It's funny with all the changes in health care and the implications of AdvaMed, you think that all doctors would try to be ethical in their dealings with sales reps. WRONG! There are still doctors out there who think the rules don't apply to them, and they will ask you do something unethical in order to win their business. These are the health care professionals whom I refer to as a Dr. Shady. They are older, usually have been given a lot of free shit by pharma reps, medical device reps, manufacturer reps, and they expect the "gravy train" to keep on chugging along. They kinda make me sick.
First of all, these assholes already make a lot of money, but they also have these little scary "side businesses" that they deal in, like they own a home health agency, or a nursing home. Dr. Shady always knows how to best work the Medicare system to his/her advantage, and they take full advantage of the perks provided by Medicare. In fact, they actively find the loops in the system and work them for more money. I once had a Dr. Shady who kept applying the same skin graph to a patient because he made money on the reimbursement for not only the procedure but the product itself. He even had his office manager set up a fake Durable Medical Equipment company so he could sell products to his patients. Dr. Shady is what someone might call "sketchy". In other words, everything he does walks a fine line between legal and illegal, and most of the time his work falls on the unethical side of the health care professional conduct line.
Dr. Shady has many of the following characteristics:
- He/she works in the ghetto but lives in Beverly Hills, because the rent is lower, and the patients don't complain, or in some cases they can't complain because they are illegal immigrants.
- He/she always asks for free samples. Even when they have a closet full of shit.
- If you offer a free lunch for an in service with his/her staff, he/she will never say "no". He/she is cheap and won't buy his/her staff lunch, but if you buy them lunch guaranteed he/she will take the credit for it.
- Dr Shady will always ask for a dinner for the staff and their spouses on you. Even though it's not an educational dinner and it's against AdvaMed guidelines to pay for it, Dr. Shady will respond, "Well the other rep from your competitor offered to do one, but I guess it's up to you."
- Dr. Shady is always being paid "under the table" for something. Whether it's to order products from a certain manufacturer, to testify in court as an expert witness, or send patients to a particular nursing home or home health agency. Kickbacks are routine for Dr. Shady.
- For some reason they even look a bit disheveled, as if they just rolled out of bed. Most male versions of Dr. Shady traditionally sport the Albert Einstein haircut, or a greasy haired almost vampire look for some others. One of my docs, looked like he was going to drain your blood, instead of treat you.
- They respond well to gifts, even though you're not supposed to provide any gifts except educational ones. Still they expect something.
- Dr. Shady will always look with fond memories of the old days when they consistently received free stuff.
- Dr. Shady will never give you a straight answer.
- Dr. Shady is cheap, cheap, cheap. He/she would ask a homeless person for money.
A couple years back, I went into one of the largest clinics in East Los Angeles to work with a doctor who previously had ordered a lot of my company's product. The orders had slowed down considerably when I was assigned to the territory. I did an in service, meaning I demonstrated our product, fed the staff lunch and the doctor never once observed the in service. Instead he came by after I was finished and decided to grab some food. I saw that as an opportunity to try and find out why the orders had dried up.
"Hi Dr. Freebie. I haven't met you yet, I'm M, and I'm the new rep in the territory.", I said and extended my hand for him to shake.
"Hello M. Please to meet you, don't my the bandage on my hand, just a mild case of scurvy.", he said and he shook my hand. I laughed because I thought he was joking about the scurvy.
"You're not serious are you? Scurvy?" I could see he was not laughing,and looked very serious. But who get's scurvy? I only heard of someone getting scurvy on boat trips or treks across Antarctica. How the hell does a doctor get scurvy?
" I don't understand. What's so funny? You never met anyone with scurvy before? "
" I apologize doctor if I insulted you, but no I haven't met anyone with scurvy before. I'm sorry."
" Well I just don't like fruit and I've always had this vitamin C deficiency ever since I was a kid. "
" Really, I'm sorry to hear that. I hope it's not too bad.", I muttered, feeling embarrassed and wishing I could leave the office at that moment.
" It's not that bad really. And it's not scurvy, I was just messing with you. I cut my hand in the kitchen last week washing a wine glass. It broke in my hand." he said loudly and was laughing the whole time. "Man you are gullible. Who the hell get's scurvy nowadays? Who am I? Earnest Shackleton?" He got a big kick out of that joke. I however didn't really like the joke too much since it was on me.
"Good one doc. Very funny.", I said, and I chuckled a bit.
"Man I can't believe you fell for that! That was really funny. Well, thanks for coming in and buying my girls lunch. I really appreciate it."
" No problem. Happy to oblige. I noticed that you didn't catch any of my presentation. Did you want me to go over some stuff with you?"
" No. I order a lot of your product. I know what it does for my patients. It's very good stuff, and the reimbursement is a amazing."
" Oh so you like it. Well that's good. And I noticed you DID order a lot of my product. But you don't anymore why's that Doc?"
" It must be the other docs on my staff who aren't ordering. Maybe you should do another in service for just the other doctors on my staff."
I saw this as viable opportunity and I was excited. All I had to do was in service his other doctors and soon the order would start rolling in for me. I jumped at the chance to answer him, "Really? I would love to do an in service for the other doctors. When do you think we can do it?"
" How about next Friday? At Ruth's Chris Steak House? I'll have the docs come and bring their spouses. What do you say?", he said and then smiled. A big, toothy, all knowing smile. As if to say, "Yes I just asked you to do something illegal. So what?"
"Doctor, I'm afraid I can't do that. Isn't it against AdvaMed guidelines?"
"Did you see that pretty rep from Eli Lilly who just left?"
" Yes I did.", and I did notice her right away. She was like a lot of new pharma reps; young, attractive, flirtatious, and wearing a skirt that was so tight she could barely move her legs to walk in her 6 inch heels. She even flirted with me on several occasions, just to see if I was her competition, which I wasn't. Thank god.
"She did one for me last week. We didn't have any issues. We do it all the time. I can have 6 doctors there with their spouses and it'll take just a few hours. I'll pay for half the drinks."
Now he was throwing alcohol into the mix, which is also against AdvaMed guidelines. I was not about to go down that road with him.
"I can't do that unless I have a guest speaker which I don't have at the moment, and I definitely can't pay for everyone's spouse. I would get fired."
"Oh please. You ARE a new rep. Everyone does it. Well if you want those docs to order then you might want to think about it. You got any samples for me today, or are we done here?", now he most definitely was pissed. I suppose I had insulted his character, or really the lack of character he displayed.
" I have a few samples for you which I need you to just sign for and then I'm out of here. Sorry to waste your time."
" It wasn't a waste of time. My staff got a free lunch. Thanks for the samples, and have a good day.", he said flippantly, and then walked away down the hallway and disappeared into one of the rooms.
I had a feeling that was the last time I would be doing an in service for Dr. Freebie and his staff. And I was right, he never took my calls, never allowed another in service, and basically stopped ordering our product altogether. At first I thought to myself that I had blown a huge opportunity, and I should have taken him up on his offer. I was pretty distraught about the whole thing. It was one of the largest clinics in my territory, and they weren't ordering my product. It looked bad on my resume. In fact I was so distraught I called my boss to ask for his advice.
"Hey Tim. Listen I need your advice about one of my accounts. He used to order a lot from us, but now he doesn't order at all. I think I pissed him off."
" What doc?"
"Dr. Freebie. He used to order a lot of product and then the orders went down, so I went to see him and now the well is dry. No orders."
"Let me guess. You met with him, he asked for a dinner for him and his docs and you turned him down. Am I right?"
" Yeah, that's right. He was asking for all this questionable shit. How did you know?"
" The reason you're in that position M is because the last rep didn't turn him down, and got their ass fired. So you did the right thing. Fuck that guy. There's plenty of doctors out there who don't ask for free stuff. Focus on them and you'll be fine."
Sound advice from a good manager. Refuse Dr. Shady and he'll/she'll be annoyed, but oblige their requests and you'll be unemployed. Have a great day selling!
-M
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