Making the transition from clinical medicine to the pharmaceutical industry – Perspectives from real world experiences of a physician

A career move from clinical practice into the pharmaceutical industry is a growing trend among physicians in primary care and a wide range of subspecialties. Opportunities exist for internists, surgeons, pediatricians, obstetrician-gynecologists, and sub-specialists from virtually any field in medicine to hone their skills and expand the horizons of their medical acumen. They can be involved in the discovery, clinical development, successful licensure, and marketing of drugs, vaccines, or devices in any therapeutic area. With the move from clinical medicine come the promises of a greater work-life balance for practicing clinicians, an opportunity to impact the health of populations on a global scale, a chance to develop elusive orphan drugs for rare but devastating diseases often of a genetic etiology, or to engage in cutting-edge translational research with the potential for a highly satisfying career that is devoid of the rigors and detractions of clinical practice.

Despite the seemingly greener pastures that may await the newly transitioning clinician, new medical school graduate, resident, or fellow, there are many hard lessons to be learned in making what is often a leap of faith. In this article, I will attempt to address many of the real world challenges one might face, drawing from my personal experiences as a clinician who has taken that step, as well as those of friends and colleagues who have either found success or for whom it has been a misstep. Many such challenges stem from deficiencies inherent in medical school, residency and fellowship training that do not provide adequate preparation for the demands of a corporate working environment. Others arise from the need to develop and nurture a proactive as opposed to a reactive work ethic, the demands of performance reviews that can significantly impact compensation and opportunities for promotion; reporting hierarchies in which physicians are managed by non-physicians; limited opportunities for attendance at conferences or congresses and for Continuing Medical Education (CME) to satisfy licensure requirements for those physicians who desire to maintain an active license to practice; less vacation time, limited opportunities for ongoing part-time clinical practice, and increasing job uncertainty as layoffs can affect even the most accomplished of employees in pharmaceutical companies during times of reorganization or cost-cutting.

Work ethic in the corporate environment

As medical students, we are taught, and indeed almost programmed, to respond to events, minor or increasingly catastrophic, that impact the wellbeing of individual patients. A patient typically comes to the clinic or presents in the emergency room with an illness or injury that demands a physician’s intervention designed to preserve health or life. In industry, such a reactive approach certainly applies in a myriad of situations that arise, often unexpectedly, for instance to address an unexpected drug safety concern, respond to a request from a regulatory authority to provide more data for a product licensure application, or to act to prevent patients from being exposed to a substandard batch of a company’s product. However, a proactive mindset is critical to success in most functional areas in industry in which a physician is likely to work. Such an approach seeks to anticipate opportunities and challenges that may be pivotal to success. Examples include, but are not limited to:

• Clinical development planning
• Strategic planning for medical affairs activities
• Communication of medical information to external stakeholders pertaining to product-related adverse events not yet fully updated in product labeling

Performance reviews

Performance based pay is no longer an idea foreign to physicians, owing to an ever-increasing demand for quality-based payment driven by government health care agencies and payers, including health insurance companies. Quality indicators used for such purposes are predominantly focused on individual patient encounters and outcomes. In industry, performance is measured by accomplishment of predetermined, self-designated, manager-approved project goals, typically reviewed biannually at midyear and year-end. Performance metrics also include peer and manager evaluations, all of which factor into computation of annual bonus payments and year-to-year salary increases. Physicians transitioning into industry are more often than not unfamiliar with such measures, and will need to adapt to the demands of focused attention to achieving set goals, and the possibility of facing lower than expected compensation if goals are not achieved.

Reporting hierarchies

It is not unusual for physicians to find themselves reporting to non-physicians (usually PhDs or PharmDs), particularly those in clinical development and medical affairs roles. It is important that physicians recognize the fact that fellow physicians are not necessarily the best-trained people managers. A personal experience has been the fact that I have been managed by physicians in three out of four jobs in major pharmaceutical companies, yet my experience with one non-physician manager has been the most productive and enjoyable experience of all. People management requires skills and personal attributes in a manager that physicians are often ill equipped for as they emerge from academic or clinical environments and transition into industry. These can be developed in a corporate environment in which attention is paid to leadership development, as is very often the case in major pharmaceutical companies.

Continuing Medical Education

Employed physicians typically have designated time and even allocated funding for attendance at congresses and other meetings or activities designed to help them fulfill state CME requirements for renewal and maintenance of licensure to practice. In industry, this is often not the case. CME time is best negotiated at the time of hire, and physicians should, where feasible and appropriate, seek to include these terms in the employment contract. In most instances there is no additional time or funding provided for CME activities that are deemed not to contribute directly to the needs of the company, although some companies are more flexible than others in this regard.

Opportunities for part-time clinical practice

Most companies permit employees to engage in clinical practice in their own time, which effectively means during weekends, or after hours. However, some do encourage physicians to maintain clinic hours, and will often give permission, by mutual agreement, for a half-day or full-day clinic each week. Others will even provide medical liability insurance coverage to their physician employees while they engage in clinical activities. It is important for those physicians who intend to continue to practice on a part-time basis to discuss this with Human Resources or their managers at the time of hire, or as and when a decision to practice is made subsequently

Job layoffs

The global economic downturn of the second half of the past decade and the early part of this one have resulted in the introduction often drastic and sometimes unanticipated cost-cutting measures by pharmaceutical companies to minimize the attendant fall in profit margins. Such measures have included job layoffs to which even some the most seasoned of pharmaceutical professionals have not been immune, particularly within larger pharmaceutical companies. Physicians can be affected by such measures just as any other employees in the corporate environment. This calls for careful contingency planning and the need to be open to change, often at a few months’, or even weeks’, notice. A job loss can be devastating, particularly for those physicians who may have not been employed for long, as severance packages are often based on length of service and may be insufficient to bridge the gap between losing one job and finding another.

Internal reorganizations

Similar to job layoffs, internal company reorganizations, which are not an uncommon occurrence in larger pharmaceutical companies every few years, or sometimes even months, call for change management awareness and capabilities among employed physicians. The outcomes of such reorganization include new reporting hierarchies and greater or less responsibilities and visibility within the division or company. Such changes can make for very stressful periods of uncertainty for the unprepared physician.

Personal career development planning

The opportunity to chart out a personal career path and plan for the acquisition of leadership skills is one of the greatest benefits of a career in industry. Many companies have well-defined mechanisms in place to ensure that employees have an opportunity to discuss and develop plans for career advancement, although pathways for promotion are not always clearly defined or transparent. Any physician joining industry should discuss both career development planning, as well as potential future avenues for promotion, with Human Resources at the time of interview and/or hire, with subsequent dialogue with their managers as appropriate once on the job. Performance reviews will often include a component dedicated to career development.

Conclusion

Physicians making the transition into the pharmaceutical industry often do so without sufficient prior knowledge or understanding of the workings of the corporate environment, and may thus be ill-prepared to handle the many challenges they may face. That said, mechanisms do exist to facilitate and accommodate the needs of the physician, but these often require that the he or she be proactive in paving the pathway to a successful and fulfilling career.

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