Reps

[Sushirolls]

Outside my office suite, showing my logo, name, etc says a blurp, no walk ins , and y'all need an appointment to enter.

Repeatedly I and the sleep doc that subleases from me, get reps coming in, with out an appointment.

I have been nice and politely said not interested and shooed them out. This takes time. Its annoying. And its disrespectful when there is a clear sign on the door.

Today, I got little grumpy and asked 'did you not see the sign?' And more gruffly said please get out and not interested.

I fantasize about walking them out, point to the sign, ask them read it out load and then ask them "do you have an appointment?" and say, don't ever come back.

But the point of this thread is to group think the issue of professionalism. How should I roll? Or perhaps how gruff should we be?

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[WisNeuro]

Why not a sign that specifies no reps? They may assume that the sign only pertains to patients/potential patients.

 

[calvnandhobbs68]

Outside my office suite, showing my logo, name, etc says a blurp, no walk ins , and y'all need an appointment to enter.

Repeatedly I and the sleep doc that subleases from me, get reps coming in, with out an appointment.

I have been nice and politely said not interested and shooed them out. This takes time. Its annoying. And its disrespectful when there is a clear sign on the door.

Today, I got little grumpy and asked 'did you not see the sign?' And more gruffly said please get out and not interested.

I fantasize about walking them out, point to the sign, ask them read it out load and then ask them "do you have an appointment?" and say, don't ever come back.

But the point of this thread is to group think the issue of professionalism. How should I roll? Or perhaps how gruff should we be?

I mean if you aren't gonna prescribe Rexulti or Vraylar or Azstarys or whatever they're peddling be as gruff as you want. They're mostly helpful for getting med samples or discount cards for patients or helping navigate financial assistance if there's a patient who can't afford Rexulti or something. Vyvanse rep tends to be helpful to refill Vyvanse 0 dollar copay for first 3 month cards for me (cause you can't get that deal online anymore with them).

But yeah, why not a sign that says no drug reps?

 

[nexus73]

I’m not a drug rep. I’m your Jannsen science advisor.

 

[TexasPhysician]

I do the opposite. Reps allowed as long as they buy lunch/dinner for ALL of my staff. I choose the restaurant. Staff get appreciated at no cost to me.

 

[allantois]

They are just doing their job

 

[PikminOC]

They are just doing their job

They have no boundaries

 

[adiradirim]

They have no boundaries

That's part of the job lol

 

[littlefred]

I do the opposite. Reps allowed as long as they buy lunch/dinner for ALL of my staff. I choose the restaurant. Staff get appreciated at no cost to me.

But then you show up at Home | Open Payments Data - CMS

 

[MedMan80]

But then you show up at Home | Open Payments Data - CMS

So? I had an attending who used to rack 20-30K speaking for Latuda per year. Unless you're doing that, most won't bat an eyebrow

 

[deleted1100659]

When I first started here, reps were really intrusive and came all the time. Now, they come in only on occasion when they bring food and samples. Honestly, im nice to them if they're respectful. If they feel pushy or annoying, then im rude. May get some judgement from this, but they're used car salesmen essentially. They're useful for samples, info about coverage, and free lunches but other then that they tend to get in the way of me so I am very gruff with them. Also I have a resting male bitch face so people tend to not try to give me crap, lol.

There is this one rep though, who is actually a nice guy, for ingrezza. He does bring me some random platters of stuff so im fairly nice with him because hes respectful, and given that there arent 2000 vmat inhibitors out there, he doesnt have much competition, lol.

All the reps here are though are generally older people, mainly male. When I was in medical school I distinctly remember them being younger attractive women around my age. Damn.

 

[deleted1100659]

But then you show up at Home | Open Payments Data - CMS

Ive done medical surveys, went to dinners and various other things and so far not in there. I think its pretty hit or miss. I doubt most patients check it or care. Probably the ones that care are the annoying ones anyways, lol.

The outside perception of reps is so off base. They really dont influence my prescribing, I still do whatever I want. Some of them i never prescribe their antipsychotic but they still bring lunch, lol.

Besides, they're useful for samples. I can someone on abilify maintenna for example, while the PA is in the works, so they dont have to wait. Same with ingrezza.

 

[Merovinge]

I do the opposite. Reps allowed as long as they buy lunch/dinner for ALL of my staff. I choose the restaurant. Staff get appreciated at no cost to me.

Yup, if you buy the staff food at a top place in town I will anti-actively listen to whatever you have to say. Surgery staff got preposterous stuff from the device reps, we need to give some love to our mental health staff.

 

[Merovinge]

Ive done medical surveys, went to dinners and various other things and so far not in there. I think its pretty hit or miss. I doubt most patients check it or care. Probably the ones that care are the annoying ones anyways, lol.

The outside perception of reps is so off base. They really dont influence my prescribing, I still do whatever I want. Some of them i never prescribe their antipsychotic but they still bring lunch, lol.

Interesting, I show up on mine and I've never went to a psychiatry one, but I sure went with my wife to her dinners and they listed on that site.

 

[deleted1100659]

Interesting, I show up on mine and I've never went to a psychiatry one, but I sure went with my wife to her dinners and they listed on that site.

Yeah I really think its luck of draw, lol. I just think its funny. Sure there may be some corrupt doctors out there, but im not about to completely shift my prescribing habits because an old white guy in a suit buys me a nice meal, lol.

 

[tr]

Yeah I really think its luck of draw, lol. I just think its funny. Sure there may be some corrupt doctors out there, but im not about to completely shift my prescribing habits because an old white guy in a suit buys me a nice meal, lol.

Go ahead and believe you're the exception. Everyone else thinks they are too:

"The majority of the physicians do not believe that they are affected by PSR interactions.1 10 32 33 35 37 43 59 However, a sizeable percentage in various surveys responded in the affirmative when asked whether they thought that their peers are vulnerable"

https://bmjopen.bmj.com/content/bmjopen/7/9/e016408.full.pdf

 

[TexasPhysician]

But then you show up at Home | Open Payments Data - CMS

How does that effect anyone?

 

[calvnandhobbs68]

Go ahead and believe you're the exception. Everyone else thinks they are too:

"The majority of the physicians do not believe that they are affected by PSR interactions.1 10 32 33 35 37 43 59 However, a sizeable percentage in various surveys responded in the affirmative when asked whether they thought that their peers are vulnerable"

https://bmjopen.bmj.com/content/bmjopen/7/9/e016408.full.pdf

Yeah if they weren't cost effective you'd bet your ass the pharm company would stop sending them around. it's the same idea that everyone thinks advertising doesn't influence their buying patterns when it clearly does. I mean come on, you're a psychiatrist....

 

[deleted1100659]

Yeah if they weren't cost effective you'd bet your ass the pharm company would stop sending them around. it's the same idea that everyone thinks advertising doesn't influence their buying patterns when it clearly does. I mean come on, you're a psychiatrist....

Well i suppose it comes down to in what way were talking about influence.

For me the only part that it plays is that most of my patients have no income. So if I have free samples of a medication that has an amazing patient support program (these drug companies will happily eat the cost if it means exposure) then sure I might put them on the drug. I don't do it because a drug rep asks me to, I do it because this way I know the patient gets a well tolerated medication for free and I can treat them. The trintellix and vraylar patient support programs are amazing and ive been able to ensure patients get treatment this way by enrolling them in these. Where I work, we utilize patient support programs very, very frequently.

I only care about how I can get a patient the medication long term and ensure they get a treatment that is sustainable and well tolerated. For stuff like that, these people are useful to me and my patient population.

From a logic standpoint, I dont think any self respecting psychiatrist would significantly change what they prescribe unless it was in the patient's best interest.

 

[futureapppsy2]

Yeah if they weren't cost effective you'd bet your ass the pharm company would stop sending them around. it's the same idea that everyone thinks advertising doesn't influence their buying patterns when it clearly does. I mean come on, you're a psychiatrist....

Right? It’s a bit ridiculous to say that someone buying you an expensive free lunch (or multiple free lunches, etc) while repping a specific drug isn’t going to have some influence on your cognitive/affective associations that drug versus an alternative come prescribing time.

 

[deleted1100659]

Right? It’s a bit ridiculous to say that someone buying you an expensive free lunch (or multiple free lunches, etc) while repping a specific drug isn’t going to have some influence on your cognitive/affective associations that drug versus an alternative come prescribing time.

I have reps come in consistently for medications that I never use. Again, its about access. If a rep can get my bipolar or schizophrenic patient who has virtually no money, access to an SGA with a good side effect profile and they can stay on it for free long term then its hard to argue with that. In the community setting that im in, if something is >10 dollars a month then its basically useless for probably 1/3 of my patients. At the end of the day efficacy wise, SGAs for example, are fairly comparable for psychosis with the exception of zyprexa and clozapine, so it comes down to cost/side effect profile/interactions.

I mean I understand your opinion on it, but to be honest I find most of the drug reps particulary annoying and for my setting just a necessary evil to deal with. The ingrezza rep seems to be fine here, but again, he doesn't have to be pushy as he only has one competitor, and austedo is dosed BID and requires titration, and compliance is a huge issue for some of my sicker patients.

 

[TexasPhysician]

It certainly works, but I think the primary component is educating me on the coupon, discounts, or samples program. I’m not going to Rx a product that wastes my time due to no one affording it, PA’s, etc. Rarely does any other info impact my prescribing.