The patient was a 77-year old diabetic with an ulcer on her big toe. There was almost no blood flow to the foot, and she was in terrible pain. The vascular surgeon examined the patient. A radiographic scan showed a calcium block in the patient’s leg, in the area around the knee. The surgeon was determined to avoid amputation, so he called Yvette Villa. “If you’re available, I would love your assistance with this procedure,” he told her. Inside the operating room, the doctor asked Villa if she thought they could save the foot with a 1.5 solid? She thought they could.
Later that day, the patient went home. With her leg fully intact.
The story seems straightforward. But what may be surprising is that Villa, who played a key role in saving the patient’s foot, is not a doctor. She’s a medical device company representative, and like thousands of others around the country, she plays a vital — yet often hidden — role in healthcare, sharing her broad base of knowledge with physicians, introducing them to new products, helping them understand how and when to use them, and — most important — enhancing health outcomes.
One of the biggest jobs of medical device representatives is to educate physicians in the use of their devices. At Cardiovascular Systems, Inc. (CSI), the company where I serve as chief medical officer, we make devices that treat peripheral artery disease (PAD). Each year, physicians perform 160,000 amputations as a result of PAD. The cost of these amputations is incredibly high. Fifty-five percent of PAD patients with one amputation have their other limb amputated within 2-3 years. At that point people often have to make regular visits to high-cost facilities. Their mental health and quality of life rapidly deteriorates. Survival rates are abysmal.
Fortunately, amputation is not the only treatment for people with PAD. Peripheral vascular interventions such as atherectomy can be performed in less than an hour. When successful, patients who once suffered debilitating pain in their limbs can walk out of the O.R. on the same day as their procedures.
However, not every physician can stay abreast of cutting-edge technologies like this. Which is why physicians like Dr. Siddhartha Rao, an interventional cardiologist in North Carolina, says that Tim Staub, a district sales manager at Cardiovascular Systems, is a vital part of his practice. “Tim’s not just selling devices to me,” he says. “Tim plays an important part in making sure any staff member who needs to be trained is ready to work with the devices when the patient comes in the door.”
The second role that device sales representatives play is to coach and provide guidance to physicians as they perform procedures. Even a very busy physician who specializes in treating PAD may only see 250 cases a year. But device representatives often see ten times that number, and frequently consult each other for advice.
Villa says she’s assisted with thousands of patients in the twelve years she’s represented Cardiovascular Systems. In several cases involving severely diseased arterial tissue, Villa shared her experience watching other physicians use low-inflation balloons to expand blocked arteries. “It’s great to feel essential and to know that physicians depend on your experience to help them make the best decisions for patients,” she says.
As a surgeon and a healthcare executive, I’ve learned that the best device representatives are defined by what they won’t do: push a physician to use their product when it’s inappropriate. Just like physicians, sales representatives have reputations to protect. A physician will recommend a helpful and knowledgeable sales representative to a colleague; but if the sales representative is clearly only interested in their bottom line, they’ll soon find that their calls go unanswered.
But there’s a more important explanation for why the best device representatives won’t push their products to boost sales. Simply put, that’s not why they’re in business. “People see through if it’s just a business transaction,” says Staub. He says the key to his success is “engaging physicians in an educational way and getting across that you can be a partner in the care of their patients.”
When asked why she does her job, Villa thinks about the 77-year old woman she helped that day she drove to the hospital in the early morning. When the woman’s foot, which initially had turned grey, started to turn pink after the procedure, Villa says she was overcome with “a wonderful feeling. Saving limbs and saving lives. That's the beauty of our job.”