Open Letter To Merck Leadership

Anonymous

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An Open Letter to Merck Leadership:

I am a Sales Representative in the Southeast Commercial Operations Group and am writing to you on behalf of many of my colleagues in the Southeast. In a recent video address, Mr. Ken Frazier said, “our size and complex operating model have created inefficiencies and redundancies in the way we do business.” In Focus Forward in the U.S. Market, Mr. Bob McMahon requested direct and transparent feedback in areas we succeed and areas in which we need to improve.

In that spirit, I wish to present, in a challenges/solutions format, an area of inefficiency and redundancy my fellow representatives and I are experiencing in our region, neighboring regions and perhaps all regions. The inefficiencies, discussed below, negatively affect not only our bottom line but how my fellow representatives and I make business decisions on a daily basis.

In my region we have eight Customer Team Leaders (CTLs), Sixty-ish representatives, two Medical Account Managers and, of course, one Director of Commercial Operations (DCO). The Region ratio of CTLs to Representatives is 1 to 7.75 with some CTLs managing six or less representatives. Incidentally, our neighboring region has virtually an identical ratio. An individual sales territory, within a district, consists of two CTLs and four representatives. The bottom line is CTLs are required to spend four days per week in the field with representatives. We simply have far too many managers and these managers do not have enough work to keep themselves occupied. The result is managers spending a minimum of two days and on many occasions three days per month with representatives.

Does this situation have a negative impact on our business and the way we make business decisions? Consider the following. In our district we have been asked to focus on and hyper-target our top HCPs. Spending time with those who can have the biggest impact on our business is a strategy we as representatives completely support. Unfortunately, we cannot implement this directive. In order to have an adequate pool of HCPs to accommodate the excess field visits it is necessary for us to develop relationships with everyone so we don’t subject the same high prescribing physicians to constant field visits. So, whether a physician prescribes one product X per year or one product X per hour these HCPs effectively have the same weight or value because we have to cultivate relationships with everyone. This situation is further exacerbated when you throw in the occasional field ride with a Director of Commercial Operations and/or a Medical Account Manager.

During any given month, CTLs are in every sales territory two of the four weeks. Our customers are getting weary of seeing managers as often as they do and are expressing their dissatisfaction. In the late 1990s our company, and industry, made a terrible decision by over-hiring. The result was representative fatigue by HCPs and lack of perceived value by our customers which led to reduced access and lock-outs in some cases. Despite the introduction of the Medical Account Manager, our region has not made any headway in reversing policies of restricted access. We are, once again, going down a similar path of overwhelming customers. This time it is with managers rather than representatives. One of my colleagues referred to this system as a pyramid scheme. How productive is our system when leadership feels they must baby sit representatives and representatives feel their job is to entertain leadership? As an organization we must do a better job at evaluating the laws of unintended consequences before implementing strategies affecting how we interact with our customers.

According to Customer Team leaders, the primary role of a CTL is that of a coach. If the average cost of a CTL (salary, benefits and expenses) is $180,000 per year, our region spends almost 1.5 million dollars per year on coaching – an outlandish sum by any reasonable standard. Additionally, how does our company justify paying a CTL to manage five or six representatives? Yester-year regions were filled with representatives in their twenties, many fresh out of college. Frequent managerial interaction was necessary to bring these inexperienced representatives along the sales continuum faster. Today, we do not have one representative in our region under the age of thirty. The vast majority of representatives are a bit gray with a few wrinkles and reading glasses close at hand. This demographic shift has resulted in a sales force with tremendous amounts of experience in this industry. While everyone can improve their craft, representatives do not need the excessive amount of managerial interaction we are forced to endure. Historically speaking, the Merck management team was once a highly skilled, wise group of leaders who knew when to help a representative and more importantly, knew when to get out of the way. Due to the situation described above, region leadership has become a laughing-stock in the eyes of too many representatives.

My solution is as follows: Regions should be combined, immediately. Early in my career, a Regional Business Director (today’s DCO) had two, three even four times as many representatives under their direction as compared to today. CTLs should have a bare minimum of twelve to twenty representatives to manage. Most of the administrative duties of CTLs could easily be handled by a region administrative assistant (approving expense reports, etc.) freeing CTLs up for coaching activities. Another idea is to put a detail bag in the hands of CTLs. Mandate that one day per week (in addition to their office day) CTLs call on customers who have lock-out or sign only in policies place. Perhaps the weight of a CTL title will prove beneficial reopening access to some of our most important customers.

Thank you for your time and consideration.
 




Bravo. You hit every point. Thank you for your bravery in speaking up for all of us. The only point that I would like to add is that my CTLS and MGAM like to use us as chauffeurs. This always cost me at least one call because at some point, I will get a request to take him/her back to the car because he/she needs to get home early for some trite reason. We who are still focused on the job are being urged to make that one extra call a day, and yet, we have to deal with this nonsense. Let them all get reevaluated, and then have them reinterview for their positions so that we can keep the best and get rid of the baggage already.
 




That $180k salary and benefits figure for a CTL is wayyyyy under reality. Even with the benefits shrinking and getting more expensive from the employee side, the employer side is climbing even more. Add in employer side payroll taxes on each employee and it costs a company 60-75% over your salary to cover all related benefit and tax expenses.

And CTLs aren't going anywhere.
 




Agree completely! Very very well written. This is a real issue that needs to be addressed. The one thing that I'd add is the need for an MAE in a non-progressive market? Not saying get rid of the person, I'd suggest that they flex the role. Like mentioned above....carry the bag. The MAE may really be "trying" to get meetings and appointments with c-suite people in an effort to "partner" with accounts, but when it's been 3 years and it's not happening....you gotta ask why we have this role. It's not needed in our area.
 




This is a thoughtful analysis of an inefficient process but there is no 'bravery' in posting it anonymously to a board which mostly contains gripes from the field. You know the email addresses of evryone in the food chain at Merck up to Frazier. Send it to them, even if you use an anonymous remailing service to do so. Otherwise the leadership you seek to inform will never even see it.
 




There is a simple solution to the problem: eliminate managers. This " coaching" function is a made up activity to give them something to do. Most are very bad at it, having never darkened the door of a training department since they were trainees. Eliminate the position altogether, saving a ton of cash, nepotism, favoritism, and all this field ride pressure on customers. Most if not all of the most important job activities have long ago been delegated out or automated away from managers anyway. They don't hire, are poor evaluators, things like expense report approval,training,speakers can and are being done on the regional level.They don't have key account responsibility. Have a regional trainer do field rides and report directly to the dco. This would be more objective, consistent, and cheaper. Probably more productive for the rep as well as the actual activity would be evaluated and not the job itself- the rep wouldn't feel constantly bullied and his job threatened.
The job of a manager is obsolete and should be eliminated. You can help that demise along by having the following conversation with your physicians:"Dr. Why do you see managers? If you think it's because it is helping the rep., rest assured, for the most part, it does not. Mangers take up a lot more of your time, don't know any more about diseases or products or treatments ( many times less) than the rep. And are here simply here to excerpt more pressure on you to write product not to help you practice better medicine. Now this is your office and you can do as you wish but if it was me I would no longer see managers as, if you really think about it, serve little purpose in coming into your office and provide you with little to no benefit."
 








I'd like to know why there are MAEs in non-progressive markets. I do see some value in the role if the market warrants it but it's a ready head-scratcher to me why we have this role in an area where we don't need one. I think we all have a pretty clear understanding of how merck can "partner" with accounts where there's an opportunity. But after 3 years and nothing has happened in terms of partnership with accounts... Then go sell something!! Sitting behind a computer and sending emails to c-suite people is a waste of money and time.

Not saying get rid of the person, I'm suggesting that they carry the bag.
 




This is the most accurate post I have ever read.
It is unfortunate that although the solution is painfully
obvious the Executive leadership of Merck is incapable of
Implementing an effective strategy to fix it.
Our region too averages 7 reps per CTL bringing little if any value
to the equation. Providers are hanging signs indicating NO PHARMA MGRS!
There is no trust in this industry for any field representative and there
never will be despite the high cost of hyper micromanagement.
Senior leadership is so far removed and completely clueless that
this business model will ultimately kill the industry.
Maybe someone with decision making authority will read this thread but
then again who can make such a decision? Some "focus group" will meet for a
year and over analyze and re- engineer some old idea and call it a new commercial model
or something and force feed it to the organization.
What a joke.
Get out if you can as there is no intelligent life here.
 




I am the poster of the original thread. In response to the "bravery" comment above, I did email this letter directly to Bob McMahon anonymously through a gmail account. Given sophisticated filters and administrative assistants acting as gatekeepers I have no idea if he received it or not. My regions advisory board member did forward this letter to Bob Yoder on my behalf though the Merck email system. I wish I would had the courage to identify myself to these members of senior management but the risk of retribution from my DCO and CTL is too high. My regions advisory board member recommended not forwarding it to our DCO. The advisory board member felt our DCO would become very defensive.
 




Do you realize the OP's comments are about problems and issues that have existed to some degree at Merck for years, if not entire pharma careers? Merck's problem with inefficiencies and waste reflect the same problem of our federal government. KF states complexity as the problem. I wish he would have included "needless" before complexity. The reps job is to drive business while keeping management apprised of and in touch with current market conditions. This creates opportunity for decentralized strategic marketing decisions to be made. It's not complex at all, that is, until Merck management makes it much more difficult with unnecessary distractions for the rep and attendant unproductive activity and inefficiencies. There simply are still too many positions in field sales that are not effectively serving the customer or driving business. I'm frankly amazed that as many physicians still see us given the joke that has been made of the rep's job. We've talked about being customer centric but have for the most part stubbornly refused to abandon a centralized one-size-fits-all approach to field sales management. CTL's must be in field 4 days per week riding with reps. WHY? To give them something to do? Not very smart or efficient. We must have pretty hapless reps if that much "coaching" is necessary on a regular basis. This has only fed our joke and hurt customer focus and relationships. The solution to our biggest problem requires strategic management at the local market level with field managers allowed to make strategic decisions. This requires abandoning the standard check-box mentality and trusting/empowering lowest level managers with decision making about how best to drive business in a given market. We've had this at times in the distant past but lost it when we became bloated with field sales employees. Individual markets require individual strategies for resource utilization to produce the greatest return on investment. This can't happen and won't happen until our upper management allows it to happen. Will it? I'm not optimistic since more heads will have to roll.
 












It is my understand that there is a manger in FL with five reps and two of the five are job shares. One CTL with four full time employees. Leadership at Merck is a joke. So much for K? Fraziers redundancies and inefficiencies. BTW, a district in our regions is undertaking a campaign to ask docs to ban managers. Now that's what I call a call to action!
 




Only reps displaced, no CTLs

Of course only reps, and no CTLs...While I admire the original poster's willingness to "stop the insanity" at Merck, it all just amounts to farts in the wind....

Merck knows exactly what the OP is saying...In a logical world, where up is up and down is down, Merck would jettison the masses of highly paid, useless CTLs, and make things run the way they should, aside from not continuing to piss of our customers with ridiculous "field visits."

Where the OP strays off point, is actually believing that the CTL's role is to "coach." (Yeah right--and Miley Cyrus is a major talent too.)

The whole role of the CTL, is to reverse the over-hiring that the OP references in his/her post. There were way way too many employees hired due to the pharma industry's greed, and now these companies are big , fat, slow and bloated...

The CTL earns their money with the field visits, (from now on lets call them what they are -- harassment opportunity visits) to force people out of their jobs...Let's drop the ridiculous pretense that CTLs are there to coach...most of these folks couldn't coach their way out of a Chucky Cheese restaurant.

Merck executives are perfectly happy keeping these folks in place...if they force out one or two reps a year, they have more than paid for themselves...Hitler had his brownshirts and SS...Merck has its CTLs...both were hired to be the muscle and thuggery for their leader.
 




What really bothers me is that most CTLs don't even try to take on some tasks that we don't have time for. My district has only five reps, and my manager is always looking for a point rep for some task. We are spread really thin already, and of course the S3 is not allowed to be a point for anything. The manager didn't even offer to be the point for the Thanksgiving basket that we do on a "volunteer" basis. What a joke. The managers in my region couldn't even find the time to train the inventiv reps properly. I know of three instances where a Merck rep had to explain why the Inventiv rep was on the verge of committing a major policy violation. Yet the CRLs all have been working on updating their resumes on Linkin. We have a few awesome And well respected CTLs that are calling on customers on their own, and who bring value to a field visit. I know because of all of the shuffling around, I have worked with every one of them. Why not have one of the stars train some of these car seat warmers. And if someone from compliance is reading this, you might want someone to review all pollicies with the contract reps. Don't depend on the CTLs for this, or Merck might be fined soon.
 




Two points; one an agreement another a complete disagreement.

1) Agreed that number of rep/mgr ratio can be increased ~12/CTL an ideal target
2) However (perhaps because I have had a really good CTL for some time now), appropriate leadership training is the solution. Removal is not the answer - managers are always needed. To remove them would be like sending a football team out without a Head Coach or Assistant Coaches. True, each player knows what to do but how would the game progress and what would the end-result be?
 












And in vaccines it is even more critical to get the ctl out of the way. I know my customers, my market and my products. But my CTL thinks that the provider needs to hear about burden of disease every call. The providers that have treated shingles for years understand the burden of disease. Shingles burden is far less than the burden of cardiovascular disease, COPD, diabetes etc. Oh and my CTL really needs to hear me repeat the limited info I can talk about regarding P23. Peds offices...let me do my thing. Just let us manage our accounts (as in the past) and all will be fine.