Controversy: Medical Device Sales Reps Staff Many Hospital Operating Rooms

Critics say that they too often push surgeons to use the most expensive device, but proponents say the reps have become an important part of the surgical team.

Surgery is brutal. There’s hacking and sawing and screwing in bolts. Surgeons need a strong stomach. So, apparently, do medical device sales representatives. They’ve become an integral part of the operating room team. And aside from the sound of whirling drills and hammering, surgery rooms are often quiet places, and that’s in part because of the presence of the medical device sales representatives, Kaiser Health News (KHN) reports.

When the surgeon asks for the right tool or device at the right time it is placed in her or his hand mostly because the sales rep arranged everything beforehand. “The logistical role has essentially been filled by the manufacturers instead of hospitals in recent decades,” KHN reports. “And now surgeons may trust their reps more than anyone else in the room. They’re often the first call he or she makes when scheduling a case, to make sure the device will be ready to go.”

Adriane Fugh-Berman, MD, of Georgetown University, studies the relationships between industry and physicians and appreciates that the speed of medical device innovation makes having the sales reps on hand tempting. Still, she tells KHN that “what we need are skilled helpers in the operating room who are not making money off of the choices of the surgeons.”

She anonymously interviewed sales representatives who’ve told her that they are pushed by their employers to encourage surgeons to use the latest, and most expensive, device. But, she tells KHN that “the newest device is not necessarily the best device. In fact, it may be the worst device.” She thinks sales reps should be banned from operating rooms.

Those reps are often trained by watching how the devices work on cadavers, so they have developed the stomach to witness operations. And, as KHN reports, “hospitals are reluctant to remove reps, for fear of irritating surgeons, who typically don’t work directly for a particular hospital and could move their cases to another institution.”

One hospital that tried to lay down the “no sales reps in the operating room” dictate was Loma Linda University Health in Loma Linda, Calif. In 2015, Loma officials said that doing so helped it reduce costs for total knee and hip replacements by more than 50%.

“But a hospital spokeswoman now says that the medical center has abandoned the effort, though she refused to discuss why,” KHN reports.