Hey, guys. Welcome to the podcast. My guest today is Sarah Ussery. She is a medical affairs leader, and we discuss the MSO role and the differences in large pharma versus smaller biotech. Really interesting conversation. I think you guys are gonna enjoy this.
Don't forget to follow me on LinkedIn and check out the announcements for MSL talk live, which is a panel discussion similar to this podcast, which we air once a month, typically the 1st Tuesday of the month at 1:30 PM EST, but look for the notifications on LinkedIn. And as always, thank you for joining me. Thank you for sharing this podcast. We really appreciate all your support. Welcome to MSL talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical.
Hey, Sarah. Welcome to the podcast. Thanks for joining me. Hey, Tom. Thanks for having me. I'm excited. I am really excited. So guys, you know how I like to just give you the lowdown on how these podcasts come about. Well, Sarah and I met recently. We met both virtually and live because I had the opportunity to meet Sarah at ASH, and she's awesome. And we had this idea to do a podcast together.
And it's gonna be about the differences between big pharma and small biotech or small pharma because there is really a distinction. And a lot of people have asked me that over the years that we've never covered it. So, but before we get to that, why don't, Sarah, why don't you introduce yourself? Sure. Thanks, Tom. Yeah. So I am a PharmD by background.
I'm a trained TMONC pharmacist and, worked in the clinic for years before coming to industry about 12 years ago, and I worked, exclusively in field medical affairs, as an MSL as well as in leadership positions. And I, have had the opportunity to do field training as well as, various leadership roles in different companies. Been in about 5 companies now ranging from big pharma to small, you know, biotech type of, settings.
So really excited to kinda share my experience, and the differences between the two that I've seen. And Sarah's the perfect person to talk about this because she has really good, vast experience at these companies. So you guys are ready for the treat. Before we go into that, just wanted to mention this podcast episode is sponsored by the MSL Mastery program. If you guys aren't familiar and you haven't checked it out, Sarah Snyder and I started a coaching program.
And the first official program is called the aspire MSL program, and it's for those that are looking to break into the MSL position. So if you want more information, go to mslmastery.com and search under aspire MSL. A lot of people are getting interviews and jobs, and it's going really well. So I just wanna share that with you guys. Check it out. But let's jump into this topic because I think that this is something that a lot of people need to know because there are differences.
But let's start with big pharma. And if you could just explain, like, what exactly does that mean and what companies would be considered big pharma? Yeah. Absolutely. So, generally, big pharma is really focused on refining development of molecules, compounds, therapies, focusing on, you know, conducting the clinical aspect of testing.
Some big pharma companies do have their own internal development, but many of them rely on the smaller biotech companies to maybe do preclinical development, maybe first in human studies, and they really have expertise in doing, you know, registrational pivotal phase 2, phase 3 trials and beyond to bring drugs to market. They generally kind of follow a big business model, focused on generating revenue from FDA approved products, and those marketed products that are on, clinically available.
And oftentimes, like I said, they rely on those small the the engine, the biopharmaceutical engine that is, like, generating compounds and development in preclinical settings and then bringing, those into the big companies, sometimes in a co development type of situation. We can talk about that too.
And, generally, another kind of distinction, and before I jump into kinda giving a few examples, I'm sure everybody could rattle off big pharma companies off the top of their head, but another distinction in big pharma is generally, it's it's top heavy in the sense that there's lots of leadership layers. So that comes into play a little later when I talk about some key differences, especially for MSL opportunities.
But big pharma companies, by example, are like Bristol Myers Squibb, you know, Pfizer, Novartis, GSK, companies like that. Yep. That makes sense. Totally makes sense. And thank you for that explanation. I kinda learned a little bit on that too because you don't always know what the differences are as far as who's responsible for what and what those distinctions are. So, conversely, I'm curious now to hear your take on what qualifies for, like, a smaller pharma or, like, a smaller biotech.
Yeah. Perfect. So, generally, when you think of a small biotech or small pharma company, you think of kind of a younger company. It's a sometimes an emerging company. Some have been around for 15 years and maybe have changed faces over the years, but generally speaking, they're they're new they're up and coming. And they're there to develop products, you know, in different therapeutic spaces. A lot of the biotech terms companies, are developing biological therapies like DNA, RNA, etcetera.
And they don't typically have FDA approved products or marketed products. Some companies are in the process of developing those products, and maybe have one product on the market, but generally speaking, these small companies maybe are free commercial, kind of setting. So generally, like I said, young entrepreneurial, they follow a small business model, so most of their, you know, cash comes from investors, comes from loans, things like that.
And even bigger companies as I mentioned collaborating with them and maybe co developing and maybe giving them a little bit of a cash flow to help them do first and human studies and then potentially that company, big pharma, might buy that asset down the road. And they are often referred to, as I kind of mentioned earlier, like the research in the engine of the pharmaceutical companies.
So some examples of small pharma include, you know, Legend Biotech, Biogen, company I was just with, Mersana Therapeutics, and I you could probably rattle off tens of 1,000 more. So it might not be recognizable, but those are a few that might be recognizable to the crowd. Well, you know, what's interesting is you mentioned, you you actually you mentioned Biogen, which started out as a small biotech, and now they're kind of a large biotech, but certainly not large pharma.
Yeah. So it's kinda funny how you can get caught in the semantics of this. The other thing too is and this is what I've kinda noticed as a paradigm shift over the last maybe 5 or 10 years is that when I first started in this business as an MSO recruiter 20 years ago, 20 plus years ago, only large pharma was hiring MSLs. Mhmm. Now we have even smaller biotechs, as small as, like, 10 employees Mhmm. That believe it or not, wind up hiring MSLs and building out MSL teams.
So the crazy thing is this could be teeny tiny, and it could be Biogen, which is large, but still continue biotech. Does that make sense? Absolutely. And I think you could actually spend some time on here talking about those midsized companies because they can actually, flip to both to either or models, like, when we're talking about distinctions between the 2. And so, you know, we could spend a whole another, probably, podcast on that.
But, yeah, as you mentioned, in general, you know, medical affairs portions of organizations, including the MSL, spill teams, can form in a company as little as 20 to 50 employees. Generally, what I've seen is it's around the 100 mark, 100 to a 150, and it's usually, when a company has decided to develop, their and have their own internal development of a compound and potentially come to market with that compound. It's usually when they start to bring in medical affairs or MSLs.
However, like you said, it's kind of changed. It's kind of morphed. And there are companies that bring in meta MSL teams and see the value early, in order to help enrollment to studies. Maybe they have a broad pipeline with lots of assets, and they're needing assistance with the some first in human studies. And so a lot of the work that those MSLs are doing are really focused on the clinical trials and enrollments and identifying sites.
But it can it definitely can vary, and it's it's definitely not, you know, just one definition for when you would bring in or one time in a in a in a growth of a small company that you would bring in medical affairs. True. Yep. So let's talk about what the responsibilities are for MSLs. Let's start with the large pharma side. What what how and and what that looks like. Yeah. So for, big pharma MSL type of roles, generally, you know, the MSL team is can be rather large. You know what I mean?
We're talking, you know, anywhere from maybe I mean, you could say 6 of large depending on what, you know, assets you have and what you're covering to, you know, 20 MSLs. So generally, the territories, are smaller in contrast to maybe small pharma I'll talk about here in a minute. So in that, you know, 1 to 2, maybe 3 states that a MSL is covering. So travel is probably a little bit more manageable. 50% of the time, you know, generally, we think of MSLs or traveling.
That's about the situation in in big pharma. When you think about kind of prioritization of what MSLs are doing in big pharma, say, what comes to top top of the list, generally is the bulk of the focus is around supporting marketed products.
So that cross collaboration with your commercial marketing, colleagues in order to help support medical education around marketed products is definitely key, especially if you're in a launch mode, obviously, bringing in either a new drug to market or a drug with new, indications. Secondarily, the focus is on, clinical research, of course.
We know that's a bread and butter of the MSL function, but when you think about the clinical research in big pharma, a lot of times it's more focused on the later stage assets, Those assets that are in phase 3, pivotal trials, maybe phase 2, you know, with a with a randomization maybe arm. And then, you know, the focus on investigator sponsored work or investigator initiated work maybe to a lesser degree, than in maybe smaller companies.
Generally too, I think another distinction is that, you know, MSLs will have the opportunity to take on leadership roles as well as special projects as we've seen, very successful MSLs and big pharma roles. But, generally, I think it's limited more to our medical affairs opportunities, maybe even the MSL team opportunities, which I'll contrast here maybe a little bit different in a small company in terms of special project leadership, roles.
And to add, in those companies, as I mentioned, they can be kinda top heavy, in the sense that there's a lot of leadership. There's a lot of, you know, c on your c suite, ERV, VPs, and executives. And and because it's such a big company, MSLs don't generally have as much visibility, and maybe as much face time, if you will, with that those leadership, portions of the organization and the company. Whereas in small biotech, it might be a little bit different we can talk about.
Yeah. And before we get into that, one of the things that just kinda dawned on me as you're talking about this, and I've I've spoken about this before, but for those that are looking to break into the MSL role, there's a lot of aspiring MSLs that listen to this show. You you definitely might wanna consider pursuing large pharma as your first role in the industry versus small biotech. Because of the capacity for training and development, there's just more resources available in large pharma.
And they also are more equipped to take on, somebody that's new into the role. So you're gonna have a different experience working starting your career out in large pharma than you would at a smaller company. I wouldn't discourage you from considering a smaller company. I'm just saying that, there are some nuances and maybe some advantages to starting your career out on the large pharma side. So let's go ahead. I'm sorry. I didn't say you're exactly right.
And that's my career trajectory, and that's a lot of times when I'm, you know, helping, mentor any any, in this professionals that wanna come into industry into the MSL role. I do recommend going to the bigger companies. They generally will, take inexperienced industry professionals and coach you and have the resources to do that. Yeah. So let's talk about the the smaller, side of the equation. So what are the responsibilities for MSLs when they're coming in Mhmm.
At a smaller biotech or a smaller pharma? Yeah. So in, my experience, it's definitely been, where the geographies that you're covering are generally a lot bigger. So thinking about probably more travel time, you know, 60, 70 percent of the time, you might be on the road. I know post COVID, some of that has changed. I know you've had some discussions around that in other podcasts, but, you know, the the so it's a bigger geography.
So when I came into my last job, I was the 1st MSL, and so I covered the whole country. It morphed over time as we added, obviously, additional headcount. So that's a a big differentiation. So maybe more travel, smaller companies.
Additionally, kind of the number one priority, and I already alluded to this earlier or probably said this earlier, is that, the focus is really around supporting clinical trial enrollment, identifying sites to add on to maybe new studies or a study that they're going for pivotal, you know, registrational. Additionally, you know, some of the smaller companies have the capacity and the desire to do investigator, initiated trials.
Maybe it's a company that already has a marketed product, so they have some cash flow where they can support more IITs, ISTs. And so there's a lot a a pretty big role for MSLs obviously in that space too, which may be a little different than in big pharma companies. The medical education piece, which I mentioned in big pharma is probably like the number one thing you're doing, It's a it's a little more secondary.
You're mostly talking around you know, educating around the pipeline, who the company is, because most people might not have any clue who you are yet. So a lot of, telling the story of the company, the pipeline, where you're going, you know, the unmet need that you're filling with the the molecules you're developing.
And the other thing that I mentioned earlier, is a difference, from big to small is kind of the opportunities to, really wear multiple hats, in addition to, take on special projects outside of even your department and working cross functionally across the organization with clinical development. You know, if there's a commercial marketing team, other translational, other parts of the organization, and you have direct access because generally, these companies are pretty flat structure.
Everybody kinda rolls up their sleeves, you know, grabs an arm and just no matter what your job title is, you're just doing the job that needs to get done to help this, company be successful. So you have you really I would say you can't hide in small biotech or small pharma. You are you are readily accessible, and the leadership is, like, rather, really accepts accessible to you as well.
And because of that, would you say there are there any differences when it comes to opportunities for growth and opportunities for advancement? Would you say that because there is a little more visibility in on the smaller biotech side, and small pharma side that you have more opportunities for growth and advancement, or is it more so on the large pharma side? Is there or is there no difference? Yeah. There are some key differences I've seen.
And personally, my professional growth, into leadership roles have come in the smaller companies. And so I would say, you know, in big pharma, there is definitely defined career ladders for MSLs. You don't have that in small pharma, so that's a big difference. But, you know, it's a bigger company. There will be opportunities that come, but in my sometimes your advancement may take longer in big pharma versus small pharma.
Rapidly growing, always adding new, new positions, new FTS in the department, outside of department. You know, and like I said, so many opportunities to wear multiple hats and try different things. Maybe you figure out that you're, you were made to be a marketer, you know, and you had opportunity to work with the marketing team so closely on maybe brand planning for something. So, yeah, I would definitely say, there it's different.
But I do see a lot more promotion within in big pharma versus small biotech. Like, you can move around, but not a lot you can and you can advance, but I see a lot more people coming from the outside in into small biotech than, you know, maybe you see in in big pharma. And definitely, I've experienced that in my recent, you know, you know, need to find a new job as well. Yeah. No. That that actually makes sense. It makes total sense.
But what about the what about the job market and evaluating opportunities? Because it's such a challenging market right now. Would you say that there's any advantage to pursuing positions at larger company versus smaller companies, or is there no difference? It's a great question, actually. I have to take pause because I've evaluated that a lot in recent, months. And in my opinion, I don't think you should limit. There are opportunities in both.
You know, as you mentioned, maybe if you're trying to break an industry, big pharma is probably the way to kind of focus. But if you've been in industry and you're kicking around, what should I just look at small? Should I just look at big? Should I look at midsize? Whatever the case may be. I would say look at it all.
You know, they're obviously, with small companies, it's a bit riskier, higher level of volatility, but we've seen this year, even in big pharma, you know, the volatility is there as well. The risk on, you know, even with having marketed products and and a big wide pipeline doesn't necessarily keep you safe. Right? So, you're not agnostic to layoffs anywhere. And so what what I always recommend is where do you thrive?
Like, you if you have the experience in big and small, what what makes you tick? What makes you get up each day and feel satisfied in your job, feel challenged? For me, it's and we could talk about a minute, is a smaller company. It's where you get to wear multiple hats and do a lot of different things. But I would say, you know, look at it that way, but keep your options wide. Keep the net wide in both in both arenas.
I agree. I I I think and and if you have a strong preference just because of your experience, different story. But if you don't have a preference or if you've never worked in industry and you're looking for opportunities, especially in this market, I think you have to cast a wide net. I don't think it makes sense, to be overly selective right now, unless you you just have this aversion to 1 versus the other. So I think I agree with you. I think you need to keep an open mind.
And I think that there's just like any other companies, any other job opportunities. You know, there's pros and cons to to anything. You just have to weigh those out and see which, you know, what works for you. Can agree more. Speaking of that, you know, in any job, there's always frustrations and aggravation that exists. Would you say that there's more frustration, in large versus small or small small versus large in your experience? Yeah. I would say there's frustration in both.
They're just different. So it depends on, I feel feel like, your personality type and, again, the type of environment that you thrive in, that, you know, personally in smaller companies where you kinda get to roll up your sleeve and wear multiple hats and do different things. Every day is a little different, new challenges, you know, very nimble and flexible environments.
Generally, small companies where you're flexing constantly, you know, to meet the need and being very innovative, entrepreneurial, you because there's not a lot of cash flow. So you gotta, like, figure out a way to do things, like, with, you know, less amount of of, you know, change. So, you know, the opportunity to innovate and be really, you know, strategic is is a little bit higher in smaller pharma than in big pharma.
So some people might find the changing every day, like, you know, how not every day is the same might not be your cup of tea. You know, in big pharma generally, you know, there's there's more bureaucracy, maybe more red tape. It takes a lot more time to get things moving or done and make changes and flex and so less nimble for sure. And that could be frustrating for some people. That was probably a little bit more frustrating for me in some of the roles I was in, you know, earlier in my career.
And I've seen, that for me, I thrive better in that. Let's, you know, kind of we can flex real quickly, make changes, adapt, innovate, try new things, type of environment that small companies generally provide. Yeah. Yeah. And and it's, again, this this really is one of those things where just like anything else, there's there's you you really have to evaluate the situation. And if we're in an interview scenario, you have to ask a lot of questions. Absolutely.
And you have to ask people in both comp in in different companies, what they like about their current job. What's most gratifying for them? What are some of the frustrations that they might experience? Depending on who you're talking to, You you need to be careful, but there there are ways to learn about organizations before you even get there. And maybe it's not an interview.
Maybe you're you're just finding a colleague, a mentor, somebody that has experience either currently or prior at an organization where you can learn the nuances. Mhmm. Which leads me to my next question. I think culture is so important Yeah. When evaluating organizations. Would you say that there's any real distinction in how culture plays out in large companies versus small companies? Yeah. I really do. And I kind of touched on it a little bit with kind of the frustrations piece too.
Is that really the culture of big pharma is, you know, much more operational, much more bureaucratic. You know, every company is gonna say, you know, what we wanna do is give drug to patient. Like, that is obviously the goal of every company is to develop therapies that are gonna be able to change, you know, lives. And that's that's like ubiquitous. Right?
But what is, you know, different is kind of the the way that, you know, small biotech kind of has that more entrepreneurial, more innovative, kinda able to flex, you know, think outside the box, different approach to work, taking on multiple projects, different roles outside of your written job description. Whereas, you know, in the smaller or the bigger companies, you know, you're kinda just doing what your written job description is. And so, that's preference. Right? We talked about that.
Which which one do you prefer? You want the structure? You want the defined? Or you want something loads, you know, more nimble, flexible changes, you know, on a dime sometimes. And I think the culture culture is defined based on the different environments. And I've noticed actually recently with interviewing with bigger and small midsize to bigger and smaller companies is I feel like the smaller companies are more interviewing me for, like, culture fit more so than the bigger companies.
More of the bigger companies like, who do you know? What do you know? You know, how, you know, how can have you ever covered this territory before? Things of those nature. And so I think that that kinda speaks too to, like, a little bit of a difference in the culture than itself between the 2. Good point. That's a really good point. So what about would you say there when we talk about, like, resume builders, let's call it, and how you can add to your experience and your career trajectory.
Is there a preference, would you say, in going to a large pharma versus a smaller company in how you can build up your resume? Yeah. I would say, like, if somebody looks at my resume, I have not had any issue with the fact nobody has had any issue with the fact that I've been at big pharma and I've been at small, and I've been at midsize. I think both are attractive and experienced, and I would say try both. And because you don't know what to entree it. Right? Don't take my word for it.
You know? Try it out. And I think though, in different seasons of your life, you know, a big pharma company may more be more attractive. For example, I talked about from the MSL perspective, generally, big pharma companies, you have smaller territories, more defined job.
Maybe you have little children, and you can't be away very much, versus maybe later in your career where your kids are launched, you're an empty nester, you you know, maybe you're you could take on the risk of the, you know, the these small companies, and have the ability to travel more because you are covering the whole United States, for example. I say, you know, that might be the time when you you give it a chance. You know?
So I think a lot of times it'll be personal preferences based on where you are in your career, your life, and career goals. Like I said, I've advanced more quickly in the smaller, companies than I would have probably had the opportunity should I have stayed in the bigger companies. And again, not that you can't advance in bigger companies, you definitely can, but my growth trajectory went much quicker in the smaller ones. So I think it's both are attractive. Both, I think, should be considered.
And like I said, when you if you're looking right now, cast a wide net. Yeah. For sure. Always. I I I just think you always should keep your options open because you just don't know. And a lot of times, you don't know till you know. You you know, you could go and interview with a large company and think it's the greatest thing in the world.
Then you get there and you're like, you know, I didn't connect as well with the people, and didn't get the same feel for the way I connect with the people at this other company. And and cultures are gonna vary. Opportunities, are gonna change even within like, we're talking in broad strokes. We're talking about what you've seen in your experience in large pharma and what you've seen, you know, on the small biotech side. And some of it's gonna be consistent.
Some of it's gonna be nuanced where it's like you really kinda have to get in there and see what it's all about. I'm curious, though, if I had so feet to the fire. If if Sarah has to pick between 1 or the other off the top of your head, which where would you go? You have 2 opportunities, 1 with large pharma, one with a small biotech. What do you take? Oh, okay, Tom. It's an interesting position to put me in since I'm currently in the interviewing phase.
And by the way, I didn't tell Sarah I was gonna put her on the spot. This is, like, total surprise. Yeah. No. I appreciate it. Because it's definitely what I've been kinda soul searching right now and, you know, interesting get interviewing actually this morning first with a small company. I just I think it's a way better fit for me based on the environment I thrive in. Although a lot of the pull for me has been stability.
Yeah. But like we said, you know, stability isn't always there even in the big companies. And so, right now, if I had to choose today, on this day, which could change, it would probably be a small company. Alright. There you have it. Well and guys, listen. I I wanna go back to what we Sarah and I have been talking about this whole time is you really have to evaluate everything, and and give I think it's really important to give companies and people a chance.
Do your homework and make an educated decision when you're interviewing or evaluating organizations or or even just looking at the next step in your career. I just think it's important, to to be very calculating, and do your homework and do your research. So, last question, Sarah. Let's talk to the MSLs that are out there that are listening. What advice do you have for them as we close out we're closing out 2023. We're starting 2024. Any advice for folks as they look into the new year?
Yeah. Absolutely. I think we're, I think we're turning a corner in all ways. Not only for job opportunities and growth, but also for I think we're coming back into my hopes and what I feel is a more stable environment. Sure. There's going to be ebbs and flows. Sure. Companies, aren't always gonna have positive data, but I feel very hopeful for the new year and I hope you all do too, especially being on the market right now for new opportunities.
I do feel like it's turning around, and maybe that's due in part to the economy also turning around, in investments, I think is, starting to come back around into, biotech and pharmaceutical industry. So I'm hopeful. I'm hearing those things. I'm kind of feeling those things. So I hope that, everyone would agree. And that way, that's where we'll be in 2024 on a positive note. Well, you know me. I'm a glass half full kinda guy. So I am totally with you. I see the same thing.
I think 2024 is gonna be a great year. I think that we're gonna put some of the, you know, the the frustrations of 2023 behind us, and there's gonna be a lot of opportunity. There's gonna be a lot of growth. And I think the that anyone that's in medical affairs or is looking to break into medical affairs is gonna see some really exciting times. So I agree with you. You're awesome, Sarah. This was great. Thank you so much. Thank you so much. Time with us. Yes. Absolutely. Thanks for having me.
It's been fun. Awesome. And thanks for listening, guys. We'll see you next time. Thank you so much for listening to the show. And if you enjoyed it, please subscribe so that you don't miss an episode in the future and feel free to leave a rating or a review or a comment. Thanks again, and we look forward to seeing you soon.