Technician-led vs a 'Rep-less' Model

Technician-led vs a ‘Rep-less’ Model

The widely used term ‘rep-less’ within the medical device industry seems to imply the absence of sales representatives in the operating room. It also implies that the need for their assistance has become redundant. This, however, is not entirely accurate because surgeons still require the support of an expert technician to assist in the OR, particularly when the degree of complexity of surgeries requires varying technical capabilities.

A technician-led model is more aligned with the changing roles of who is required to be present in the OR. It is less about the absence of a device specialist, but more about the source of where the support is coming from.

There are several factors which are driving the gradual evolution of this shift in representation.

Ethical questions

An article published by the Washington Post closely examines this area and blatantly questions the role of the sales rep in the operating room. Patients are often not explicitly advised of who is in the OR during their procedure. This grey area also includes the extent of influence and decision making the sales rep actually exerts. The Code of Ethics by the American College of Surgeons states that:

‘The HCIR (healthcare industry representative) serves as an educator and facilitator. In this role, the HCIR:

  • Should not engage in the practice of surgery, nursing, or medical decision making

  • Should not scrub in or be involved in direct patient contact

  • May be involved in the remote calibration or adjustment of medical devices (for example, pacemakers, laser technology) to the surgeons’ and manufacturers’ specifications

  • Should have his or her activities monitored and supported by the surgeon or at the surgeon’s discretion by the perioperative nurse responsible for the patient’s care’

Liability issues

The realm of accountability in the healthcare sector is prickly territory. For distributors it is somewhat more risky as manufacturers’ policies may provide inadequate coverage for the the medical devices that are used in the OR.

The distributor in addition to the manufacturer or sales representatives are also liable, since they have the same responsibilities in ensuring the devices are used correctly and safely. A conflict of interest as the distributor is also responsible for the sale of the product, an ever-present ticking time bomb for the manufacturer, sales rep and distributor. In some ways a third party technician can minimize the liability to distributors because the liability shifts to this team and the conflict of interest is minimized.


One of the main concerns for hospitals is the overall traffic in the operating room. With more bodies present in the OR, the opening and closing of the door reduces sterility, putting patients at greater risk of infection. The goal of many hospitals is to ensure that only the necessary persons are present during any surgical procedure, to reduce the number of times that doors are opened as well as the duration of time they are left opened.

Technicians are multi-skilled members of the OR team, hence why overall traffic in the OR can be reduced.


The need for transparency in pricing is becoming ever more important as hospitals and patients scrutinize the costs involved with surgical implants. ‘Some industry personnel have stated that the “cost of a sales representative” is about 40% of the price of the medical device.’ Lack of funding and budget constraints are age old challenges that the medical industry has faced and with an ever increasing demand for high quality care and service, the allocation of resources must be justified. As more generic implants become available they will directly compete with branded devices, becoming a more appealing option for the cost-savings that are undertaken by hospitals.

There is also a significant shift from high cost labor to a tech-intensive operation. Consolidating the costs so that the assistance provided by the technician is also married with their knowledge of the product means that the service and product provider can be one and the same.

A Technician-led approach

Taking into account these factors, as well as the emergence of more generic implants becoming available at a lower cost, the Technician-led model makes more sense as the way forward.

As an independent, unbiased case management provider ExperTech offers high-level technical support to surgeons and hospitals, and works closely with manufacturers to ensure that implants are used correctly.