Notes of a Pharma Rep: Who's Last in Line?

Prologue

Once upon a time… on March 4, 2020, I published a post in the Typical Pharma Rep online community1[1]. It got 762 likes, 31 shares, and 68 comments. So here it is:

My friends were stunned when, five minutes before midnight on New Year's Eve in Palace Square2[2], I bought a bottle of water from a kiosk with a line about fifty yards long in thirty seconds flat.

Ten years on, I can finally admit it… yes, I'm a pharma rep.

Here's what ten years and three companies have taught me.

Emotions. The main engine of success. No mood, no results.

Lines. Honestly, not that scary. Once your body accepts that this is simply how things are, it switches to ignore mode. With proper training you can last an hour, an hour and a half. But you still get bored eventually.

Quick sales. You will never need the "sell me this pen" skill. It's all nonsense. Quick sales wreck long-term relationships. The client immediately senses they've been played.

Self-positioning. Sometimes playing dumb is very useful. Or not even dumb, just a naive little girl you can tell absolutely everything to.

Reports. Those who work well report badly. Or the other way around. Or you can keep up with everything by giving up on your personal life.

Image. Every rep at a generics company wants to move to a brand-name company. Every rep at a brand-name company can't quite tell you what the big deal is.

Honesty. Patients will always hate you. To them you're "a walking advertisement." Spawn of hell. So never blow your cover.

Perks. Every corporate toy (iPad, phone, car) can turn into a huge headache, and one day it will be used against you.

Bosses. Whatever the party line, if your direct manager is an asshole, run. Far. There's no negotiating.

Memory. A doctor is under no obligation to remember you. Even if you've talked twenty-five times before. And once he finally does remember your face, he'll probably just keep calling you "young lady"3[3]. At which point you'll be thrilled whenever he calls you by the name of your drug instead. Introducing yourself again at every single visit becomes routine.

Money. Everyone wants money, but love and loyalty can't be bought. No comment.

Education. All doctors are excessively proud of their degrees. By default, they assume you're a doctor too. At the slightest doubt, you'll have to field the question: "And you are, pardon me, a physician?"

Color perception. One day you suddenly realize that blue plastic shoe covers4[4] are SO. INCREDIBLY. BORING!!!

Transport. A Škoda Fabia5[5] can do 100 mph. And every joke about the company car's off-road capability is true.

And finally… Purpose. If there's a goal, there's a point. Otherwise it's all for nothing.

And now, in 2021, as one tiny person who had an unfortunate lunch somewhere on the other side of the globe6[6] keeps rewriting how billions of people see the world, it suddenly occurred to me: why not write about us, the pharma reps? Remember my own stories, tell other people's. Maybe even make up a few things that never happened but very well could have.

With the obligatory disclaimer that

Chapter 1. How I Sank This Low

Let's get acquainted. I'm Polina. I love dogs, cats, kids, deep sleep, good food, light filtered beer, and saying what I think. That last item has caused me a lot of trouble in life. But I don't lose heart and keep on being myself.

Where did my story begin? With a move from Krasnoyarsk1[7], a city of nearly a million at the time, to Petersburg, a city of nearly five million. And separating from my parents. By August 8, 2008, I already had my first child, my first husband, an "incomplete higher education"2[8] consisting of four years of a biology degree with a specialization in biochemistry, and some very foggy plans for the future.

Actually, no. I'm lying. I did have plans. Hold on to the city with everything I had, get my diploma, and land a well-paid job, ideally one I'd love.

I realized in my very first year that, biochemistry degree or not, I would never work in a lab digging through blood and urine samples.

We'd been students for a week or two at that point, going to some classes and carefully testing the limits of what we could get away with, trying to figure out: who's actually keeping tabs on us? At school, teachers snitched to the homeroom teacher about skipped classes and bad behavior. The homeroom teacher complained to our parents. At university, at first glance, there was no control at all. It was baffling. It simply couldn't be true.

Then we found out our group3[9] had some kind of faculty advisor. Someone from the department. Who had never once shown his face. So we got together and went to introduce ourselves. The man was surprised, to put it mildly, but didn't refuse. He sat us all down at desks in an empty lecture hall and agreed to answer any questions we had. I don't remember what we asked. I remember one question: where do biology graduates end up working? There were three options: in science, as a lab technician, or outside their field.

I decided then: science. Because the other two options didn't suit me at all. Then, in my third year, writing a term paper that required digging through foreign sources in English — a language that simply wouldn't stick — killed any desire to do that for a living.

The lab tech option suddenly didn't look so bad, but it stopped being viable when, after my fourth year, I moved to Petersburg to study by correspondence and missed the specialization courses without which no lab would hire you. I needed a new plan.

Job-search websites revealed a couple of new options.

Plan A. Clinical trial monitor. A person who lives on airplanes. Someone who coordinates clinical trials of drugs, biologics, or medical devices.

Pros:

• Good salary

• Good benefits

• Public respect

• Doctors love you and look forward to seeing you

• Company car

• Company laptop and phone

• Sometimes you get to work from home

Cons:

• You have to learn English

Plan B. Pharma rep. A talking head who makes one-on-one visits to doctors and/or pharmacists in the territory entrusted to them.

Pros:

• Good salary

• Good benefits

• Company car

• Company laptop and phone

• No English required

Cons:

• Public hatred

• Doctors don't want to see you

By the time I sent out my résumé, I had learned English after all. At least at the bare minimum level needed to get through an interview at a company that ran clinical trials. I had two résumés on the job site: a monitor's and a pharma rep's.

I was never offered a monitor job. They needed doctors or PhDs. Or doctors with PhDs. Ideally. But an opportunity came up for a position as an assistant clinical trial monitor, with the prospect of working my way up to monitor.

And so Plan C was born.

Pros:

• A path to Plan A

Cons:

• Low salary

• No car

• No laptop or phone

• You work with paperwork, not people

At the same time, I got an offer from a pharmaceutical company. And between a very concrete Plan C (with a ghostly chance of moving to Plan A) and Plan B, I chose the latter.

I start on July 19. The job is kind of dumb, honestly. Going around to doctors, praising Company #'s drugs, getting them to prescribe. But right away it's 30K4, a car, a computer, insurance. And in two or three years I could become a regional manager or a product manager, and that's actually interesting. And the money's not bad. My classmates snort, but I don't want to be like them, digging through samples in some hospital lab.

Chapter 2. Sell Yourself

If you have to sell your soul to the devil, at least haggle hard.

We all want to sell ourselves for a higher price to a more prestigious company, to scratch our invisible ego behind the ears. We prep for interviews and hunt for life hacks online. What posture to take, what to do with your hands, how to answer the most common questions, like "Why did you leave your last job?", "Where do you see yourself at this company in five years?", "What are your strengths and weaknesses?" All those wannabe experts on their wannabe websites teach us that if you don't bite your nails in the interview, don't say your ex-boss is an asshole, behave with dignity and restraint (but energy!), and answer the weaknesses question with "Unfortunately, I'm a workaholic," your chances of getting hired shoot up to a hundred percent. No!!! Nonsense, garbage, lies. They don't hire the best. They hire the ones who fit. The ones they like.

When I was applying to my first company, with no work experience and no interview experience, they asked me what the hardest part of preparing for the interview had been. I said: finding a suit that fit my post-maternity-leave1[10] figure. They laughed. Turned out my future boss had also just come back from maternity leave and understood my problem perfectly.

When I was applying to my first brand-name company, one of three managers sat me down across from him and asked if I was comfortable. My chair swiveled, and I said that overall yes, but the chair swivels, so I'd probably be swiveling during the interview. The three grown-up managers in business suits on the other side of the table instinctively, in perfect unison, wiggled left and right and said that was fine. Their chairs had just been replaced, and they'd be swiveling during the interview too! That's when I knew I wanted to work with these people. Because they were awesome.

In that same interview I opened up so much that I said something unforgivable. I said I was looking for a new job because of a new manager who was bullying the team while being completely incompetent himself. I explained why. Then I asked them to invite my friend to interview too. I rode home feeling like a total failure. I'd done everything wrong. Half an hour later, they called back and scheduled an interview with the general manager over Skype. Two hours after that, they offered me the job of being their first employee in the city, promoting a new drug. And later they hired my friend too.

There were interviews with no spark. The right questions, the right answers. They never called back after those. There were ones that were just — whoa, bravo, pop the champagne! They called back, but turned me down. There were outright disasters. But with those, everything became clear on the spot.

You'll never know what's going on in the interviewer's head. How they picture the ideal candidate. A self-starter or a follower? Creative or meticulous? And even if you manage to guess and squeeze yourself into the imagined role, you need to understand whether you can keep playing that role day after day, year after year — or whether it's just not you.

In the end, an employment contract is an agreement between employee and employer. The company chooses you, and you choose the company. Not only when you send your résumé. While talking to a potential boss, you should already be figuring out: will you be comfortable working together? Will you be able to find common ground? And run from those stress interviews that were so popular at one point. Unless, of course, you're a masochist.

Speaking from personal experience, the one thing you absolutely must not do before an interview is read jokes about interviews. To this day, an answer I once saw on Pikabu2[11] to "Where do you see yourself in five years?" keeps spinning in my head. The suggestion was to answer: "…I've been blinded by the dazzling prospects!" And now, EVERY TIME I'm asked that, every thought in my head shuts down, and only one answer surfaces. But the people hiring you don't want to hear it. Even if you warn them it's a joke. Yes, I've tested this.

So what do they want to hear? That the economy in our country has been in such a state for the past ten years that in five years I see myself in the exact same position, just with a couple of extra wrinkles on my forehead and a few extra pounds I won't say where? That I don't see myself at this company, but at another one? Smart people advise answering: "In five years, I see myself in your seat, and you as my manager." But kissing a potential boss's ass that openly, and on the very first day we meet, is against my religion.

— A girl came in to interview with me once. For a pharma rep position. In a stretched-out Mickey Mouse tank top and some kind of leggings. Said right away she'd come straight from the beach. Spread her fingers out on the table like a fan3. A gold ring on every finger. And launched into telling me she didn't need the money at all. — She doesn't need money, so why'd she come? — Oh, the usual… For self-realization. And the delivery was like, you know, I don't give a crap about any of you people, I'm about to self-realize right here, right now. And she honestly believed that was a model of successful behavior. Like at some bazaar out in the boonies. You're buying a T-shirt. You like it, but so as not to drive up the price, you say condescendingly: "Well, okay, whatever… I'll take it for 150 rubles4." — Did you tell her to get lost? — Are you kidding? I gave her the full interview! How could I pass up a character like that? Candidates all say the same thing. Whatever the recruiting agency told them to say. Boring. And then this…

Chapter 3. Climbing the Ladder

The summer of 2010 stuck in Russians' memories for its record-breaking heat. The head of Roshydromet1[12] declared that Russia hadn't seen a summer this hot since the days of Rurik2[13], which is to say in over a thousand years. Massive wildfires and unprecedented smog in a number of cities and regions caused economic and environmental damage. Meanwhile, I was planning to launch straight from maternity leave into a dizzying career. Because for twenty-three-year-old me, raised on movies about the American Dream, nothing was impossible. All I had to do was work hard, not screw up, make the company as much money as possible, and be that reliable employee to whom, without a second thought, they could hand over a manager's duties.

I didn't make this model up. At my first company, two of the three first-line managers were newbies. My direct boss, Valeria, was in her second year in pharma. One year as a rep with excellent numbers. Sales growth, scripted ride-alongs3[14], a Hollywood smile, a successful interview for a management position, and there she was, hiring newbies for her own team. Her colleague Viktor was in his third year at the company. Same pattern. Young, ambitious, successful. The third manager was experienced. But we never really got to know each other. She interviewed me and quit the next day. The company poached someone from another company to replace her. At that point, an ordinary hospital rep4[15]. Not bad, right? Today you're pushing Indian aspirin into a district hospital, and tomorrow you're leading a team of young fighters, conquering doctors' minds and winning their loyalty to the company's drugs. To them you're father, teacher, and spiritual leader.

Life around me was boiling and steaming. People got promoted and fired. Faces changed. The company grew. One colleague went for a junior product manager position that meant moving to Moscow. His medical degree made it possible. He got the job. Another colleague, less than a year in, left to become a manager at a brand-name company. Connections helped. She had studied medicine too. In Petersburg.

After a year and a half, I also tried my luck on the job market, hoping to land a juicier position. I remember sitting at a recruiting agency acting like a big shot. Telling them I had no plans to be a rep anymore. But times were changing fast. Managers stopped being promoted, and they sank their teeth into the positions they already had. Terrified of losing what they had and ending up back out in the field with a daily plan of ten doctors and four pharmacies. I rolled up my ambitions, put them away, and took a job at a brand-name company as the most ordinary rep, secretly hoping to grow there.

…Among my peers, people around thirty give or take a couple of years, I'm seeing a career-planning crisis. People don't know how to become bosses. For a long time I couldn't figure out what was going on, and yesterday I think I finally got to the bottom of it. Of course, there are plenty of reasons why people want to break into the boss ranks fast, start ordering others around, and ask for a bigger salary. It all sounds good. But behind doing the job there has to be experience and skills. And not just professional ones, but life skills too. Everyone wants to lead, but not everyone actually can. When today's thirty-year-olds finished school, it was the early 2000s. Oil prices shot up with terrifying force. In 1998, $30 a barrel was a dream; just five years later the $50 mark was reached, and prices kept rising and rising. The money trickled down to the people unevenly. Some got a pension increase of three thousand rubles; others built themselves a palace on the Klyazma5, and the builders skimmed enough off it to build palaces of their own. Every contractor hanging drywall got a little something in his pocket. Household appliances and new cars flooded the country. Drunk on power, the authorities banned imports of twenty-year-old right-hand-drive Japanese beauties6, which had been saving the entire eastern half of the country throughout the '90s, and, it must be said, there was so much money in the economy that people switched to new foreign cars en masse without complaining. This dazzling boom of the good life lasted just five years or so. Those were exactly the years when today's thirty-year-olds were graduating and starting their careers. The job market was rising like yeast dough. When I was hired, the head of HR described the career path of a hardworking, capable specialist like this: "Now you're a junior specialist, in a year a regular one, in two years a senior one, in three years you're a manager leading a dozen other specialists. After that, every path is open. Run a department, build new business lines, transfer to Europe to run a region." No limits. And that's exactly the kind of career moves I saw around me. Naturally, fresh from university halls and lab benches, I figured that's just how things worked at companies. Especially since my friends from Moscow State University7 who had landed jobs were growing roughly that way. Then came 2008, and the job markets took a punch to the gut. Some had to look for new jobs. Some just didn't get a raise for a whole year. To people used to getting a raise of one or two hundred euros a month every six months, this seemed outrageous. They just hoped the hard times were temporary. Each of us thinking only about ourselves, we missed the moment the whole country's explosive growth came to a halt. Only in 2010 did it turn out that, for some reason, nobody had become a manager in three to five years. Growth soon resumed, but the stunning success stories were nowhere to be seen. And now it's 2015. Along with their first work experience, thirty-year-olds absorbed a hunger for growth, a hunger for high income, and a habit of living in luxury. Trips abroad, expensive gadgets, clothes from Italian fashion houses, thousand-euro handbags all became the norm. Hotel and restaurant staff in Southern Europe learned Russian, and we thought that was only right. We were bringing them money that we believed we had earned honestly. In just ten years or so, the cycle was over. Those ten years were the entire conscious adult life of today's thirty-year-olds. A conscious life in which money isn't a problem, opportunities are unlimited, and promotions come every year. A life in which prosperity is the natural state of things. Now that economic growth has stopped, this whole generation is in for more depression. None of the thirty-year-olds are prepared to work in the same position for ten years. Never mind a whole lifetime. Although, generally speaking, that's normal. Now we can say with one hundred percent certainty that the past won't come back. There won't be growth like that again, because there's no longer that low base of the nineties, and no longer a country with brilliant economic prospects. Thirty-year-olds should call and visit their parents more often, and learn from them how to live…

In eleven years in pharma, I managed to be a regular pharma rep, a hospital pharma rep, a senior pharma rep, a product promotion specialist, and an orphan drug specialist, but I never did become a manager.

Well, unless you count territory manager. Of an enormous territory. Half of Russia. But let's take things in order.

Chapter 4. Copy, Paste, Repeat

When I worked at my first company and promoted generics, I was doing a good deed. At least, that's how it felt. Maybe because they let me believe it.

And why not, really? We were bringing treatment to the people. Quality treatment, affordable treatment.

A small aside. At my first company, the one with the four-letter name, we were taught to strike the adjective "cheap" from our vocabulary when talking about our drug. Because "cheap" means "cheapo." And nobody wants to own something cheapo.

And yes, I'm still not ashamed of that company's drugs. They really were (and are) great. I still recommend them to grandmas and friends. And buy them myself when I need to.

The thing is, generics vary a lot in quality. Sometimes, chasing profit and undercutting competitors' prices, pharmaceutical companies put something into the factory box that is not at all what the doctor ordered.

Why are brand-name drugs so expensive? Because research is expensive. Unbelievably expensive. Out of 10,000 molecules, only one makes it to the pharmacy counter. Researching a single drug costs a billion dollars.

From the moment the first study begins, a clock starts ticking on the legal protection that keeps copies of the drug off the market. And the company has only a few years to finish its studies, register the drug, recoup its costs, and make at least a little money.

Before I worked in pharma, I thought that as soon as a drug came onto the market, it immediately reached patients. Later, launching1[16] my first brand-name drug (that is, doing everything it takes to bring a new drug to market), I realized it's all much more complicated.

The drug shows up at the distributor's warehouse in your city (by that point, the market access managers have already done an enormous amount of work), and you have to somehow sell it. Prescription drugs can't be advertised in Russia2[17]. Doctors know nothing about them. Often they don't believe in their efficacy or safety. They need a key opinion leader to tell them everything's fine, he's studied the clinical trial results and run his own trials on a handful of patients. It all works, don't wet your pants. The first opinion leader is believed reluctantly. For some, he's no authority at all, they need someone else. Almost everyone wants to sit back and wait, to see experience pile up among their colleagues. For the molecule to prove itself as well as possible. And only then, unhurriedly, do they start prescribing the new regimen to their own patients.