By Anonymous Pharmaceutical Physician
Have you ever wondered about putting your clinical expertise to work by bringing new therapies to the market? Have you participated as an investigator in a clinical trial but wished you could have changed the trial design or chosen different endpoints or indications for the compound? Are you curious about the business behind the international pharmaceutical industry but afraid that the only career paths are in sales and marketing? Did the administration at the hospital you work at suck the last bit of joy you were getting out of patient care through their mismanagement of your workspace during the pandemic?
The pharmaceutical industry is an alternative that can be intellectually stimulating and financially rewarding, and it can provide an opportunity to contribute to the discovery and development of new therapies which change the practice of medicine.
I have spent over 25 years as a physician in the international pharmaceutical industry. I did not choose the career out of financial considerations or to escape patient care but because I wanted to learn more about clinical trials to build a career in academic medicine. I found that pharmaceutical medicine can include a wide variety of career paths, allow one to continue to be active in scientific publications and applied research, and be very financially rewarding. I get a little boost every time I see mention of a marketed pharmaceutical that I began to work on before it had been tested in the first human volunteer in a trial.
Pharmaceutical Industry Landscape
I think of the industry as having three broad divisions based on their products: generic pharmaceuticals, the “research-based” biopharmaceutical industry, and medical devices. Most pharmaceuticals used in the US are from generic manufacturers, but those companies, largely based outside of the US, are in a low-margin commodity business. They have few physicians compared to the volume of products they sell, and they do not offer the salaries that the “research-based” industry does. Medical devices have shorter product cycles, and they are more expensive to market on a per-product basis than pharmaceuticals and biologicals. Biopharmaceutical (“Pharma”) companies are the largest employers of physicians in this product space.
The Pharma industry can be further split into small companies with no or very few marketed products and the larger companies you know well. There is often an impression that innovation and new drug development are more likely to come from smaller venture companies, but I think that is incorrect: almost all of those small companies fail. The hardest part of bringing a new drug to market is passing through the clinical development and regulatory review process, and that expertise is concentrated in the larger pharma companies. The small, creative, venture companies can be great at the underlying science for compound discovery, but they then cripple themselves with mistakes in the preclinical and clinical development stages that are impossible to undo before their funding runs out.
If you are interested in a career in pharmaceutical medicine, my advice would be to start at one of the larger companies where you are surrounded by decades of expertise in the drug development process and its many quirks and pitfalls—especially, if you want to eventually start or work at one of those tiny startups.
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Careers for Physicians in Pharma
Most physicians working in the pharmaceutical industry are working in either Clinical Development (CD), Medical Affairs (MA), or Pharmacovigilance/Drug Safety (PV). Once in the industry, it is not unusual to move between those areas. Just as medical specialties come with different lifestyle characteristics, these three careers differ. Clinical Development frequently requires very long hours and round-the-clock availability for emergencies, and they can be highly stressful, especially when finishing a trial and during the regulatory submission process. It is difficult (but not impossible) to rise far in CD outside the therapeutic area in which you are trained. For instance, even though a Nephrologist working in Alzheimer’s disease may know far more about their compound than any Neurologist, it becomes difficult for them to work with the Neurologists both within and outside the company who are engaged in those clinical trials because of their different core specialty expertise. Larger companies tend to be more insistent on a specialty background that matches the therapeutic area you are working in. In general, those working in CD will tend to be better compensated than their colleagues working in PV or MA, but they also have less job security because they may lose their job if the compound fails. They can also lose their job if the compound is successful and gets licensed out or for commercial reasons and doesn’t require further studies.
In contrast, Pharmacovigilance (“PV”) is more frequently a “9-to-5” job. It may seem like PV workers would be up all night, frequently dealing with safety emergencies. But medical emergencies are handled by medical monitors in CD, and PV would work with CD on the evaluation and regulatory response for such issues. I have been a global head of PV for over 20 years, and while I have had my share of late-night emergencies, I’ve almost certainly slept more than the heads of any one of our CD projects. PV also attracts many women physicians, and over the years, most of the regional leaders for PV in my company have been women. Because PV is an essential function, both during clinical development and post-marketing, it comes with better job security than either CD (which is subject to sudden changes in development programs) or MA (which can be affected by in- and out-licensing decisions and changes in commercial focus).
Medical Affairs (MA) can vary between companies. In some companies, MA is responsible for within-indication post-marketing clinical trials, while in others, it is solely involved in synthesizing and communicating information that comes from Clinical Development and the scientific literature. MA is a relatively recent career path compared to PV or CD. It can be misunderstood to be part of Marketing, but there are important regulatory reasons why it must be independent and focused on evidence generation and communication. I think it does attract physicians (and other professionals, including pharmacists, Ph.D’s, etc.) who excel at communication and understanding how a treatment landscape is evolving. In the US, most Medical Science Liaisons (there are several variants on this title) are not physicians, while in many Asian and Latin American countries, that is more common.
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Getting the Pharma Job
Because prior experience is important, the first job in Pharma is likely to be the most difficult to land. For hiring physicians, most companies will use a recruiting firm, sometimes even as the liaison to hiring someone they are already familiar with from prior consulting. A recruiting firm helps by creating a buffer between the candidate and the employer during negotiations, allowing a company to consider multiple candidates at one time and to help set expectations for the candidate. For this reason, approaching a recruiter who specializes in Pharma hiring can be an excellent way to start your job search or to get advice on your prospects. Keep in mind that the recruiter ultimately works for the hiring company, but they need candidates in order to do their job and can be open to working with you even before you have industry experience.
Candidates are much less attractive to a company if they have little or no clinical experience because it is a direct understanding of the practice environment that sets a physician apart from the many Ph.D. scientists and pharmacists who may compete for a similar position and who often have deeper scientific knowledge than clinicians. Starting salaries in almost all cases would be lower than the average income for a practicing physician in that specialty. But as their career progresses and if a physician becomes a functional head in clinical development, their income could be well into seven figures. Perhaps the ideal hire—for both the company and the employee—is someone who has worked with the company as a consultant or a clinical trial investigator and who has already proven to give useful advice for the many practical and strategic problems that come about during clinical development. That kind of hire is still the exception rather than the rule, but it is one way that income might go up immediately upon switching from clinical practice to Pharma.
Companies are very selective in hiring. Do not approach the job search with the assumption that it is easier to get hired than it would be to match into a selective residency. When my department hires graduate students, we typically review 200 candidates in order to hire two. Those are not physicians, but most unsolicited requests for employment from physicians are not even considered unless they already have some industry experience or are coming through a trusted recruiter or current employee. The typical rejected request comes from an academic physician who is frustrated with their job and thinks a Pharma company will be happy to hire them because their drug sales reps are always so polite and deferential. It is important to present yourself with enthusiasm and a desire to learn, because medical school and clinical practice have not prepared you for how you will apply your medical knowledge in this highly regulated industry.
Many physician jobs in Pharma do not require a US medical license, and this can be an avenue for foreign-trained physicians who are not licensed in the US. Alternatively, it can be one of the few ways that a physician can work in many different countries over their career, because they do not need to become certified to practice. There is a growing field of “Pharmaceutical Medicine,” but apart from a few, mostly European, countries, it is not a recognized specialty. In any case, it’s not a requirement for working in the field.
Clinical pharmacology used to be an important pathway for physicians to work in Pharma, but at this point, only a fraction of physicians in the industry are trained in clinical pharmacology. Most of the clinical pharmacologists I have worked with were not physicians. However, the concepts in clinical pharmacology come up repeatedly in our work, and it’s wise to have some knowledge of the field. Postgraduate work in clinical pharmacology or pharmaceutical medicine can be an advantage when looking for work in Pharma, but is not a requirement. Pharmacoepidemiology has grown in importance to the pharmaceutical industry in recent decades, and it can be useful both in MA (many post-marketing studies are database studies using the techniques of pharmacoepidemiology) and PV.
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My Experience as a Physician in Pharma
I had my first, brief introduction to the pharmaceutical industry in 1990. I had graduated early from medical school and had six months to fill until residency. I wrote to 34 pharmaceutical companies using addresses in a stock investing book I found in a business school library. Eventually, six offered me jobs (only two had any form of an interview first), and I chose the offer that had the highest salary. I realized later that the key to getting those offers so easily was that I was offering a limited time commitment for the companies. I had also attended well-known schools, and I came with no strings attached or specific salary demands.
During the short time that I worked there, I discovered the amazing resources and expertise Pharma can devote to drug development. As an undergraduate, I had worked in one of the leading organic chemistry research labs for an advisor who later won the Nobel Prize. But that lab’s resources did not compare with what the mid-sized pharma company had available to quickly identify new compounds in their synthetic chemistry discovery process or to answer key questions about drug-target interactions. The experience gave me new respect for the Pharma industry, and I decided to return for a year after residency to get experience in managing GCP clinical trials so that I could become a more productive academic physician. I returned after finishing my residency in 1996, but my job role expanded quickly and the work became more interesting so I have stayed at that company ever since.
I work in drug safety and pharmacovigilance, which means that I am involved in the review and design process of all our clinical trial protocols as well as the detection and reporting of new adverse events during clinical development and marketing. My favorite part of the job is when we receive the topline results of a pivotal clinical trial for a new indication. There is nothing quite like seeing results for the first time that you know will change the practice landscape. That is, unfortunately, the exception rather than the rule for drug development since most development programs fail. Even those that succeed usually result in only marginal improvements over existing therapies.
During my first years at the company, my most important role was to build an international system for the company for compliance with pharmacovigilance regulations as it was entering the US and EU markets for the first time. That work relied very little on my medical training but required being a physician, as it meant hiring a network of physicians and mastering the complicated regulations on safety reporting in each country where we were expanding. In 2007, I was made a corporate officer for the company which gave me new insight into how large listed companies are governed, how major business decisions get made, and the ways company officers need to interact with the Board of Directors.
Compensation for Physicians in Pharma
My experience with compensation has been somewhat atypical, because of the unusual skill set I developed (I am bilingual and was willing to live overseas, I teach pharmaceutical medicine at several universities, and I have served on several expert committees for industry organizations, etc.). From 1996-1999, my income was just above $100,000. I received a promotion that increased my salary to the $400,000-$500,000 range from 2000-2006. It then increased to the $700,000-$1 million-plus range. Like many senior executives, my income varies depending on how the company performs, and I can move from the top to the bottom of that range even after an extremely busy year where I performed well but the company did not. Also, a substantial fraction of that compensation has been in restricted company stock which I cannot sell.
I have enjoyed my career, and I would choose this path again without hesitation. But I do have some regrets. I really enjoyed direct patient contact during my clinical career and the physical sense of accomplishment from performing surgeries. Neither of those is possible in my current work. However, the combination of science, business, and the chance to help mold the therapeutic landscape has been a good match for me. The pharmaceutical industry hires not only physicians but also veterinarians, pharmacists, lawyers, and nurses, so a wide variety of those in The White Coat Investor community might consider this career choice.
Have you thought about making a career change to the Pharma industry? What do you see as the positives and negatives of making such a move? Comment below!
[Editor’s Note: The author has worked for over 25 years in the international pharmaceutical industry. This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]