Selling Medical Devices is Much Different

The End User is the Patient, NOT the Buyer

When a decision is made to use a particular device in a procedure, the end user, the patient, is rarely the one making that decision. The patient depends greatly on the knowledge and expertise of the surgeon or doctor that is deciding to use a particular device or product to help their condition. So what goes into that decision? There are a lot of variables, and most people have no idea what is involved in that decision. Many of the considerations aren't related to the patient's best interest at the time of the purchase, although general consideration is intended.

When a new medical device comes to the market it has already been through a lot of review and consideration. If it is an improvement or modification of a currently available product - such as a new pedicle screw for spine fusion, there have been many of these designed. The concept is usually very similar to what has gone on in the past. In this case, the FDA allows what is called a 510(k) approval to market the product. That means that since the use of such a device has been accepted in the medical field for intended applications, the new pedicle screw can be accepted provided it meets a number of criteria such as sterilization, strength, infection or allergy control, materials used in construction and so on. If a new metal or combination of metals were found to be lighter, stronger, allowing for a smaller diameter screw that provides the same "grip" as a larger one, a new product may be approved.

This process goes on every day with literally hundreds and thousands of products. Every nuance of a currently utilized product is evaluated for possible improvement in the use, application, or time to deploy the product, all of which have a direct impact on the value of the product but each in a different way.

Who cares if it takes less time to complete a certain surgery? You may think it is only the patient in that they are "under" for less time which has to be good? You might give some more thought and consider that the hospital considers how many more minutes they can get the use of their very expensive surgical suite and the employees they are paying to be there - more efficiency is valuable. What about the surgeon? If he can get the same job done in half the time with at least as good or better an outcome for the patient, he can now do twice as many cases in the same time. And the device maker? Of course, if the doctor can do twice as many in the same time - and there are sufficient patients needing the procedure, they sell twice as many devices.

So this makes the point that there are a number of fingers in the pie when deciding about a new device. The hospital also must consider its liability as does the surgeon. If there is a good history with the product line, it is likely this isn't much of a block. Inventory can be, however. If there are already 3 separate lines of a similar medical device used in surgery, it is less and less likely a hospital is going to add an additional line unless there can be something proven to add efficiency or other value to the patient and hospital.

When a salesman calls on a surgeon, what is it that he can offer the surgeon that they aren't already seeing? Can he say, "doc, here's the deal. I make a ton of profit off this item, and if you will use this once a week, I'll give you a new Mercedes every two months." Nope, can't do it. Believe it or not, this used to be done pretty consistently - well maybe not exactly to that extent but certainly there were perks for doing business with certain companies. Today the laws are very certain and demanding on reps and doctors. There can be NO incentive offered in cash, cash equivalent, or even a round of golf, that may be construed as intended to sway the decision of a doctor to use one product over another. Is it still done? Sure, there are ways around the law and there will always be companies and doctors that find ways to do that. Most do not circumvent the law however.

In the real world, we hope for altruistic doctors and hospitals with our best interests in mind. Do they exist? Maybe to some extent in some cases they actually do. But doctors in the US in particular are also businessmen. They have employees, buildings, expenses, insurance, all things that must be paid for. They are always looking for means to cover these expenses, just like the hospital is doing it. So getting the doctors attention in explaining why this latest and greatest innovation should be used must present a value proposition to the doctor. Getting the hospital's attention for doing so is no different, although the proposition is probably different for the hospital than the doctor. Where does the patient come into the equation? They don't really.

When a physician is used to doing something a certain way, and it is successful doing it that way, getting them to consider doing something a different way has great risks. The risk to the patient is one of them, but only one. I know of a podiatrist that has always assumed that if a patient presents with necrotizing fasciitis (flesh eating disease) the best and most likely response is to go up the leg as far as possible and amputate immediately. A new product has made great headway in the marketplace that has allowed doctors to remove all infected tissue and grow everything back using the lining of the placenta as a source of growth encouraging cells. Another podiatrist has been working on the foot pad of the heel where a special form of human "fat" tissue is held in a very interesting matrix somewhat like a honeycomb so that when you put your foot down it doesn't just smash around the ankle. He is injecting some of this product from the placenta along with some other products to replenish heels that have worn down. This could be a huge new market but it took doctors that look at healing (no pun intended) in ways that science offers new ways to do.

I know a neurosurgeon that has used every spine product ever made - almost anyway. Recently a rep showed him a new product that didn't require any screws or plates or rods to secure the spine for fusion, only a single implant between the vertebra. He studied the science of the new implant, then looked at cadaver and live studies for the product. He remembered seeing something like this 20 years ago but it didn't expand after it was implanted; this one does. Now, after half a dozen successful surgeries, he likes it. What is in it for him? Some flexibility to use this device where it fits, time - in some cases he has gone from what had been a minimum 4 hours surgery to just over an hour for the same thing, His patients have less disruption of the area around the spine so faster healing and less pain.The hospital - now has more hours available for the same procedures. Everyone wins - but keep in mind, first it took a physician saying, "let me see that. I think I see how that can help."

Selling in the medical field is different. The patient is rarely involved although they are the end user. It is up to the doctor to even consider a new way to get something done and getting his attention requires persistence and a reason for consideration. Just another of the same thing isn't going to sway doctors and hospitals to try something else.


The Inventurist.

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