive, as w/ anything & as Darwin stated: ""There are underlying, and largely irresistible, forces acting in societies which are like the natural forces that operate in animal and plant communities. One can therefore formulate social laws similar to natural ones. These social forces are of such a kind as to produce evolutionary progress through the natural conflicts between social groups. The best-adapted and most successful social groups survive these conflicts, raising the evolutionary level of society generally (the 'survival of the fittest')."

  53. @8:39 It is obvious that 8:50 falls into the category of reps without clinical knowledge or professional relationship skills. As you state, true sales reps bring value and are regarded by their customers as members of their team. Their clinical knowledge, combined with their indepth knowledge of their company's products, allows them to advise their cusomters on the best use of their products to help treat the patient. While the surgeon is the ultimate decision maker, the best ones listen to ideas provided by their reps, PAs, techs, etc. and then they choose the treatment they believe provides the best likelihood for a succesfull outcome. As for 8:50, he/she obviously fits into the category of box opener/instrument delivery guy/gal that believes they should make $200k+ per year and blames PODs and everyone else for only making $75k.

  54. 8:39...I must say that your take, as a surgeon, is rather refreshing. If all, or even most surgeons had your perspective, the lousy reps and companies would be few.

    The problem is that you are in the minority. Most surgeons are engaged in sleazy relationships with sleazy reps and companies.

    Your commentary reflects your understanding of the true value of a good rep...which actually makes me hopeful for the first time in a while with regard to our industry. I consider myself to be a good rep, and I will match my work ethic, clinical acumen and business savvy with anyone's. That used to be enough to rise to the top.

    Unfortunately I have lost a lot of business to the declining standards in our business, and the lust for a couple of extra dollars. I have seriously thought about setting-up and engaging in POD's, against all of my best judgement, simply because I feel like I have to to simply survive. I am facing an ethical, and financial crossroads.

    At this point, I still work hard and live by the belief that if I follow my compass and adhere to my morals, I will win in the end. I must admit, though, that I am worried that nice guys actually do finish last.

    After over a decade in this business, I have seen a lot of fads come and go, and I have seen a lot of people come and go, and this is the first time I have ever felt like the industry (much like our country) is destroying itself from within.

    MM, maybe we can have a commentary about alternative career paths, or other sectors of our economy where our background may be a good fit, for those of us that see the writing on the wall with regard to spine...???

  55. 8:50

    Point missed.

    Let me be perfectly clear that the surgeon is always the Pilot in Command and we have total responsibility for any procedure. Reps possessing a good clinical decision making skill-set, simply means that they can understand what is transpiring in any given case as it progresses just by watching, and anticipate a surgeon's needs on the back table so as to keep delays to a minimum. The good reps, the ones that are apparently making 300k+, all possess these skills. It appears that the ones that don't, are simply looking for things to gripe about.

  56. @8:39

    Thanks. By the way, we are not all slimy devious overpaid reps. Thank you for pointing this out! Many of us have been in the business for years and feel a very strong desire for every case to go well. We understand the need to contribute to we look to gain as much knowledge as possible to bring to each case. 8:50 is just bitter and confused

  57. 9:14 here-

    9:17, it would be logical to think that is the case...I am an example of a rep that has passed-up management opportunities, among other opportunities to stay in my position because I love the role I play, HAD great relationships with surgeons, that I thought were etched in stone. I have received accolades from my customers, for my efforts, and was the last island above water as small company "consultancies" and now POD's one-by-one picked off my customers. I carry great products and have seen a ton of surgery. Every doc that bailed for the almighty $ has been very honest with me, and they all try to use me a little...that is the only reason I can still feed my family. The bottom line is, though, that the lure of a fewextra bucks has become more important to them than the value I add.

    9:07, social Darwinism is a nice idea, but natural Darwinism works only in uncontained nature, not in a zoo or a nursery. Our industry has variables that influence the success of a "species" that are not part of the natural order.

    With all due respect, surgeons have very little time, energy or instinct to see beyond their immediate surroundings. While everything may function as it always has in your little world, it is changing rapidly around you.

    I don't want anyone to mistake my views as complaints, because I can adapt if I want, and I can recapture the business that I have lost if I choose to do business a different way. I am just not sure it is worth it.

  58. "MM, maybe we can have a commentary about alternative career paths, or other sectors of our economy where our background may be a good fit, for those of us that see the writing on the wall with regard to spine...???
    April 25, 2011 9:14 AM"

    Interesting idea 9:14....but it does sadden me to ever think of leaving.

    After much shadowing/reading/researching/studying and nose to the grind stone fighting I made my way into this industry.

    I was given a territory in a medium sized midwest town that we had no business in. Lots of opportunity, good training, and a 60k base.

    Like lots of folks out there I would have liked a higher base, but because I'm new I feel like I need to prove myself before that comes. An "in" with device sales is not an opportunity to pass on.

    It's a slow process but I'm building relationships, staying busy in the hospitals and delivering grade A service on revisions or any small cases that come my way. It takes time but as a one man show with a small guarantee in a town that has 10 year reps and POD"s I can't help but feel like I'm up against a wall. However, that doesn't mean I will back down anytime soon.

    As I learn more about the industry I feel a bit helpless (like a pawn if you will) but I love being in medicine and the challenge is never ending. In all reality, I will not be giving up any time soon - but the comments page sure paints the picture of a bleak reality.

  59. 9:14 here again,

    10:10, I love your attitude. Keep fighting the good fight. You may have a chance in the midwest...I don't know much about the market where you are, but I do think that in general, values and morals are more important to people who live in the middle of the country.

    I am on the west coast, and I think that the cost of living, coupled with the lack of morals is what is degrading the industry. I have actually thought about moving into other areas to get away from the crap around here.

    I know that lots of POD's and sleaze exist even in more rural America, but I can't imagine that it is as pervasive as it is out here.

    Keep fighting the good fight, I am pulling for you (us.)

  60. 9:39

    I apologize on behalf of my surgeon counterparts who feel compelled to adopt a means of passive income that creates further conflict of interest. While I understand the argument of "why not if it appears it's legal", most recognize that the balance of society does not rely simply on the legality of any given practice to define it's lure.

    On the other hand, it appears by the rep comments spewed forth on this blog about your surgeon and hospital customers, that you have your work cut out for you on the rep side, in overcoming a negative perception that many hold. These comments about overweight nurses and ignorant materials managers, are neither productive or do they foster a perception that reps are interested in doing anything to try to improve the situation.

    I don't perform any spine surgeries so I can't really comment on the reps in the room for spine cases, but the arthroplasty reps seem don't seem as preoccupied with bashing each other as your spine counterparts. Good luck and I hope you keep your ethical outlook.

  61. TSB - This is not good. I am embarrassed for us. There are good people in this industry. Unfortunately, not many in seems on this thread so it seems.

    Save us from post.

  62. Hey TSB - got my hot little hands on an Omega proposal from from one of my docs. Care to take a look?

  63. I have been in the industry for 8 years and truly like and respect all my surgeon and hospital customers. Sure we don't always see eye to eye but that is part of any job or relationship. We address the issues and solve the problem.

    I see the young punk reps all time complaining about everything. The younger generation feels entitled to make 250k/yr and when things don't work out the blame game starts. The problem is they were givin trophys for finishing last when they should have suffered the feelings of defeat. I can't stand them but love competing against them.

  64. 8:39 & 9:14

    Glad to see the adults commenting on this thread. I too have been in this business for nearly 18 years, the last 8 in spine and previous to that in cranial neurosurgery. 9:14, you and I have seen the degradation of the professional sales rep over the last 10 years, and are saddened by it. Surgeons like 8:39 who have been in practice long enough, appreciate the level of service, and the depth of knowledge to which we aspired, in order to be a contributing member of the surgical team. What the younger reps, who I believe are the majority of contributors to this website, fail to realize is that because we put in the hard work, we were/are worth the high incomes that we have had through the years. Because so much has been commoditized, and there has been no real scientific breakthrough in the last number of years, companies have been able to pick up any slug off the street and teach them the order of instruments to be handed to a surgeon, and how to write down the on a sales order the size of a screw and put a price next to it. In turn the companies get to hire someone at a much cheaper price.

    I too have, and continue to hold out hope that the POD's and surgeon owned manufacturer's will someday go the way of the dinosaur, because there is a conflict of interest and an ethical imperative, which will one day be realized. I have, especially in the last six months, lost a good deal of revenue because of these shady arrangements, but I look at what is happening in Alabama, Oregon, and hopefully, at hospital near me, and for the first time in my career, I am hopeful that the ambulance chasing lawyers are going to bring down these shady deals through lawsuits, especially since the government and the Societies have failed to act on them.

    My solace is, that when the house of cards does come crashing down, I will be one of the last men standing, as everyone that knows me, and knows how I do business, know that my morals and ethics are above reproach.

    For those of you that are involved in the shady shenanigans, you don't have to respond to this, but I know you will. You will, because you have to try and justify yourselves and your actions. Just know this, that even though I have lost income, I still make more money than any of you will ever hope to make, and when you fall, I will make even more.

    Doctor 8:39, thank you for identifying that which is important. It is all about the patient, and, yes, there are those of us out here who do strive to make meaningful contributions to the care of that patient, and education and knowledge is how we are able to do such. My surgeons that I work with me, know and appreciate that from me and the reps that work for me. It sounds as though you are smart enough and confident enough in your skills, that you are not afraid to discuss matters with someone who might not have as many letters behind his name, and someone that you respect as a valued member of your surgical team. Thank you.

  65. @8:50

    It is ignorant comments like yours that create a negative impression from our hospital staff and our front office regarding sales reps.

    I have witnessed some of the best surgeon champions in the US take clinical decision advice from others in the room. Not just during my training but even recently during a webcast surgical conference, hosted by one of the major companies. We are all humans and have the ability to contribute.

    Based upon your comment, we can clearly conclude that you have never provided sound constructive clinical feedback based, upon your years of experience, to a good surgeon during a difficult and complex case, as you are unable to even conceptualize the situation, but simply look to criticize a surgeon, paying your craft and those reps we know work hard, a compliment.

    Good luck, and I hear McDonalds is hiring 50,000 workers. With that attitude I would suggest that you go stand in line.

  66. New post.
    The 2 idiot reps who post vitriol and garbage regularly on here are not indicative of the solid reps the surgeons see in the industry. They are as loud and boisterous on here as they are in the OR. It is very well known by every hospital who is worth it and who is not. You are NOT pulling the wool over anyone's eyes. I know because they tell me about you regularly. "When is Globus going public". Why? Do you really think the 25k diluted shares you received are going to set you up for life? Try working for the customer and providing solutions. It's a much better bet than playing the lottery.

  67. TSB -

    This is undoubtedly one of the most surreal posts I've read. Little mid-day absinthe?

    Woe to the arduous, misunderstood spine sales rep; challenge, misfortune, corruption his only friends.

    "Whether management, surgeons, or hospital personnel believe it, your hard work is what makes this industry thrive. You are the stimulus that pumps life into a company. Whether TSB has been in sales or in management, the bottom line is the infantry gets the job done."

    I'll take this at face value and ask only this? Can I blame the reps for the price erosion we're seeing? As the 'thriving' engine of our organization, that is pumping life into our company, can they please stop killing margins with statements like 'we'll lose the business if we don't match price, do a study, get'em on board.'

    I think you and I both know there's more to the story here. Great products die with poor commercial execution. And you can be friggin' Ricky Roma and still not succeed if the market for what you're selling is diluted or dries up.

    It's like you're pitchin' a play where spine sales meets 'Annie'.

    It is an apathetic, harsh environment to work in, but as one playwright put it, "If you don't like it,'s for closers!"

    I have the highest respect for real dedicated sales professionals who truly earn their business. Who do care about patients because that is the bread and butter of healthcare. Who push themselves in good and bad times to CREATE business, not simply procured through corporate patronage. Is this truly the majority of spine sales representation?

    If TSB isn't drinking absinthe, and this blog is a representative sample, the post and responses confirm only that the best days are well behind us and TSB is playing the role of motivational blogger. Atta boy!

    Next stop, CafePharma! Whoot! Whooot!!

  68. 11:02

    Send it as an attachment to my e-mail address i will keep your identity confidential as I have any other individual that has sent me information. Thank

  69. 8:47 AM, any chance that range rover could teach you third grade english? My nine year old has a better grasp of the language than you. Seriously, if I ever started a post with "we'll, we'll, we'll," I would kill myself out of shame. That is hands down the dumbest thing ever posted on the world wide web. Lucky for you, literacy is apparently not a job requirement.

  70. MM how about a consultant agreement from Alphawreck

  71. 12:21 again

    TSB, I read your post again just to see if I might have missed the nuance and earnestness I've come to respect (even when I've disagreed) in your blog. I found only humor, real humor.

    I postulated one of the following cases for this post:

    A. In a time management crunch you've highered an intern with a creative writing degree.

    B. You lost your BB in a hospital changing room.

    C. Nigerian medical sales reps have hacked your account.

    D. This was blogger-bait (I think I just made up a new word) and you wanted to pull these comments out of people. For sport or political commentary, I know not.

    'There are new cardiac centers, children's centers, women health centers, cancer centers, and parking garages, yet no one seems to be questioning and demanding accountability on their part.' I almost teared upon that one. High comedy.

  72. Reality:
    A good rep is also a good business person. In fact, you are supporting his/her business everytime you choose their services/products. If you don't like people getting rich off of your usage of products... then utilize everyone... there are over a 100 companies out there willing to send you their crapola to implant.
    That way everyone loses! You'll love it... but, you will soon find you're service will be shit, too.
    Deal with it... we are business people. Use the best service and business person. What they make is none of your business... So long as the comission they make is 'fair market'.

    The best of the best will move on to other opportunities... because we are business people. If this gets much worse, that is exactly what will be very prevalent.

    In fact, you will be left with the worst of the worst. Who is that... well, it's your girlfriend, the brother in law, the guy giving you illegal kickbacks. etc.
    You'll also have the over eager idiot fresh out of college or what have you... loud, obnoquious, knows nothing... etc.

    So keep sucking up your shady deals, getting your blow jobs from your whore girlfriend/rep, ... look in the mirror bitches.

    It's a reflection of you.

  73. John Houghton former Stryker Biotech Player who managed the development and launch of OP-1® (BMP7)) Opinions please.........

  74. As one of the "younger punk reps" who recently left, I have something to add. I didn't leave because I felt entitled to anything. There's only so many dollars out there, and I'm well aware that tenure and relationship matter. It's a long-term sell.

    The current issues we have, though, with PODs, consulting agreements, and countless competitors clawing for the same pool makes the long-term even longer. No end in sight. How does that fit with my manager's guarantee/timeline?

    There's no one to blame and that was my stance. As many of you "wise" reps say, you can always leave. So I did. I spent a lot of time trying to be clinically sound and relevant to the OR Staff as well as the patient. But I had no interest in cutting any sort of deal with my docs, so I was happy to leave with a clean conscience.

    I hope this industry recovers, but taking a look at this particular segment with a broader financial perspective, I'm not hopeful. I recently attended a national customer service meeting with leaders from multiple fields of healthcare (hospital, implant, insurance). Let me tell you, they are scared about the days ahead. The only consistent theme from each of them was their collective plans to rein in spending as much as possible.

    In a time of shrinking dollars, regardless of whether PODs and consulting agreements last, having a high six-figured rep in the room is a luxury, whether you can admit it or not. Yes, many of you add value, and many more you aspire to. But it will come down to whether or not you are really necessary or not.

    The only way I see tenured reps hanging on to their high incomes as prices continue to erode is by absorption of territories, like the good ole' days when some of you started.

    Either way, I wish you all the best. I felt fortunate to work with many people that had great intentions and integrity, and I know this board ins't indicative of the entire industry.

  75. Did a bunch of replies disappear over night?

  76. When I entered this market as a rep 18 years ago, I already had 20+ years of experience as a rep in this industry.

    I'm offended that anyone has been allowed to try to follow in my footsteps and had to start at the bottom as a service rep. I'm further offended that anyone entering the business would expect to have a rewarding and lucrative career like I've had.

    Some of you people take yourselves WAY too seriously.

  77. The relationship between reps and surgeons is clearly an issue of supply and demand.

    Surgeons: supply < demand
    Reps: supply >> demand

    This is simple. Surgeons are in demand, which will drive up their salary and since of entitlement. On the other hand, there are plenty of people trying to get into medtech sales. This will inherently drive down the overall salaries and perceived value in the field. Sure, some reps are still worth the $250k, but some can be easily replaced with the next young guy coming out of school. This is not true for surgeons, hence the unbalanced relationship between surgeons and reps in the industry.

  78. @10:18am

    No sh*t Sherlock!!

  79. Anything that has the possiblility of making me work harder or get paid less is unethical by definition. Perpetrated by scumbags with crap implants. Any company that sells to PODs (cutting me out of the food chain) is a scumbag company. Its just a matter of time before all these jerks are in jail, for basically robbing me. I want it back the way it used to be.

  80. @10:18am

    Which companies out there are hiring random Joe-schmoes off the street as sales reps (sales reps...not associates or "coverage reps")?? Maybe Alphawreck's PODs are doing it, but definitely not any of the top tier companies. The top tier companies hire reps with relationships (primary) and experience (secondary). This is why most sales reps make 100k+, and will continue to earn this kind of pay far into the future. What I'm getting at is that your "supply and demand" scenario above does not take into account that companies will always be willing to pay a premium for relationships and experience. This is the ONLY way a company can expect to generate new business in such a comoditized market.

  81. I love reading these blogs and posts from my background. So, I am on the Product Development side. I can understand the differnce between earning a living and relationships.

    From what I have gathered from numerous OR trips, Sales meetings, surgeon appointments, and sit downs I feel that some underappreciate what they have.

    Sales may fuel the company, but Products are the tools that which you fail to ever appreciate. How many of yo9u have thanked PD or RD for your new 7 Series or McMansion or Beach Home.

    BTW, you're welcome....

    As for some of the points MSM made (based on my previous company):

    Gas - Expensed as a part of mileage erimbursement

    Tolls/Parking - Expensed

    Meals - expensed

    Company phone - covered by company

    Personal phone (bc some don't like to use the company phone) - expensed

    Car - some allotted car allowance

    65K base

    Extrememly high commissions.

    So, ust be tough spending all that Out Of Pocket money to make a sale...

    And, before you all jump down my throat, I enjoy making product that actually treat patients, not selling the highest margin product vs what is right. That's why I don't do sales.

  82. Dear PM/RD
    Some of your stuff is good. Some of it is shit.
    None of it is great... or greater than everyone else's. Let's face it dude, moreorless, you do nothing but re-engineer a wheel... day in... day out.
    I mean "thanks" for that stellar new cervical plate... I mean, really, where would I be without it... let alone medicine.
    You make an average salary and live an average life. Which is good for you.
    Reps, successful ones, ride a hard roller coaster life and reach for, work for the very best... you can't hang dude. And, by the way, you are ''welcome'' for taking it up the ass when your product sucks shit. Oh, and by the way, when your product injures a patient where are you, nerd? That's right, hiding like a coward behind your desk.
    Sales people, the good ones, make your salary for you.
    That's why were called sales people. If your product was so hot we'd be called 'order takers' instead.
    Sales is the engine of any economy, industry... what have you. We are the infantry.
    So, thanks for making the bullets... but we are the ones on the front line... bitch.
    Go back and sharpen your pencil.

  83. No, you "don't do sales" because you're an idiot. Go back to your Popular Mechanics magazine and stay off this blog... BTW, I think your pocket protector has a hole. You have ink all over that pretty short-sleeve shirt of yours.

  84. "it a shrine to mediocrity" Jack Burns

  85. So, I'm sure sales people are selling prior to havign a product, right. Thats what happens right...

    I'm pretty sure it is innovation that leads the way, then an investment from an organization (bank/lender), then a model to distribute the product to the field to return the investment and turn a profit. So, that being said, I am pretty sure it is the product and not the Reps that drive the industry. Reps drive the company. Make them more money so they can in turn invest more back into new products (in theory)

    Also, we don't cower behind a desk. Pretty sure we know it when a product sucks shit. It's called getting fired. Also getting hammered by the FDA investigator.

    I have nothing against the "good" reps. I have an issue with whiners and complainers that ask for moer research, mro product, and more lit and then still suck an ass at theri job.

    If the Reps would stop requesting it, we will stop making new plates, and screws, and rods, etc. And for the record, I work in the materials side...

    So, you are welcome for stem cells, and BMP, and PMMA, and synthetic bone graft...

    So, since I am re-engineering the wheel with all these new technologies, I will get back to making sure my protractor has the right degrees on it and that my wheel is slimmer and and lighter than the competition.

    I can see that 12:22 is working "hard" today for that $250K. "Wait, I need more products.... I can't sell the ones I already have... I'll make quota if I just had one of those in my bag.... The surgeons said he likes this feature..."

    And.... Since I was so threatened by your post 12:22... I won't be returning... I hope he doesn't escalate this

  86. 11:49 Mr. Product Manager:

    I agree that people who oversee product development rarely get the accolades that they deserve. You are under appreciated, especially if you know your craft and know how to manage a product from concept to commercial launch. But to counter your argument, the majority of us that are independent reps pay for our own expenses, granted we may write them off at the end of the year. In the larger picture I'd rather have today's than tomorrow's dollars, considering what is happening to the U.S. Dollar. Unlike most people i have been on many different sides of the industry, most sales people have no clue as to what goes on into getting a product into the marketplace, especially if you are dealing with "prima donna" engineers. You know the ones that never go into the operating room but always have all the answers, LOL. Keep up the good work, you're just another brick in the wall, like we are.

  87. I just appreciate the feedback here on this blog. I read this to gain a Rep perspective since I am not in the field everyday, but want to know the battles they face day in and day out.

    At the end of the day, I am putting out the best product I can, not the prouct I want to/desire to develop, but the product that Management has dictated "we" need.

    I don't take all this "nerd" talk and "pocket-protector" jibberish to heart... I appreciate a Sales Reps sense of humor, especially when it is a long 5+ hour surgery and they are standing by waiting for their time to shine.

    Keep it all up, I'm just here to offer a different perspective. And MSM, I tried to preface my Rep knowledge around my prior company's set up.

  88. well said 12:49.

    The Sales reps are very very insecure and nervous because they can see the writing on the walls for their positions and are fighting to justify their diminishing existance (and pay).

    You can call names all you want but good RD/PD can never be completely wiped out and slowly drive the industry forward no matter how minor the product changes are.

    Surgeons simply figured out what most in the industry knew- that the sales reps are idiots with overinflated egos- so they might as well just start PODS and hire people they like who will do the work without all the whining and collect the extra cash.

    The only positions you absolutely need in the spine industry are surgeons (to treat the patients) and Product development/manufacturing(to make improvments and new technology). Most of the rest are just overpaid middlemen who embellish their importance to make as much as they can.

  89. 1:27pm ---- You just fall off the turnip truck? "The only positions absolutely needed in the spine industry are surgeons and PD/MFG...". You must be joking or have never left the ozarks or wherever you are from not to realize what goes into producing a product and actually distributing it to market (let alone in a FDA regulated industry). I will save my breath in educating you in the various roles of a company beyond product development/mfg.

  90. Chicken or Egg? You decide:

    - "if it wasn't for engineers, you wouldn't have the technology to sell..."

    - "if it wasn't for marketing, you could have the best product in the world and it wouldn't get to market or be noticed..."

    - "if it wasn't for sales reps, you couldn't penetrate the majority of hospitals, surgeons and ORs no matter what the product..."

    These are always great discussions when salaries, bonuses and commissions come up. You'll have an engineer pissed he doesn't get a bigger slice of the pie for a next generation design he/she does (although last time I checked, its called a "job"). Then you'll have reps that are merely spinning their wheels with corporate accounts/consultants and not growing or attempting to grow business (you're getting what %age on a consultant doctor??). Last but not least you have Marketing saying why do I get 5 phone calls from the same rep on something that was FedEx'd or emailed a bunch of times (are they too damn lazy to read and retain crap or isn't just easier to call the office every 3rd day)

  91. Wow. Is there really NO respect any more? I was raised, many years ago, to have respect for my seniors, whether it be by age, experience, or title. I am appalled to see successful sales reps mouthing-off publicly to surgeons.

    I am frequently embarrassed by comments made on here. If it weren't for TSB's great posts and some of the more professional two cents added, I would have dismissed this site a long time ago.

    TSB, I appreciate your blog. You have great insight and wit! I wish I was as fluent with lyrics as you are. It is a great, appreciated touch!

    Advice for the day:
    Class never goes out of style. Invest in it.

  92. 1:56

    No, I realize the industry is far more complex but am breaking it down to fundamentals. No matter how much you may whine the rest of the positions are purely support for the surgeons and those that develop and manufacture their technology. Most of the other positions have a tremendous amount of fat that can be cut even if they can't be eliminated entirely.

    Most surgeons realize this and that's why you see the development and spread of PODs. They don't need the excess bureaucracy of the big companies and if they have to deal with idiots anyway they may as well deal with their family members and women they screw.

  93. PD Mcgillicuddy (11:49), you suck. Your product is used 85% off label and has strangled patients to death. And it's a marvel that FDA approved it in the first place considering it was a steaming pile of sh*t that your friendly and talented RA specialist had to spend months polishing. Which pretty much describes all of your work.

    Seriously, you should be kissing your sales rep's feet, because you would be designing the next generation dog toy if it wasn't for their efforts.

  94. 2:46

    Don't dismay, most of what you read in the comments is not real. Fake surgeons, wannabe reps, investors and molesters.

    If it was not for Anonymous the blog would yield little. Yet by sifting through the noise you will eventually find a truth.

    Thanks TSB or M&M or whoever you are. Keep it up.

    "You say the hill's too steep to climb,
    You say you'd like to see me try,
    You pick the place and I'll choose the time
    And I'll climb
    The hill in my own way
    just wait a while, for the right day
    And as I rise above the treeline and the clouds
    I look down hear the sound of the things you said today"

  95. wow, to think i started this mess on the last blog, i learned everything i neede to know. you all hate eachother, and you all need eachother, good luck!

  96. Companies don't need engineer's

    Many of the products on the market are over-engineered

    When a product fails, and I get a call from a company engineer...he/she tells me "it's technique error"

    Really? I somehow predicted your response

    Engineers, you need us to help you with your projects. Why? Cause you have no idea what is needed to use the instruments/implants in-situ

    Reps, at least you are in the trenches with us...

    Engineers sit in their cubicle, drawing specs of four barrel drill guides, on their fancy software programs, eating cheetos, gutting fish and playing tetris. And we wonder why consulting agreements are here to stay...

    "error in technique"...comical

  97. I was feeling a little bad for the distributor that I terminated today for acting like the people on this blog. After reading the comments, I may need to find another to terminate next week.

    - Former Engineer, Current CEO

  98. Douchebags:
    Yes, that means you... ha ha
    Have you ever heard of a wireless Ipad or Iphone.
    We don't have to sit at our desk to blog here... you stupid lazy fuck.
    We multi-task.
    Waiting for a surgery to start... in the O.R. whatever.
    We are on our phones/computers/Ipads etc. 24/7
    Stupid mother fucker.
    I run circles around your ass.
    If you dipshits ever listened to your reps you'd have product 10x better than what you 'over engineer'.
    Back to work Elmer... back to work.
    That's a good boy. Look busy. Minimize your screen. A salesperson or someone who gives a shit is about to walk by.

  99. 6:53

    Yet another "c" student with an over-inflated sense of self-worth. At the end of all of this industry shake out you will long for the good old days of 2010.

    Have fun selling used Hondas to old ladies, idiot.

  100. 6:36 and 6:53

    most reps don't know enough about spine to really give worthwhile feedback. We realize that you have high enough opinions of yourselves and your knowledge but it's not something that can be translated into product development.

    None of it matters because most of you are slowly being wiped out of the industry.

    If your job can be replaced instantly by some bimbo with big tits or some surgeon's kid straight from college then it just isn't essential no matter how much you think so or talk it up. Your own customers and employers are dumping you as fast as they can.

    Aside from that I never understood what made the reps so "cool" and the engineers so "nerdy". All of the reps I know are just as nerdy as engineers. Carrying medical equipment, sitting in an OR, spending all day surfing the net on an Iphone? Stop pretending!

  101. So now it's "engineers vs. reps"? Seriously?

  102. I've been in this business (med device sales) for 10 years. Some days are a drag and some quarters are stressful but honestly it's the easiest and most lucrative field I've ever had the privilege to work in (I've worked other industries, served in the military, etc).

    It's amazing how far you can get in life if you simply know how to keep an appointment, respond to a phone call, complete a report, and do what you say you are going to do when you say you are going to do it.

    On the other hand, it dumbfounds me how many knuckle heads, both in our industry and out of it, don't know how to do those basic things--in spite of the fact that they're on the Ipad/Ipod/crackberry/whatever 24/7.

    Good luck all, and appreciate what you have.

  103. Hey 9:16, don't give away advice to the overpaid "customer service reps" in the spine industry. Very few "salesmen" out there.

  104. Synthes for 21,3 M$. . . Wake up dead. . .

  105. Synthes/J&J just changed the landscape forever... And, Medtronic is about to lay-off 200 people in Memphis... After the dust settles on this transaction (2013, considering it will close a year from now), Medtronic will now have a formidable competitor, from which they will be competing from a weakened position (InFuse DOJ issues will have surfaced & settled by then, Kyphon will have been consolidated to Memphis & marginalized, and the 200 people that they will have laid off will have ended up as competitors somewhere else). Meanwhile Stryker & Zimmer will be forced to do something with either Nuvasive or Globus, because a few $300-500mm revenue players can really compete with two players of $3.5-4.0B & $2.0B respectively. There will be massive dislocation of reps, surgeon relationships, & incredibly talented people (engineers, marketing, RA/QA, logistics, etc.) that will now not have a home (mostly because of politics & favored loyalty). Innovation was painfully slow at J&J and drying up at Synthes and now will be dead within the combined organization.

    Who wins in all this? Certainly not the surgeon or the patient... Probably the hospital administration & the insurance companies...

    Just getting bigger for the sake of market share position will not simply be better - the fundamental problems plaguing this industry will not be addressed with scale... They must believe the Wall Street mantra of "too big to fail"

  106. Who has some good information on Zimmer buying NUVA and Stryker going after Globus? Please don't even say that Orthofix is going to by NUVA...that just wouldn't happen. Would Stryker real need the bag that Globus has in a declining spine market?

  107. @1:24. Who wins in all of this? Not the patient? Not the surgeon? Seriously?

    We need to keep things in perspective. Most spine cases are open cases using traditional pedicle screws and interbodies. How old are those technologies? Didn't surgeons use pedicle screws in the 70s? 60s?

    How much do these things cost to make? $50-$100? So tell me why a company needs to be charging $2000 per screw for old technology. The only reason that prices have remained so high for this long is because there is no "generic" competition like there is in other industries. Now that some of the smaller companies have come out and made almost identical products and charge less than 50% for them, how does that not help the situation?

    Implants have been overpriced for quite some time. It is finally starting to normalize.

  108. Paul Harrington used screws in the pedicle once or twice in the early 60's, Raymond Roy-Camille designed and used the first 'dedicated' screws in Paris (those damned French again) in the late 60's, and Art Steffee was the first in the US to design and use pedicle screws systematically, initially on patients with severe multilevel spondylolisthesis. His work really started the industry this side of the Atlantic. As far as price is concerned, a good vendor should be able to make you 3 or 4 regular screws for that amount, and include gift wrapping as well.

  109. NPR JnJ buys Synthes for 21.6 billion. Something big has finally happened in spine in the last 6 years.

  110. @6:53 I don't know where you are, $2,000 screw? Try $500-$750 per in my territory.

  111. I know what spine company is about to blow up, and im talking huuuuuuge!!!

  112. Ok, what are are you waiting for? Let's hear it.

  113. Medical Device sales in general is going down the tubes. Everyone needs to take a look at what has happened to the pharma industry. Watch.....the next 5-10 years, base salaries, comission/bonuses and bene's are going to drop (like they have been the past 5 years) and the industry won't be lucrative.

    I remember 15 years ago, the pharma industry was where it was at. EVERYONE wanted in because of the money etc. The 90's came and as healthcare tightened, drugs came of patent, R&D suffered and companies realized that there were waaaay too many reps in the field. Take a look whats going on in device sales. R&D is a complete joke.......yes, PLEASE give me another pedicle screw to sell!!! Healthcare is tightening more than ever (reimbursement to hospitals decreasing every year) and device companies are INCREASING the costs to hospitals every year. Distributors and companies are dropping commission rates, big territories are being sliced up into smaller ones (more reps) and the bene's (health insurance) is SKY ROCKETING.

    Get ready folks...........If you're in your 20's, start looking for a new career now. If you're in your 30's, better hope you move into management or higher (Good luck!) and if you are in your 40's.......YOU'RE SCREWED!

    Good luck.

  114. Drug reps vs. Spine Implant reps. The only difference is the spine rep is way over paid.

  115. Dudes and Dudets lets just all calm down. For those of you that have been in this business...let’s just say, before Cap pricing, POD's, Surgeon investment companies, shit the list goes on. Remember the good 'ol days when you could actually SELL! YEs sell on your product knowledge. You knew your competitors products inside out and knew the landscape. You were truly an assets to the team in the OR and they counted on your ass being there. Hell I can remember many of times getting a call for the circulator in the room setting up a room asking me "are you on your way", no she wasn't wanting to know if I was on my way with coffee and a breakfast sandwich, she/he was calling because we were a part of that team and they relied on us! I am in no way ashamed of being one of those reps that make over $300K but I don’t need to EVER through it out there, unlike a total joint rep does (sorry). Those days of going into the surgeons office to actually template a case, yes for you newbie’s, we used to go into the office to actually go over the cases we had planned weeks/days in advance. Those days of actually speaking to a surgeon in the OR while looking at an MRI/CT/XRAY and actually engage him/her in the planned procedure are gone. Now I am not going to knock on the surgeon here, cause I have "heard" a few of them "might be checking" these blogs..please! If you are a surgeon and are checking these long winded blogs, you should be asking yourself "HAVE I THANKED MY SPINE REP LATELY". Do you as a surgeon REALLY know and can you really appreciate what your rep/reps do for you, for your staff, for your family etc…??? A good rep is not only what I mentioned above, but at times is a trusted friend. Let’s face it, spend 6-7 hrs in a case x 3-4 days a week with you we are going to know and hear things that you might not even tell your buddies outside of the OR. I have seen the demise of this type of relationship over the years and I have been in this business for 11 years. I have seen the up’s and down’s in this business and for the most part it has been UP. It has afforded me and my family an excellent lifestyle, but NOTHING was given to me or the others on this blog. Some of us cut or teeth as case coverage persons, while some of us trauma, and some of us had super territories split and had some dumb ass come in only to totally make a mess of the relationships we cultivated in the first place. But who cares where we all started, we should be treated with respect just like you would your circulator, your scrub or PA or RN etc…lets face it people, really, think about the times that your surgeon and OR staff counted on your asses to help them in that pinch, to help them with the removing some piece of shit hardware that they knew nothing about and you come in and help provided and say hey “it’s a 2.5mm hex head man”. GAME OVER!!!!