A Commercial Mind
“Generally medical doctors who work in hospitals have no idea about what we do in the company,” remarked the head of medical affairs at a leading American biopharma company. On one hand, there appears to be a very strong demand for medical doctors (MDs) in Asia, but at the same time, there is frustration about the quality of physicians who are working in the industry.
Morunda interviewed a broad cross section (45 participants answered questions by email or phone) of the pharmaceutical industry, including medical affairs, pharmacovigilance, clinical development, human resources, marketing, and regulatory affairs, and asked, “What characteristics or experience does an MD need to have to demonstrate to you that he/she was commercially minded?” and “What questions would you ask an MD to determine whether he/she is commercially minded?”
Some believe that doctors have difficulty adapting to industry and that they have difficulty seeing themselves as part of a company. One MD said that many doctors struggle to share the same goals with colleagues and sing the same song. A director of medical affairs at a mid-sized American biopharma company said the term “commercially minded” could be translated into the following:
An MD should understand that a company needs to profit from commercial activities in order to pay employees and to invest in pipelines. Thus, even though an MD for development and medical does not have direct/primary responsibility for sales, he/she needs to collaborate on commercial functions. MDs for drug safety should make critical decisions independently from commercial impact considerations but need to collaborate with the commercial team in order to minimize negative impacts when implementing decisions.
He went on to explain that the characteristics of “commercially minded” MDs could be to have the capability to understand that all employees are responsible for maximizing sales or for minimizing negative impacts on sales caused by necessary decisions/actions, while keeping patient safety/benefits as a top priority.
A leading medic from a top-five American pharma company said that they don’t typically include “commercial mindedness” in their criteria for selecting MDs, rather they focus on the following criteria when seeking to hire MDs, with the emphasis on leadership potential and evidence for learning agility:
- Scientific capability/track record
- Relevant clinical experience that can be translated into clinical development or medical programs
- Experience in clinical research
- Leadership potential
- Evidence for learning agility (i.e., ability to adapt and perform well in new situations)
A marketing VP offered a different perspective:
MDs, especially in medical affairs roles, need to have a good balance of scientific credibility and business acumen because their main role is to collaborate with their business colleagues to ethically commercialize products that have proven successful in development trials. Successful medical affairs colleagues are those able to translate the science behind a product and simply convey the value the product brings to health-care professionals and ultimately to patients.
Other responders spoke of “business acumen” and “team orientation.” Business acumen or business insight is understanding how the business works, how competition works, and the business language, such as marketing tactics, strategies, and interests in all of these elements. If candidates with an MD background want to live in an academic tower with a researcher mentality, they don’t have business acumen.
An HR director based in Shanghai looks for an understanding of the impact of activities on patients, how MDs integrate medical activities into commercial strategy, and whether they are cost conscious. Through our discussions with commercial and medical professionals, it soon became apparent that there are various paradigms. Commercial directors said repeatedly that a medic’s role is to offer support, not to act as a police person, to follow the directives of the regulators, and to collaborate with marketing and sales.
A regulatory affairs director of an American specialty-care pharma company highlighted the difficulties of new companies seeking a new market/therapeutic area to establish a network of health-care providers and/or prescribers in those therapeutic areas. MDs can add great value to sales and marketing to open doors if they have the necessary expertise in a given therapeutic area. She stressed that “commercially minded” means to support market and sales representatives on the medical side and to explain clinical characteristics, efficacy, and safety of the product. Generally speaking, health-care providers trust the medical message from doctors over that from medical representatives.
An American executive based in Singapore stressed the importance of business training:
Structured management/business training presents a strong indication of commercial mindedness. Having strong interests in business statistics and business strategy are other indications. Besides having business sense, cross-functional collaboration, proactivity, and clear ideas on medical governance are equally important traits. They need to understand that they are part of a commercial enterprise. Lines need to be clearly drawn between medical and marketing, but, ultimately, a pharma company is a commercial enterprise.
A Japanese MD with more than 15 years of industry experience stressed that attitude and mind-set are important factors to determine success. “In my view, what being commercially minded means is the willingness to understand the commercial value system and the competency to deliver the medical and social value of a program to users.”
A leading European physician based in Shanghai simply stated that “Good science is good business.” A medical affairs director in Tokyo agreed:
Commercially oriented doctors must understand what is good for the patient and what is good for business. Such doctors, however, should be able to make the right treatment decision in favor of the patient, not the business. And such doctors should be able to utilize the available medical and scientific data to boost a drug’s potential for successful marketing. Simply put, to find the best drug for the best patient in the best market.
If the patient comes first, explained a clinical director, then commercial success will follow, and the truly successful MD in business has the ability to think beyond approval and to think “beyond one patient at a time,” which is typically the approach a physician takes.
A physician with a commercial mind-set considers not only products in development but also products that are commercialized. Truly commercial-minded MDs have worked with brand teams that include marketing and sales. They have participated in international brand teams and have been listened to in these brand teams. They have also been involved in initiated/supported medical affairs trials (investigator-sponsored or company-sponsored) that have helped establish a product commercially through generating data that drove practice change, integration of product in treatment practice, and expansion of indications.
Keep MDs in Science
Other respondants argued that MDs should be kept squarely in science where they provide the greatest value and not in commercial functions. One MD working in industry said, “Basically MDs in a pharmaceutical company should not be working in commercial functions because MDs have to keep a scientific opinion and make scientific decisions.”
Another physician at a major European company said:
MDs should only be used in noncommercial or medical scientific departments, such as clinical development, pharmacovigilance, and medical affairs. Having a commercial mind is not mandatory. In fact, being too commercially minded is risky for balancing risk and benefit in terms of the ethical/medical and business perspectives.
A medical affairs director suggested that Asia offers a different landscape for MDs:
I think the expectation for a commercially minded MD is quite different in Asia, unlike the US or EU. I know several MDs who are in very high positions in pharmaceutical companies and have a successful track record in the company but are not really commercially minded. Most of them are expected to be medical experts representing the company in various developmental situations to discuss or debate with physicians in developmental studies.
Others suggested that pharmacists have the necessary skills for medical affairs as most pharmacists have a very high skill level. Foreign companies have a preoccupation that the head of medical affairs should be an MD. This is wrong! Most MDs don’t have the knowledge of prescription drugs as do pharmacists.
Questions to Ask When Interviewing a Medical Doctor
We asked our group to list examples of questions that they might ask MDs during an interview.
Does the MD Have a Commercial Mind-Set?
- How would you help increase revenue (or minimize negative impacts on sales if the revision of a package insert influenced sales negatively)?
- Explain the commercial opportunities this product (example shown) brings to the company.
- What is the size of the x product business? Which country is one of the top three in sales? How should we promote the product? Will this product be a business success?
- Explain the P&L structure of the company you work in. Which activities have the best ROI?
- Would you prescribe drug A (your company’s product) to a patient who really needs drug B (your competitor’s product)?
- How do you plan to increase your company sales with your medical knowledge?
Expected answers would be: A1, No; A2, by scientific data gathering and refining the product messages to find the best fit for a patient’s needs.
- What are the most critical unmet medical needs to be solved in the next 10 years?
- What are the most interesting scientific/medical advances that could be applied to future therapies? What could be the differentiating points of a new drug from existing therapies (with appropriate information provided)?
- How comfortable are you with meeting customers? Are you comfortable with the term “customer”? Do you believe it’s important to work with sales and marketing?
- Have you helped a compound break new ground, either from helping with its introduction after new approvals or reaching new groups of patients?
- How can you contribute to new therapies or new ways of using old drugs compared to a candidate who can only describe the basic science behind their research interests?
- What is the most successful pharma company in your assessment, and why do you think it’s successful? What do you think are the core competencies of that company?
Leadership and Learning Agility
- Have you/do you supervise junior staff as an MD? How did you manage your staff?
- Have you held any leadership positions outside your medical career (in student organizations, professional bodies, hospital committees, voluntary organizations)?
- Can you give an example of a success in your career and how you contributed to the success?
- What do you think is important in leadership? How would you lead/manage a small team if you were asked to do so?
- Have you ever had to influence someone who didn’t agree with you in order to meet your goals—how did you do it?
- Have you ever had to deal with someone not doing what they were supposed to do (if they have no direct leadership experience, we would focus on dealing with other staff in a hospital or lab)? How did you deal with the situation?
- Can you describe a major change in your career? What challenges did you face, and how did you deal with them?
- Describe a time when you needed to work with a person that you didn’t like.
- Describe two relationships you formed: one with a group inside your organization and one outside of your organization.
- Tell me about your experience working in a team. What kind of role did you play? What was the biggest hardship? How were you able to overcome the hardship?
- Describe your scientific capability. What are your major achievements?
- Describe your relevant clinical experience. How could that experience be translated into clinical development or a medical program?
- Describe your experience in clinical research.
- Describe a time that you led a team. What challenges came up for you?
- Describe a time that you had to adapt to a new environment. Looking back at that experience, what did you learn about yourself?
Usually points 1–3 are not the issues used to decide whether or not to hire, rather points 4 and 5 are used. Our experience is that compared to the United States or the European Union, MDs in Japan show a depressing lack of leadership (we have met exceptions). It may be that what other companies describe as “commercial awareness,” we classify as “leadership and learning agility.”
- What do you want to do when you join this company? How are you going to contribute to this company? Why are you excited about working in pharma?
- Are you interested in leading technical functions based on your medical knowledge?
- Are you interested in creating, managing, and leading a key opinion leader (KOL) group with your knowledge and experience in a hospital?
- Are you interested in improving the academic knowledge level at an organization with your knowledge and experience in a hospital?
- What do you think is the greatest difference between clinical/research and business?
- What do you want to learn, and how do you want to grow in pharma?
- Describe a few of your contributions and past achievements.
- Give an example of how we can turn an unmet medical need into an opportunity for the organization.
- Give an example of how you have put across the case for an increase of resources for the medical department in the past.
- Have you been involved in product prelaunch and launch work? What role did you play?
- Provide examples of actual experiences to explore potential treatment/therapy, an unsatisfactory experience with an existing pharmaceutical company in clinical practice, managing experience of a treatment team composed of different functions, and experiences of achieving things at a project level (all to prove his/her solution-oriented mind-set and aptitude for working in a commercial industry).
The demand to hire top medical talent in Asia is increasing, and the ability to screen and interview correctly has never been more critical. Asking the right questions is paramount. Our survey also discovered that there are differences of opinion internally at many pharmaceutical companies on the role that MDs should play. There appears to be a need for training and alignment on how best to use the services of MDs in Asia.
Doctors are learning that a pharmaceutical company serves a customer, and, therefore, basic business courtesy is mandatory. The doctor is part of a team servicing hospitals and clinics. One clinical director suggested that MDs should practice listening 90% of the time and talking 10%. This is not to downplay the critical role that MDs have in the industry, but it underscores that businesspeople first need to understand the situation at hand before offering an opinion.
The pharmaceutical market in Asia is calling for businesspeople who are MDs as opposed to MDs who happen to work in the industry.