The Gatekeeper

Every salesman of medical devices faces the same conundrum. You’ve got a great product which you know backwards and forwards. You know that the product would help the patients of a specific doctor and would help the doctor herself, both in terms of time and efficiency as well as reliability. If you could get in front of the doctor, you could make a pitch that would stick. The quandary lies in how to get that toehold in the doorway.

Even after twenty-five years in practice, I can’t give you a surefire method of getting to the back office. Part of that comes from not being sure how the system worked even in my own office. Most doctors have a wall of protection ringing them that they often did not set up. The staff is doing their best to keep their providers focused, both in the interest of patient care and in expediency. Remember, a doctor’s delay effects everyone in the office from patient to billing agent.

But there are ways to present your case that are better in establishing a level of trust with a provider. You might not make an instant sale, but at least getting the doctor’s attention, however briefly, may lead in the long run to an effective and lucrative partnership.

So here are just a few tips that I can share, a small peek into the mind of the working surgeon, to give you a clue as to what will catch the doctor’s eye and ear and facilitate the exchange of the crucial information that will get your product into the doctor’s hands.


The most important thing to remember is that a doctor’s time is precious (at least in their own eyes). Another is to understand that we are great at detecting bluffers. If you don’t know something, admit it but promise to follow up. That may even be more advantageous as it almost guarantees a second look.

The first pitch should be efficient, but not too slick. Touch on the important facts and how your device or product ties into standard practice and the specific doc’s one.

Also, try to share your doctor’s enthusiasm for the subject. Most of us are in the field we chose because of abiding passion for it. Show you are curious, invested and eager to learn about our favorite subject and we will often take the time to work with you.


What does the doctor treat and how does she treat it? For instance, there is no point in previewing a new TLIF system to a pediatric spine surgeon.

Also, know the doctor’s personality. Is she formal or casual, serious or funny, bookish or outgoing? When in doubt, ask the nursing or support staff. They know us far better than we would care to think.


It sounds silly, but if a surgeon is trained in one place, he may have rivalries with another. Telling him what those rival surgeons do with your equipment may not be the best strategy. It’s better to pick a neutral side or whenever possible one that is firmly in the sphere of influence for the provider. The info is out there although sometimes you need to put two and two together to understand it. Check the doctor’s web page and other bio sites.


When you do get in, give as much detail as you can, even if it doesn’t seem to be the most important info. You never know what aspect of a system will catch the doc’s eye the most or what kinds of thing she might be thinking about using it for. Be ready for offbeat questions about equipment and instruments (without compromising your “on label” integrity). Most doctors are very creative and the novelty of an object, product or instrument is what will catch their interest


Most of us would rather see a real study than testimonial letters. A white paper is okay, but even unpublished data will be much more convincing as long as it is well thought out and organized. Although most docs are not scientists, we are all trained to understand and respond to scientific articles.

A corollary to this is to know the literature yourself. Most providers will ask what studies are out there defending a product. Have those studies on hand, even printed out in list form if possible. Whenever you can actually have reprints that is even more effective


Never, never, never make a statement that is not backed up by the data. Never boast or brag and never claim that your product will make the subject a better surgeon/ doctor. Even if it is true, that is no way to influence people of high confidence


Some docs like a bite of lunch themselves, some don’t. Ask about the office policies first, and always adhere to federal laws (i.e. Sunshine Act). Often a provider will draw the line at taking a meal from a rep for the optics of it all. But we all appreciate it if you bring something for our loyal and tireless staff. Remember, the way to the heart of a back office is through breakfast.


It is not worth your while or even that effective to try to wine and dine. A steak and an expensive bottle, although seldom refused, will seldom lead to any lasting interaction. I have been to a couple of “working dinners” at less expensive restaurants where the rep actually put the instrument cases on the table for us to look at over food. It was much more effective and memorable than an overpriced steakhouse (although we did raise a few eyebrows in the restaurant).


Some surgeons will work through the day, but many like to “come up for air” late morning or at lunch. Although there is always work to catch up on (charting, calls, etc.), most often the provider is at her highest mental acuity and receptiveness at these times. Most of us actually like to hear about new technology during this period.


We are fellow humans (although we may not always admit it). Although some docs have been known to have a temper, most will be courteous and at least hear you out. Consequently, don’t be afraid to approach them in a surgical lounge or in an OR corridor. Worst case, you get shot down. Best case, the doctor is looking for some way to pass the dead time anyway and may give you a good listen.


The surest way to engage a doctor’s interest in a product is to ask her advice about it. How does it look to you? How does it fit into your practice? Will other doctors benefit from it? Let the provider know you care about her opinion and she will be much more attentive to both the product and to you.

There are other methods but remember that most of us do not like being ambushed. Tackling a doctor in the parking lot is poor form as is stalking them at their house.

None of these techniques will work all the time. All docs are different, and even an individual provider may be different from one visit to the next. But in general, if you are honest, engaging, respectful of the doctor and her staff, definitive and confident – in other words perfect – it will go a long way. It is best to think of your interaction as a relationship and not a sale. By forging trust, mutual confidence and a sense of equality and professionalism, you may be able to create a working environment which will yield the kind of long-term and stable collaboration that truly is good for patients, doctor and you.


Keith Mankin, MD

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