The rep is dead. Long live the pod.

Fewer than half of US physicians still accept an in-person visit from a pharmaceutical representative. In Europe, the figure is about 52%, a rebound from a COVID all-time low of 20%, but nowhere near where it used to be. Of the European doctors who do open the door, roughly two in three now limit themselves to three pharma companies or fewer.

These numbers are not shocking to anyone in the industry, most of us have felt it and seen it, but they are a driving force behind everything that is happening to the field force now.

And yet, this is not where the story starts. To understand why pharma is rebuilding its commercial model now, you have to go back thirty years.

1995: the golden age

In the mid-1990s, a pharmaceutical sales representative in Sweden made up to seven calls a day. Seven. The same number held in the US, in Germany, across most of Europe. Access was not a problem. It was the premise. Physicians were curious, pharma was the single best source of new clinical information, and the commercial model scaled in the simplest way a model can scale: if a market was growing, you hired more reps.

2005: the first tightening

By the mid-2000s, the door had started to close. Hospital formularies were consolidating decision-making away from individual physicians. Compliance codes arrived, the Sunshine Act in the US in 2010, tighter EFPIA rules in Europe, and the wine and dine era quietly ended.

Pharma’s response was structural. It pivoted from primary care toward specialty: oncology, immunology, rare disease, later gene therapy. The economics of a twenty-rep primary-care team made no sense when the target was a hundred specialists in a country. And more importantly, specialists did not want a sales pitch, they wanted data, a conversation about mechanism of action, or a Phase III subgroup, or a newly published real-world cohort. Pharma needed a new type of role that could support all these physicians.

2010: the rise of the MSL

The Medical Science Liaison was a good idea executed inside a constraint. The constraint was regulatory: medical and commercial functions had to be firewalled from each other to keep promotional conversations separate from scientific ones. That was the right answer for compliance. It was the wrong answer for the physician on the receiving end.

What the KOL experienced was two people from the same company, visiting in the same week, forbidden from sharing notes, working from different plans, measured on different metrics, reporting to different leaders. The scientific conversation got sharper. The overall experience got more fragmented. Coordination was technically impossible by design.

The silo was a feature, not a bug, and the feature created a problem.

2015: the cross-functional team

The industry’s response was sensible on paper: align everyone around the account. The KAM, the MSL, the market-access lead, put them on the same slide, call it a cross-functional account team, hold a quarterly meeting, and share the customer plan.

And it kind of work. But the people in the team still reported to functional leaders. They still carried functional KPIs. The KAM was measured on calls. The MSL was measured on KOL interactions and scientific exchanges. The access lead was measured on reimbursement milestones, each team member optimising for a different equation. Coordination became a meeting. Accountability became diffuse.

Cross-functional teams were the right instinct but they were never given a true opportunity to show what they could do.

2020: COVID breaks the model

In March 2020, in-person access collapsed to roughly 20% almost overnight. The field-based commercial model, the one built in the 1990s and patched every five years since, simply stopped working. Pharma had no option. It had to think differently, because all physical access was stopped.

What followed was the most rapid commercial experimentation the industry had seen in decades. Virtual advisory boards. Video detailing. Omnichannel sequencing. Digital engagement specialists recruited in weeks rather than months. Real-time dashboards replacing monthly call reports. Multichannel thinking, a phrase nobody used in 2019, became the default by the end of 2020. Organisations that had debated digital transformation roadmaps for five years shipped them in five weeks.

When physical access partially came back, two things had permanently changed. First, HCPs had tasted hybrid engagement and preferred it, nearly one-third of accessible European physicians now prefer a mix of video and in-person, and hybrid engagement generates almost three times the promotional response of face-to-face alone. Second, and more importantly, pharma commercial teams had finally experienced working as small, integrated, digital-plus-physical units. The muscle memory was there.

That is the gift COVID accidentally gave the industry. It built, under duress, the exact capability the next operating model would need.

2026: the pod

A new pattern is emerging, and it looks different enough from what came before that the industry has had to find a new word for it. Borrowing from software engineering, where Spotify squads and Amazon’s “two-pizza teams” popularized the idea of small, persistent, multi-disciplinary units owning an outcome end-to-end, consultancies and the thinkers have started calling it a pod.

A pod is a small, stable group of roughly five specialists: a field lead, a digital engagement specialist, a data analyst, a market-access lead, and a patient-support expert. They share a single outcome metric and they are measured on it together. They do not rotate. They do not each chase a functional KPI. They hold internal decision rights to reallocate effort between themselves without escalating upward. They scale up at launch and contract at maturity as a unit.

A pod differs from a cross-functional team on four specific dimensions: it is account-bound rather than project-bound, persistent rather than rotating, collectively accountable on a single patient-outcome metric rather than on five functional ones, and holds decision rights to reallocate effort internally rather than escalating upward.

The three consequences already visible

The medical function has moved upstream. The MSL of 2020 explained data to KOLs. The MSL of 2026 translates real-world evidence into regulatory dialogue, participates in label-expansion conversations, and works with patient advocacy groups on access pathways. The MSL is no longer a scientific emissary, but a strategic connector between internal evidence generation and external decision-making.

Key account management is finally being built the way it has been talked about for over a decade. KAM-as-enterprise-strategy is not a new idea. Consultancies have been making the argument since the 2010s, and most pharma leadership teams have nodded along for almost as long. What is new in 2025–26 is that the organizational reality is finally catching up with the slide deck. It took ten years and a pandemic, but it is happening now in a way it was not happening in 2018.

AI is rebuilding the economics of the surviving roles. Early deployments of agentic AI tools are showing 27% time savings on call preparation and follow-up, 85% user satisfaction on generated insights, and more than 15% increases in omnichannel-equivalent customer contacts. AI does not replace the rep. It makes one well-prepared rep economically equivalent to one-and-a-half old ones, which is exactly what you need when headcount is down 15% and the account is more complex than ever.

What this means for the people still in the field

If you are in a pharma commercial role today, the honest news is this: the team is getting smaller, and the work is getting harder. The less obvious news is that the work is also becoming more strategic, more influential, and considerably harder to automate than the one it replaces. You are moving from being the person who delivers the message to being one of five people responsible for a clinical outcome.

The professionals who are thriving in 2026 are not the ones with the best relationships with the most doctors. They are the ones who are fluent in data, comfortable in regulatory conversations, confident working alongside a digital specialist and a patient-support lead, and calm about being measured on something a patient experiences six months later rather than a signature on a call report.

From seven calls a day in 1995 to five people on one outcome in 2026. That is thirty years of commercial evolution, compressed into one sentence.