ALTHOUGH he’s standing in a long queue waiting to register to see a doctor in a first-tier hospital in Shanghai, William Wang is actually in good health.

“I have to pretend to be a patient to see the doctors, so when they see me it will remind them to prescribe my company’s drugs,” pharmaceutical company representative Wang tells Shanghai Daily.

Once he’s admitted to see a doctor, Wang will say hello and see if they want any coffee, lunch or snacks.

Wang, 27, has been working for an overseas pharmaceutical company in Shanghai for five years. With a backpack filled with his company’s products, price lists and product material slung over one shoulder, he moves around consulting rooms in the hospitals on his beat every day, a typical image of pharmaceutical company representatives.

“We (pharmaceutical representatives) are in a very difficult situation now. Hospital security is eager to report us for cash rewards and an increasing number of doctors now turn us away. Meanwhile, sales targets from the company remain the same. To be honest, I want to quit,” says Wang, speaking for many pharmaceutical company representatives in China.

There are more than one million pharmaceutical company reps in the country, according to statistics by Chinese Pharmaceutical Enterprises Association.

Since last year, when the Chinese operation of British drugmaker GlaxoSmithKline was found guilty of massive bribery to boost sales of its medical products, the image of drug company reps has become increasingly tarnished. The job is associated by most people with corruption.

Hospitals have focused on banning contact between doctors and pharmaceutical representatives and doctors can get fired for seeing a rep and getting “benefits” from them.

Pharmaceutical companies are also cracking down, says Wang.

“Companies are conducting internal investigations and if bribery is found, the pharmaceutical representative will be fired at once,” explains the rep.

Facing so many pressures, the job can be dangerous too. Last month, a drug company rep fell from a hospital building while being pursued by security, according to the Southern Metropolis Daily newspaper.

Pharmaceutical company reps first appeared in China in the late 1980s, when it was a good job offering decent pay.

At first, most reps were young doctors. Since being a young hospital doctor was a tough and badly paid job, many went to work for foreign medical companies.

“The whole promotion system was fairer and better and there was less hierarchy as well,” says Michael Chen, a stockbroker who used to be a drug company representative.

“The main purpose of our work was to communicate with doctors to come up with the best plan of drug use for patients, while holding conferences to help doctors know the latest information about drug development,” he explains.

As new companies entered and the market became extremely competitive, the status of pharmaceutical representatives began to decline. A junior college student can now become as a drug company rep, in a role which is now a salesman.

Observes moods

It can be tough going for these recent generations of reps, trying to ensure that doctors learn to remember their faces and so hopefully dole out their products to patients.

“I had almost no self-esteem when I started this job and I have even less now,” admits Wang.

He carefully observes the moods and habits of the doctors. If it’s noon, he will get them lunch. If they look tired, he will go and buy them some coffee. He knows who likes latte with or without sugar, who doesn’t like caffeine.

Even late at night, he will come to visit with snacks.

Wang always carries some gift cards when going to hospitals — with values of 300 yuan (US$48) to 500 yuan — to slip to doctors.

A coffee or meal, even a gift card are hardly benefits, simply a little reminder, insists Wang.

And Wang’s strategy of little reminders may indeed pay off, says retired doctor Helen Shen.

“There are many drugs company representatives coming to doctors offering benefits that they sometimes forget who represents what,” she says.

“When they see someone coming with food or drink, that brings to mind that they once accepted benefits from them. So on their next prescription, their product will be on it,” adds Shen.

So for 29-year-old Jerry Sun, being woken by a midnight phone call from a drunk doctor asking him to pay a bill is, while inconvenient, very good news.

“It shows he is close enough to me and will always remember to prescribe the drugs from my company,” drugs company rep Sun says.

One common way of bribery has traditionally been to give doctors a fixed percentage of the money made by prescribing the drugs.

“As I understand it, a hospital doctor can get a fixed income of 3,800 yuan a month for prescribing certain drugs,” said a young doctor at a leading hospital.

“Except for the cheapest drugs that have little profit, many drugs — especially new ones — have a fixed percentage of money going to doctors who prescribe them,” he adds.

“Doctors always need to prescribe one or another anyway, and some bring some doctors extra money,” he adds.

However, the doctor also says that far fewer pharmaceutical company reps now come to his hospital.

In the past, he saw the familiar faces of at least 10 salesmen in the general surgery department. Recently, there have only been two or three.

Drugs companies also paid bribes to doctors under the guise of “lecture fees” at fake academic conferences and by creating bank accounts for fake work.

“The most outrageous case I’ve encountered was when I saw call girls appear in a high-end night club VIP room that was filled with doctors and pharmaceutical company representatives,” says Sam Yang, who works for an overseas pharmaceutical company as a senior staff member in medical research.

Some reps also reportedly offered their own incentives to doctors.

In a leading hospital of Nanjing, in neighboring Jiangsu Province, a doctor became infected with HIV after having unsafe sex with a pharmaceutical company representative.

“This story is well known by insiders in the drugs industry,” Yang says.

But Yang says bribing doctors, in all forms, is now far less widespread.

“With the fear of both doctors and representatives being reported and caught, the old ways of bribery are massively reduced,” says Yang.

“Also, as many who used such bribery were fired or resigned, instances have fallen,” says Wang.

Instead, supporting doctors engaged in advanced studies or releasing papers in professional magazines has become the “new trend,” according to Wang.

He calls it the “academic way.”

“A company will pay tuition fees for a doctor engaged in further studies in China or abroad and doing research,” he says, claiming this is a win-win situation.

Doctors get to improve their medical knowledge while learning about the best use of a product, explains Wang.

And on return, the doctor will prescribe more drugs from the company, according to the rep.

Another sign of changing times is that due to their poor reputation, many pharmaceutical company representatives have changed their title to pharmaceutical liaison staff.

Retired doctor Shen says raising standards will remove once and for all the problem of reps bribing doctors.

“If medical treatment is improved and if doctors can have higher pay and better working conditions, then I think the whole situation would be very different,” says Shen.