Did we miss the opportunity?

Last week I read that Novo Nordisk has now cut 13,000 jobs, 4,000 more than it announced a year ago. A few weeks earlier Pfizer added another $2.5 billion to its cost programme, with about $2 billion of the one-off costs going to “digital enablement” and severance.

Neither company says how many of those jobs are in the field. One phrase keeps coming back, though. Further investments in digital capabilities. Whatever that means.

It took me back to 2008.

Talk about bad timing. I joined the pharmaceutical industry in 2007, a couple of years after it had peaked. One year later my position was cancelled. The whole primary care field force was scrapped, a division which represented the financial engine of the company when I joined. Some colleagues were offered other positions. Most weren’t.

I was lucky and managed to hang on by a thread. The directive from HQ was clear: Change the company from a primary care selling machine into a key account management organisation. Whatever that meant…no one really knew.

At the time it felt like a crisis. Looking back, I think it was also an opportunity, an opportunity we never took.

Half the reps, more than twice the market

ZS Associates has tracked the number of US pharma sales reps for decades. In 2005 there were 102,000. That was the peak. Today the figure is around 50,000, according to EY. There’s no good data on the situation in the rest of the world, but I think we can safely assume it is very similar.

IMS Health put US prescription drug sales at $252 billion in 2005. The IQVIA Institute puts them at $606 billion in 2025.

Half the reps. More than twice the market.

Looking only at those numbers, you would think each rep had become five times as productive. That is not what happened. The industry moved from relatively cheap primary care drugs to expensive specialty medicines including oncology. Sales per rep went up because the medicines got more expensive.

Fewer doctors, bigger meetings

Here’s what changed underneath the numbers.

When the target was GPs, we aimed for six or seven calls a day. There were thousands of them, and each one prescribed for a few of our patients. Today many reps are happy with one call a day. The customers are specialists, there are far fewer of them, and each one decides which expensive treatments their patients should have.

Roughly, I think one call with a specialist is worth about ten calls with a GP.

Think about what that should have meant for us in 2008. If a meeting is worth ten times as much, you prepare for it ten times as well. But that’s not what happened.

We cut the number of reps. We changed the target lists and our titles. The meeting itself stayed much the same. Campaigns, key messages, a detail aid, a call target. Just fewer of them. We moved the GP call into the specialist’s office.

Is it too late?

For one kind of meeting, I think it is.

I have written before about how AI will take over one of the most common tasks field teams do today: informing HCPs about the product. As doctors and nurses turn to AI models with their questions, the value of a meeting that only passes on information will approach zero. If “digital” means pushing the same product message through more channels, it only speeds that up.

That is the meeting we never replaced. Now the decision is being made for us.

But the meetings that need a person are worth more than ever.

AI can’t make a new treatment accessible to patients. That takes logistics, new procedures and staff training. You need a human for that.

Research shows that a primary care practice is almost three times more likely to adopt evidence-based practice when it gets practical, recurring support from a human being.

Take note. This is a BIG arrow that points towards our future.

If you want to keep your job and stay relevant for your company and HCPs, I suggest you start your journey towards YOUR future already today. The time to act is now. Don’t wait for someone else to do it for you.

Your move

You don’t need a new programme from head office to start doing what we never did in 2008.

It starts with your next meeting.

• Pick your most important customer. Write down what you could bring them that will give them new ideas and perspectives on their work. Something they can’t get from an email, a congress or an AI. If the list is short or empty, that just means you have more preparations to do.

• Swap one product message for a position statement that is connected to the thing you’re bringing. A position statement does three things: It demonstrates you’ve done your homework, it positions you as an expert in the field and it opens up the conversation giving you deeper insights into the topic.

  Here’s the structure: Last time I was here I talked to Dr A, and I understood that one of your key priorities this year is X. When I research X I found that many care units, similar to yours, are facing the same challenge. One way of addressing this challenge would be to do Y. What is your perspective?

• Based on what you learn, more often than not, the stakeholder you’re talking to can do with some help addressing the challenge. Your product will become a natural part of a collaborative effort like this.

In 2008 the change was done to us. This time there is still a little time to make it ourselves.

You’ve read this far, so I’m betting you’re ready to start.

/Mats

Background research and sources

Novo Nordisk. 13,000 job cuts disclosed at the Capital Markets Day in London, 21 September 2026, against 9,000 announced in September 2025. Novo has not said which functions were affected. https://cphpost.dk/2026-09-21/business-education/career/novo-has-cut-4000-more-than-first-announced/

Pfizer. On 4 August 2026 Pfizer added $2.5 billion in cost cuts through 2029 ($1 billion in its cost realignment programme, $1.5 billion in manufacturing). Of $6 billion in one-off costs, about $2 billion is for digital work and severance. Pfizer declined to say what the technology changes involve. https://www.biospace.com/business/pfizer-cuts-2-5b-more-across-r-d-manufacturing-in-ongoing-restructure

US sales rep numbers. ZS Associates, PharmaForce Deployment Analyzer, as reported by Pharmaceutical Commerce (2017): 102,000 reps in 2005, 61,900 in the second half of 2013, about 70,000 in the first half of 2017. The figure of about 50,000 is from EY (Arda Ural), quoted by PharmaVoice in March 2023. ZS’s own series ends around 2017, so “around 50,000 today” rests on the EY estimate. https://pharmaceuticalcommerce.com/brand-marketing-communications/sales-rep-count-holds-relatively-steady-70000-says-zs/ https://www.pharmavoice.com/news/pharma-industry-salesforce-strategy/645956/

US prescription drug sales. IMS Health: “U.S. prescription drug sales grew 5.4 percent to $251.8 billion in 2005.” IQVIA Institute, June 2026: US medicine spending reached $606 billion at net manufacturer prices in 2025. The 2005 figure is at invoice prices and the 2025 figure at net prices, so the real growth is larger than the two numbers suggest. Neither is adjusted for inflation; US consumer prices rose about 65% over the period. https://www.biospace.com/ims-health-reports-5-4-percent-dollar-growth-in-2005-u-s-prescription-sales https://www.iqvia.com/blogs/2026/06/us-medicine-use-climbs-amid-continued-affordability-and-access-challenges

Sales per rep. My own calculation: $252 billion / 102,000 is about $2.5 million per rep in 2005. $606 billion / about 50,000 is about $12 million per rep in 2025.

Calls per day and the one-to-ten specialist/GP comparison. From my own experience, not from a study.

Support from a human being. Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Annals of Family Medicine, 2012. A meta-analysis of 23 controlled trials: “Primary care practices are 2.76 (95% CI, 2.18-3.43) times more likely to adopt evidence-based guidelines through practice facilitation.” The facilitators in these studies were trained quality-improvement staff, not pharma reps, and the setting is primary care. https://pubmed.ncbi.nlm.nih.gov/22230833/