How Coincidence, Correlation and Causality are Creating Stress for Reps

By January 21, 2021January 25th, 2021LTEN Bonus Focus

By Patrick Veroneau, MS

The pandemic of 2020 has played a significant role in influencing how many organizations have had to adjust their approach to markets where access to sales representatives has been severely restricted.  These adjustments have caused a great deal of stress and anxiety for many sales representatives in the life sciences industry, who may be contemplating the security of their jobs.

To understand the level of concern from the representative’s perspective, it is valuable to understand what I would call the “three C’s” of how a drug is prescribed/sold in pharmaceutical selling: coincidence, causal and correlation.



Anyone that has sold in life sciences has witnessed a vacant territory in a district that was over-performing or had qualified for President’s Club, even without a representative having been in the territory for months.  This speaks to the coincidental aspect of selling.

This does not mean that a representative is unimportant or doesn’t provide value.  It simply means that, on a macro level, a physician that has an appropriate patient is going to prescribe a treatment that has the right indication, solid efficacy and acceptable safety, regardless of them meeting with a representative.  Agreeing to this, reps and managers can focus their efforts on where they can really partner and make an impact with healthcare providers.



Correlation is the next trigger that describes how a provider may decide to use a certain treatment for their patient.  When a representative consistently follows up with a physician, mid-level providers, nurses, pharmacy or any other staff, and the patient is prescribed the treatment the representative is promoting, this is a correlation.

Oftentimes one of the biggest and most valuable services the representative can provide is to ensure that the patient will have access to the treatment through their insurance. Or, they will be eligible for patient assistance if the patient does not have insurance or the financial means to pay for the treatment.  In the oncology space, where I spent most of my time, this was very common.



A provider can also choose to use a certain drug for a patient because of a causal interaction.  This means that the representative just happened to show up on the day that a patient had been identified and the representative was able to present data that influenced the prescriber to use the treatment that they were promoting.

This is the rarest of the three ways a representative may experience a sale, but it is the most rewarding.  This sale would also be announced to other team members in the form of a “success story” to motivate them to do what the selling rep had done to get a sale.


Another C: Current

In the COVID-restricted environment representatives have experienced since March 2020, one can begin to see how the “three C’s” in prescribing is creating a great deal of stress and uncertainty for representatives.  The longer representatives are kept away from offices, the less they can prove that their presence has significantly impacted their providers prescribing habits.

As prescription data continues to show utilization without their direct involvement, the more representatives are concerned that all their sales will be seen as a coincidence rather than a correlation or a specific (causal) interaction.  In this environment many representatives are feeling helpless about how to demonstrate their worth.

While the current environment seems to be one that will be with us for a while, that does not mean that representatives and life sciences companies cannot find ways to gain access to providers and their staff.  However, it does mean that the usual approaches of lunches, conferences and speaker programs won’t work and probably weren’t really working before the pandemic.


One More C: Challenges

The industry needs to look at the challenges that healthcare providers are facing and find ways to partner with them and address the issues.  The companies that help healthcare providers address issues such as burnout, stress, bullying and leading through crisis will be the companies and representatives that increase their access.

These are all issues that have increased because of the pandemic and have proven to have a direct impact on the health and wellbeing of patients. The shortsighted approach will be to overlook these opportunities to partner because they don’t directly deal with a representative’s specific product.

To gain physical and virtual access to healthcare customers, companies should focus on providing opportunities where their representatives are seen as partners with their providers by helping them to address the challenges that put their patients at risk.  To do this, companies will have to abandon the old belief that “if you are not talking about product you are not selling.”

Unless representatives are provided with tools and resources that help their healthcare customers, they will increasingly find themselves moving market share by coincidence rather than as a correlation or a causal effect from their interactions, which is far more effective.

Patrick Veroneau is president of Emery Leadership Group. Email Patrick at

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