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What drug rep visits cost you


By swearing off meetings with detailers, some doctors are seeing more patients-and watching their earnings rise.

Key Points

Benjamin Brewer, an FP in Forrest, IL, turned up the heat on pharmaceutical representatives by framing a simple question: Are their visits worth the patient encounters they cost a doctor?

In 2005, Brewer decided that the 15 or so drug reps-also known as detailers-who visited his office each week distracted him from patient care. So he went cold turkey, refusing to meet with them or accept their samples. Life without reps, as he recently wrote in his online column for The Wall Street Journal, has allowed him to treat a few more patients each week, and earn an extra $6,300 a year.

"I didn't think rep visits cut into my time with patients, but a few minutes here and a few minutes there added up," says Brewer.

Not everyone sees it that way. Most of the doctors we informally surveyed welcome the attractive men and women who show up with pizzas and meds. But many have nevertheless tried to rein them in, only meeting with them during lunch hour, for example, or limiting how many can come to the office on a given day. Here's a closer look at how some doctors deal with detailer visits.

"Reps cost us far too much money"

Nationwide, there are an estimated 90,000 to 100,000 reps; each calls on eight to 10 physician offices a day. Some practices may get only two to four visits a week. However, in 2005 and 2006, primary care physicians deemed as "heavy prescribers" were called on by an average of 29 reps a week, according to Health Strategies Group, a research firm that tracks the pharmaceutical industry.

How those visits break down hints at the possible strain on physician practice: In 2005, 85 percent were drop-ins, 5 percent were appointments, and 10 percent were lunch dates.

Hearing a drug spiel over a fajita wrap may not disrupt the schedule, but drop-ins and appointments eat up roughly 60 minutes a week, Health Strategies Group reports. If you used that extra time to see four established Medicare patients, using CPT code 99213 for an intermediate visit, you'd collect roughly $60 per visit, $240 per week, and $12,000 over 50 weeks. Subtract 50 percent for overhead, and you'd net an extra $6,000 a year-just a hair under what Brewer cleared after dropping rep visits.

Some doctors eliminate face-to-face conversations but still accept samples, a practice FP Patti Roy in Muskegon, MI, started 10 years ago that freed up a whopping three hours a week. "The staff brings me the form to sign for samples," says Roy. "I don't even say good morning to the reps."

The three-doctor Acacia Family Medical Group in Salinas, CA, takes the same signature-only approach. "We're convinced reps cost us far too much money," says FP and group president Sumana Reddy. "I have always wondered how doctors can spend that precious time listening to a solicitation."

Yet many physicians insist there's little time lost, since they book the maximum number of patients and see drop-in detailers in between. That time management strategy sounds good in theory; in practice, it can derail a doctor's schedule-and annoy patients.

"Every rep visit makes the patient wait an extra five to 10 minutes," says pediatrician Tammi Schlichtemeier in Coppell, TX. "I often hear their frustration when they open the exam room door, only to find me talking to a rep. The question is always, 'How much longer?' " To stay on track, Schlichtemeier limits detailers to 9 to 11 a.m. and 2 to 4 p.m., with no more than two per session.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health