The Covid 19 pandemic and the subsequent introduction of “Social Distancing” rules and changes across the broader society and in particular the healthcare industry has disrupted and changed the methods of communications and the nature of interactions between surgeons and medical device companies.
The cancellation of meetings, conferences, journal clubs and training courses has limited surgeon industry interactions. Hospitals have limited face to face meetings and theatre access, which have disrupted fine tuning and technical support for medical devices being used in clinical cases.
This disruption has had a short-term negative impact on many medical device companies; their commercial goals, growth and modus operandi. It has, however created opportunities for companies to revisit their sales, marketing, training activities, communication processes and use of technologies.
The aim of this commentary is to discuss the impact of the Covid 19 pandemic on the process of engagement by medical device companies with surgeons across a range of settings.
Adoption of digital interactions and communication
The adoption and use of digital interactions between surgeons and the medical devices companies has been increasing for some time. Digital interactions have the potential to add value one to one interactions, predominantly in the sales, education, training and technical support.
Social distancing has had a profound impact on the adoption and use of digital communication within the medical devices industry.
In pre-pandemic days, attendance at conferences and meetings was a key component in the development of a surgeon’s career and profile. These events provided a forum for surgeons to speak and make presentations.
Additional benefits to conference attendance included:
- the gathering new information and ideas
- peer-peer networking
- the seeking new roles or training opportunities
- gaining CEM points,
- attending professional society committee meetings
- interactions with the industry
The spread of the SARS-CoV-2 virus and introduction of social distancing rules had an immediate impact on medical conferences. Conference organisers were faced with major limitations on travel, which included local post travel mandatory quarantine requirements, which was coupled with surgeons needing to make individual decisions to not attend in order to mitigate the risk of infection. In March 2020 alone 55 major medical conferences were cancelled or postponed indefinitely due to limited registrations and faculty attendance.
Organising committees of professional societies had to respond rapidly, pivot and reinvent their 2020 conferences. Conferences were transformed into virtual. The extent to which greater access and use of social media will balance a loss of networking opportunities at medical conferences and meetings is yet to be fully established.
At the same time as medical conferences were affected, hospitals initiated a range of access policies to respond to the Covid-19 pandemic to preserve valuable Personal Protective Equipment (PPE) for the delivery of services and to mitigate the risks of disease spread. This resulted in a significant reduction of access to surgeons and the theatre environment by medical device company personnel.
Medical device companies were faced with a significant disruption in what was historically their major communication channels. The style of communication was changing from one-to-one (synchronous) communications to asynchronous communications with the adoption of digital communications to surgeons.
In parallel, a significant uptake in the use of telemedicine occurred. In Australia alone between March and September 2020, the COVID-19 Medicare and Primary Telehealth program provided more than 30 million services to 10 million patients. In the USA in response to the Covid-19 pandemic, Federal and State agencies delivered a regulatory relaxation and increased funding. Contreras noted that surgery departments across the USA adopted telemedicine to maintain delivery of clinical services and revenues. A snapshot view from a single centre in the USA saw a significant jump in telemedicine visits from fewer than 100 encounters per day to well over 2,200 per day.
As more digital tools are used for communication, training and education, questions arise as to what factors will influence surgeons to continue to use them.
To understand technology adoption in medicine, Goh applied Normalisation Process Theory, (a sociological framework which enables an understanding of how new practice is incorporated in a social system) to the adoption of digital technology in medical education in response to the Covid-19 epidemic. He noted that a transformative change is underway in medical education across the world. The extent and rate of change and adoption of digital technology is not predictable at this early stage. Furthermore, one of the identified key barriers to adoption is technology’s limited capacity to replicate the experience of clinical encounters.
Shah observed that one of the challenges for the medical device industry, in the face of limited synchronous, one-on-one access to surgeons at this time, so how extensively will technology adoption occur and to what extent will surgeons accept digital interactions as communication substitutes with medical device companies?
49% of Medical Science Liaisons’ (MSL) members reported that KOLs were ‘somewhat’ receptive to virtual meetings and almost 50% reported a significant reduction in virtual access to KOLs. 
Whilst MSLs are a primarily employed by pharmaceutical firms, Bain & Company’s recent survey of US surgeons revealed that 60% believed that restrictions on in-person sales rep visits would continue into the future. More telling findings showed that pre Covid-19, of the 75% of surgeons who preferred in person interactions, 49% now prefer virtual interactions or less frequent visits. Notwithstanding, 53% of the surveyed group still preferred an in-person visit from a med tech sales rep.
The consequences the Covid-19 pandemic are likely to endure, driving more change. It could be argued that tipping points have been reached that will see increased, and possibly, a permanent shift in the use of digital communications between surgeons and medical device companies as the momentum to sustain the use of digital technologies will continue. However, it is likely that medical conferences, meetings and training will eventually return – although with distancing adjustments in place.
Companies have sought to sustain relationships with surgeons in order to meet commercial goals and sales quotas. One-on-one contact has been augmented by digital communications across traditional offerings around education, medical affairs, new product introductions and providing fine tuning, technical support and training for medical devices in the operating theatres.
This response has affected organisations and employees alike. Hartman discussed the complexities of support and upskilling sales staff needed to enable sales staff to effectively use digital communications in the sales process. This demands both technical skills training and development of skills to use digital tools and material to communicate with. While the mobile phone is ubiquitous in today’s world, not all mobile phone users have the necessary skills to effectively use digital communication platforms and tools.
Surgeon demographics are broad and while there is a growing number of “techno-omnivores”, digital connectivity and interaction skills are not universal. Just getting connectivity, having adequate internet speed and a program to work can pose challenges which may fall on the organisation and customer facing staff to provide solutions in their efforts to enable communications. Challenges can be further exacerbated when high-definition 3D clinical videos are utilised. Inadequacies or the inability to deliver digital content effectively has the potential to impair effective communication between the company and the surgeon.
Replication of technical product support in theatre for existing products may provide a unique set of challenges when there is limited access to theatres under social distancing policies. Medical affairs and clinical support staff are being challenged to produce relevant digital training and eLearning material to imitate and or replicate the interaction between medical device technologies and surgeons in the clinical settings, not an easy task.
Solutions are emerging as demonstrated by organisations like Avail  that have developed the ability to deliver real time feeds from the operating theatre to company support staff and sales representatives. Utilisation of these technologies requires the provision of significant IT support resources which if adopted may increase the work load of already stretched IT teams, who are already having to provide support to employees now working from home. Time will tell the extent to which these types of technologies become mainstream.
Improving Surgeon Engagement
Although the impost on medical device companies caused by Covid-19 is significant, the increasing use of digital technologies may provide considerable opportunities. The growing use of webinars will allow companies to deliver content of a similar standing to what is available at major conferences and meetings by engaging local and international KOLs to participate and deliver content.
Webinars by their very nature are not defined by geographical boundaries, thus making local and international access far easier for surgeons. They offer asynchronous communication that can be downloaded and watched at times suitable to surgeons and content access is not time or place bound as would be the case at meetings.
Digital technology enables the production of content tailored to interest to surgeons, and delivered so that surgeons can more efficiently use their time..Further, organisations are now able to more easily assemble self-interest groups across local, regional and international geographies to meet virtually and engage.
In the face of COVID-19 and the post pandemic world, organisations have and will develop the digital offerings for surgeons. Conversations will shift online. However, surgeons in due course will be faced with dealing with the patients on growing waiting lists. Access to the surgeons and their availability may be reduced for some time to come.
Modelling published in the British Journal of Surgery, estimated that globally 28 million elective surgeries will be cancelled or postponed in 2020. There is a real prospect that surgeons may be significantly time poor and digital engagement may be less compelling compared to one-on-one engagement activities. Crafted well, the use of digital content and assets as part of the selling process may enable organisations to deliver value and to sustain the relationships.
The restrictive environment imposed by the Covid 19 pandemic has disrupted traditional communication channels between companies and surgeons. Organisations have responded by increasing their adoption and use of digital technologies to convey value, technical information and support in company interactions with surgeons. Although this is growing as a strategy to address the commercial objectives of medical device companies, human interaction through face to face communication and building of trusted relationships will remain paramount in the engagement process.
 Merriam-Webster https://www.merriam-webster.com/dictionary/social%20distancing
 Big Words of HealthCare: Synchronous vs Asynchronous https://www.purview.net/blog/big-words-of-healthcare-synchronous-vs-asynchronous
 Coronavirus: Subsidised telehealth to get a $2bn boost. The Australian September 17th 2020 https://www.theaustralian.com.au/nation/politics/coronavirus-subsidised-telehealth-to-get-a-2bn-boost/news-story/8aab909513d7ba7860df8ee93951d2c9
 Telemedicine: Patient-Provider Clinical Engagement During the COVID-19 Pandemic and Beyond. Contreras, C.M., Metzger, G.A., Beane, J.D. et al. J Gastrointest Surg 24, 1692–1697 (2020). https://doi.org/10.1007/s11605-020-04623-5
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 Role of MSL’s in a Covid-19 World – adapted from the Medical Science Liaison Society global survey results. www.healthindustryhub.com.au
 Medtech and Pharma Sales Go Virtual, September 03, 2020, https://www.bain.com/insights/medtech-and-pharma-sales-go-virtual/
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 Avail https://avail.io/
 This telemedicine system could get medtech sales reps back to ORs https://orthofeed.com/2020/08/14/this-telemedicine-system-could-get-medtech-sales-reps-back-to-ors/
 COVID-19 disruption will lead to 28 million surgeries being cancelled worldwide. Royal Australasian College of Surgeons News, Media Releases & Advocacy May 15, 2020 https://www.surgeons.org/news/media-releases/covid-19-disruption-will-lead-to-28-million-surgeries-being-cancelled-worldwide