Sorry about being away for so long. Real life has been taking its share of my time, keeping me away from the computer.

I have been dreaming a lot recently about what I would do if I was not a Physician Assistant? Like what would I do if I could do anything I wanted? I thought that being a fireman would be cool, but my groin chafes easily in the heat so this might not be the best idea. Then I thought about being an astronaut flying around the stars and exploring the galaxy, but I get really queasy during long trips so maybe not. Oh, I know. Start working on my acting career. “To be or”… this is not to be. How about spending my days hanging around in a strip club? Yeah, that would be great. Getting free food, having gibbering big busted women running around in tight clothing pushing their breasts all in my face and telling me a bunch of lies about how awesome I am in order for me to feel better about myself. If they manage to stroke my ego just the right way, I will become a bumbling idiot that has lost all common sense and while I am dribbling all over myself these ladies are making some serious bank.

Wait a minute!

That’s not a dream. That’s actually what happens every time a pharmaceutical sales rep comes in my clinic. They show up with their mindless prattle and hope that my glans penis will take over my thought processes while the grey matter takes a back seat. A veteran porn star could not make “renin-angiotensin-aldosterone system” sound as sultry and inviting as a well-trained Benicar rep. I swear, when I have the money and time (and the ok from the misses – never going to happen), I am going to make a real porn called “Pharma-screw-tical Reps”. When I was a student out on clinicals I thought it was the coolest thing in the world for a pharmaceutical rep to give me the time of day. I would whip out my spiral notebook and start scribbling down every word. Asking all kinds of questions; “So how do you spell fenofibrate?” I thought that these educated people were trying to teach me something. What an idiot I was.

Listen up Physician Assistant wannabes and Physician Assistant Pups, don’t be an idiot like I was. These pharmaceutical reps are not in any way interested in teaching you anything. They are focused on one thing and that thing is increasing the amount of prescriptions that are written for the product they promote. The goal for them is to brainwash young prescribers, convince them of the superiority of the “new” medicine so that you will blindly write for that product. To say that pharmaceutical reps are trying to educate you about medicines is like saying Adolf Hitler was just trying to teach people how to make camp fires. As an upcoming Physician Assistant you have to always be considering the motives of the pharma rep. Which as it turns out is reasonably easy since they only want to sell more drugs.

Just so you know, pharmaceutical reps are actually in a very difficult situation. They have a constant fear that any given day corporate will start handing out pink slips to all those reps that are unable to perform their job well. With that always hanging over their head, it’s no surprise to me that they are driven to lie and mislead about the products they have. I mean it; could you imagine worrying that if you did not do your job, you would be fired. It’s awful, truly awful. So it’s easy to understand why pharma reps do what they do. I catch myself flushing my reputation, my pride, and self-esteem down the commode daily with my patients in order to maintain my job.

It does not take long to realize the pharma freaks game. I can’t tell you the number of times I have had a pharmaceutical rep who is pushing a certain product swear that their medicine is far superior to anything on the market get fired and return to my clinic working for a competing big pharma company. Now pushing a different product that is of course far superior to anything else on the market, including the medicine that they told me just last week was far superior to anything on the market. F’n shysters. Recently Forest laboratories patent on Lexapro expired. As the patent was coming to an end the sales rep for Lexapro (a real used-car salesman type) was letting us know how much it will hurt his wallet now that he is losing the best SSRI on the market, but that he had a new med coming on board that would save him. He would not give any juicy details about the new product, only that it was going to be a real winner for our patients. (Not sure how my patients also become his patients.) This guy showed up at my clinic the very same day that the Lexapro patent expired to introduce me to Viibryd, the best SSRI on the market. All of the sudden from this day forward, Lexapro sucks a@@ and Viibryd kicks a@@. He listed his 5 stupid reasons why Viibryd was better. He even went so far as asking me to switch my currently happy Lexapro users to Viibryd for the same stupid 5 reasons. Can you believe this guy? Of course you can, that’s how they role. Nothing more important than bringing up the numbers for a new outrageously expensive and utterly redundant medicine. Too bad used-car sales guy, I have been using Citalopram and Sertraline almost exclusively when one of my patients needs an SSRI since day one.

We had a rep for Seroquel once come in and hand out invitations for a dinner presentation. For those that don’t know, it is common for drug companies to host dinners where you can learn all about how totally awesome their drug is from some hired gun doctor. The doc gets up to the mic and spits out the required propaganda then walks home with a fat check. So this rep is giving us the spiel on this big dinner at this very fancy steak house. I never go to these dinners myself. I just don’t care to be involved in a 2-3 hour long infomercial on the latest and greatest depression med. Plus, if I am eating dinner with these reps; than I am missing dinner with my family. It also bothers me to some degree that the reps ignore most of the staff in the clinic. So I started running off at the mouth to this rep all the reasons that I was not going to attend this dinner meeting. She told me that they had a webinar version of the program if I was interested? No, I am not interested. Why would I possibly elect to sit through an hour or so of some lame a@@ webinar trying to convince me that Seroquel is the only way to treat depression and not even get a free steak out of the deal. No thanks. So this chick then tells me that the food is not the reason people attend these dinners, it’s more about the presentation. WTF. Did I actually hear her correctly? Did she just tell me that the free food from a top of the line steak house is not why people attend these dinners? That was about all I could take. So I asked her, “If the food is not that important why don’t you host a dinner presentation down at the local $4.99 pizza buffet chain instead one of the finest steak houses in the metroplex?” Her answer, “Because nobody would show up, but it’s not about the food. It’s about the material being presented.”

(Be sure to check out my first post. “You’ll never be number one.”)

I just gave up on her right then and there, but really wanted to push her buttons. I told her that even though I would not be going to the non-dinner dinner, if she would expand her invite to all the MAs, reception, and back office personnel (all the people that may not be able to afford to go to an expensive steak house), I would guarantee her that she would see an increase in the number of prescriptions I wrote. She looked almost like I slapped her. She was like, “You are saying that if I let all of them go to dinner then you will start writing scripts? That is like buying scripts. I can’t do that!” I told her she absolutely could do it, and she did already by inviting me to this dinner. That is the whole point behind asking me to go to your dumb a@@ dinner. Your big pharma company is buying my scripts with a fancy steak dinner. (Damn, I’m cheap.) This idea that she was buying scripts no matter who she invited was totally beyond her. The only thing she was worked up about was that I was actually asking for something instead of being offered it by big pharma. So she all huffed and puffed out of the clinic. I told the girls in my clinic that I was sorry I could not get them a free steak dinner. We all laughed and went on with our day. Exactly two hours later the same pharm rep turned up and was asking for me. I was like sweet; she changed her mind and is going to get these girls some top of the line Angus beef for dinner. Man, was I wrong. She told me that she spoke with her supervisor and he informed her to return to the clinic and take back all the invitations to the dinner. She was un-inviting me and all the providers from my clinic to the dinner because I was asking for a bribe. Can you believe that sh$^, asking for a bribe. Do you know how many free F’n lunches, dinners, donuts, breakfast, and fruit bowls are brought into my clinic every month? And I have never asked a rep for a single thing. This dumb chick really missed the whole point of our conversation. First I was like, “Are you kidding me?” I can’t believe this rep has such a stick up the keister. Then I just took her to the spot that the flyers were kept, in the trash can where they had been filed right after she walked out of the clinic. If she had shown back up to the clinic one hour earlier, she would have missed the lunch hour. She would not have had to dig her stupid dinner flyers out from under someone’s chef BoyArDee spag and meatball leftovers and some kind of green slime thing. It was freakin hilarious. I swear I was actually laughing out loud at the whole situation. I am still laughing when I think about it. She had no choice, her boss-man told her to get the flyers and by god she was going to get the flyers. Too funny really.

Just so you know, I don’t dislike all the pharmaceutical reps that come into my clinic. I actually think that most of them are good people that just have an awful job. I have had few reps help me out with a non-insured patient or two, and I fully understand that it is with the express purpose of increasing the number of scripts that I write. Ultimately the insulin dependent diabetic with no insurance does not give two turds about how they got the medicine. On the whole, pharmaceutical reps are pre-programmed automatons whose only goal is to increase the company bottom line so they can upgrade to that C-class they have been eyeballing. I am even ok with them wanting to improve their status in life. It’s the American dream to become wealthy enough to be comfortable in life. Just try and do it without being conniving, morally vacant, lying, two faced, opportunists. As Physician Assistants we will do well to remember that the relationship with your pharmaceutical reps is that of a salesperson and a client. As we get lulled by the free food, big tits and overload of bullsh@$ info; it is easy for us to forget the actual type of relationship we have with the pharma reps. I promise you this, no matter how many sandwiches and smoothies the rep brings to you. No matter how many times they laugh at your stupid jokes. No matter how much they ask about your family, or tell you about theirs. They never forget the exact nature of the relationship they have with you.

(No pharmaceutical reps were intentionally harmed during the making of this post.)

  1. Jessica says:

    Love the blog, Tex.
    Since I work in a community health center drug reps rarely come through. But when they do, before I let them give me their long lecture I interrupt and ask them which medi-cals cover their new fancy drug and do they have a patient assistant program. For those that come bearing samples I will lend an ear and gladly give my sig for those samples. But we usually don’t have many visitors and we never get goodies brought to us. We do get some invites, but as you mentioned…that’s more time away from my family.

    • qfwm2001 says:

      Thanks Jess. You are so lucky that you don’t have to deal with drug reps much. My SP loves having them come in and they take full advantage of it. Really drives me up th wall dealing with them.

  2. Mina says:

    I love this blog! I’m a pre-PA student, and I’ve never read a PA blog that is as candid, humorous, and honest as yours. Thanks for your stories, this was REALLY hilarious. She really dug in the trash though?!?! Ooo I bet it would’ve been hard for me to keep a straight face while that was happening lol.

    • qfwm2001 says:

      Thanks Queen for the reply and the props. I don’t post as much as I should due to having a real job and all, but do enjoy the blog. My focus is to open up the eyes about what it is really like to be a PA. I am glad you find it informative. And yes, that pharma rep absolutely was digging in the trash to get her invites out. She ahd no choice, she was told to un-invite my clinic. I can tell you to this day when she calls on my clinic, I remind her about it. I can’t help but crack up everytime she shows up. Thanks again and good luck on becoming a PA.

  3. Bill says:

    As ridiculous as the invite situation may have been, I’m wondering what your response says about your character. Do you routinely belittle people, or is it only when you see yourself as more important?

    • qfwm2001 says:

      Bill, thanks for the reply Bill. Sorry it took me so long to get back to you. You have waited four months for an answer to you question so I better make it good. The answer is “Yes”. to both parts. I routinely belittle people only when I see myself as more important than them. Those that I do not feel more important than, I still belittle. (just not routinely).

  4. Margaret Gladski, PA-C says:

    Great post…made me laugh out load because those are usually my exact thoughts. I realize everybody needs to make a living so I try to be polite and I usually have very little time during lunch hour anyway. However, some of the pharma reps who have been particularly pushy and almost shoving their “studies” in my face while I’m trying to eat (even if I’m eating my own lunch as I’m a vegetarian), I’ve had to literally say please stop talking to me about your nonsense research during the five minutes lunch time I have to shove food in my face before my next patient. You ALWAYS have to remember the exact relationship like you say: unless you are truly friends (prior to the provider-pharma rep relationship), you don’t have any relationship other than salesperson to potential buyer. The samples are nice to get for patients, especially the insulins.
    I like your straightforward style. We need more of that in this world.

    • qfwm2001 says:

      Thank you for the kind words. I have been way less active with the blog recently than I would like. Life, clinic, kids, ect, ect, ect, keeping me too busy. Once things settle down I will try and get back to work on it. I plan on reformatting it when I do get back into the groove, so don’t give up on me. Thanks again for taking the time to reply. Q.

  5. ellen says:

    i side with the rep on this one. it was a bribe if you stated that you’d write scripts if your staff could go to the dinner. that is exactly what a bribe is. for her to invite you to view a presentation at a dinner and then make a decision about writing a script is different and not a bribe; there’s no actual agreement there.

    • qfwm2001 says:

      Ellen, just because big pharma reps hide bribes behind fancy steak dinners that does not make it any less of a bribe. The only difference between the reps proposal and my proposal was my willingness to say exactly what I wanted and exactly what I was willing to give in return. But truly, my saying I would write RX’s if she invited the MA’s was not even the point. The point was that the rep feels like it is okay to “bribe” prescribers, but they are unwilling to say it outright. A drug company has a rep for a reason, and that reason has nothing to do with feeding free expensive dinners to docs and PA’s. The single objective is to increase the number of Rx’s written. As a follow up to this post the same rep that came and un-invited my office from the dinner still calls on me. She has not asked me to go to a single dinner or after hours seminar since I “bribed” her. I think my office is blacklisted. BOO HOO!!

  6. ellen says:

    if you’re concerned about reps ignoring your staff, just tell them that. i tell the reps to discuss certain things with the MAs and my reps are quite nice to the MAs.

  7. JR says:

    As a current PA who was a pharmaceutical rep for 15 years, you are waaaaay off base here. You have no clue what you are talking about, and you are using every classic pharma stereotype here to fulfill your own skewed perspective. if you’ve never worked in the industry, you will never know how it really is. 99% of the pholks in pharma are honest hard-working people trying to make an honest living. The industry is so regulated, that for you to say these reps are literally LYING to you daily makes me wonder why you haven’t turned them in to the FDA or DDMAC or the OIG? Where are your ethics and integrity oh Mr Clinician? Even if you have, I highly doubt anything they did was illegal. Get over yourself. These are mostly good people in the industry, and in my short time as a physician assistant, I have dealt with more scumbag doctors, bosses, administrators, and fellow PAs who stink to high heaven and get away with it daily because they can. Pharma reps cannot do this, don’t believe the hype people.

    • qfwm2001 says:

      JR, thanks for taking the time to reply to the post. I agree with you that some of the reps in big Pharma are good people who really work hard to make an honest living. The good reps actually have a tremendously difficult time because they are fighting the stereotype that accompanies there profession. When I see the really good Pharma reps in my clinic, I am always impressed by them and tend to give them as much time as they need to explain the products they are promoting. That being said, after doing this for nearly ten years, the shift in big Pharma is to hire busty, bubbly, bouncy, bimbo girls who’s only real ASSet is the previously mentioned busty, bubbly, bouncy bit. The idea is for me as a male provider to be so enamored and smitten about the looks that I become hypnotized and begin writing there products without even a thought about what is best for my patients. My only focus should be on letting this rep know how many Rxs I wrote for her when she comes back to see me. It’s utter bull-$hit! You worked in the industry for a long time. So you know this way better than I do. As far as the lying about products goes, I should probably say mis-leading instead of lying (but I won’t because I want to call it as I see it.) The reps that I am talking about are not lying exactly, they are saying things without actually saying things. I will give you a perfect example. Victoza. Every single Victoza rep that has come in my clinic says all the normal stuff about how good the A1c control is and how well it is covered by the insurance and how safe it is and ad nauseum. But they all say something else. They never fail to mention that “although they can’t actually claim weight loss with victoza, patients are all loosing weight that take it.” (or some other version of previous statement that essentially says the same thing.) So, if you can’t actually say weight loss happens with your med then why the F— are you saying it. Let me guess! Your saying it because you want me to see your medicine as a weight loss product and not a diabetic product. We all know patients would not even consider paying for this over priced medicine as a diabetic agent, but hot da#m they will sure as hell cough up the $250 a month if there is even a whisper of the weight loss aspect. This is what I mean by lying. To say “it”, then say you can’t say “it” is bull $hit. If you can’t “officially” say something about your med, then keep your pie hole closed about “it”. As far as where my ethics have gone, if I spent all my time reporting Big Parma reps for this kind of crap, I would never have any time for what is most important; the patients. You remember those people, the ones you and I are supposed to be advocating for! I refuse to allow these reps to come in and wave a couple of D-cups in my face then expect that I promote there stuff over long standing, well proven, inexpensive medicines. (as a side note, I actually like victoza for my patients. I just don’t like the way it is promoted)

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