Editor's note: This article appeared in the June 14, 2010, edition of Quirk's e-newsletter.

2009 was a year filled with change for the health care/pharmaceutical industry, and it's now only beginning to show signs of recovery. It's reported that 15,000 industry sales positions were eliminated in the U.S. in 2009, while estimates of pharma sales force losses in France, Germany, Spain, Italy and the U.K. range from 15-30 percent. Due to this dramatic decline in sales reps, the trademark spray-and-pray method of barraging physicians with frequent visits from sales reps spouting the same spiel and hoping that the message connects with the right physician along the way is no longer preferred or even plausible. Instead, according to an annual study from New York research company Kantar Health, the stress on the industry as whole is compelling pharmaceutical companies to focus their resources on customer retention. Pharma companies are attempting to strengthen their performance on key satisfaction drivers to create and maintain more brand Apostles - physicians who are both satisfied and loyal and willing to spread good word-of-mouth along to their colleagues. On the flip side, impersonal, uneducated and poorly-targeted marketing efforts and sales visits - along with a weak portfolio - can create brand Rebels - physicians who are both dissatisfied and disloyal and likely to generate negative word-of-mouth.   Kantar's study is designed to serve as a barometer for how physicians feel they're interacted with by the top 16 companies in the pharmaceutical industry by evaluating sales reps, their skills and how they influence the physician's intention to prescribe a brand (customer retention). Companies were evaluated on eight attributes: representative conduct; representative knowledge and expertise; quality and value of visit; patient management, education and support programs; physician education and information services;...