When Dr. Joanna Haight was a medical student at the Saint Louis University School of Medicine, she often sat in on educational lunch talks coordinated by the school. At one of them, a company discussed an anesthesiology drug that wasn’t used at her institution. The presentation was data-intensive and interactive, explaining how it differed from existing products on the market without applying much in the way of pressure.
“Most of us had an open mind because we knew it was widely used at other institutions,” Haight recalls. “But the way they did it, positive and data-driven, really appealed to me.”
Haight, 28, is a resident physician at California Pacific Medical Center and will be starting her anesthesiology rotation at the University of California, San Francisco, this year. She’s half-Caucasian and half-Filipino, speaks three languages, is active on social media and has volunteered at medical institutions since her college years.
While her peers may not be as accomplished professionally, they are similarly diverse in terms of gender and ethnicity — and similarly turned off by the harder-sell tactics marketers have long used to engage with them.
“There’s certainly a playbook of very effective pharmaceutical and device marketing from decades ago, but the ecosystem has changed,” says Dr. Brian Powers, a resident physician in internal medicine at Brigham and Women’s Hospital in Boston, as well as director, population health strategy and analytics at CareMore. “The standard marketing playbook of quote-unquote understanding the needs of your customers — I don’t know if that still exists. A lot of physicians are developing antibodies around certain strategies and buzzwords, like ‘disruption.’”
Dr. Elaine Besancon Goodman, medical director at Massachusetts General Hospital and associate chief medical officer at digital health management firm Wellframe, agrees that the appeals coming her way sometimes appear to be relics from an earlier era. “Things that feel really explicit about selling something or getting on formulary on my clinic — that’s a waste of everyone’s time. It’s so easy to send someone an email now that we all just get inundated. None of them really feel like they’re for me; there’s no reason why you should pay attention to any one of them.”
Behold the changing face and preferences of the American physician. HCPs such as Haight, Powers and Goodman sit at the vanguard of the most profound shift in HCP demographic makeup in the history of American medicine. Yesterday’s doctor was demographically homogeneous: A white male physician, most comfortable with paper, phones and one-way conversations. However, today’s HCP is more diverse in any number of ways. To begin with, women outnumber men. According to the Association of American Medical Colleges (AAMC), 36% of the physician workforce in 2015 were women, up from 22.8% in 2000 and 17% in 1990.
That trend is likely to continue. Per Publicis Health, 60% of physicians younger than 35 are women. For the 2018-2019 academic year, the AAMC notes that women applicants to U.S. medical schools exceeded men by a 51% to 49% margin. In 1980, men comprised 71% of applicants and women comprised 29%.
The amount of racial and ethnic diversity has similarly surged, with the number of minority physicians increasing 5.2% between 2008 and 2018, according to Publicis Health. Through July 2019, the AAMC reports that 56.2% of active physicians identify as white, with 17.1% identifying as Asian, 5.8% as Hispanic and 5.0% as black or African-American. In 2010, 75% of physicians identified as white.
In certain corners, these demographic shifts have been downplayed or dismissed entirely. A doctor is a doctor, right? Isn’t accounting for differences between, say, primary-care physicians and oncologists more important to marketers?
No and no. When patients are given a choice, they’re more likely to choose an HCP who more closely resembles them in terms of racial, ethnic or cultural background, according to data compiled by the Health Professionals For Diversity coalition. Similarly, the organization notes that those who are treated by physicians with a similar background to their own report higher satisfaction levels with the quality of their care.
It’s not just physician demography that’s evolving. Today’s HCP is as likely to be a registered nurse, physician’s assistant or nurse practitioner as a physician proper. In terms of media consumption habits, she’s a digital native who’s fluent across channels and devices.
Why does it matter if the HCPs of today and tomorrow are so digitally focused? Because younger patients are basing their care choices in large part on digital facility. According to Publicis Health, millennials are more likely than their baby boomer forbears to select HCPs who provide electronic prescription refills (42% of millennials vs. 30% of boomers), online access to test results (44% vs. 29%) and online appointment management (40% vs. 19%).
Meanwhile, as has been well documented, HCPs have more on their plates than they once did. Publicis Health adds that the overall degree of frustration has intensified: A whopping 89% of millennial physicians say they don’t spend enough time with their patients. While patient care has always been and will always be their primary responsibility, it’s safe to assume that earlier generations of physicians didn’t devote much time or energy to, say, online reputation management.
This generation’s HCPs don’t have much of a choice, given that 37% of patients say they’ve avoided a physician based on a negative online review, per Publicis Health. And that’s before social media, and all the emotional and intellectual energy it too often saps, enters the mix: More than 40% of consumers report that information gleaned from social media influences how they manage their health, meaning that HCPs cannot tune it out entirely.
As if all this isn’t enough to digest, there’s evidence that, before too long, the U.S. healthcare system will be strained even further by a lack of physicians. Last April, the AAMC reported that, by 2032, the country could see a shortfall of anywhere between 46,900 and 121,900 doctors. That’s in addition to current physician deficits in certain rural geographies and practice areas (notably primary care).
So where does this leave marketers attempting to connect with and influence this new wave of HCPs? Based on conversations with a host of young physicians, they need to fundamentally rethink their tactics and investments.
“I laugh when I see so many of the commercials on TV and ads in magazines, because the patients are so dissimilar to what we see in the hospital,” Haight says. “Lots of my mail goes straight into the recycling bin. Anything that’s not evidence-based is inherently not credible.”
The traditional rep model of HCP engagement isn’t likely to go the way of the manatee as a result of these demographic and generational shifts, but it is likely to evolve into something that would be unrecognizable to the brand managers who deployed sales armies in decades past. Couple this with the trend toward limiting rep access to physicians, especially in hospital settings, and the use of old-school tactics will continue to generate shrinking returns.
That doesn’t mean marketers should abandon those tactics altogether. Rather than the usual rep brigade, brand team leaders may instead choose to deploy them more strategically — fewer reps, trained in a manner to facilitate more meaningful HCP encounters.
As it stands, today’s physicians seem almost inured to those encounters, increasingly infrequent as they are. “You get a lot of, ‘Hey, can I just get a couple minutes of your time?’ without any context, and obviously you can’t say yes to all of those,” Goodman says. “It’s not like anybody is sitting around thinking, ‘Oh, I was looking for something to do with my eight free minutes today.’”
There’s a way to render them more useful — and, dare we say, pleasant — to younger HCPs. Razorfish Health president David Paragamian believes the key lies in a more minimalist approach, one that acknowledges both the time constraints under which physicians operate and the digital facility that defines the way they interact with the world.
“We live in an era of show-me-don’t-tell-me,” he explains. “The core visual aid a rep is carrying may be a 10-minute mechanism-of-action video, which may be a beautiful piece of filmmaking and medically correct. The problem is that there are very few scenarios in the real world where a rep can open it up in the hallway and watch the whole thing with a physician at their side. These encounters have to happen at the speed of TikTok.”
Dr. Russell Kerbel, an attending academic hospitalist in the UCLA Health system, deals with few rep visits owing to the type of organization for which he works. That said, he doesn’t believe today’s younger HCPs are eager to return to the quid pro quo of free lunches and promotional tchotchkes.
“We end up interacting with those reps at professional society meetings. I get my dose of marketers there, when they are the sponsors,” he explains. “But them showing up at my place of work? The times have changed. It would surprise [the younger generation] if those rules got reversed to what they were.”
This thinking holds for nonpersonal promotion and medical education, as well. The days of the traditional 20- to 30-minute KOL testimonial video are numbered, with younger physicians eschewing blocky content in favor of patient testimonials and other interactive materials that simultaneously engage and inform.
“There’s still a little of what we internally refer to as an ‘Internet 1.0’ approach here,” says Dr. Amit Phull, VP of strategy and insights at HCP community hub Doximity. “Some companies still take something older and traditional and port it over to mobile or wherever they think HCPs want to see it. The bigger wins won’t occur until folks begin to better understand the new paradigm and develop material specifically for that paradigm. You can repurpose an email, but the real opportunity comes when you start from scratch.”
Another potential opportunity comes in the form of communications in and around the electronic health record (EHR). Kerbel enthuses about the potential of a new, secure chat portal within his organization’s EHR system that enables him to communicate in real time with RNs. At the same time, he cautions marketers not to conflate enthusiasm about a single, isolated EHR communication feature with tacit acceptance of all kinds of EHR messaging.
“If it’s presented like ‘marketing in EHRs,’ I think that would upset a lot of physicians,” Kerbel says. “Our EHRs are, as of right now, somewhat distraction-free. We get a lot of alerts, but those are mostly clinical notifications. Maybe best-practice advisories can be built out within them.”
As for what comes next, younger HCPs appear wary about privacy, especially given how many of them have lived the entirety of their lives during the Internet era. While reps have always attempted to connect on a personal level with their targets, Kerbel wonders if marketers will pull information from social media feeds and use it to create instant familiarity.
“I would imagine that our digital footprints are probably being accessed by marketers,” he says plainly. “We’ll probably be pinpointed in a more AI-type way in the future. That feels like an inevitability, for better or worse, though some of it may be more subtle than others.”
Goodman, on the other hand, senses a renewed degree of effort from the companies and brands attempting to appeal to her. “They’re certainly trying to adapt the channels they’re using,” she says. At the same time, she’d like to see more content that acknowledges how the profession itself has evolved over time.
“In addition to the complexity of medicine and EHRs and everything else, a lot of doctors are in two-career families,” she continues. “How you manage burnout is the reality for physicians now, especially the younger cohort. ‘Let me help you with burnout and anxiety, and also tell you a little about this product’ — maybe you build that into the way you’re marketing things.”
And Haight also sees generational evolution in marketing on the immediate horizon. “The idea of ‘this is what a physician is supposed to be like and look like’ — I suspect that will change,” she says. “I could definitely see social media being used a lot more. As physicians change in terms of demographics, the way marketers use technology is going to change as well.”