Crossing the threshold: More than half of physicians restrict access to sales reps

— Graduates of top medical schools, today's medical industry consolidation contribute to industry's highest cut-off in access yet —


EVANSTON, Ill. – Sept. 2, 2015 – Tumultuous market conditions – including changes in medical education and a frenzy of health care M&A activity – have led more than half of today's physicians to place moderate-to-severe access restrictions on pharmaceutical sales reps. This marks the first time that the number of physicians who limit access has crossed the halfway point, according to the spring 2015 AccessMonitor™ report from global sales and marketing firm ZS.


AccessMonitor™ aggregates sales-call records from 70 percent of all U.S. pharmaceutical sales reps. The report examines how often over 400,000 physicians and other prescribers meet with sales reps who visit their offices.


Overall access to physicians has declined steadily since ZS conducted its first report in 2008. Today, 53 percent of physicians in the U.S. place moderate-to-severe restrictions on visits from sales reps – compared to last year's 49 percent. In addition, 45 percent of physicians restricted access in 2013, 35 percent in 2012 and 23 percent in 2008.


"The pharmaceutical industry is in the middle of a fast, steady decline in physician access – and we expect this pattern to continue for the foreseeable future. Even traditionally rep-friendly physicians now limit sales rep access," said Pratap Khedkar, managing principal and leader of ZS's global pharmaceuticals practice. "Interestingly, oncology was considered rep-friendly in 2010 with 75 percent of oncologists labeled as 'accessible.' Now, the tables have turned: Seventy-three percent of oncologists are labeled as 'access-restricted.'


"In fact, each specialty has further limited access to sales reps since the first AccessMonitor™ report in 2008. The four most access-restrictive specialties in 2008 ranged from 60 percent to 76 percent accessible. By comparison, the four most accessible specialties today land in this same range, while the most restrictive specialties, such as nephrology, fell to as low as 19 percent accessible. This 43 percent drop in rep accessibility for nephrology is an indication of accessibility issues that will have big implications for the pharmaceutical industry."


The extent to which particular specialists and physicians, in general, limit sales rep access varies based on local market conditions. This finding aligns with a study co-authored by Khedkar and featured in the Journal of Medical Marketing.[1] For example, previously rep-friendly metropolitan areas – such as St. Louis and Knoxville, Tenn. – have become more access-restricted after a spate of provider consolidations in 2014. Both cities experienced a 7 percentage point decline in access from 2014 to 2015.


Trends in acquisition and educational training impact rep access


Consolidation among providers – driven by local economics, the Affordable Care Act and new alliances among other industry players such as insurance companies – leads to an increased demand on the doctor's time and causes doctors who previously owned their own practices to relinquish control of practice-related decisions, such as rep accessibility. This trend toward consolidation indicates that physician access restrictions will also continue to grow.


"After health system mergers, sales reps may no longer be able to see many of their customers. We saw mergers quickly cut off access to as many as 4 percent of local customers, on top of general restrictions physicians place on sales reps today," said Malcolm Sturgis, an associate principal at ZS and leader of ZS's AccessMonitor™ offering. "In fact, we found 19 out of 25 recent, major mergers corresponded with additional decreases in sales rep access within one year following the merger."


In that vein, an increasing number of medical schools and university-affiliated health systems (especially top-tier programs) restrict access to physicians – a behavior graduates often take with them when they enter the workforce.


On average, graduates of the top 12 medical schools in the U.S. are more likely to restrict sales rep access throughout their careers compared to graduates of other medical school groups. While 47 percent of doctors nationwide are considered "rep-accessible," only 36 percent from top schools are "rep-accessible."


"With minimal exposure to sales reps during medical training and fellowship, the new generation of doctors limits in-person visits with sales reps. We've watched this trend for nearly eight years and realize its implications for the industry," said Sturgis. "There is hope, however, if sales forces can take advantage of the dozens of alternative communication channels available today. These range from conferences, to peer-to-peer programs, to digital channels – such as mobile platforms or social media forums."


The 'orchestrator rep' triumphs in a heavily-restricted world


While in-person visits remain the most effective method for sales reps to communicate with doctors, pharmaceutical companies can no longer rely on these visits alone. Instead, they must personalize and coordinate new, alternative communication channels for each customer.


"The future for sales reps is less about, 'How can I see a doctor?' and more about providing the full spectrum of sales and marketing information to doctors via their preferred method of communication to increase engagement," said Khedkar. "Even if certain physicians are 'rep-accessible' now, they could limit access in the future. Sales reps who orchestrate all communication channels – including digital – to supplement sales force interactions and cater to the physician's preferences will experience the best results."


For more information on ZS's AccessMonitor™, including an executive summary of the spring 2015 report, please visit


About ZS

ZS is the world's largest firm focused exclusively on improving business performance through sales and marketing solutions, from customer insights and strategy to analytics, operations and technology. More than 4,000 ZS professionals in 22 offices worldwide draw on deep industry and domain expertise to deliver impact where it matters for clients across multiple industries. To learn more, visit or follow us on Twitter (@ZSAssociates) and LinkedIn.

About AccessMonitor™

AccessMonitor™ is a proprietary data source that incorporates the call reports from more than 45,000 sales reps across the U.S. pharmaceutical industry. It examines how often over 400,000 physicians and other prescribers meet with pharmaceutical sales representatives who visit them and then classifies these doctors into one of three groups: 1) "accessible" (physicians who met with more than 70 percent of reps who call on them); 2) "access restricted" (between 31 and 70 percent); and 3) "severely access restricted" (30 percent or less).The report equips companies with data to make the best use of sales and marketing resources in a systematic way and includes sales operations, field management and marketing strategies. In addition to the bi-annual national industry reports, participating companies also receive a prescriber-level, company-specific AccessMonitor™ report that provides customer insights based on industry data that is processed, cleaned and anonymized according to a rigorous set of rules. To learn more or to participate in the next round of reporting, visit