Starting a conversation around the four different service levels in the OR – 1/ Full-Rep, 2/ Rep-Light, 3/ Virtual Rep and 4/ Rep-less.
This is a taboo subject, so let’s jump in.
As we sit here in late 2024, the debate over the appropriate level of rep service in the operating room has evolved into a complex balancing act between cost, expertise, and efficiency. With full-service reps offering critical hands-on support for complex surgeries, part-time reps providing flexible, cost-effective coverage, and virtual reps emerging as a remote solution enhanced by advanced technology, hospitals are faced with a spectrum of options. Meanwhile, the rep-less model, driven by cost-saving incentives and hospital-trained staff, challenges the traditional role of reps altogether. In a landscape where technology and healthcare economics are rapidly shifting, what is the right mix of service for hospitals, surgeons, and, ultimately, patient outcomes? The answer lies in carefully matching the level of rep support to the complexity of the devices and procedures at hand.
1/ Full-Service Reps
Best for: Complex Devices or High-Touch Markets (e.g., Total Joints, Spine Devices)
Full-service reps have historically played a significant role in the operating room, often possessing deep expertise about the devices they supply, sometimes even more than the surgeons themselves. Their hands-on involvement in the OR has been crucial for ensuring patient safety, particularly in complex surgeries where technical challenges may arise.
Advantages:
- Expert Guidance: Full-service reps provide essential on-the-ground technical support, troubleshooting issues during surgeries involving complex devices like total joints or spine implants.
- Relationship Building: These reps often develop strong relationships with surgeons and hospital procurement departments, fostering long-term loyalty and smoother business operations.
- Real-Time Feedback: They serve as a direct link between surgeons and R&D teams, relaying real-time product feedback to spur innovation.
Best Case Scenario: Companies scale effectively while maintaining high-quality support. Well-trained rep teams create a competitive edge by ensuring proper product use and delivering crucial in-surgery assistance.
Challenges:
- High Costs: The operational costs associated with full-service reps, including salaries and travel, are significant.
- Scalability Issues: Dependence on full-service reps can hinder growth, especially in less-dense regions.
2. Part-Time Service Reps
Best for: Moderate Complexity Devices (e.g., Trauma, Sports Medicine Devices)
Part-time reps offer a more flexible, cost-effective alternative, providing essential but limited support. This model is ideal for procedures of moderate complexity, where full-time, on-site presence may not be necessary.
Advantages:
- Cost Efficiency: Part-time reps reduce operational costs, providing flexibility to scale the workforce based on regional demand.
- Targeted Penetration: They can effectively manage markets in lower-volume or rural areas, providing just enough support to maintain service quality.
- Flexibility: This model allows companies to scale up or down depending on demand without the burden of full-time commitments.
Best Case Scenario: The company balances cost savings with effective market coverage, ensuring enough support to maintain high-quality outcomes for procedures like trauma or sports medicine implants.
Challenges:
- Inconsistent Service: Part-time reps may not build the deep relationships and consistent service that full-service reps offer.
- Time-Sensitivity Risks: The level of support may be insufficient for highly complex or time-sensitive surgeries.
3/ Virtual Service Reps
Best for: Remote Support in Complex or High-Volume Cases (e.g., Orthopedic Surgeries, Advanced Implants)
Virtual reps are the cutting-edge solution for remote support, allowing experts to assist multiple surgeries without being physically present. This model gained prominence during the COVID-19 pandemic and leverages platforms like Enhatch, Avail, and ExplORer.
Advantages:
- Increased Coverage: Virtual reps can handle more cases per day, across multiple locations, without the need for travel.
- Cost Savings: Eliminating travel and on-site presence significantly reduces costs while maintaining high levels of support.
- Technology Utilization: Advanced platforms provide real-time video, procedural imaging, and interactive tools to offer remote guidance that rivals in-person assistance.
Best Case Scenario: Virtual reps become indispensable in hospitals prioritizing remote solutions, providing expert guidance via telemedicine technology and enhancing service coverage.
Challenges:
- Surgeon Resistance: Some surgeons may prefer having a physical rep in the room, particularly for high-risk or complex procedures.
- Technical Limitations: Connectivity issues and unfamiliarity with virtual tools may hinder the effectiveness of this model.
- Adaptation Period: Reps and surgeons must adapt to using these virtual tools, which requires time and investment.
4/ Rep-less Model
Best for: Low Complexity or Commodity Devices (e.g., Surgical Tools, Basic Trauma Devices)
The rep-less model is a radical cost-saving strategy where hospitals train their own surgical techs to replace the roles traditionally filled by reps. This model has been successfully implemented by hospitals like Loma Linda University Medical Center, saving millions annually.
Advantages:
- Cost Savings: By eliminating reps entirely, hospitals save significantly on labor, travel, and commissions.
- Independence: Hospitals gain control over device use, without relying on external sales reps with potential conflicts of interest.
- Direct Sales & Digital Solutions: Hospitals can utilize direct sales models or digital tools like e-commerce platforms, virtual training, and AI-guided surgical tools.
Best Case Scenario: Hospitals standardize devices that do not require in-surgery support, utilizing digital tools and e-commerce to streamline purchasing, training, and procedural guidance.
Challenges:
- Limited Differentiation: Competitors may adopt a similar no-rep approach, leading to reduced competitive advantage.
- Surgeon Preference: Surgeons may still prefer companies that offer direct support, especially for complex cases.
- High Initial Investment: Developing the necessary e-commerce and digital training systems can be costly upfront.
Conclusion: Choosing the Right Level of Rep Service
The four levels of rep service—full-service, part-time, virtual, and rep-less—offer distinct advantages and challenges depending on the complexity of devices and the needs of the hospital. Full-service reps are invaluable for high-complexity surgeries but come at a high cost. Part-time reps provide flexibility and cost-efficiency for moderate-complexity cases but may lack the relationship-building benefits of full-service reps. Virtual reps represent a promising future, offering remote support while increasing coverage and reducing costs, though they require significant adaptation. Finally, the rep-less model delivers substantial savings but may struggle to meet surgeon expectations for on-site expertise in complex cases. The optimal model depends on striking a balance between cost, expertise, and scalability based on the specific demands of each hospital and surgical procedure.