Monday, June 24, 2013

If I were the CEO of an Indian pharmaceutical company

The primary job of a CEO is to maximise profits , and as a pharmaceutical company CEO , I know that the best way of doing this is to maximize the number of prescriptions of my drugs.

Since the people who write the prescriptions ( the influencers and the decision-makers ) are doctors , like any sensible CEO, I will spend a lot of my energy in convincing doctors to prescribe my drugs. This is what the Pharma industry has done for many years , using advertising and marketing and an army of medical reps in order to create relationships with doctors , so that doctors will prescribe their brands.

However , this is a broken model . For one, it's very expensive and cost ineffective. This is a very competitive field, because all pharma companies are vying with each other to occupy the same limited "top of the mind" space in the doctor's head. This means that it is no longer cost effective to continue to use this technique - and it's only because of inertia that companies continue to do so.

Second, governments worldwide are exerting regulatory pressure in order to crackdown on the doctor-pharma nexus, as this has been one of the reasons drugs have become so expensive and cause healthcare costs to spiral out of control. Since providing financial gratification to doctors has become illegal in India, this is now being done under the table , as a result of which it becomes that much harder to crack ! Sadly, many companies merrily continue using inducements ( such as funding overseas trips to medical conferences) in order to manipulate doctors . Until the Indian government makes an example of erring doctors, this is unlikely to change in the near future. The tragedy is that it is the senior , influential doctors ( who have  the most
clout ) , who are part of this nexus, and because they benefit the most from these sponsorships, it will have to be an outsider who will need to clean the system.

The good news is that principled doctors are refusing to be manipulated by Pharma companies. They are no longer willing to waste their time seeing medical representatives , so that the old fashioned route of influencing a doctor based on his relationship with the company reps is going to die a natural death.

So what is the alternative ? I still need to influence doctors, and if I refuse to do this unethically, what are my options ? The answer is simple - I would try to make the doctor’s life as productive as possible . If I can solve doctors’ pain points , they will be obliged to me, and the first principle of exerting influence is that of reciprocity. Doctors whom I can help would be much more willing to prescribe my drugs 
( assuming , of course, that their quality is good – and most drugs today have similar bioequivalence, no matter who manufactures them!)

So what are the doctor’s pain points which I can help to solve in a cost effective manner ?

One major issue is practice management . While most doctors enjoy taking care of patients , they are not very good businessman , because they do not realize that running a clinic means that they need to think of themselves as being entrepreneurs. Many do a bad job , because they do not have the requisite skills. This is a relatively easy problem to fix - it's a simple question of teaching doctors practice management strategies ! Not only would I hold workshops , I would actually provide real-life and online training for the Doctor's office staff - the receptionist , the secretaries , and their assistants, to help them become more productive and efficient. The good news is that a lot of these resources are easily available  - it’s just a question of adapting them to the needs of Indian doctors.

The second pain point which doctors have is that it is difficult for them to remain up-to-date . I would provide them with access to online resources from leading medical publishers , so that they have 24/7 access to medical textbooks and journal which they want. This is something which is likely to be heavily utilized, because doctors understand that they need to update their knowledgebase on a regular basis.

The third pain point today is that doctors need to earn many hours of continuing medical education ( or CME) in order to renew their certification and license to practice from their State Medical Council. The trouble is that the only way the Councils provide certification today is for attending medical conferences. Sadly , most conferences are not academically productive at all, because they flout the basic principles of adult pedagogy. Doctors don’t actually end up learning much – as a result of which most serious doctors are quite disillusioned with the conference business, which they rightly treat as a circus ! Even worse, conferences do not allow any way of documenting whether any learning has actually occurred or not. I would provide online CME for doctors, which would be recognized by the appropriate Medical Council . This is easy to do , since this model has been shown to work very well in the USA – the country which invented CME !  Since the Doctor can do this CME online , he will not need to travel , and this would save him a lot of time , and be much more convenient . Doctors like learning  - it’s just a question of designing engaging teaching materials for them. Even better, by ensuring that the doctor answers a quiz at the end of the CME, this would allow documentation that he has mastered the information which was presented.

The fourth pain point for doctors is medical record keeping. Most keep very poor records – and they have a hard time finding the information they need about a particular patient. This means that even though have enormous clinical experience, this is very poorly documented, so that they are not able to systematically review this – or publish it in medical journals either. This is such a waste ! Information Technology has helped to revolutionize how medical records are stored and accessed today in the USA and I would provide doctors with online electronic medical records ( EMRs) . This will help them take better care of their patients , because they would be able to accurately document and access everything they need to know about their patients. It would also help them to keep their patients happy , because I would provide a patient portal , through which patients could access all their information online !

The fifth pain point for doctors is financial. I would help them to improve their profitability, both by helping them to get more patients; and by providing them with tools to delight their patients. The best way to do this would be to provide doctors with their own personal branded websites, so they can establish an online clinic . Affluential Indian patients are all online  today - and doctors understand that they need a digital presence as well. By giving them this, not only will I be able to help them improve their patient flow, I would also allow them to keep their patients happy , by educating them online with suitable educational materials about their illness. This would help patients to have more realistic expectations of their medical treatment – and save the doctor a lot of time, as he would not have to explain the basics all over again.

By implementing these five measures , I would be able to make doctors lives more meaningful and productive . I would fund this by using the money I would save on no longer employing an ineffective army of medical representatives, most of whom have become dinosaurs in this digital age. Even though this is not my core business, I can do this on a large scale by outsourcing it cost effectively. This is likely to enhance my reputation and standing amongst doctors , which will improve the sales of my brands and the profitability of my company ! This is a disruptive innovation, and I am likely to reap a lot of benefits by being the first mover in this exciting space !


  1. Great thinking ! :)

  2. I 100% agree .. nice article!

  3. Very sincere article and much appreciated that it comes directly from the doctor, however, all of your proposed solutions are considered under the category of financial support and are really no different than a direct cash payment in the eyes of some regulators ( in the US and UK as well as many parts of EU). Thus, although Pharma would welcome providing such services to doctors, it is illegal to do so. Admittedly, I am not completely familiar with Indian law so perhaps it is the exception.


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