Sales Reps in The Operating Room – There is Room and Need for Them

A recent article in the Washington Post described how company representatives for medical device companies are allowed to participate in operations. Rather than focusing on the impact and legitimate reasons why such representatives are permitted entrance into the operating rooms, the author of the article chooses to focus on meaningless details and one negative case.

The article does not acknowledge that most representatives who work in operating rooms carry at least three separate credentialing certificates: a blood borne pathogens card, an OR protocol card and a HIPPA compliance card. In order for these representatives to become certified to enter the OR, they must successfully complete class work and exams administered by independent training organizations.

Seemingly, the author’s progress with discussing one particular salesman who works with Kyphon, a manufacturer of medical devices used to repair fractured vertebrae. As the article itself states, the salesmen who entered the ORs was “doing his part to advance a new procedure called kyphoplasty.”

The article uses this positive example of how a salesman could help develop a new procedure to assert that salesmen in ORs are merely a reminder that “medicine is business.” That medicine is a way for company’s to “promote efficiency, boost sales and extract profit.” What do they expect? Saving lives and making people healthy is not free, and up until now, the government hardly ever took an interest in it, other than seniors and veterans (the people most likely to vote).

What complaint can these authors or the public possibly have about  representatives bringing artificial hips or knees, or pacemakers to the OR? Do we ask to see the butcher who killed the cow before we eat a cheeseburger? Do we care about the oil drillers who provide us gas before filling up the tank? Saving lives is a business because the investment is a matter of life or death, happiness or pain.

Accordingly, the article asks whether company representatives should be in the OR. In response, the authors themselves noted that “in an age of rapidly proliferating technologies, the salesmen may know more about their products than the doctors who use them do.” In addition, sales representatives can provide data about the relative effectiveness of one product versus another or “even about the merits of doing one procedure over another.” The article also acknowledges that company representatives “speed procedures along, making time for more.”

One orthopedist, Ted Parks, even noted that sales reps “are critical to the efficient execution of hip and knee replacements.” Additionally, David Nexon, senior executive vice president of the Advanced Medical Technology Association, asserted that “many medical devices could not be used — or used safely — without sales reps.”

On the other hand, some believe that sales reps are there to only sell their products, and not to recommend what is best for the patient. These critics believe that doctors should not have to rely on sales reps expertise. But with such fast advances in technology and new devices, who is going to bring doctors up to speed, especially when a patient has little time to wait?

What critics easily forget is that these reps are actually making a difference and helping save lives, as Vince Proffitt, a spinal implant salesman noted. He added that salesmen are not only helping patients, but doctors as well by creating a team atmosphere to support every effort at a successful surgery.

Jim Rogers, a former sales executive and founder of the American Institute of Medical Sales, began training people to be salesmen in operating rooms last year. He noted that the “curriculum at the institute ranges from how to perform a joint replacement to how to get inside a surgical suite without an invitation.” The institute even includes training on anatomical models called sawbones.

Still, opponents of  reps in the OR believe that “it can put the interests of manufacturers before those of patients.” They also cite a 2003 case involving Endovascular Technologies who pleaded guilty to federal charges that it covered up malfunctions of a device used to treat aortic aneurysms. While this case should not be ignored, the public must realize that devices and any surgery or treatment come with risks.

In order to minimize those risks, “most surgeons who use medical devices in their procedures expect a technical field rep to be present during the procedure, because they understand that the rep’s special product expertise enhances patient safety,” according to Medtronic spokesman Charles Grothaus.

In some devices such as Left Ventricular Assist Devices (LVAD) for patients waiting for heart transplants, surgeons may have one or two patients in the course of a year who qualify for the device.  It is important that a representative from the manufacturer is present to ensure successful placement of the device.

Accordingly, technical reps also get doctors interested in new procedures and breakthroughs, and then teach them in “one-day courses in which they practice on cadavers.” These classes involve “other surgeons who lead the class, while the hands-on training is done mostly by the sales reps.” 

While the case the Post talked about highlighted one negative story, they underscore the importance of technical field reps who are usually the most technically trained people in the industry. Moreover, there concern for conflict should be minimal, if any, since there are no sources of gifts or food in the OR, just hip replacements and pacemakers. The idea that these sales reps are “selling in the OR” is problematic because journalists forget that these devices and equipment are upgrades from older equipment that lead to more successful performance on a patient.

Ultimately, working with new technology and devices requires more then just theoretical learning: it demands hands on experience that highly trained members of industry are suited to provide. The sales reps are not the ones deciding to use a particular device or procedure, the doctor is. Once a physician makes this choice, the doctor has an ethical responsibility to the patient to use all sources of assistance, including sales reps, to make sure the procedure goes as planned.

 As a patient, would you rather have your new hip delivered in a box the day of your surgery by FedEx or have the manufacture send a sales rep to the OR with your hip who can help your doctor with your surgery?

The industry should consider re-labeling these company sales reps as technical assistants or technical engineers which is the job they end up doing anyways.

By allowing sales reps into the OR, doctors can focus more on the clinical benefit to patients and rapid implementation of these beneficial new options without unnecessary delay or undue risk to patients based on operator inexperience.