A notable power struggle is playing out in hospital operating rooms across the country. As surgeons begin to perform elective procedures again, they aren’t always pleased about who’s writing the safety rules tied to expanding O.R. volume.

“In our interactions with our advisory boards and various societies, I’ve heard repeated comments from surgeons in particular with whom I interact, that the infectious-disease guys are getting their heyday to rule the roost,” said Kurt Hudson, global portfolio leader, surgical site management, at med-tech giant 3M.

“Historically, in the world of the O.R., the I.D. doc doesn’t tell the surgeon what to do,” he added. “You would hear this frustration being expressed by them in a lot of different ways.” 

That tension between physician groups is one reason why commercial execs fear hospitals may be reluctant to loosen restrictions on reps’ in-person access to doctors, even as they open their doors to more surgeries.

From 2019 to 2020, the volume of surgical procedures declined by 11.3 million, or 12%, due to postponement or cancellation of elective procedures (or because of attrition, given the virus’ massive death toll). The backlog is expected to push volume up by 28% in 2021, according to a projection from research firm Life Science Intelligence (LSI). That represents nearly 22.5 million more procedures. 

Meanwhile, just as it poured fuel on a whole host of other industry dynamics, the pandemic caused many medical facilities to tighten existing limits on industry contact, or to erect new guardrails around their clinicians. 

“COVID-19 gave institutions a reason not to let reps in,” said Marcus Girolamo, VP of marketing/business development for wound care product maker Urgo Medical. “People assume this is happening as a result of pandemic-related safety concerns. In many ways, accounts have been waiting for the opportunity to kick people out.” 

On one hand, device and diagnostics firms have been grappling with the phenomenon of “no-see” doctors – those who are inaccessible, either by dint of institutional policy or personal preference – for at least the past decade. On the other, industry had traditionally enjoyed a strong relationship with surgical customers. Clinicians and reps often work in tandem to the point that, in certain product categories, med-tech reps are considered an extension of the surgical team itself. Similarly, on-site industry support is often championed by department heads.

But marketers say COVID has driven a wedge between the parties. “Just because there is a strong internal advocate and champion doesn’t mean hospital administration goes, ‘Sure, come on in,’”’ Hudson quipped. “I’ve heard this repeatedly.”

That’s proven a jarring new reality, especially since med-tech marketers are more dependent on the in-person visit than their biopharma cousins. In the pharma marketing world, Zoom-based meetings and digital marketing picked up much of the slack when reps were shut out of doctors’ offices last year. 

“Drug companies, in many cases, can get their message across through virtual information. You’re not physically needing to use the product, if you will,” said Hudson. “That’s certainly not the case in med-tech.”

To wit: In the three months prior to December, pharma reps’ ratio of virtual to face-to-face was about 60/40. In December, it flipped to 40/60, according to data from ZS, which tracks rep access primarily among pharma companies (but not among med-tech firms). 

That said, the pandemic hasn’t necessarily ground all med-tech access to a halt. “We started meeting with customers in coffee shops and in hospital parking lots,” said Hudson. “Reps realized, ‘I can still engage with doctors. I can’t go into the hospital, but how do I keep that value connection?’”

Hudson said 3M set up global, quick-response “tiger teams” with commercial units around the world to enable service and interaction with its customer bases. Some were affected more than others, because last spring’s surgical hiatus cut differently depending on procedure. 

LSI data project that aesthetic, dermatologic, plastic and general surgery volumes will ultimately take the biggest hit from the pandemic, given the large percentage of those procedures which are elective. Orthopedic, spine and ENT surgeries were also forecast to see major declines in 2020, followed by a strong rebound in 2021.

“Where those procedures were deemed as non-essential, when they started up again those reps were back in the O.R. and never missed a beat,” Girolamo said of spine and orthopedic reps. 

Basically, the more essential a product is to a therapeutic area, the better shot that the rep can maintain access. It depends to a large extent on how much the medical team values an organization.

“It’s not always just a binary division,” Girolamo explained. “Sometimes you’re simply in or out, but essentiality to that therapeutic area or procedure warrants your ability to access.”

Furthermore, he added, there are “lots of shades of gray.” Girolamo also noted that longer-tenured reps performed better during the pandemic owing in large part to their relationships.

In other cases, the pandemic changed how the device and diagnostics industry engages doctors. That’s because med-tech marketers’ big three fallback promotional channels – the sales force, trade shows and product marketing – lost their edge in 2020. 

“If you’re still banging on those three channels, you better be thinking about other ways to get your messages on target, because I don’t know if the value of those channels will ever be the same,” Girolamo said.

The solution, he believes, is for the sales model to evolve, which is very challenging for a business that’s so heavily relationship-based. There’s no such thing as “the new normal,” Girolamo continued, given that COVID didn’t create anything new. Rather, it merely accelerated what was already happening in the marketplace. 

But med-tech companies, not unlike their biopharma brethren, have become a lot more adept at conducting business through remote web conferencing and phone calls. “We’ve found we’re more productive than we would have assumed going in,” Girolamo said.

He expects the pendulum to swing back to face-to-face somewhat, particularly early on in the recovery, because people are so eager to be in front of each other again. But ultimately, marketing “will settle into a mixed approach, especially for the institutions – hospitals, outpatient departments – where there’s an expectation that you’re there maybe not as often but present in a digital way because it’s more efficient.”

The expectation is that the backlog of elective surgeries will start taking place in the second quarter, and that hospitals will need more than a little time to recoup the billions of dollars in losses suffered due to the 2020 lockdowns. During that adjustment period, reps may or may not be welcomed back into the surgical suite.

Hudson said he foresees continued struggles for sales organizations “We all knew how to show up at a congress and how to be effective there from a promotional and engagement perspective,” he explained. “Now we’re moving that stuff to virtual and guessing, ‘How can we be effective in this format?’” 

That represents an adjustment – and it probably has something to do with why it took a global pandemic to force the industry’s promotional hand. 

“Post-pandemic, a lot of walls will continue to be put up around access,” Hudson added. “It was already a trend and that trend was accelerated. And I don’t think it will be put back to the old way of doing things as vaccines continue to be distributed and as we start to see the spread and threat level drop. All of that is certainly going to get doors open, but it won’t be business as usual – at least we don’t anticipate it.”