As they make their way back into doctor’s offices, drugmakers are increasingly recognizing the impact of the COVID-19 pandemic on the healthcare workforce. Among other steps, pharma companies are coaching sales reps to pitch with empathy and recalibrating incentives to account for clinicians’ emotional state.
The higher level of sensitivity to doctors’ needs is a departure for sales forces used to touting their products’ superior scientific attributes.
“We have to do it tastefully,” said Darrell Wakefield, a VP at Sanofi Genzyme who heads up commercial operations for Jevtana, an established brand for mCRPC. He’s also leading the charge for two late-stage oncology meds poised to reach the market in 2022 and 2024.
Of the scenario in which physicians return to seeing non-COVID patients – but in a very different state of mind than they were pre-pandemic – Wakefield stressed the need for sensitivity.
“We can’t assume things are back to normal,” he explained. “Never before have we had to take into account what doctors are up against. We just assumed they were partners who drove business for us. But they were just on the front lines of a major war.”
That warlike experience, Wakefield believes, dictates a more respectful approach. As he attempts to build momentum and morale among his rep teams, such hardcore sales tactics as calling on a doctor 13 times per year “need to be more balanced,” he said. Sanofi Genzyme is simultaneously looking to adjust rep incentives and sales quotas in COVID’s wake.
“If a rep can’t get in to see a customer, it’s not fair to keep that expectation the same,” Wakefield said.
Rejiggering the call plan to account for doctors’ fragile emotional states could be a touchy issue, given Wall Street’s typically relentless expectations for big pharma company performance. However, there’s no doubt the clinician’s mental state has changed.
According to a recent study that measured the psychological state of physicians, support staff, nurses and EMTs, one in three healthcare workers is battling depression and more than 73% report feeling negative about their mental state because of the pandemic. Researchers found anxiety, depression and a sense of loss were common among all groups.
The researchers also found that, due to COVID’s impact on their lives and their practice of medicine, physicians are 1.8 times angrier than the general population. In that regard, doctors were just ahead of the overall healthcare workforce, which is 1.6 times angrier.
Findings from the study, “Voices of Healthcare Heroes,” have profound implications for pharma, according to Lili Gil Valletta, CEO and co-founder of CIEN+ and CulturIntel, which conducted the research by mining about 49 million open-source conversations on the web from March 2020 to March 2021.
“We’re used to seeing HCPs as a gateway to influence the patient,” she said. “All of this data forces us as pharma marketers to rethink the role of the HCP as a provider and as a patient herself. That is a different paradigm.”
Physician burnout had been rampant before the coronavirus pandemic. The crisis poured fuel on the fire of clinician distress.
“About 50% of physicians are suffering from some form of burnout,” said Steven Nelson, CEO of Illinois-based multispecialty physician group DuPage Medical Group. “It’s this mental and physical place you get to where you say, ‘I’m working as hard as I can and I’m not seeing a lull or a light at the end of the tunnel. And I’ve forgotten what I’m doing and why I’m here.’”
There are multiple contributors to that sense of hopelessness. In addition to the physically and mentally grueling work itself, physicians bear the brunt of the challenges of providing care in a fragmented healthcare system. By the time they reach mid-career, many discover that their experiences don’t match up with the expectations they had at the start of medical school.
“I have a lot of conversations with doctors who say, ‘I started thinking one thing and now 10, 15 or 20 years out, it’s not really what I was expecting,’” said Nelson. “That dissonance contributes to it as well.”
Burnout wasn’t something clinicians were conditioned to talk about. That stigma is lifting.
“When you say, ‘I have anxiety,’ that’s risky. People go to doctors because doctors are confident,” Dr. Jonathan Fisher, a cardiologist who has struggled with depression and the founder of August’s inaugural Ending Physician Burnout Summit, told MM+M.
Doctors’ declining mental state is but one area of fallout from the pandemic. Drugmakers must also take into account the implications for patients who delayed treatments and their ability to afford medications.
Pharma support services, including ones related to affordability, are seen as more helpful to doctors than they were pre-pandemic, according to an Accenture study from May 2020. But the consultancy found that companies are missing the mark: 58% of HCPs agreed that at least one pharma company has “spammed” them with digital content during COVID-19.
The industry is also struggling to remain relevant. Fifty-seven percent of HCPs said pharma sales reps fail to understand the real impact of COVID-19 on them, Accenture noted.
All of this dictates a different value proposition. “Eighteen months into the new norm, there’s getting to be burnout, both from a physician and a corporate standpoint,” acknowledged Paul Murasko, head of North American digital customer interaction for Ipsen Pharma. “We have to find what that right mix is going forward.”
A number of factors have influenced pharma to shift its mode of engagement. First, there’s the access barrier, driven by the trend of doctors joining institutions and group practices. ZS, which has tracked accessibility over time, showed the overall rate slipping from 55% in 2012 down to a low of 7% in 2020 and back up to 40% so far this year. Oncology is among the most access-restricted specialties, with only 21% of doctors open to rep visits.
Even if they weren’t on the “inaccessible” list, many doctors had already expressed a distaste for in-person rep interactions. Calls have grown for more of an on-demand mode combining face-to-face and digital contact.
According to the Accenture study, 87% of physicians prefer a mix of digital and in-person engagement. Only 10% pined for a return to the pre-pandemic days when biopharma sales forces leaned on in-person meetings with doctors.
COVID-19 itself has been a tremendous digital accelerator for pharma. The industry was forced to engage virtually when face-to-face contact was impossible due to health system closures and lockdowns.
Then there’s the prevailing demographic trend. According to Murasko, the next generation of specialists is increasingly comfortable with, “‘Hey, I’ll see you when I need to see you, but otherwise just let me know what the links are and I’ll get the information.’”
Pharma is adopting, but it must continue to do so with great care. Gil Valletta believes there are three “non-negotiables” for anyone considering a drug launch.
The first involves social determinants of health. “You need to make sure you’re layering an understanding or asking yourself, ‘Are there are any social determinants getting in the way of my new drug reaching its full promise?’” she explained.
Gil Valletta adds that commercial strategists should ask, “How do my reps show up with my new therapy or treatment with an empathetic pitch, so I’m not just selling you on the greatness of the science?”
If a lack of coping mechanisms is one contributor to burnout, then Gil Valletta suggests meeting it head-on with resources and support. Reps should come armed with tips to make the clinician’s life easier – “a pitch wrapped with empathy and value” is how she characterizes it.
“I’ve talked to a lot of sales teams about this,” she said. “Empathy is free. It’s how you show up.”
Finally, as the industry learned while trying to jumpstart COVID vaccination rates among the vaccine-hesitant, there is a large trust issue in diverse communities. Healthcare institutions are not always the best messengers in public health campaigns.
Just as industry displayed a new willingness to engage with nontraditional partners for COVID education – such as faith-based communities – companies would do well to practice a similar form of inclusion going forward, or at least be more open to it.
“How do I leverage other trusted voices to be bearers of my message when I launch my product?” Gil Valletta said, noting that local advocacy organizations or public health experts can serve as endorsers. “When they are part of my messaging from the bottom up, I gain that trust.”
As COVID-19 vaccines become available throughout the country, pharma companies have slowly returned to in-person selling. In January, life science companies started approximately 660,000 virtual meetings, according to Veeva Systems. In September, the number of such meetings had dropped to 530,000.
But it’s not business as usual in those interactions. Industry is on the cusp of discovering a new norm in HCP engagement, and it seems to include a move away from the old, rep-driven “push” model.
“No one should throw rep interaction out of the plan,” Murasko stressed. “But how reps engage, when they engage and by what channel, be it live or a video call or email, has to be put into the equation.”
Along with rethinking modes of engagement, companies have started to factor in the unprecedented human toll of the pandemic.
Wakefield said that “partnership” has become an overused term to camouflage attempts to deliver one’s own agenda. But for sales teams he’s managed throughout the pandemic, partnership focuses on, “‘What needs do you have that I can help you with, Dr. Jones?’”
That can include automated sampling portals, patient access assistance and medical-information chatbots. The latter are getting better at leveraging AI, machine learning and natural language processing to interpret doctors’ questions and provide highly specific responses.
As a result, companies need “to make sure what’s at the forefront is our ability to help minimize the pandemic’s impact on [providers],” Wakefield continued. “We are definitely coaching our reps to acknowledge what the healthcare field is going through and to be super-empathetic, because it’s a trying time for all of us.”