Underwriters: The Importance of Nurse Practitioners and Physician Assistants


How many prescriptions did you lose today? If you didn't call on the nurse practitioners and physician assistants in your territory, you may have lost as many as 21. And your smartest competitors know exactly where to find them.

The American Medical Association reports that "there is now a shortage of physicians, at least in some regions and specialties, and that evidence exists for additional shortages in the future."1 As our nation's pool of primary care physicians continues to shrink, growing ranks of NPs and PAs are emerging as the front line of primary care delivery. The U.S. Department of Labor ranks physician assistant as one of the fastest growing occupations through the year 2014, and projects "patients relying more on other health care providers-such as physician assistants, [and] nurse practitioners."2

Nationwide physician shortages and changing physician demographics have remodeled the landscape of primary care in the United States. Nurse Practitioners (NPs) and Physicians Assistants (PAs) are now occupying the front and center of patient care and may be one of the keys to your success as a pharmaceutical sales representative.3

Collectively, nurse practitioners (NPs) write 494 million prescriptions per year and physician assistants (PAs) write 250 million4, yet they have traditionally been regarded as secondary targets by most pharmaceutical companies. A lack of fully developed prescribing data for NPs and PAs has made it difficult for pharmaceutical companies to quantify the impact of educational and promotional initiatives with this group of clinicians. Therefore, many pharmaceutical companies only assign representatives call credit for physician details.

However, thanks to a new national educational initiative called the Practicing Clinicians Exchange (www.practicingclinicians.com), pharmaceutical companies are beginning to realize what successful sales representatives already know - that "face time" with NPs and PAs is vital to their success.

The Practicing Clinicians Exchange (PCE) has taken the lead with an innovative series of live CME/CE symposia and home study materials created specifically for NPs and PAs and multi-supported by some of the leading pharmaceutical companies (AstraZeneca, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, King Pharmaceuticals, Inc., Reliant Pharmaceuticals, Inc., Sanofi-Aventis Group, and TAP Pharmaceutical Products Inc) that understand the need to develop an enduring educational relationship with NPs and PAs.

Besides making the NPs and PAs in your territory aware of PCE programs, what can you do today to build productive relationships with these clinicians? As with any of your customers, you must begin with an understanding of what their needs are and how you can meet them.

Product information and samples – Once considered physician adjuncts, NPs and PAs now play an increasingly independent role in the delivery of patient care. Many maintain their own patient caseloads and manage all aspects of patient care, from initial diagnosis and treatment to monitoring progress and providing follow up care.

Keep in mind that the NPs and PAs in your territory are faced with the same prescribing choices as the physicians on your target list. And they are 744 million prescriptions strong. Your product presentations are the foundation of their product education, so take them seriously.

"Drug reps need to detail me with the same professionalism they show with the physicians in the practice" advises Phil, an NP in western New York. "They need to be ready to discuss outcomes data, co-morbidities, PK/PD profiles, treatment guidelines...in addition to standard dosing, side effects, formulary status and cost. If a rep isn't prepared to have that kind of a discussion on a professional level...how can I take them or their product seriously?"

Provider education – Although NPs and PAs have as much need for professional education as physicians do they are not usually on the guest lists for company-sponsored educational dinner programs and conferences. Programs like the PCE can help fill the gap, but how do you gracefully tell an NP or PA that they're not invited to a program when they overhear you invite their practice partners? "It's embarrassing to invite a doctor to a program and have to tell an NP, who's standing right there, that she's not invited because she's not on your target list" said Tom, a primary care representative in Albany. "She knows I get credit for her prescriptions, and here I am saying she can't come to the program. Not a good way to build rapport."

Tara, a 2006 President's Club specialty representative in Seattle, offers this best practice: "I'm up-front about it with the NPs and PAs in my territory. I tell them that although I'd love to invite them, I'm as bound by my professional regulations as they are by theirs. Then I offer to schedule a lunch meeting immediately after the program to review the program highlights and give them any handouts or other resources that were distributed. I usually get a good response because they see that I'm doing everything I can to include them. And frankly, it's in my best interest to give them information that will support them prescribing my product!"

Patient education – NPs and PAs typically spend more time with patients than most physicians, with a major emphasis on patient disease state counseling and preventive care. Lisa, a PA in Atlanta, says the best pharmaceutical representatives put a priority on patient education. "I have a responsibility to make sure that when a patient leaves the office, they have a good understanding of their role in their own health care - from making treatment decisions to making lifestyle changes. I rely heavily on drug reps for patient education materials, screening tools, and samples."

Clinicians particularly appreciate non-branded materials that strive simply to educate patients without selling to them. In addition to your company-provided materials, non-profit groups such as the American Cancer Society, the American Heart Association, and the National Sleep Foundation are great resources for free patient education information.

Respect – Like physicians, NPs and PAs are medical professionals. Respecting their time and their title will help you earn you their respect and attention. Then you can work on gaining new prescriptions and expanding your business. It is time to consider these clinicians as important as physicians when it comes to the delivery of primary care, just as their patients do when relying on them to provide their healthcare.

Even pharmaceutical representatives who appreciate the value of NPs and PAs to their business are challenged by time constraints and target lists. The reality is that you have a finite amount of time in territory every day (and a finite amount of energy)...do you have time to do more?

Yes. You do if you decide to. After all, you find time to call on pharmacists when you have coupons or other pull-through programs to promote. You spend time getting to know the receptionist at a pivotal practice. NPs and PAs are prescribing clinicians. They deliver care to the patients your products are indicated for. They are the future - and the present - of primary care. Can you really afford not to call on them?


  1. Association of American Medical Colleges. An analysis of medical school expansion plans. Available at: http://www.ama-assn.org/ama/pub/category/15327.html. Accessed on 7.19.06.
  2. US Department of Labor; Bureau of Labor Statistics. Available at:www.bls.gov/oco/ocos074.htm#outlook. Accessed on 7.19.06.
  3. Bacchetta, Sally and Green, Robert, DO. Tipping Point Ahead: Prepared for a New Primary Care? Pharmaceutical Executive. September 2006.
  4. Tinsley R, Carl T. The prescribing impact of nurse practitioners and physician assistants grows. Inflection Point. November 2004;1-3.

Originally published in the August 2007 issue of Pharmaceutical Representative magazine. Copyright 2007 Sally Bacchetta and Robert Green, D.O. All rights reserved.

Sally Bacchetta is an award-winning freelance writer and sales trainer. She specializes in writing and presenting pharmaceutical sales training programs that are relevant and engaging from start to finish. She also publishes articles on a variety of topics, including sales training and motivation, pharmaceutical sales, and emerging technologies. Contact Sally at info@sallybacchetta.com or read her latest articles on her freelance writer website.

Dr. Robert Green, Brad Mock, and Nick Kiratsous are the leadership who are producing the Practicing Clinicians Exchange, and are dedicated to the national NP and PA community and their patient population. The PCE is a division of the Continuing Education Alliance (CE Alliance), a continuing medical education company located in Greenwich, CT. The CE Alliance partners with other educational providers to offer continuing medical education (CME) for physicians and physician assistants and continuing education (CE) for nurses and nurse practitioners. In addition, the CE Alliance is an accredited provider of continuing pharmacy education (CPE).