The recent expose' by Bloomberg and WSJ have become a lightening rod for our industry. It seems that these articles have been construed as a personal attack on the spine industry, and has raised the personal ire of whom else, but the Professor Umbridge of the spine world, Robin Young. It seems like Professor Umbridge has thrown down the gauntlet and has been named as the teacher for defense against the dark arts at Hogwarts. But the question must be asked, who is the Minister of Magic Fudge?
Could the Minister of Magic Fudge be Medtronic? Highly unlikely. Could Professor Umbridge have an ulterior motive in his attack on Bloomberg, and our beloved Wall Street Journal? Potentially. In all likelihood he is just attempting to protect his own vested interests so that the questionable and at time unethical practice by companies within our industry remains status quo. Just out of curiosity, the public would love to know what type of IP or consultancies are these surgeons getting paid for? How many surgeons does it take to design a cervical plate? How many surgeons does it take to design an ALIF, TLIF, XLIF, PLIF? Professor Umbridge should know the answer from his many affiliations with "You-Know-Who." I leave it up to our bloggers to fill in the blank for the Lord Voldemort's of the industry. If MSD has nothing to hide, now is the time to step up from behind AdvaMed's skirt and let the public know what they are paying royalties and consulting agreements for. Could it be IP that was purchased and has never been used?
So TSB will ask our bloggers the $1.85 million dollar question, if all things are equal, how do you make a sales call on a surgeon that is being paid by a competing company? How many of you would manage your time efficiently if you knew in advance whom to call on, or whom not to waste your time with?
We know what the truth is. The truth is there are many surgeons that are in it for the money, just like there are those that love their craft. There are companies that attempt to play within the rules, and there are those that have mastered the art of breaking the rules, and influence a surgeon's choice of implants by waving money as an incentive in using their products. So in closing, it isn't a surprise that Professor Umbrage came out of Hogwarts to express his views. You know what they say, once a suck up, always a suck up.
I know the pitchfork wielding mobs are out in force and marching towards MSD but I gotta tell you I have had a different experience working for them. I have been with MSD/MDT/MSB (whatever it is this year) for over a decade and honestly have only sold on product, service and relationships. From the sounds of it I am in the minority, although if I am it is a well hidden secret within the company and they just treat me like the naive stepson?
ReplyDeleteI have dominated my area my entire career with the exception of a few years ago when a me too company came in and dropped shorts to get in a physician owned facility. I have never had a physician consultant, as a matter of fact I have lost out on a few opportunities with customers because it was so difficult to get them involved with MSD from a research standpoint when the doc expressed interest. I will say that over the last 12 months or so I am seeing more physicians with "interest" in "working" with industry. I am at a huge disadvantage in this area though due to all of the restrictions and needs assessments you have to go through to get a guy involved. The smaller companies (Globus, Zimmer, K2, Nuvasive, etc..) operate WAY below the radar and can get a guy involved quickly ( I have seen this first hand)... I simply cannot.
All in all I suppose I am happy in my ignorant state though, I still make sales calls and still rely heavily on relationships and take pride in the fact that I hold most of the cards in my territory.... not corporate.
Just thought I would throw my experience with big blue out there for all to see since it appears to be different from everything I read on here, a lot of which seems to be perception.
I am not however so naive to think that everyone operates with the same ethics and morals as I.
Signed,
Happy right now but concerned with the unknown around the corner.
Hey 8:14,
ReplyDeleteGreat post, well conveyed, and I'm sure you are not the minority. Much of what is said here are impressions by jealous competitors extrapolated from isolated situations. I've read the Medtronic consulting lists and my impression is it represents only a fraction of their customer base. Furthermore, I know many of the surgeons on the list, and their interests aren't purely financial. They either work with many other companies also, or take Medtronic support for legitimate purposes, e.g. royalties or research. There are a number whose research contributions are questionable, and for whom the criticisms are merited, but they would account for only a fraction of their business.
The reason for Medtronic's success is simple. They have the broadest, most complete and refined product line of any spine company. They have no holes in it. Almost every product is good. If they aren't a spine surgeon's number 1 company of choice, then they are number 2. There is hardly a spine surgeon out there who doesn't use (often reluctantly) at least one Medtronic product on a regular basis. And that can't be said about any other spine company. And those habits of product selection and usage aren't going to change overnight, no matter how many POD's spring up. And they have marketed very well over the years. First to provide consignment inventories, first to recognize neurosurgeons' interest in hardware, first with new technologies, largest contributor to surgeon meetings and research support, and so on.
And I've never worked for Medtronic or Sofamor Danek,only competed against them for many years. Gotta tip my cap for market domination well done. They wrote the book.
Hey MM:
ReplyDeleteWhy are you so anti-Medtronic? Is it because they , as Sofamor Danek, stood up to the DOJ in the early 90's, fought back and created an industry that provides food and shelter and lots of very nice junk for families of so many reading this blog? Is it because they defended, under Ron Pickard, the right of a surgeon to use a product as he sees fit? Perhaps it is because they refused to allow blood sucking class action lawyers to destroy the spine business by fighting and winning every single baseless lawsuit brought against them. How about a little gratitude? When Depuy was shelling out $300M and getting out of the spine business, Sofamor Danek was busy spending $50M to ensure surgeons had access to the best spine products and ultimately to ensure that most of you have jobs.
You either used to work for them, wished you worked for them or have been beaten like a red headed step child by them. Whatever it is you are negatively biased towards them and you don't seem to have the facts. You seem to throw out the general rant of most reps or industry people that are beaten by MDT's superior products. I have got news for all of you losers who like to use excuses; it is not MDT KOL's in your territory that lead to your low market share, rather it is your inadequate product portfolios and, most importantly, your lackluster selling skills. I will be honest, many MDT spine reps have gotten complacent by baby sitting huge accounts and making fat checks to simply maintain share. They are still the best trained, most knowledgable spine and biologics reps in the industry.
If you don't think the ridiculous allegations that have been churned out over and over for almost a decade now by Senator Grassley through the WSJ and NYT apply to the entire industry, then you are missing the big picture. Wake up! They want to curtail and control the entire medical device industry and you are all in their sites. MDT just happened to be the 800 pound gorilla that was the whipping boy for this government crusade. Once all companies start adhering to the future sunshine laws, like MDT, then we will see what rats come running out of the spinal industry woodwork.
I'll agree with 8:14 - I formerly worked in one part of the country where there was very little "consulting" between surgeons and hardware companies. In fact, the few surgeons that did were regarded poorly by the other docs in the community because of it. I then relocated and found the opposite extreme in that community - easily 70% of the doctors had an "interest" in "working" with companies, as 8:14 said.
ReplyDeleteIt's definitely regionally dependent. If you live in a city where a very large distributor or company has a corporate presence, then it's highly likely you're going to see much more of it from what I've seen and heard.
Conversely, I will agree that many reps jump the gun and accuse/assume too quickly. Just because a doctor went to a competitive company's course and doesn't use your product doesn't mean he/she is being paid. It's the rep's responsibility to do their homework and find out what's true or not, which can sometimes involve asking hard questions.
That said, someone needs to ask many of these docs those hard questions.
I worked for MSD and had zero consultants. In my experience since leaving the Death Star, and specifically in the last 3 years, ive seen a few of the smaller companies with much more questionable surgeon "consultancies".
ReplyDeleteGlobus being the main offender.
To answer the question, it would help tremendously if i knew who was a consultant ahead of time. Doesnt mean i wouldnt call on them, but I would better know how to target them and not waste my time.
of course, the office cows would miss out on a lot of lunches!
5:36 --- derogatory statements about surgeons' support staff is bad karma.
ReplyDeleteI have been associated with Sofamor Danek/Medtronic for nearly 20 years as both an employee and independent representative and I agree with the previous posts. While in a senior management role I had many surgeons demand consultantcy contracts that would not have been appropriate under the specific circumstances. In every one of these cases Medtronic acted ethically and within the law, often losing significant business as a result.
ReplyDeleteMM seems to have an issue with Medtronic's support of Advamed. So be it, but the Advamed guidelines simply follow federal law as it pertains to dealing with healtcare professionals and providers. How can you be against that?
Poor naive poster.
ReplyDeleteAdvamed was created by Medtronic as a front so that they could simultaneously reduce their cost of sales and look like the good guys vs. the ankle biters.
Unlike buying Kyphon at it's apex, this move was brilliant!
10:53 AM - I believe that MSD, DePuy Spine, Biomet, etc were all members of Advamed at the time that they agreed to deferred prosecution agreements. Clearly, they were breaking the law while members of Advamed. IMO, Advamed is a sham.
ReplyDeleteHowever, the real issue that the WSJ should have reported on are the PODs. PODs are just as unethical as buying business with consulting agreements. The "reducing health care costs" drivel is merely a diversion.
11:11 AM- Advamed was founded in 1974 so I don't think it was "created by Medtronic...". I don't get your association of Kyphon with the discussion topic. Contrary to what you may have heard (I doubt you've ever read anything), ignorance is not bliss.
ReplyDelete10:53 AM- DePuy Spine has never been part of a DPA. Perhaps you're thinking of DePuy Orthopaedics?
Q: "So TSB will ask our bloggers the $1.85 million dollar question, if all things are equal, how do you make a sales call on a surgeon that is being paid by a competing company? "
ReplyDeleteA: By walking in with a new product, one that the competing company doesn't have yet. Totally insane, I know, but it works...or it used to until reimbursement became a serious issue.
I have seen a steep increase in the number of surgeons interested in getting some sort of equity or other compensation for their services since the late '90's. This seems to be happening even as this practice is even harder to justify to regulators, payers, and patients.
ReplyDeleteI attribute this to a few things;
-decreasing reimbursement for their surgical skills,
-increased pressure to spend more time analyzing/reporting the product of their work (cases performed) without additional compensation for that time,
-increased scrutiny and criticism for resource allocation and utilization,
-increased criticism over clinical effectiveness,
-situational awareness at national meetings like NASS that there are colleagues of theirs making millions of dollars when their inventions sell, or when a large sponsor like MDT, DePuy, &ct... is counting on them to make the numbers happen in their PMA product's clinical trial,
-seeing that graph that depicts the steep rise in implant costs and their increasing percentage of the overall cost of a surgical case, against the falling line of the surgeon's reimbursement and the decreasing percentage of the overall cost of a surgical case their share represents,
-Resentment that a sales rep that has multiple accounts can make more money than they can
11:58
ReplyDeleteSince reimbursements are an issue, isn't it time that the industry and every other specialty coalesce and pool their resources to legally challenge McCarran- Ferguson? How long will we allow the insurance industry to hold the American Healthcare System hostage? The problem is that docs are greedy, envious of one another, and divisive as a profession. How ridiculous is it for someone to pen the comment that there is resentment that reps can make more than surgeons? Do isolated situations exist? Absolutely. What would that percentage be? 1-2%. If surgeons are so concerned with what we earn, they never intended to go into medicine to help people, an honorable profession that pays pretty damn well. Just like Professor Umbridge says, it's free market economics. As for new technology, show me one improvement in the last few years that really is changing the outcomes. Contrary to what Professor Umbridge reported, there is a difference between a stop gap measures versus permanent relief. The bottom line is that if you're not going to challenge the status quo, then companies will need to convey to their shareholders that its time to tighten up their short-term belts to prosper long-term? Like TSB said, the industry is looking for its holy grail, it will be interesting to see if we can find it.
You say you want a revolution well you know, we all want to change the world......
i love going into an office and having the surgein tell me "ya, ya i want to try that" and logically you say ok can i speak with your scheduler and get everything set for a case... (or something like that)... and then after you speak with the scheduler and get an idea of what's down the pipeline, she says the dr will pick your case and get back to you... and then the surgeon gives you the heisman and blows you off and you got to explain to your manager that you are making progress when it's all over...sure, maybe i said something wrong, maybe i didn;t probe well enough...there's many reasons why the surgeon might not use me...but i;ll tell you, i'd rather have someone be honest and say they aren;t going to use my stuff rather than act like i am earning a spot on their team, a spot i try very hard for. kudos to the big dogs in the industry, this is a tough industry where everyone thinks we are waaaaay overpaid, but few understand how hard it is to make business work (approvals, pricing, laws, perfect case, dealing with circulators and scrub techs, and assistants, and office staffs, questionable competition supposedly)...and we have zero room for error...until TODAY when i saw an idiot rep cover a pretty straight forward 1 level lumbar case, and the rep knew nothing about her alif cages, nothing about depths, markers, inserters, upbiters...nothing... this is ruining us.
ReplyDelete2:57,
ReplyDeleteThat is only ruining him, not us. You should cheer that knucklehead on because its reps like him that make the good ones stand out.
A doc will NEVER "get back" to you and pick your case, take the list of cases to him and ask which one would work best. Keep grinding man, your hard work will pay off at the end of the day.
LOL @ 11:11 "Medtronic created Advamed"........ shuddup stoopid!
There are so many people kissing MDT's ass that it feels like a love fest. Now off your knees and get back to work.
ReplyDelete3:33
ReplyDeleteI work for Medtronic and agree w you!!!!!
"Since reimbursements are an issue, isn't it time that the industry and every other specialty coalesce and pool their resources to legally challenge McCarran- Ferguson? How long will we allow the insurance industry to hold the American Healthcare System hostage?"
ReplyDeleteThis is barely comprehensible, but nonetheless I will try and respond to what I think you are saying: the solution to reimbursement challenges involves suing private companies to make them pay for other private companies' products? I think that is actually wrong, and completely antithetical to the real spirit of capitalism and free-market economics. In fact, if an insurance company decided that an operation isn't worth covering, isn't it intellectually consistent with capitalism to assume that their decision is the best one? Especially considering that the alternatives are to let someone in, *gasp* government make that decision?
"How ridiculous is it for someone to pen the comment that there is resentment that reps can make more than surgeons?"
It is not ridiculous to say that some surgeons believe that their sales rep makes more than them! Not only is it factually true in some cases, but to point out that some other people hold an opinion - that happens to be widely held - is not ridiculous, at worst its banal...boring, but not ridiculous.
"If surgeons are so concerned with what we earn, they never intended to go into medicine to help people, an honorable profession that pays pretty damn well. "
Your reading comprehension skills are very poor, or you have a very simplistic way of thinking. I wrote a LIST of contributing factors to the current change in attitude by surgeons towards the practice of making more money from the manufacturers of the products they use - this does not explain why people made a decision 10-15 years ago, it is to explain how a person who chose medical school could come to feel that they need to make more money themselves TODAY, while they help a lot of other people make a lot of money.
"As for new technology, show me one improvement in the last few years that really is changing the outcomes."
Why do I have to show YOU anything? I was making the VERY ACCURATE statement that if you want to sell to a surgeon who has a relationship with another company you can do it by walking in with a product that the competing company does not have. Some examples? Well, from the field-rep point of view these have come and gone over the years but when they were new they had names like: APLD, BAK, IDET, ADCON-L, Kyphoplasty, Charite, X-STOP... if you were a rep selling the first iteration of these products back when they were new, you could get in to see people who could otherwise say "I have that already". Since Charite, reimbursement for new devices seems to be all risk.
Not that this will do anything, but: I AM NOT CLAIMING THAT ANY OF THOSE PRODUCTS WERE GOOD or BAD, JUST THAT SELLING THEM WAS EASY WHEN THERE WASN'T ANYTHING TO COMPETE AGAINST THEM.
Circa 2006 even the Depuy distributor in Chicago was allowed to distribute X STOP alongside Charite - whereas Zimmer wouldn't let its distributors carry it because of DYNESYS...these decisions, and the decision by Kyphon to buy the X STOP, were based on their theory that the product could open doors for their reps, not clinical benefit.
That was then, I don't think it works that was as easily today...
Do you have any idea what McCarran-Ferguson is? Maybe you should brush up on some history before you respond. McCarran- Ferguson is antithetical to the real spirit of free markets and capitalism. Allowing insurance companies to be regulated by individual states banking and insurance commission is a joke, its the equivalent of the foxes guarding the hen house. By the way have you met your respective state's insurance commissioner? He probably is a former executive at an insurance company. Read the US Antitrust Laws before you get crazy. Wait until you or a loved one needs surgery and someone at the insurance company denies you coverage, then come back and sing me a different song.
ReplyDeleteAs for my reading comprehension, it must be pretty good, considering I got this far in life.
tsb.. "sing us a song your the piano man, sing us a song tonight, we're all in the mood for a melody 4:16 you're totally right"
ReplyDeleteBut how could a Depuy istributor get away with that?
The times they have changed TSB, quit drinking your own kool aid.
Companies are churning and buring some geat products right now, but there's so much competition, that after 1 comes out w a version of a stand alone for example, 12 others scoot one out in no time. ie globus.
globus please go public !
sincerely,
pharma the karma
Globus going public, LOL. That company is so diluted its scary. They're running a close second to Small Bone. Sounds like someone is hoping to hit the lottery
ReplyDeleteHey 4:16
ReplyDeleteHave you ever experienced healthcare in a country that has a public option? You know the big bad evil socialist system, don't knock it until you have tried it. You yanks know it all without ever experiencing anything. you people watch way too much television.
"Musculoskeletal Man...had a hissy fit @ 5:09"
ReplyDeletehahaha, gotcha didn't I, you've lost your cool and you're ranting now.
None of that has anything to do with what I said originally, or in response to your response to me.
Reimbursement for the majority of the technologies I mentioned was initiated, or denied, by either Medicare and later CMS, or by Blue Shield via its Tech Assessment Committee. Lately other private companies have been crafting their own policy decisions in parallel to the Blue Shield/CMS system. Regency does a good job of describing its position on new technologies:
http://blue.regence.com/trgmedpol/surgery/sur127.html
This is not the product of McCarran–Ferguson Act, it is the product of a private company making a decision that effects its customers. That their decision also has an effect on the private companies that make artificial discs is not their problem. If their customers feel like they are missing out on something then presumably they would just switch to a new insurance company that does cover what they want, or pay for it themselves. As for the people that make artificial discs - well, make better ones. It seems to have worked for Spinal Kinetics, which while US based kicked ass in Germany with a handful of reps against entrenched competition - with a superior product.
" Wait until you or a loved one needs surgery and someone at the insurance company denies you coverage, then come back and sing me a different song.
As for my reading comprehension, it must be pretty good, considering I got this far in life."
I guess I've gone just a little bit farther then, since that scenario doesn't scare me as much as you - I'd pay cash for me or a loved one who needed surgery that I believed in - whether a private company agreed or not, and have the money to do so.
And even though I can afford it, I actually support almost any attempt at health-care reform, including what all of the amnesiacs who somehow supported both Bush and the Tea Party call ""Obama-Care"", since I believe we should spend more on health and education than on war and defense. I've just been playing devil's advocate here...
Cheers~
Cheers~
Hey 4:16/ 6:44, well said on all counts!!! MM, time to just nod your head and concede the round. You've won plenty in the past, and you'll win plenty more, but not this one, my friend.
ReplyDeleteHey 6:37, I've seen your posts before about us "yanks"....we GET it, you dislike Americans. Good to know that you brits (I assume you are british) still have the same attitude that lost you the war of independence. We should have let Germany blow your little island off the map. Too far??
ReplyDeleteSorry folks, I have nothing constructive to add to the relevant topic. Nice blog though TSB.
TSB loves to joust, 4:16 by a TKO great debate mate.
ReplyDeleteMM
I'm not sure why everyone IS kissing Medtronic's ass on here,,?? Their products are no better than anyone else's,, and the folks selling there are average at best. Simply take a look at the lack of success they've had w/ DLIF and trying to dent Nuvasive's hold on lateral surgery,,
ReplyDeleteMedtronic is successful simply because they were one of the earliest players in the market. Sure they've seen their market share % eroded over the years, but they still have a HUGE advantage of being a "legacy" company vs. all the new tiny "wannabees".
Bottom line is that if you take away Infuse from their portfolio,, they're certainly not significantly larger than Synthes, DePuy or even Nuvasive.
The reality of this business is that everyone is out to make a buck & with HUGE hime run moneymaking deals in the past like the acquisition of Spine Tech back in the day, or even Kyphon, everyone knows that the biggest payday is to have a solid equity stake in a company that either goes public or gets acquired in time.
However, the problem today is that there are too many "also rans" who have stepped up to the plate in hopes of a "home run" & have in turn done nothing but struck out badly.
Ex. - Trans 1, Alphatec, K2,, the liost goes on & on.
Everyone is just looking for their payday.
4:10
ReplyDeleteYou are absolutely correct. Many of the aforementioned companies were either started or bought with the intent to reap a windfall. Unfortunately, market dynamics play are unpredictable even if you are a revered Wall St analyst. Today, many of these companies compete in a steroid induced industry. Eventually it will balance itself out. The strong and intelligent will prevail, the weak and greedy will fall to the wayside. Contrary to criticism, the legacy companies have the capital, the organization and clout to weather whatever healthcare will throw at them. The ankle biters are the companies that need to
worry. Many of them were started with the intent to sell them off, regardless what some will say. Today they have to figure out how to grow in a troubled market. The time was ripe 5-7 years ago, that opportunity no longer exists, and potentially may never exist.
4:10 & MM,, I couldn't agree more. Simply look at a company like Nuvasive and the growth they've produced w/ something like XLIF,, yet their stock price is at roughly the same level it was nearly 4 yrs. ago. MM, you couldn't be more right than to state that the opportunities of the past no longer exist,, at least not in this current market/ economy.
ReplyDeleteIt makes me laugh when I hear or read above that Globus is going public. They've been saying that for 4+ yrs, yet haven't found someone willing to take the risk of underwriting the stock as the fear is that they'll face the same type of outcome as Alphatec or Trans 1,, their best bet is to look for an out similar to K2.
Big windfall paydays are a thing of the past.
TSB:
ReplyDeleteLove your Blog - but what's up with the new red background. You are killing my eyes. Let's go back to the black font with light colored background.
Yours truly,
Saved Retina
Agree with the light colored background suggestion
ReplyDeletered background- I was just thinking the same thing. I cringed thinking of having to open the site and get that BAMM! red on my face. We stare long enough at our computers, pick something softer, like the Big Bear's belly!
ReplyDeleteRed is killing me too!
ReplyDeleteRepublicans took majority control of the house today. The red background is just piling on. Go back to the prior version.
ReplyDeleteLove the website. I check it every day.
out with the red
ReplyDeleteTerrible background for reading. My eyestrain is killing me after ten minutes of reading.
ReplyDeletePlease change the background to light purple. And the text to a dark purple.
ReplyDeleteAs a courtesy to those bloggers that are experiencing retinal pygmentosis TSB will be modifying the background color 2 nite, the people's voice has been heard
ReplyDeleteI wish our government would respond and react like the MM!!!!
ReplyDeleteTSB, thank you for ad hoc collaboration forum! 2011 is your year to shine again.
ReplyDeletehttp://www.youtube.com/watch?v=pmvJ4sFxz54&feature=related
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After a hurricane comes a rainbow
Maybe you're reason why all the doors are closed
So you can open one that leads you to the perfect road
Like a lightning bolt, your heart will blow
And when it's time, you'll know
You just gotta ignite the light
And let it shine
Just own the night
Like the Fourth of July
Cause baby you're a firework
Come on show 'em what your worth
Make 'em go "Oh, oh, oh!"
As you shoot across the sky-y-y
Baby you're a firework
Come on slet your colors burst
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You're gunna leave 'em fallin' down-own-own
Boom, boom, boom
Even brighter than the moon, moon, moon
It's always been inside of you, you, you
And now it's time to let it through
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Come on show 'em what your worth
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As you shoot across the sky-y-y
Baby you're a firework
Come on slet your colors burst
Make 'em go "Oh, oh, oh!"
You're gunna leave 'em goin "Oh, oh, oh!"
Boom, boom, boom
Even brighter than the moon, moon, moon
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Even brighter than the moon, moon, moon
love the biege
ReplyDeleteIs that Katy Perry song really that filthy, or is it just the way she sings it?
ReplyDeleteTo anon 4:10am on Jan 5 . . . hate to pile on but I'm so tired of people throwing around false comments regarding sales data that is readily available if lazy people would just do a little research.
ReplyDeleteMDT is most certainly significantly bigger than all the companies you mentioned AFTER pulling out InFuse. MDT discloses this info each quarter. For example, in FY2010 MDT sold $2.6B in hardware and a little over $800M in biologics.
You could combine Depuy Spine and Synthes Spine annual sales ... multiply that number by 2 and you'll equal or barely exceed MDT's annual spine number. I consider that to be significant.
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