Getting face time with busy physicians is becoming harder for pharma reps every year. The fraction of doctors open to meet reps fell nearly 20% last year—to 58% from 71%—while inaccessible doctors now account for 9% of the total, up from 6% last year—a 50% increase.

The findings come from ZS Associates’ AccessMonitor report, which monitors rep-related interactions of more than 500,000 physicians, NPs and other prescribers nationwide and tracks both the planned and completed details of about half the nation’s sales reps (more than 41,000).

Even docs who were open to seeing some reps became more selective. That trend made some 8 million planned sales calls nearly impossible to complete. Companies are requiring reps to call on prescribers who either refuse to see any sales people at all or refuse to see reps as often as management wants them to, and it’s costing pharma more than $1 billion per year.