Free Ride Home
by Steve Elias, M.D., FACS
…..but what a story he told me, one pointed and resonant. It took me a year to understand….:“Patrol went up to the mountain. One man came back. He died before he could tell us what happened. I waited for the rest of the story but it seemed not to be that type of story”.
So writes Michael Herr a journalist during the Vietnam War in his book Dispatches. He states it is the shortest but most poignant story about war that he ever heard during his time in Vietnam. Why?
It took me a while but I believe it is about wasted actions, wasted lives and no one benefiting from anyone’s experience. The next patrol that goes up the mountain still doesn’t know what to expect.
Last time in this column we heard from AVF members, this time it is members of industry. Some of them have climbed a mountain and returned. Some are starting up the mountain.
We brought them together to share their experience so that we may all benefit and get an idea about what is happening now regarding their views of venous disease and educational support in our
changing and challenging landscape. Our participants included: Nina Davis, President of CoolTouch, Inc.; Meg Heim, Vice President of Marketing, BioMedix Vascular Solutions, Inc.; Tom Musone, Director of Marketing, Julius Zorn (Juzo), Inc., and Scott Cramer, VP of Strategic and GlobalMarketing, Vacular Therapies Division, Covidien, Inc. A recap of our discussion follows.
Question #1 How has the current economic climate impacted which tools and mediums you do and don’t support in terms of venous education?
Tom: Within our business segment, we are still seeing tremendous growth, which is fortunate for us in this economic climate. As a result, from a marketing standpoint, we have continued to invest more in venous education. Our market includes the growing baby boomers - and greater awareness of our products is key to this continued growth.
Nina: The economy and credit crunch has affected larger ticket items such as the lasers we sell, so we have had to scale back a bit and pick and choose. Phlebology is a very important market to us, so we still invest in this area but are doing so in a more controlled fashion.
Meg: Our trade show schedule has changed and we are now looking to dig deeper into which conferences will give us the greatest impact. We are spending the same and still attending the same number of shows but we are approaching it differently. We are looking at attendance, ROI figures and who is actually at the meetings. As an example, we may attend the same meeting from last year but sponsor specific break out sessions versus the overall conference.
Scott: Vascular Therapies within Covidien is growing rapidly. We are looking to support as many educational activities as possible keeping in mind the crossover many shows have and the increasing costs for the show and the personnel to staff the shows. Covidien is also looking into more educational symposiums in conjunction with trade show activity.
Summary from Elias: You are each looking to get biggest bang for your buck in terms of supporting conferences – both in terms of which you support and how you support them. It is interesting that Tom has seen growth despite our economy. He is selling a non-procedure product. The others are making some tactical decisions.
Question #2 We all agree that phlebology is still on a growth curve. That being said, how are restrictions with Advamed, pharma, etc impacting how you can invest your educational dollars?
Meg: Even though we are not a member of AdvaMed, we follow the guidelines. We are channeling our support through physician organizations. Everyone still needs support, but we are redirecting it through these organizations so it’s clear and appropriate without ambiguity.
Tom: Some of the policies being put in place are just common sense and so we are really just continuing to follow our normal course of business. These controls really haven’t changed our decision-making in terms of marketing investments.
Scott: Covidien is an Advamed member and we insist on following the guidelines set forth. Advamed is not restricting the flow of funds, just how those funds are allocated and to insure it is 100% for education purposes. One big switch is meeting locations. Resort locations do cause a conflict with some guidelines.
Nina: We have always taken the high road and don’t try to push the envelope. We try to respect physicians’ accomplishments and then do what is proper and falls within maintaining good, strong ethics.
Summary from Elias: As we know, laws are established for those who are more likely to break them. As Dylan states, “To live above the law you must be honest.” Clearly, most companies are doing the right thing. It’s the few that aren’t that need these controls but it sounds like each of you have been taking the right approach and taking the high road already.
Nina: It actually levels the playing field for those that have always taken the high road.
Elias: Agreed. That’s an excellent point. These restrictions actually benefit everyone by leveling the playing field for the industry players that are already doing the right thing.
Question #3 What initiatives have each of your companies undertaken to educate the public about venous disease?
Tom: We support the AVF National Screening program. We also run a campaign in March, a cross-promotion with dealers to promote DVT awareness. Since we work with dealers in home medical equipment (HME), pharmacy and durable medical equipment (DME), it gives us a large network to tap into for patient education.
Nina: We support the ACP Foundation, which has a charter to educate the public. That is our way to support outreach to the consumer. As a small privately held company, this allows us to make an impact on public outreach with our size and resources.
Meg: We are a member of the Venous Disease Foundation and the Venous Disease Coalition. Working with the Coalition is very important, because we offer a complete venous education guide to each of our clients. It is a turnkey program with outreach to patients, hospitals and the community, and allows us to co-brand specific materials.
Scott: We support the ACP Foundation, as well as the AVF in many ways. We are actively working on informational websites that talk about the disease state, provide guidelines for physicians and as an organization we are committed to educating the public.
Summary from Elias: Venous disease is a self-diagnosed disease. You are all supporting it through major venous organizations and affiliations with your specific company. You seem to agree that supporting third party groups to advance phlebology education and science is key. It also gives you an opportunity to work side-by-side with your competition for the common end goal of education.
Question #4 Do you segment out who you support educationally? Do you separate out, for example, new practitioners, versus an established practitioner transitioning to a vein care from another specialty? In other words, if you had limited dollars, would you segment out how much you support these different types of vein practitioners?
Meg: Newer physicians have been trained in new ideas and techniques versus seasoned practitioners who have been practicing medicine for 25 years. Really, if you are savvy, you can market to both of these groups separately and effectively. It’s easiest to reach newer physicians by marketing to them electronically, which is much cheaper if you have limited resources. Veteran established practitioners need to be targeted with trade shows, conferences and networking.
Scott: As the vein world continues to develop, we are seeing doctors both young and old want to learn new things and become involved. We are offering tools that can be used by anyone regardless of experience level. An example is our course offerings where we see all experience levels signing up.
Tom: Juzo has online learning programs to help physicians learn about our products and services. We view the future of the venous disease market as very bright and want to continue to build ties with medical professionals who are entering into this category. What we bring is our expertise in compression. We’ll take new practitioners on a tour, and show them the technology behind compression stockings; the doctors find this really interesting.
Nina: As Meg said, it’s essential to market to both segments if you are clever and know how to address the needs of both types of physicians. We have experienced a lot of physicians moving from one specialty to another to improve their quality of life. We are targeting both younger and more established physicians as they are both looking for new opportunities and resources to build their vein practices.
Question #5 What is important to offer a new physician going into vein care? How do you support their education and their help them build their practice?
Nina: In terms of up and coming students, we do that through our affiliations with associations because we have limited means to support physicians directly. We have ties to many practice management groups. When someone buys our technology, they get not only training on our products but also full practice management support – in terms of marketing, billing, etc, This way, we are helping them learn not just how to run a practice – but to run a business as well.
Tom: We use traditional marketing methods to work with new physicians, such as in-services. We also have Juzo Academy where physicians can get training on our products and also addressing the whole area of patient compliance.
Scott: A majority of practice development efforts are run by our VN US business looking specifically at how to help doctors build their own brand. Our reps are trained on both the procedure through a multi-week intense program but also on practice enhancement activities. Since venous disease can be self diagnosed, it is important that the public get educated as well as the physicians.
Meg: We support industry groups and new practitioner meetings. We provide on-site training and have a Physician Launch Kit for all new users of our products. The kit supports operationalizing the products into a practice. It includes everything from brochures, wall displays and electronic displays to promote a practice and support the patient and physician experience.
Summary from Elias: It is easy to educate physicians on how to use your products but what’s nice to hear is that you are working to help the doctors develop their practice as a business. And I think this is another key way to support physicians– not just in venous clinical training – but in the practical side of business and practice management education.
Question #6 Let’s look at this the opposite way. If your company had unlimited resources to support venous education, what would be top on your wish list? What is the one thing you would do if you had no budget constraints?
Tom: All of us feel that we could do more to increase awareness in the public about vein disease and the fact that it is treatable. This is not a revolutionary idea but more work needs to be done to educate the public and make them more aware of what we can do to help them.
Meg: Direct to consumer outreach would be top on my list too. Commercials on popular television shows like“Dancing with the Stars” would be great. Also, the new programs through NI H in venous training are important to attracting top notch physicians and to get more physicians involved in vein care.
Tom: Wouldn’t you think with Surgeon General’s call to action that we would have had more visibility?
Meg: Unfortunately, it was announced the same day Lehman Brothers closed their doors and got pushed into the news background. What we need is a celebrity to tell this story to the public through commercial television. The Surgeon General doesn’t sell in today’s celebrity market. More resources needed to be applied to this announcement.
Scott: Without a doubt, direct to consumer advertising would be the way to go. An ad campaign like the ones utilized by the big pharma companies has impact and drives awareness. We have also seen where it makes doctors take notice that the market is changing as well.
Summary from Elias: Clearly, if resources weren’t an issue, direct to consumer advertising with television commercials and other mass media would be the simplest and fastest way to let people know that their lives with vein disease can be greatly improved with new technology. This allows patients, physicians, and industry to benefit.
Question # 7 Where do you think that the bulk of our resources should be spent for continued growth of the industry on patient education?
Nina: Certainly if you bring more patients to the table, you will attract more physicians, especially new physicians trying to figure out what specialty to go into. They want to pick a field that can assure them that there is strong patient demand – especially in this environment where the economy is tough and they may be paying off medical school loans.
Meg: A lot of physicians – new and experienced – are looking at quality of life issues. They want to practice medicine but also want balance in their lives. A practice in vein disease offers a decent income and regular call hours. The quality of life issues are key for medical students and a great way to attract young physicians to this specialty.
Nina: We also hear that vein physicians get great feedback from their patients, which makes it a rewarding and an even more attractive specialty for medical students.
Scott: There needs to be a balance. More patients typically mean more doctors, but we also must insure that the doctors receive the advanced and specialized training to be able to insure the best possible outcomes.
Summary from Elias: What you have each said is that if you have unlimited resources, the goal would be to focus on making patients aware that they have a treatable condition. At the same time, young physicians need to be educated when they are in medical school that if they choose this specialty, there will be numerous patients waiting for them who will benefit from their care with an improved quality of life.In essence, we need a two pronged approach:
- direct to consumer education and
- getting to younger physicians before they pick their specialty to show them the advantages of selecting phlebology for their future practice.
These two goals will ensure the growth of phlebology. Industry now has a number of challenges as to what they can or can’t do regarding educational support. Nothing can be construed as inappropriately influential. The new Pharma and Advamed guidelines will need to be sorted out. As the sculpture “Free Ride Home” highlights, all the pieces in the educational aspect of venous disease are interconnected. Take one piece away and the entire structure collapses. All of our industry partners have picked common goals and organizations to support for the common good. Educational restrictions and economics are hurdles to understand and address.
When visiting the London Fog Raincoat Company in Baltimore, Don Draper, the main character in the TV series “Mad Men”, is trying to encourage the president of the company to stay focused. The president feels that he needs to branch out into other areas because he is concerned the business landscape is changing. Don reminds him “that there may be good times and lean times but one thing I am sure of, it will always rain.” We need to remember that there will always be patients with vein disease. Someone will always be needed to support and educate those of us treating these patients.