The turnover is high because of the market growth demands year over year. It's not uncommon for a rep to do really well for the first year or two until they capture the most market share possible, all the while, additional growth is always expected, even when the market saturated. Eventually the pressure of higher numbers drive people away, and managers will hirer someone with perceived better relationships with doctors and facilities. I've been in the industry for over 8 years. I've seen dozens of reps come and go and have really only survived myself thanks to timely job changes while working around non-competition agreements. When they hire you, their buying your relationships, not your sales skills. No more, no less.