Why pharmas’ need fields

Several things have been generally accepted as ‘true’ in pharma for as long as I can remember:

• Field representatives are a thing of the past – ‘they’re dead’
• Doctors universally want more types of content available on more channels
• All things digital and data are the new oil and are critical to success.

And yet what’s also generally ‘true’, if slightly less talked about, is that:

• Without field teams proactively driving digital permissions, or virtual event attendance, or website engagement, marketing and medical-led digital tactics are typically failures
• Pharma websites of every type are typically dead within a year of launch (at least in terms of meaningful activity)
• All the data in the world hasn’t really changed anything meaningful – we’re not doing anything that matters in marketing, medical, or the field, fundamentally differently today than we were when everything was paper.

In fact, Medical Marketing and Media magazine recently estimated that only 4% of pharma’s digital-only products (including websites and apps) have been successful. This highlights that digital doesn’t deliver well without strong support from the field.

All these things being ‘true’ is decidedly unhelpful – I mean what do you do when all the trendy things you’re told to do by consultants and agencies and tech companies don’t really deliver?

What if, at least for the next five minutes, we all agree to do a Dallas (a 1980s soap that was hugely popular where a whole season was famously just a dream so a key character could be resurrected from the grave) and agree to forget a lot of the recent narrative and go back to basics for a little bit?

NB Mehrnaz Campbell (who I asked to input into this issue) rightly pointed out that doctors do of course want field teams to use digital tools such as video calls and email brilliantly. And, they want pharma to be able to provide them with great content in a range of digital and print formats. All of which I agree with completely and are a given from my point of view.

Waking back up to the fundamentals

The sales funnel is over one hundred years old and despite people in the ‘dream era’ regularly trying to change it to flywheels, hexagons, messy middles, and all sorts of other things…

…the old-fashioned funnel is still, in my view, the simplest and least bad way to understand the fundamentals of effective customer engagement.

One of the things I like most about it is everyone gets it without explanation from one slide – see below.

From the bottom up

For me, funnel thinking starts at the bottom. This is because the ultimate behaviour you want from people is the foundation that ladders up into everything else you do. Typically, for most medicines, we want a relatively small number of prescribers to prescribe our medicines to patients in one or more scenarios.

And, we have 50 years plus experience of being really good at this bit. Pharma field teams are typically brilliant at reactive requests for calls. They have great materials and great training, and despite the bizarre shouts of ‘reps are dead’ they are in fact very effective.

It’s also relatively easy to measure stuff at the bottom of the funnel – there are sales data, call request data and masses of CRM data we can use if we want to get granular.

The modern challenge at this end of the funnel is call volume. Veeva recently produced a wonderful slide adapted by me below showing that only 5% of all customer engagements are at the customer's request (or inbound calls). You can be sure that inbound calls are the ones where there is time for data to be presented and discussed and that typically leads to more appropriate prescribing. One way to read Veeva’s most recent Pulse data report is that these calls are 2.5 times more effective than outbound or proactive top-of-funnel calls.

One of the key objectives for marketing and medical teams should be to generate more inbound calls for their field colleagues – it’s a huge miss that this is rarely called out in marketing KPIs.

Into the middle

It’s critical to note that doctors and other HCPs have never been busier. Typically, they are seeing up to 20% more patients a day than 20 years ago and some are literally buried up to their ears in admin.

That makes the delivery of activities that move them from knowing a medicine exists to considering using it for some patients, and then either prescribing or setting up a call with a field person, really quite hard.

And the fact that the audience has less time isn’t the only problem:

• there are more medicines than ever and more noise from more companies
• doctors are more restricted in their choices and are expected to adhere to local formulary and prescribing guidelines
• the internet has created an entirely new competitor set (all the third parties who provide education and medical information to doctors for free)
• HCPs struggle to keep up to date with the volume of new information and data available to them
• And regulation of pharma content gets stricter every year which slows production time and increases production costs.

All this means careful planning and prioritisation of middle-of-funnel marketing and medical-led activities is critical. The most important thing is considering the value and appeal of the activity to the target audience. Mehrnaz rightly pointed out how valuable it is to work with the audience to create brilliant content and meetings. Put simply doctors are typically most interested in what other doctors think so peer-to-peer activities orchestrated by the field, medical, and marketing have never been more important.

Reaching the top

The top of the funnel is where I feel we have really lost the plot in the last 20 years. Pre-internet we were really good at this bit. We ran great print ads in journals sent only to target HCPs, we sent great mailers to specific HCPs, we created print supplements and leave pieces and generally made a tonne of noise about our medicines that was really quite targeted. Lots of it wasn’t ‘engaged’ with, nor was it that measurable, but it was good at creating awareness of medicines and feeding the right doctors into the top of the funnel.

Then the web arrived and GDPR followed, and it all got rather complex. Journals largely disappeared or moved online and a tonne of new third parties sprung up to compete for HCP eyeballs. The result was:

• most adverts got much, much smaller – going from whole pages or even double pages to tiny little banner ads
• adverts were suddenly valued based on eyeballs (or impressions) rather than circulation – the challenge being to know whose eyeballs they really were
• Unsolicited emails come with a bunch of rules unsolicited snail mail doesn’t
• The audience got distributed across a lot more ‘publishers’ – at one time most doctors might have read two or three journals – today you might find them splitting the same amount of attention over 100 websites or apps
• We stopped printing things as part of being modern and efficient and environmentally friendly…

…and slowly but surely, we ended up in a situation where the only effective top-of-funnel activity is the field team and the odd HQ email.

We still pay lip service to the idea of ‘multi-channel’ with a few banner ads and other bits here and there but if you really look at their performance (outside the US which is a different beast) there is very little evidence that the right people ever see them. To me going back to print is a significant opportunity for anyone brave enough to do it. It’s really targeted, nobody else does it anymore and it’s proven over 100 years to work well.

Today, the reality is that the top of the funnel today (at least the effective bit) is dominated by just the field's proactive engagement. Mehrnaz highlighted to me how effective the field is at generating leads by identifying pain points for individual customers and connecting brands to these pain points. This is the sort of personalisation that is hugely effective at moving people down the funnel – it’s also the type of personalisation that’s hugely difficult to replicate with tech.

Content is not king, the field team is

I’m hoping you're noticing a distinct pattern here. The engagement type chart included above features the field team and email and mentions ‘events’ in passing. And that’s largely the reality of ‘omnichannel’ for most companies – the field (via in-person, video, phone, and email), events, and HQ emails.

That’s not really many channels – and, if you actually did ‘kill’ your field teams, you’d immediately lose 55% of your customer engagement based on the data from Veeva.

Using the funnel also highlights the huge impact not having a field would have across the board. You’d have way less reach, way less engagement around events, and ultimately way fewer discussions about where your medicine could be used to help patients. And this point is key because while MSLs have huge value they are typically reactive, or bottom-of-funnel focussed. This means that if, as some suggest, we get rid of ‘sales reps’ and replace them with MSLs we’ll likely see call rates drop through the floor – having both is key to feeding the funnel.

What to do now

Don’t, whatever you do, get rid of your field force. Do the opposite. Train it, engage it, support it, and think about maximising its value all the time.

In addition, reorganising and reprioritising marketing and medical teams to support the field more effectively and directly may offer a tangible commercial advantage. The field is after all what most doctors see of pharma. It makes sense that they should be the most important people in any pharma organisation after R&D because they drive most of the value creation. ?

To me, all this means that ‘the field’ is still pharma’s superpower. We need to equip them to make maximum use of video calls. We also need to find the right balance between medical and promotional field team numbers. However, what I think is most critical is re-orientating our thinking and our resources to focus on supporting the field to offer maximum value to doctors and other HCPs.

This mindset shift, I believe, will stop the trend of decreasing field access. People love people who make their lives simpler. So, let’s help field teams make the lives of healthcare professionals simpler by organising ourselves behind them – by recognising that they are the hero of the story, a hero we can’t kill off without killing the whole show.

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Many thanks to Mehrnaz Campbell for her considerable expert input into this Issue of The Irregular Pharma Marketing Newsletter.