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Over my last 20 plus years in academic medicine, I have had the privilege of meeting many detail representatives from the pharmaceutical and biotech industries. Most were well versed in the science of the products they were selling. Some were clinicians who also had practiced as a pharmacist or a nurse. Others had done original research in different scientific arenas and were able to speak authoritatively about the products they were hoping we would write prescriptions for. The vast majority of my interactions were positive in all ways. Of course, much has changed in the past 5 years as the pharmaceutical industry has come under a virtual siege regarding some well-described excesses and corporate misadventures. I have covered aspects of this sad story elsewhere (2004). Now I want to surmise what the future role of a detail rep might be.
Our Department of Health Policy at Jefferson Medical College is one of a handful of medical school-based departments that conduct specialized training programs for detail representatives from pharmaceutical and biotech companies. We do not focus on specific products or even clinical areas. Rather, our training is centered on an enlightened understanding of the nature of clinical practice today and the growth of integrated delivery systems, managed care companies, the for-profit hospital industry, and other broad economic changes.
As a result of our participation in these innovative training programs, I have begun to think more about what the future role of a well-trained, capable pharmaceutical representative might be. Frankly, I believe future reps must be armed with a new skill set, one that will make them integral to the success of the hospital-based formulary. For example, reps will be trained as medication safety experts with a deep understanding of the interrelatedness and process of care. They may even be black belts in process improvement with long-term experience in lean production techniques, enabling them to participate directly in hospital projects related to medication, quality, and safety. In other words, I believe that we may one day reach out to reps who present a new skill base and seek their specific input as to how we might improve our own medication delivery process. This will be particularly important as the complexity and expense of new biotech-derived products increase.
Although this work will be largely nonproduct related, I believe it may forge a new relationship among clinicians in hospitals, other reps, and by extension, academic medicine and the pharmaceutical industry. Imagine reps who have had formal training in some of the Accreditation Council on Graduate Medical Education (ACGME) competencies, especially systems-based practice and practice-based learning and improvement. Please visit «www.acgme.org». for more information about these competencies. Few medical school faculty members have formal training in systems-based practice and practice-based learning. This may denote a growth area for rep involvement. I recognize that this may be provocative, and even heretical for some, but I am convinced that with appropriate oversight, trained reps with unique skill sets could help to plan, implement, and evaluate specific projects related to the improvement of the quality and safety of care, especially as it relates to medication selection, administration, and follow-up.
The rep of the future may embody a new level of professionalism. Professionalism means that we confront and embrace a rigorous self-evaluation. It also means we are willing to change the paradigm and seek out new sources of knowledge and resources for conducting our work. And, it is an explicit recognition that we cannot give every patient every new biotech drug every time!
Certainly, the rep of the future is not a panacea for all that ails the relationship between medicine and the pharmaceutical industry. I hope that the training programs that we have created in our department are just the beginning of an evolutionary process to transform the rep of the future into a sought-after resource.
If you would like to learn more about our unique training programs, please feel free to contact our director of education and training, Alexis Skoufalos, EdD, at « firstname.lastname@example.org.» Of course, I am also interested in your views, and you can reach me by e-mail at « email@example.com».