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

Chapter 5. Getting on the Shelf

In the last chapter I wrote that an important stage in selling a drug is getting it stocked in pharmacies. When I worked at my first company, the starting task for every newly minted rep was to stock about twenty pharmacies in their territory with our blood pressure drug. According to the plan, each pharmacy had to take at least two packs. The logic was that ordering a drug at a patient's request takes at least three days. The day of the request, the day of the order, the day of delivery. And if the first pack sold quickly, there had to be another one left in the pharmacy.

The drug cost about three hundred rubles1[19]. Not a fortune, but the pharmacies resisted as if they'd been asked to foster a pink elephant. On a purely human level, you could understand them. We were the ones with a plan and orders from above to ensure availability. They had no such plan. And keeping the sixth generic of the same brand-name drug on the shelf, on top of five others, promised very doubtful success. A product has to sell and make a profit. Ideally, within a month. At worst, before it expires. Otherwise the pharmacy takes a loss. Pharmacy staff have to make a superhuman effort to move it. Offer it to customers as a substitute with the same generic name, run promotions, give discounts. Or hunt down the company's rep responsible for promoting the ill-fated drug in the area.

On the other hand, you can't fall for the classic "if people ask for it, we'll order it" either. They won't. Theoretically, every pharmacy is supposed to keep an out-of-stock log2[20]. A notebook where they record every drug a customer asked for and couldn't get because it wasn't in stock. Again, in theory, the drug should appear on the shelf as soon as it's been recorded twice. In practice, in seven years of working closely with pharmacies, I never once saw the out-of-stock log work.

Today's patients are sophisticated. Not all of them want to buy what the doctor ordered. They read something online and change their minds. If they don't change their minds, they search online and write down a list of equivalents on a scrap of paper. Then they go look for any of them at the nearest pharmacy. Or the doctor writes a whole list of generics, separated by commas, without bothering to pick a suitable one. Or the pharmacist offers an alternative from what's in stock. Hardly anyone will wait for the pharmacy to order from the distributor.

If there's no alternative to the drug, the pharmacy loses money. More precisely, it loses the chance to make money. The customer goes to a competitor. But oddly enough, some pharmacies miss sales again and again by refusing to stock anything new. I suspect it's because, working for the man, the staff see no point in making extra effort and consider it perfectly normal to sell nothing but zelyonka3[21] and bandages day after day.

At some point, the managers started disappearing from large pharmacy chains, and automatic purchasing programs started appearing. Brainless robots that judged demand for a drug by how fast and how much of it sold. For example, this morning there were two packs in stock, by evening there's one left. The program generates an order for one pack. Tomorrow another one sells, and now it orders four. Or the other way around. Four packs are rotting in the stockroom. One sells, and no reorder happens. The drug's internal rating drops, like a Yandex Taxi4[22] driver's. Getting it back up is very hard. So is breaking into the system in the first place. There are no managers. Or the managers don't decide anything. No amount of pleading from reps or requests from patients will get the program to buy that first pack. At that point, special people from the pharma company have to negotiate with special people from the pharmacy chain. Time, money, and more time.

Once I ran into a pretty ridiculous situation. A large pharmacy had one pack of an antibiotic on the books. But nobody could find it. It had gotten lost somewhere. They couldn't find the pack, and therefore couldn't sell it. And they couldn't order more either. Because the program thought everything was fine. The drug was in stock. It just wasn't popular.

But let's get back to our first mass stocking of pharmacies. We were young, green, bad at lying, and didn't really believe in ourselves. We were all afraid that in a year or two, a couple dozen pharmacy managers would stick a hand into their desk drawers, dig out the business card of some hapless rep, and, cursing, demand that she buy back the drug. My mentor Alexei, a more experienced rep, told me two things practically on my first day in the field: never feel sorry for anyone, and never buy back a drug with your own money.

And I honestly tried to get sales going before anything expired. A couple of times I did have to break the rule. Once, the manager of a frankly weak pharmacy had me by the throat. Our patients just weren't making it to her. The awkward location and the apathy of the front counter staff made selling the product impossible. So I wrote something resembling a prescription on a company notepad and sent my husband to buy the drug. The next day, the manager proudly announced that there had finally been a prescription yesterday: a young man came in and bought that very ACE inhibitor. She was so pleased that she ordered two more packs.

How did we create demand? We worked with doctors. We also got on the phone and called the pharmacies in our area over and over. Creating the impression of wild demand. And sometimes we'd swap territories with each other, walk into a pharmacy, read out a long list of expensive drugs, and then refuse all of it because one of them wasn't in stock. You can guess which one. But even that rarely worked.

At the end of our pharmacy marathon, only one girl hit her target. She didn't think about the consequences at all. She believed in the drug, in herself, in a bright future and inevitable success. A year later, she was promoted to territory manager.

Chapter 6. Eyes on the Goal, Blind to the Obstacles

When I was first sizing up the pharma rep profession, two things worried me most: how to get into a doctor's office, and how to sell a pen. We'll get to the pen a bit later. For now, the office.

I pored over specialized websites, greedily hunting for life hacks. Some advised putting on a white coat and passing yourself off as a doctor. Others condemned those who did. They wrote that it was low and unprofessional. I'll admit that in ten years on the job, I met only two reps who used that trick. And I condemned them too, at the time.

Those specialized rep websites also talked about the phrase "I just have a quick question1[23]," which patients reacted to like a bull to a red cape. Some took a deep breath, getting ready to make a scene, while others raised a fist in warning before you could even finish your sentence.

"I'm here to see the nurse" was a pretty good option. But it didn't always work, since very often the doctors did both their own job and the nurse's.

The simplest and, surprisingly, most effective method was to walk past the line without making eye contact, two loud knocks with your right hand, turn the handle with your left, a whispered greeting, a nod toward the exam couch, an approving nod in return, and slip into the office. For the fearless. Many of us, me included, lost our nerve from time to time and sat down on the bench to think and size up the situation.

A not-quite-sane manager once fired a colleague of mine because she waited her turn in line during ride-alongs. Her natural modesty wouldn't let her kick the door open. Even though her visits were wonderful, and so were her relationships with doctors.

Years on the job taught me not to fly at the goal straight through the obstacles, but to size up the situation. Walk up to the office and look around. How many people are in line? One or two? Better to wait. Ask the patients whether there's a nurse in the office. If there is, does she come out to collect the appointment slips2[24]? Lull the line into a false sense of security. Act like you're not after the doctor's attention and are happy to wait. Then wait for the nurse to come out, explain who you are and what you need to bother the doctor about. Hand over your business card. Say you have some very important information. Wait to be invited in. No time to wait? Knock… and it's the old routine. You've managed to buy a few seconds before the conflict. Use them wisely.

I used a similar tactic in everyday life too. When I needed to push my way into a rock concert, for example. When the doors aren't open yet, the crowd forms something vaguely like a circle, and people can end up standing in it for an hour or two. And the people who walk around the circle and cut in are asking for trouble. I have my own tactic. Walk up to the entrance from the side, close enough, but not so close that you draw attention as a line-cutter. Stand there for five minutes. The crowd will forget that five minutes ago you weren't there. And will start treating you as one of their own.

You can play this game even as a group of two or three. Act natural. Pretend you're only there for a moment. Maybe you're looking for someone who's already saving you a spot. And five minutes later, pretend you've been there forever. As soon as the crowd starts moving, you'll be in the front rows.

But let's get back to the work puzzle of getting into a doctor's office.

Picture a four-person ride-along at a women's health clinic. Three men (a national manager, a trainer, and a team leader) and one female rep. A two-hour line for the gynecologist. The girl doesn't miss a beat: "We have an appointment! The doctor told us to come! We need to find out who the father is!" The line lets them through.

Another option is to peek into the office at the same moment as the next patient, quickly introduce yourself, and ask if you can come in after the patient. And if not, then when?

They might tell you to get lost. But that won't mean you're bad. Or that the doctor is bad. Just as it won't mean they'll turn you down again tomorrow or next week. You'll try again. And you'll definitely succeed.

…Back then, companies still made us wear formal suits on visits. I walk in, all pressed and proper in a gray blazer. The old ladies spotted me immediately. They rose up as one and blocked the office door. That's enough of you people wandering around here, one of them says. We're sick of you, you damned drug salesmen. I can tell things are about to get ugly. Time to improvise. I put on the most important face I can manage and say: "Citizens3. Calm down. I'm here for an inspection. It's in all our interests for patients to get affordable treatment. Wouldn't you agree?" The old ladies were taken aback, flustered, and started nodding. "Well then," I continue, "it's very important that doctors are able to choose therapy based on each patient's individual characteristics, other conditions, and age. And most importantly, at a price anyone on a public-sector salary can afford." "Yes, sonny, you go in and check on them good," chimes in the loudest one. "Half my pension goes to medicine!" "That's what I'm here for. Wait here, we'll sort it all out!" I shoot back, and make another attempt to reach the door handle. The crowd obediently parts: "Godspeed, son, go on in." I don't know what came over me that day. I never did anything like that again in my life…

As for the pen… I never sold a pen. Neither did anyone I know.

Chapter 7. Training Day

Companies that hire people off the street are terrible employers but excellent teachers. That has to be admitted.

Scripts written by robots for robots, unworkable key messages, and the heavy hammer of stress that intimidated zombie first-line managers use to pound all of this into the soft brain of a young pharmacy school graduate or a young pharmacist. And turn them into a pharma rep. A sales machine.

Let's start with the phenomenon known as the induction training. It's an immersion into the company's products and processes, where they take you to some cheap hotel and brainwash you teach you for a week or two.

The generics company with the four-letter name, which made the first entry in my work record book1[25], preferred to bring everyone to Moscow. Or more precisely, to the Moscow region, and preferably so far out that employees wouldn't be tempted to go take a walk around the capital. Some explained this as saving money, others as the availability of big hotels that could accommodate everyone comfortably. Personally, I believe it was all done purely to isolate the trainees for better zombification immersion. The organizers of induction trainings would have happily confiscated the trainees' phones so their families couldn't remind them in the evenings that somewhere out there another life existed. If the law didn't prohibit it.

Once the training is over, you get tested. Managers and trainers play doctors. Mean ones and nice ones (depending on your luck). And you prove that you won't fall flat on your face when the time comes to meet a real doctor on his own turf.

Grown men and women, sometimes grandmas and grandpas, shake in the hallways like schoolkids. They rehearse key messages in front of each other and practice handling objections. The tension builds to the point where many start taking sedatives. Before my first exam at a pharmaceutical company, I ingloriously threw up in the bathroom. Even though by then I already had a university degree.

At the end of the induction training, the inexperienced reps who passed the exam breathe a happy sigh of relief as they pack their suitcases for home, not knowing that they'll now be entertained like this every six months. And that it'll be called a cycle meeting2[26].

Now, about cycle meetings. The format is very similar to the induction training, except that you're no longer being taught, you're being "perfected." And as we all know, there's no limit to perfection.

On the last day, the top brass sort of apologize for the violence done to the trainees' brains, minds, common sense, and self-respect, and throw a gala dinner. At which point the poor souls' Instagrams fill up with glamorous photos in evening dresses, with the dark circles under their eyes covered in foundation.

…It's funny how colleagues go to cycle meetings a couple of times a year and immediately post dozens of photos with champagne and hashtags like #grinding, #work, #meeting, #thisjob, or in swimsuits with #businesstrip, #lovemyjob, #teamwork. Mwahaha! Colleagues, where's all the hardcore stuff? Where are the photos from the rest of the year? The hour-long lines at clinics, the hours-long traffic jams, the multivolume financial reports, the Excel tables and visit plans? Where are the photos of reps in tears after failed ride-alongs with two or three managers, disastrous conferences, flunked evaluations? Where's all that? I don't get it…

At pharma companies' annual meetings, the gala dinners are telling.

After the gala dinners comes the staff purge. All the old-timers pretend to drink, and the young ones pretend not to. Experience comes with time.

Chapter 8. The Effective Visit

Phrase of the day: "It sounded better in my head."

So how is a professional pharma rep made? In stages.

First, they teach you to say hello. To repeat your name at every meeting. Because the doctor is under no obligation to remember what your name is. And if he remembers it today, he'll forget it tomorrow.

After the greeting, you will never forget to politely ask permission to take a few minutes of the doctor's time, stating the purpose of your visit.

Fourteen visits a day, five days a week, fifty weeks a year, will train you to always and everywhere open a conversation the same way. "Hello, my name is Polina! Snowflake Pharma. Am I interrupting? I'm here to discuss the efficacy and safety of Ground Goat1[27] with you!" (The term "ground goat" entered my vocabulary thanks to a regional manager who was convinced that selling a drug took nothing but regular visits. He said that if you came to doctors once a week with a short, simple pitch, like "Prescribe ground goat!", the drug would already be selling.)

And six months later you're calling your bank about something personal, and a recording switches on in your head: "Hello! My name is Polina. Snowflake Pha… oops. My name is Polina, I'm calling about my mortgage."

Stage two. Diagnosis. Yes, you diagnose your victim on the first visit and check for any changes on every visit after that. "Doctor, could you tell me, do you ever see patients with a livestock deficiency? Ohhh! And how many a day?.. And what do you usually prescribe for them?" That way, supposedly carefully and without anyone noticing, you find out how useful this specialist can be to the company (for example, for some reason only women book appointments with this doctor, while your Ground Goat is used for prostate problems). You find out who he's working for (for the cause, out of friendship, out of ignorance). And most importantly, you figure out who you'll be making friends against. And make friends you will. No other option.

"Young lady, what are you even talking about? Seven hundred rubles for five pills? I sit here in my office watching to make sure the patient doesn't swipe the stapler off my desk!" Some doctors can sound very convincing…

Then, once you realize the doctor's potential is just fine, your photographic memory kicks in (after yet another cycle meeting), laying out before your eyes a table for competing against the competition. You mentally pick the right column.

Next comes the need-building. "You'd agree that it's important for every doctor to prescribe a drug that works effectively?" At this point, the experienced doctor flinches for the first time. He's heard something like this before. Probably an hour ago from the previous rep. And before that, too. And then you quickly tap him on the head with your second line: "After all, the twenty-first century is the century of effective therapy." You watch a tiny muscle tense at the corner of his mouth. You continue: "And isn't it great that there are drugs that are just as effective but safer, and even available in combination with carminatives? Right?" The question is rhetorical. But necessary. You have to draw the doctor into a dialogue with all your might.

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1

An online community for Russian pharma reps on social media.

2

The main square of St. Petersburg, where enormous crowds gather on New Year's Eve. A pharma rep's superpower is getting through lines.

3

In Russia, devushka ("young lady," "miss") is the standard way to address a young woman whose name you don't know. Being called that for the twenty-sixth time is a clear sign the doctor has no idea who you are.

4

Many Russian clinics require visitors to pull disposable plastic covers over their shoes at the entrance. They are almost always blue. A rep puts on several pairs a day, every day, for years.

5

A small budget hatchback, a typical company car for reps in the author's world. Not built for either high speeds or Russian back roads.

6

A reference to COVID-19 and the popular story that it began at a food market in Wuhan.

7

A large city in Siberia, about 2,000 miles east of Moscow.

8

An official Russian status for someone who completed at least part of a university program without graduating. People really do list it on their résumés.