Hey, guys. Welcome to the podcast. My guest today is Ed Cunningham. He is the executive director of Neurology MSLs at Synovian Pharmaceuticals. And today, we discuss field medical execution despite limited resources. Awesome conversation. Ed, great. I think you guys are really gonna like this. Don't forget to follow me on LinkedIn. Check us out on YouTube, and really check out our MSL talk live discussion, which has been moved from Clubhouse to LinkedIn live.
It's the 1st Tuesday of every month at 1:30 PM EST, and you'll see announcements on LinkedIn. But it's it's an awesome conversation. I think people are getting a lot out of it, and I invite you guys to join us. Welcome to MSL talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical. Hey, Ed. Welcome to the podcast. Thanks for joining me, my friend. Thanks, Tom. Great to be here. I appreciate you having me. Yeah, man. I'm excited.
And, you know, we go back a long way. This was, like, one of those things that I was kinda hoping we would pull together, and we've been talking about it. And here we are. So you're awesome. Thank you for taking the time to do this. And why don't you do a quick intro, tell everybody, you know, who you are, where you're from, all that good stuff? Sure. Sounds good. Yeah. So first of all, I just wanna say great to be here with you, Tom. Like you said, we've been talking about this for a bit.
And just wanna say, I think what you're doing with the podcast and in general goes a long way to sharing ideas and moving our profession forward. So just wanted to thank you first and foremost. So with that, just a little bit about myself. So Ed Cunningham, I am the lead for the neurology medical science liaison team at Synovian. So I've been with the company for the last seven and a half years. Born and raised in New Jersey, lived in Milwaukee, actually, where I am now for the last 9 years.
I'm a Pharm d by training, graduated from University of the Sciences in Philadelphia. Been in the industry now for 19 years. Started with j and j as a drug information resident, spent some time throughout other medical functions, at Eisai where I spent about 10 years. And then as as I mentioned, currently working with Sanofi where I've been for the last seven and a half years. Yeah, man.
You've, that's why I wanted to get you on here because you, you have a a great track record, a great background. You've seen it all, done it all. Different sized companies, different environments. And by the way, this was your idea. This topic was your idea. I know that there's a lot of lot of companies out there and a lot of MSLs MSL leaders that are running teams and managing teams with very limited resources. So let's start right there.
What's it like being in your chair where you're you're running the show, but you have limited resources? Yeah. So, again, it's near and dear to my heart, and I figured it's it's definitely a topic that other MSL leaders are facing or even team members are facing as they're thinking about their territories.
So just talking about my experience a little bit, here at Sunovion and in prior positions, I've been in positions where we've built new MSL teams and expanded existing ones in support of things like launches and new indications. I've been in MSL too at times when companies were were building their MSL teams, so had big territories to cover, and everyone kinda doing their their part to chip in and make sure things happen, slide decks, training reports.
So I'll say most of my experience has been with midsize companies that don't have really large MSL teams, so there's often been the need to run things a little bit more efficiently in the field and really kinda think carefully about how we handle our operations and our platforms.
So, I mean, one thing I'll say in general is regardless of budget or people resources, but especially when those are limited, anything that we do as field leaders or MSO should always revolve around the medical strategies and be grounded in that Mhmm. And, ultimately, think about how we can best support our patients, and our providers. So it's kind of high level, how I see it, but happy to dig into to a few more details.
Yeah. Well, let's dig into it a little bit because I know it's it's an interesting time now. I mean, we've both been in the game for a long time, and I think things have really evolved for for medical affairs departments. There's a lot of resources available available now that weren't available even 10, 20 years ago. So how important is it to consider outsourcing services to help support the initiatives of field medical?
Yeah. It's it's a great question, and I think the the best answer to it is it depends on the individual company and your situation. So, you know, ask yourself as a leader, what are you trying to accomplish? What are the strategies and and goals of your team and your organization? And I think too, companies have different philosophies on things like headcount or outsourcing. Speaking from my own experience, the companies I've worked for tended to run leaner, as I just said.
We were less apt to grow large MSL teams only to risk having to cut them back later on. So in light of that, one of the approaches that we've taken and that we've implemented was a contract MSL team, which we've actually done at Sunovium in the past. And to give more context, that really happened before the pandemic. So just a little more context behind it. Even now, I think there's some opportunities to do it even though we're working more remotely or in a hybrid type environment.
And I'll say, you know, the goal should be very well defined. Are you trying to expand your reach to a new thought leader base? Are you trying to, educate a new group of physicians or or health care providers that maybe your your company hasn't reached before. So kinda what I was saying before, think about the end in mind and what you're really trying to accomplish.
And one way is that you one of the ways you can do that is by outsourcing, or having a contract team support what your core team is already doing. Yep. No. I got you. And I that's certainly one way. And and, there's I think there's just there's so many other things too. So I guess it depends on where a company is at in their life cycle and what needs they currently have. You know, are they doing k o l mapping? Are they, you know, planning carving out territories?
You know, what so what other types of services, I say outsourcing, but outsourcing is such a broad term. It could really be anything. And I think budget probably has a lot to do with that as well. Right? Exactly. So, you know, again, organizational philosophy, speaking from my experience, you know, headcount is often at a premium, I think, for a lot of companies, whereas there might be some flexibility in terms of budget.
And some organizations view budget as being an easier hill to climb or bridge to cross than than adding more headcount to a team. And if it's okay, Tom, maybe I'll just talk a little bit about, you know, the experience that we've had, why we decided to outsource in our situation because it might apply to a lot of other fields Totally. As well. So we were in a situation where our team was in neurology.
We were focused on a different disease state than, the company that we had just acquired with a product in a new space, that basically we needed to rebuild our expertise around that product. We were focused initially on sort of the national level thought leaders, more the research side of things, and we we recognized the need to expand. The product was in phase 3. We were just getting ready to be able to launch it in the next year or so.
And so we wanted to have an opportunity to really get a sense for what is the broader educational need beyond just the research KOLs and the academic KOLs. Had a finite number of team members, and so we we opted to go with with an agency, a contract team.
I'd say it's, again, not an option for everyone necessarily, but we we saw the need to educate more local KOLs, general neurologists, and we knew that our team just didn't have the bandwidth to do it properly while still supporting the other disease state that we were involved with.
So I think the question anyone should ask themselves if they're thinking about this approach even with, you know, management support on the agency side is understanding you need to make sure you hire the right folks who understand the role and the expectation if you're hiring a contract team. You need to also make sure what you're asking your MSL team and the contract team to do is crystal clear.
And everyone needs to feel like the work that they're doing is meaningful, that they're partick they're partnering in support of a shared goal, and that there isn't any underlying sense of hierarchy in terms of importance of the roles or who team members are actually calling on in the field. So you really wanna define it.
You wanna make sure you're preserving the culture as much as possible and that you minimize any confusion as to whether the contract team is doing the same thing as your MSL team and that the roles are just clearly defined as much as possible. Yeah. Awesome. That's a great way to put it. I mean, I think that that's there's probably a lot of people out there that would love to hear or probably did love to hear your philosophy and the company's philosophy on why that made sense in that scenario.
So what about let's talk about some some other types of like, I know there's there's a lot of virtual and alternative platforms that exist right now for whether it's sharing data or gathering insights. So what are your recommendations or experiences with those? Yeah. So I'd say I was actually listening to one of your other episodes where you had my colleague JR on, and you were talking about, you know, what are the positives, if any, that have come out of COVID for the MSO role?
And I would say the emergence of these virtual platforms for field interactions is definitely one of those and just testing the flexibility of our teams to be able to interact in different ways. So certainly certainly that's been the case for our team. So I'd say maybe I'll take the question in 2 parts. I'll start with the field interaction platforms, and then we can talk a little bit more about insights.
I'll say for field interactions, at least in my experience, our team rarely used the virtual platforms before the pandemic. But these days, of course, I think for most of us, we use them on an almost daily basis. So it gives us some efficiencies as far as getting in touch with certain key folks more often, more efficiently and without the need for travel. And it also gives us a little bit more leeway to expand, the base of external stakeholders that we're calling on.
So that said, and I I know this was part of the discussion you had with JR and Katrina is I don't think these tools are ever going to fully replace in person meetings, especially in situations where, you know, you're an MSL trying to establish relationships with new thought leaders or, you know, maybe the topic you're discussing is a little bit more complicated, and it just warrants the face to face interaction. So that's one thing as far as platforms.
As as far as insights, I've seen that really as another area of evolution within the MSL teams over the last several years. I think there's a recognition that the credibility of MSLs puts them in a unique position to have those in-depth, high quality conversations with thought leaders and really get their honest feedback, on disease state, on the company's products, and then the treatment landscape. So, you know, strategic medical insights from the field, that's really our capital.
And I think the platforms that we're using, we've moved beyond those Excel spreadsheets to capture those insights and really have a more efficient way of compiling them in a way that's, you know, transparent and maybe more digestible for the organization. I'll name a few maybe, but, certainly, there are others that exist out there. Platforms like Veeva, Kernel is another one, Tableau, just to name a few.
These have really emerged from what I've seen as important tools, not only for leaders to track those insights, but also to give better visibility of those insights to other internal functions as well. Yeah. So I I'll just say, I think there's still a long way to go, but artificial intelligence, all those other types of aspects of technology are are still emerging, but I don't think we're quite there yet. Yeah, man. There's every time I go to a medical affairs conference, there's new vendors.
There's new stuff out there. It things have really evolved. There's so much available now. Again, more so than, what we've seen in the past. So I think it, you know, really comes down to what your specific needs are, what the budget is, and how, you know, how you're looking to move the needle. So let's talk about because this is such an important topic now, especially with COVID coming out of COVID. But let's talk about best practices for KOL engagement and what your philosophy is.
What are some of the things that you're seeing out there that that's working, especially as we try to get back into a more live scenario than virtual? Yeah. So I I think, again, it it ties back to the strategy. What is your team and organization really looking to accomplish? And, you know, we think of thought leaders, I think, a lot of times as national, regional, and local as far as sphere of influence. But we've really taken a look back and thought to ourselves, what does that really mean?
Are we focusing on, you know, just the academic KOLs, the research KOLs, or is there a need also to focus on the broader, I'll call them clinical practice thought leaders, folks that are really hands on seeing patients and understanding what the treatment journey looks like in a particular disease state.
So I think depending on the size of your organization, once you start talking clinical practice KOLs, it can get pretty broad, and you need to think about how often do you meet with these folks, are they reachable. And I'd say, you know, really prioritizing and making sure you as a leader and your team members have firm territory plans. Just as a guide, that kind of ties back to what are the strategies and what the team is looking to accomplish.
I've seen teams expand KOLs, but realistically, you're not going to be able to reach a 100, 200 KOLs as an MSL in in one state trying to cover a broad region. So can you leverage virtual platforms to reach broader folks? And again, do you have relationships with existing folks already?
Those folks you might be able to reach through virtual means, but if you're trying to establish new relationships with a new set of thought leaders, probably less likely that you'll be successful doing that virtually. I think that's where in person meetings become key as well. Listen. I'm an old school guy. I say this all the time on this podcast. Like and I'm a hugger. Like, I I just think that in order to really develop relationships, you have to actually see the person.
I think there's a lot that we can accomplish through virtual engagement. We've proven that. But I think at the end of the day, there's 2 things to consider. 1, you're gonna develop better relationships live than you are virtual. And number 2, if your competitors are getting out there and getting face time and you're not and it's it's strategic or it's become a company decision not to go back and be live, you might be behind the 8 ball. I mean, do you agree with that? Am I overstating that?
I I think to some extent and, again, I think especially if you're new to a space where you've got team members who've never established relationships with, you know, KOLs in the therapeutic area they're responsible for, they will be at a disadvantage because there's there's that live interaction to develop that relationship. And maybe that can be done at conferences more efficiently.
So if you're limiting travel, you know, to only a few trips per per quarter or budget is limiting you to travel to only few trips per quarter, doing that more efficiently through regional or local conferences may be the way to go as well. But I I do think there's just no way of replacing the in person component for sure. I agree with you.
And staying on this topic somewhat, you know, when we talk about companies with limited resources, a lot of times, it might be smaller companies that, might have smaller MSL teams, which means larger territories. So how would you recommend an MSL, an individual contributor, will can maintain effectiveness handling a large territory? Great question. So, yes, again, start with the big with the big picture. What are your team strategies in the field?
And if they're not clear, have a conversation with your manager. Make sure that you're focusing on, you know, what ties to the overall strategy and what the company is trying to accomplish. I I've heard you say this before, and I've heard your guests say this before. Think of your territory as almost a small business. Who are the stakeholders you're calling on, and how would you prioritize them based on the strategies that that we just talked about before?
And then I'd say think about the practical aspects. So where are they located? How far are they? Can you drive there? Do you does that require a flight? Do you or your company have a previous relationship with them? And if it's someone you've never worked with before, again, I'd say an initial face to face meeting is probably the best approach. But even in that case, are you going to fly somewhere for a meeting with 1 person?
Maybe you will if they're that important, or maybe you wanna tie it to several other meetings with other stakeholders in the area. And then it's what are you really looking to get out of the meeting? You know, you don't wanna waste their time or yours have a clear agenda for how you wanna approach them. The other thing to keep in mind if you're thinking of a territory plan is how often do you need to follow-up with them. Is it someone you plan on visiting every quarter?
And that's defined by what's the company need, but also what is the stakeholders need. How often do they expect you to come back and and provide some follow-up? And if it's a stakeholder you normally wouldn't call on, does your team or company have non personal resources you can point them to? Stuff like department websites, YouTube videos, or other platforms that can address disease state information or product information.
And I would say even if you do that, if your company has those websites or they have virtual places where folks can pull content, you probably still wanna follow-up and make sure the information meets their needs and that they don't have any other additional questions. So it's just thinking about it holistically, making sure you're not stretching yourself too thin in terms of travel and that you're thinking about things as efficiently as possible.
Well, that was, you know, that was you probably just answered my next question, but I was gonna you know, because we hear this term burnout when someone handles you know, they have to handle a large territory or they have limited resources or whatever the situate. You wear a lot of hats. I think a lot of people wanna do that, but then you have to worry about, you know, are those people getting overstressed?
So was there any other tips that you have for people that maybe can help them adapt their territory to avoid burnout? Yeah. Again, I think it's making sure you are identifying the folks where you can have the biggest impact. If you find that you're calling on, you know, a 100 plus KOLs, you know, benchmarking tells us a typical MSL team, an individual might carry anywhere from 50 KOLs to maybe 60 tops.
Once you we're not numbers driven at the company I work with, but realistically being able to meet with folks on a regular basis. Once you start getting more than that particular number, it just becomes too much.
So really examining on an ongoing basis and adapting your territory plan as you go along, to make sure that you're not just adding folks, but really, you may need to also deprioritize, some folks that you've been calling on in the past because there just isn't the need to follow-up as often or at all anymore. Yep. In your experience, do you see a big difference in metrics for companies that may have smaller teams or limited resources? Like, how does how do metrics tie into this conversation?
Yeah. So, again, my experience with midsize companies, we we've generally not been metrics driven from a quantitative from a number standpoint. Got you. That I think any team, if you give an MSL a number, they're they're high performers as a general rule, so they will they will meet that number one way or the other. And I think virtually, that also provides some advantages for kinda meeting numbers, so to speak. I think it's really the qualitative piece that we've been focusing on.
So it's it's things like what types of insights are we getting, and are those leading to strategic changes, whether that be medical strategic changes or company strategic changes. Are they following through on requests in a timely fashion? So, really, that's been the focus more on metrics. I think if you've got really small teams and you're focused too much on the numbers, perhaps, it's it's really not going to to benefit you in the end.
It's really showing the value through insights, which as I said before, I think is really our currency, as field medical professionals. So did that answer your question? Happy to elaborate on that too. Yeah. No. No. No. That's it. Listen. That's kinda just came up with that off the top of my head. So Yeah. Yeah. For sure. You know, I always talk to folks after the fact, after you know, when I'm running into people and ask them, what what do you wanna hear about on the podcast?
It becomes you know, a lot of it comes down to performance and metrics, and, and I want, you know, I wanna learn about best practices and how I can do a better job in my territory. So I always migrate to that, but it is you know, we just did an episode last week on KPIs, and it's there's no standard for the for the most part. There's there's not a true standard in medical affairs. It does vary.
But I think that to your point, what you said, I think most peep most companies are definitely more focused on quality visits, quality engagement than they are we need you to see this number of KOLs this many times a month, Q3, or whatever it is. So I think that that's becoming more consistent.
Yeah. And I think the other thing that's evolved too is, I mean, depending on the setting for the the stakeholders and whatnot, there's there seems to be a little bit more appetite for group presentations. So, like, setting up a Zoom meeting or even having a live meeting and just bringing a bunch of folks together to do things a bit more efficiently.
And tying it back to metrics, one of the things that we've done is at the very end of our presentations, we have a QR code that provides a link to a survey that basically addresses the question, did we advance your clinical knowledge of the topic? Would this potentially lead to changes in how you approach or think about your clinical practice in light of the the content that you saw?
So kind of the the types of questions you might see at a at a medical education program, really getting some more objective feedback from the audience and allowing them to provide comments too about what they thought about the presentation. Are there more gaps in information that the company can provide and follow-up on as well? Got you. Yeah. So, you know, last question, just to kinda round things off. I always like to kinda get people's opinion on, like, where do you see things going?
Like, what is the MSL of the future look like? Curious. And not just as it relates to this topic, but in in your experience in in any company, where do you see things going? We've been saying it for a while now. I really see the the MSO role being a primary value to our stakeholders in the field. So the value we bring to the company and to the HCPs in the field will just continue to grow. You know, surveys conducted asking HCPs their opinion of of MSLs in their role.
It's clear that they wanna interact with someone from the company who can give them good technical information that's generally unbiased. Mhmm. And I think the way we all approach our work in the field, we all need to get comfortable working in a hybrid environment, I think. Maybe some of us who've only known the hybrid environment to this point need to get more comfortable with in person meetings as things evolve too.
But I certainly think there's gonna be a mix of in person meetings, and virtual meetings as we move forward. And I think technology is going to continue to evolve. The expectation that we provide things in a timely way, I've heard of MSL on demand. Some companies are have a group of MSLs actually that address things upon request for HCPs that are calling in or have a portal for addressing those requests in real time.
So timeliness of information, the value that we bring, the platforms that we use, I think that will all continue to expand and evolve as we move forward. Yeah. Well, that's definitely what we're seeing. I mean, I I totally agree with that, and I think we're all just trying to keep up and figure out what's the what's the best way to do this.
But I will say that to your point, you know, you go to these conferences, and for 20 years, I've been going to these medical affairs conferences, and almost every single one, if not every other one, there would be the topic of the value of the MSL and how to communicate the value of the MSL to internal stakeholders. Right? How many times have you seen that topic?
But I think that we've reached a point where the role has evolved, where, yes, there's still the need to communicate that value internally. But I think that to your point, you just said it. MSLs are gonna be the primary resource as viewed by external stakeholders, but I think also by internal stakeholders. Do you agree with that? Absolutely. Oh, yes. And we're seeing it in our company as well.
We're being called into, obviously, with the appropriate partnership across other functions, but we're being called into meetings, having cross functional discussions that I I've not seen us have before with a variety of stakeholders. So, certainly, the the value internally is being recognized. Good time to be an MSL, man. Good time to be in medical affairs. Right? Absolutely. Yes. Looking forward to the future. There's a lot coming, I think. So Yeah. We we gotta be ready. Let's be ready.
Well, listen, man. I do appreciate you coming on, Ed. You're awesome. And, let's do this again sometime. We gotta keep in touch and, haven't seen you in a while. I usually run into Ed from time to time, but because of COVID, I haven't really seen you. So we'll have to get together. We'll have to plan another topic, but you are always welcome to come back, my friend. Appreciate it, Tom. Thank you so much. Really enjoyed it. Thanks for joining us, everyone. Appreciate you.
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