You're missing the big picture - medical device companies are sending out sales reps instead of instructors and you're insisting that if the reps weren't there there'd be no instruction!

Imagine if any other industry operated like this. You can't fire the gun unless Colt has a sales rep sitting over the soldier's shoulder. You can't operate the bulldozer unless Caterpillar has a sales rep standing on the sideboard. You can't run the software unless Microsoft has a guy next to you saying "looks like you're trying to make a spreadsheet, would you like help with that?"

And great. You've been hanging out with the Michael Jordan of surgical reps. That doesn't change the fact that the guys I interacted with are three-martini-lunch pharma bros with a business degree from Bumblefuck State whose principle business skill is getting a good table at Spago. And I, the 23-year-old kid working on his undergrad mechanical engineering degree, got to give the rundown to the guys who called doctors "bad carpenters" because everyone else in engineering was instructed not to talk to them.

Sure. The term is like "chef." It's an unprotected term that anyone with any level of education can use. That means that yes, some b-school dropout wearing Hugo Boss is off showing a thoracic surgeon how to implant a fixation helix in an atrium.

And you know what? The surgeon has done it before. Fixation helices are not new technology. But this one has a 90/10 cut instead of a 85/15! So obviously he needs to be there to show the guy exactly how it works or something bad will happen. And when something bad happens everybody wants to make sure that their Is are dotted and their Ts are crossed because the last person left holding the bag when the depositions stop gets to pay the class-action lawsuit.

I tell you what: you require "medreps" to have a doctorate in medicine, you require them to register like lobbyists and you require them to be able to educate any surgeon in one (1) training and I'll agree with you - they have every reason to be in the theater. Until then?

no. They're business majors. Their ability to convince a person to go Guidant over Medtronic does not qualify them to stand over a surgeon's shoulder, no matter how many times they've been through the deck.