How to chase unicorns
Back in the late ‘90s and early 2000s, pharmaceutical representatives with hospital accounts were considered “specialty” representatives and had responsibilities for talking to medical students, residents, fellows, attendings, nurses and hospital pharmacists about products and diseases states. When I was a pharma rep, I would spend an entire day at one hospital attending journal clubs, grand rounds and doing inservices for my customers.
I remember the day when I heard about a doctor that only worked on the floors and only treated inpatients – he was called a hospitalist and I eagerly spread the word to my manager and my teammates about this new concept (likely from a pay phone!). I left information in his staff mailbox several times, but never heard from him. I spent three years in that job and never once met him or any others like him.
It’s been almost fifteen years since then and hospitalists now represent the fastest growing medical specialty in the United States. There are now more than 40,000. They would seem a likely target for pharmaceutical companies who either have a hospital product or who realize that patients started on a medication in the hospital will likely refill it at an outpatient pharmacy. In fact, prescriptions that begin in the hospital and then spill over to the retail channel can have a four-fold multiplier effect at pharmacies. Ten to seventeen percent (10 percent to 17 percent) of all outpatient prescriptions written by IM/FPs come from hospitalists upon discharge. Certain medical devices and diagnostics might also find receptive audiences among hospitalists. Most hospitalists are internal medicine, but some are family practice, pediatric, ob-gyn, neurology, and ICU hospitalists. The practice model is the same, but they are in different settings or different units of the hospital.
Despite the growth of the specialty, there are still boundaries to accessing this potential customer base. First, pharmaceutical marketers do not have the same type of prescription data about hospitalists that they do with other specialties like cardiology or infectious disease. These other specialties spend some of their time seeing hospitalized patients but also time in clinics and private outpatient offices where prescriptions are tracked by companies like IMS. To date, there is no individual prescription data for hospitalists available for purchase. Hospital ordering data is routinely bought and analyzed, but it’s difficult to identify which prescribers are influencing those prescriptions.
Imagine the scenario where a National Sales Director calls the brand team to ask for materials or budgets for hospitalists and the marketer has no data to substantiate the request. Or a Brand Manager who was a hospital representative wants to allocate resources toward hospitalists but can’t prove what he or she anecdotally knows is true about their influence. Or an agency who wants to recommend to a brand that they allocate spending toward hospitalists but can’t provide proof.
Another hurdle is restriction placed on pharmaceutical reps by hospitals themselves. Only 37% of hospitalists see pharmaceutical reps and 26% work in facilities that prohibit reps. Even if a hospital allows the reps to sign in at the pharmacy, they will rarely allow reps to be on the floors where the hospitalists are treating patients. Since most hospitalists are always on the move and don’t have offices, they are even more challenging to track down. Even the reps with the most admirable work ethic aren’t going to be calling on the hospitalists that cover the second and third shifts!
A pharmaceutical marketer once told me of hospitalists, “They’re like unicorns … We know they exist, we’ve just never seen one.”
So what to do?
Like any marketing strategy, it requires thoughtful answers to various questions, including “Where can they be found? How can we reach them? What messages will resonate with them?” Hospitalists can be found in several venues outside the floors of a hospital. Many hospitalists are part of a hospital medicine group that either works directly for the hospital or is being paid by the hospital to provide the service. This model often has an administrative staff that can help coordinate access to hospitalists using traditional tactics such as individual appointments and lunch presentations.
Some of the larger groups or systems might have interest in partnering on a strategic level to help improve patient care. Many hospitalists see patients in a hospital but work for a Hospitalist Management Company such as TEAM-Health, Sound, and IPC to name a few of the larger ones, and are trained and paid by this company. Some marketers and sales representatives can access the top personnel at these companies to create opportunities for access and new campaigns.
Hospitalists, like other specialists, also require continuing education and certification and attend meetings and conferences. Some of the larger meetings include the American College of Physicians which has a hospitalist track, and the Society of Hospital Medicine which is the largest national event solely focused on hospital medicine. Some academic medical centers offer hospital medicine education either live or online. There are also regional meetings held for the purpose of medical education. SHM has 37 chapters around the US and many hold quarterly meetings with access to members during the events. Organizations like ACP and SHM have additional options for marketers and agencies to access members and will list them on their websites.
Hospitalists also turn to publications and websites as a source of medical education and news. Among the most often read publications are The Hospitalist, Today’s Hospitalist, Annals of Internal Medicine, The Journal of Hospital Medicine, ACP Hospitalist,Hospitalist News and Internal Medicine News. These offer traditional print and digital advertising options.
Many campaigns intended to reach hospitalists hit their mark via multifaceted campaigns that include sponsorships, meetings and targeted advertising. However, some promotional campaigns targeting hospitalists do not seem to speak directly to hospitalists.
One company paid a good sum for a print campaign that was focused on an outpatient prescription benefit. Others fail to address the most common types of patients seen by hospitalists – those admitted to a hospital for a serious or complicated issue. For example, a diabetic patient is admitted to the hospital because she is having complications
– either side effects of the disease or because she’s uncontrolled. Some patients are co-managed with other specialists so if you are actively targeting the ICU, orthopedics, or neurology for example, understand how they work together and what the hospitalist should know. Understand where the hospitalized patient comes from – many come through the ED so you if are working with emergency physicians, perhaps you should also educate the hospitalists for when they receive this patient.
If this is your market, try to refine your message to speak to hospitalists about the types of patients they see. Your claims can be the same, but tweak your story.
If you are unsure of how a hospitalist spends his or her day, treats your patient-type and makes decisions, conduct market research. If you have a better understanding of this customer, and can be a little creative to customize your strategy, you can make your pitch or your campaign part of a competitive advantage.
Hospitalists can be elusive, but with 40,000 and growing, you can find them. medadnews
Top 10 therapeutic areas seen by hospitalists, based on prescriptions/week
5. Lipid Lowering Agents
10. Neurologics and Psychiatrics (tied)
• Hospitalists provided 67 percent of hospital-based services to Medicare patients in 2012.
• As a demographic, they are relatively young: the average age is 37.
• 84 percent of teaching hospitals have at least three hospitalists on staff.
• 89 percent of hospitals with >200 beds have hospital medicine programs.