Balancing the Bias: On Learning to Interact With Industry Reps as a Fellow

She is usually in the lab once a week. She always has a smile and always asks about my family. I like to believe that she really is interested in how my day is going. But she’s not an attending, and she doesn’t even work for the hospital. Instead, she is employed by a major medical device company, and ultimately her job is to increase the use of her company’s product at my institution.

During the past decade I have spent as a trainee, I have seen a change in how industry reps are allowed to interact with residents and fellows. As a medical student I frequently saw them in the hospital, and when I was an intern the resident library was stocked with food furnished by reps almost every day. Things have certainly changed since then. As a fellow now, I almost never see a rep unless I’m at a national meeting or in the cath or EP labs. 

The passage of the “Sunshine Act” in 2010 certainly drove much of this paradigm shift, but I think similar changes were underway at the institutional level before that. Providing the public with information on the financial compensation of physicians by industry sources makes sense. The public should have that information, although I’m not sure people can easily obtain it. Like many things in medicine, these changes were well intentioned, but they are not without unintended consequences especially for medical trainees.

“Interacting with Industry Reps” was definitely not a chapter in any of my medical textbooks, and I—as I suspect most physicians—have learned the best practices of maintaining these sensitive relationships mostly by watching others. While not necessarily a desired practice, it’s really easy to judge similar products by how much you like their companies’ reps. I’ve seen attendings run from industry reps, ignore them, and treat them like indentured servants. Others really challenge the reps on the strengths of their product. I’ve learned something from each observation, and that’s really the point of being a fellow.

We work in a field where technologic innovation is part of the evolution of care, and because of that interplay, industry reps are necessary. While I don’t think they should be assisting in procedures or handing out trips to Hawaii in exchange for pacemaker implants, I do believe they can provide valuable information to practitioners. It is easy to forget that most interventional cardiologists are working outside of the academic world. They may not be participating in clinical trials or be able to hear international experts give grand rounds. I see industry reps as an educational resource in those situations, albeit a biased one. But being aware of this bias—and knowing how to evaluate their input in balanced manner—is key.