It’s just a matter of time before some company leads from the front on this and massively reduces their primary care sales force. Once one does, many more will quickly follow suit. One just has to find the courage to tell Wall Street that this is the best approach. Because up to this point no company has wanted to risk a drop in the stock price by massively cutting back on primary care promotion when others are not doing the same.
As for true specialty care like rare disease and particularly Oncology (not fake specialty where you call on the same customers as primary care but have “specialty” attached to your team name), they will be the last people cut. The science changes too fast, there are too many approvals each year and the ability to grow business through face to face interactions with community practices is still present. They don’t need 8 people in a territory (looking at you Merck, AZ, BMS, etc.) though.