July 13, 2026 – 6 min read
by Barb Farley, Vice President Client Services
Why does HCP engagement keep underperforming even after new training and tools? Because the usual fixes target the rep while the causes sit in the company’s own setup: field teams are graded on how much they do rather than how useful they are to the physician, and no one has ever written down what a useful visit means. This article traces both breakdowns, shows how one launch team corrected them, and lays out the order for fixing measurement, definition, and accountability before spending anything on people or technology.
When HCP engagement goes flat, most organizations respond the same way. They retrain the field, or they buy another tool. Both moves rest on the same diagnosis: the reps must be the problem. In our work across pharma commercial organizations, that diagnosis is usually wrong. The reasons HCP engagement fails sit upstream of the field, and chasing the rep is the most expensive mistake in the cycle, because everything purchased to fix it is aimed at the wrong target.
The stakes of getting the diagnosis right keep rising. Access is shrinking; in oncology, roughly two-thirds of physicians now restrict rep visits (ZS, 2024). The visits that still happen have to land, and right now the industry has no reliable read on whether they do. Bain & Company asked reps how much value their visits delivered to physicians, then asked the physicians. The reps’ estimate came in two to three times higher (Bain, 2022). A field force that overrates its own interactions by that much is a symptom of something upstream. The rep is executing the system exactly as designed. The system was pointed at the wrong thing before the rep ever got the territory.
Start with what the system tracks. When a company comes to us wanting more valuable engagement with physicians, we look first at its HCP engagement metrics, and they are almost always activity and sales targets. Number of calls. Call quotas. Start forms. Product mix against quota. Managers lean on those numbers because they are trackable, and often they are the only indicator a manager has. But none of them says anything about the quality of the interaction, and quality is what determines whether a doctor wants you back. The average targeted physician already sees around nine rep visits a day (ZS, 2024). The system keeps counting visits in a market that stopped rewarding visit counts.
The gap gets wider in organizations that trust experience to fill it. The teams struggling most tend to share a belief: “Our reps are seasoned. They know how to sell. We’re not going to tell them how to do it.” In our work, those are usually the teams missing their goals, because nobody is holding anyone accountable to good call planning, and nobody knows where each physician sits on the customer continuum. Does this doctor still need education? Help identifying patients? Or are they an advocate you need to protect from competition? Without that grounding, the rep walks in without a real objective and the call defaults to reciting the message.
Which raises the harder question underneath the metrics: even if you measured quality, whose definition of quality would you use?
Today, reps are coached and scored against the company’s version of good: “Did you deliver the approved clinical message? Did you follow the model?” That is the leading indicator, and it is the only one anyone inspects. The doctor’s verdict arrives later, in prescribing and engagement scores, after the coaching moment has passed. Ask how in tune leaders are with what good looks like from the doctor’s side of the desk, and my honest answer is not very.
If I tell you call planning matters and never ask you about it again, you learn quickly that it does not.
Ask what doctors want from pharma reps and the research is consistent. Eighty percent of oncologists want a rep who understands their practice and their patients, and 60% would take that over deeper clinical or product expertise (ZS, 2024). Every call also carries a competing agenda: “I’m coming in with an objective I need to achieve, and that may not be where you’re at right now.” A good call objective resolves the tension out loud. It sounds like this: “My objective today is to help you identify one or more patients over the next three months. How does that sound to you?” Sometimes the doctor answers, “That’s not what I need right now.” That answer changes the call, and now you are asking questions and driving out what the doctor actually needs.
None of this moves, though, until someone is accountable for it.
One of our clients, a seasoned sales team moving from rare disease into a larger specialty market, needed to win big on a launch. When we interviewed the field, the strongest performers were already running their own call plans. Everyone else was inconsistent, and leadership had left them alone because they were experienced. The intervention was unglamorous. Every call required a call objective, entered into the CRM, where managers and cross-functional teams could see it. The expectation finally came with evidence, and evidence is what makes an expectation real. If I tell you call planning matters and never ask you about it again, you learn quickly that it does not.
Fixing HCP engagement starts upstream, before you retrain anyone or buy anything, and it runs in order. First, write down what a good call looks like from the doctor’s side of the desk: a clear objective, grounded in where that physician sits on the continuum. Second, require it for every call and put the evidence in a system a manager can see. Third, have managers coach and inspect against it. Then look at your engagement numbers again and decide whether you still have a rep problem. Planning takes time up front. That is the point. Slowing down there is what lets the field go fast everywhere else.
Barb Farley is Vice President of Client Services at Performance Development Group, where she owns client outcomes across PDG’s pharma portfolio: when a commercial team invests in engagement capability.
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