Let’s face it, most patients would be astonished to learn there were sales reps in the room during their operation. The O.R. in general does not at all look like it does on television. Shows like ER and Greys Anatomy portray dramatically romanticized, exaggerated versions of trauma procedures with lots of yelling and adrenaline. Nobody makes TV shows about hip and knee replacements. Maybe they should, but that’s another conversation.
Over the course of a few decades, reps have become an essential part of the O.R. team for most facilities. Hospitals essentially relinquished ownership of some operating room duties. Things like implant logistics, pieces of inventory management, training on clinically sensitive items, and intraoperative troubleshooting were ceded to the reps of medical device companies.
This streamlined things for the hospitals, drove efficiency. But the perk came with a price. The manufacturers aren’t dumb. Putting the reps in the room created a veritable buffet. After all, these are sales reps. Their job is to sell. They’re paid on commission, incentivizing them to close deals. Over time, the focus on clinical expertise faded as the sales focus flourished.
Thirty years ago, the reps were experienced clinicians, with in-depth knowledge of procedures, parts and pieces. For a variety of reasons, the clinicians are now largely gone – replaced by younger, less knowledgeable novices whose primary job is to sell. The turn-over rates are high and the knowledge benefits are gone.
How can we fix this?
If reps are fixtures in today’s O.R. world, they’re selling. Facilities should take inventory of all procedures to identify those areas where staff might be able to take back ownership of the service component.
Staff will never be able to completely replace reps as the technical expert in the room. Among other things, that would require them to attend national meetings for manufacturers – which takes them off the playing field and identifies another piece of irony. The mere fact training is a component of sales seems squishy.
So, what do we do? Many facilities are implementing surgery advisory committees – setting new policies where reps are allowed in the OR only to support cases. They’re prohibiting loitering, where reps notoriously catch surgeons at the scrub sink for some other purpose. These are minor changes but the impact on O.R. culture is meaningful.
Best-case, bring back the true clinician. Operate on your terms, literally. Create a buffer between the manufacturer and the facility / physician. A true surgery service model where clinicians, not sales reps are working for the doctor not the device company. The clinician, not a sales rep, is interacting with the device company to maintain the expertise to be actionably valuable.
Eliminate crowded O.R.’s with multiple reps. In a busy facility, there can be 20-25 reps roaming the halls at any given time. Imagine an efficient, physician and patient focused environment where a dedicated, personal clinician knows and cares exactly what the surgeon wants and needs. In this model, there aren’t two dozen randoms running around stabbing each other in the back to build business. Facilities can do it in-house. Or, they can find a partner that will go to work with them, for them, managing the manufacturer. However, it gets done, it’s worth thinking about.