Hey, guys. Welcome to the podcast. My guest today is Maya Beilman Schramm. She's an MSL excellence leader. We talk about how global MSLs and US MSLs can learn from each other and what they can do to improve. So it's a great conversation. I really think you guys are gonna love Maya's perspective. Don't forget to follow me on LinkedIn. Check us out on MSL Talk Live, which is a live discussion just like this, but it's on LinkedIn live the 1st Tuesday of every month, typically at 1:30 PM EST.
Welcome to MSL talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical. Hey, Maya. Welcome to the podcast. Thanks for joining me. Hi, Tom. I'm glad to be here today. Yeah. I'm really excited. Really excited. So we got a really awesome topic that we're gonna discuss. And, you know, we don't always venture into the global conversations, but we do have a global audience.
We actually this podcast has listeners in, right now, 88 different countries, and there's a lot of folks listening in Europe. So, let's let's do the global conversation. And but it's not just global because a lot of this is gonna pertain to all of our listeners in the US as well. We're gonna kinda talk about, some nuances and differences and and similarities and what we can all do together. So this could be a really neat conversation.
Before we do that, why don't you do a quick intro and tell everybody who you are and where you're from and all that good stuff? Absolutely. So my name is Maya Balmanstrom, and I'm currently in a global role at Merck, which in the US would be EMD Serono, just to be sure everyone knows where to place me. And, this global role is called field excellence in HCP Exchange. So it tells you I'm responsible for our exchange communication to the HCPs.
However, I wanna give you some background because I think it explains where I'm coming from and how I know the global perspective. So and actually, when I started, like, 23 years ago in pharma, I started in sales and marketing. So it helps me to put into perspective some of what we do with the MSLs. Right? But, for more than 13 years now, I'm working and focusing completely on a medical science liaisons role. And I've been in MSL. I've been leading international team.
So mainly Europe and Canada. I've been in a global MSL lead role, national MSL real real, team role, and now in the global role. And this is how I'm getting to know all of these countries. So, of course, because I've been working very closely with Europe, I have a lot of expertise in Europe. And Canada, interestingly, is often lumped into Europe. So it's in between the way that the US works and Europe works. Very interesting country, just as a side remark.
But now I have the global perspective, and I keep learning, even even more, you know, what is different than the country. So I'm actually very excited we're gonna speak about this because we don't hear about this often. So let's go. Let's go. Let's talk about some global stuff and some US stuff. Before we do that, I do have to announce that this episode is sponsored by the Aspire MSL coaching and training program.
Some of you may know, Sarah Snyder, one of the recruiters on my team, awesome awesome recruiter and prior MSL, and I started a coaching program for MSL or aspiring MSL that are looking to break into their first role. So if you want more information on how to join our coaching program, go to msl mastery.com and learn about the Aspire MSL program. So, Maya, let's talk about and let's start with what are the differences between global MSLs and US MSLs? So, for example, MSLs in Europe.
Like, what are the differences with MSLs in the US? So one of the first things that actually, I I were made aware of is that, the teams in the US usually have smaller target HCP groups. Or vice versa, in Europe, we have bigger groups. You can easily have a target group of 80 or 100 physicians, which is a lot, versus the US where you usually be around, like, 40 maybe. Some have even smaller, target groups. So that, changes the way you're working.
And also, well, in Europe, it's often smaller teams, but that's just simply due to the smaller size of the countries, I would say. And then another aspect is that in Europe, you find or greater Europe, you find that the the topics you're discussing or there's a broader range of topics you're discussing. You're going broader. Versus in North America, I find it more focused, very very strategic, and very close to the current strategy and and topic that the team are, as a as a whole, investigating.
So this is some differences. And maybe one more because I'm finding that very interesting when it comes to career steps. That is that, in Europe, the MSL is an entrance into the pharma company or the pharmaceutical industry as such. And it can be in the US as well. However, the MSL team lead in Europe is just a stepping stone. It's so hard to find an experienced MSLE because they do this once to learn leadership and then they move on.
And in the US, you actually find experienced MSLE leaders, and this is exciting. And you cannot find them in Europe. So that's a completely different thing. It may be the salary is so much better as an MSLE leader in US that people are happy. I don't know exactly what it is, but it makes a big difference when you think about career. Yeah. Well, it also opens up opportunities for folks in the US that may want to take their shell on the road and apply to positions overseas.
I mean, that I I didn't you're what you just said in the first five minutes of this conversation is new to me. That's not something that I'm aware of that I've heard of before. So I think that that is I mean, it's pretty groundbreaking. It's interesting, and it's novel because I haven't heard it. I definitely have not heard that before on this podcast. So we're off to a great start.
So then as as we look at some of the differences, but what about, like, let's talk about the role and the responsibilities. Like, what types of things might be different when we compare the 2 global Europe versus US? Yeah. So the role in Europe is a bit broader versus the US. So, for example, when you think about speaking to payers or researchers, and what I find in the US is often you would rather build a new team. So for example, EMD has an outcomes team. It's a field team.
In Europe, you wouldn't do this. You would connect with these people. They might give you a task. Let's say market access needs information. They speak to the MSA. They get a task, but they have to fill this whatever they are being asked of. Versus in the US, you have, like, a smaller corridor of responsibilities. And this leads to many other aspects. So and in addition and it's not because of that, well, partially, but in addition, the topics are broader that we discuss in Europe.
And this comes more from the historic from the history. So the role of the MSL is newer in Europe than it's in the US. And when we started with MSLs, oftentimes, and especially at Merck, we have been employing MSLs for, like, I don't know, really a long time, longer than many other companies. And in the beginning, it was often more a scientific discussion role.
Yes. But it was open what you're discussing, and they were often having a budget and supporting physicians with, studies of interest, but from a physician's perspective, interest of the physician. And this gives you a broader responsibility. I think that's where it's coming from, and it's still broader. Versus in the US, I'm finding it more focused. I'm finding it more actually, a bit more structured and strategic.
So I'm remembering this the first time I'm being in North America to congress and, at the half of the day, the MSLE brings the team in and says, guys, what we're communicating here doesn't work. We're gonna change our communication, and we do a, b, c. I've never seen that in Europe. Not gonna happen. They give you the topic. This is what we wanna discuss, and then they leave it to the MSL.
That seems like it's gotta be challenging from the perspective of tracking KPIs and metrics because in the US, when you're more strategic, it's it's a life that we think it'd be a little easier to implement a metric system and program for people to follow. But if it's broader, how do you track it? What what happens on that side of it? Yeah. So there comes the challenge. Overall, we're sharing the same metrics in terms of, you know, number of visits or field days or, you know, things like this.
And if they're useful or not or effective or not, that's another topic. Right? Yeah. But it's very similar. However, I would say overall, we have a little bit more project focused objectives, in Europe. So, for example, Spain is very big on educational aspects. So they rather track educational meetings or other more qualitative parts, maybe support on research, these kind of things. But, overall, we're all having the same discussions.
And, I can see how we can sometimes differentiate between a individual metric. I do wanna know when the MSL is in the field and how often and how many people they speak to. But in the end, to me, it's more important that we're reaching the results, and the goals that we've said we wanna reach in the beginning. And the current metrics that we often use, like number of contacts and such, does not necessarily help me in this regard. Yeah. Interesting.
So there there's definitely a lot of differences, but there are some similarities as well. So, like, what do you think we can learn from each other? Yeah. And I think it's it's to me, it's exactly this aspect of being broad or narrow. I think from the US perspective, I sometimes wish the colleagues would be more or being closer to their colleagues from other teams. So like an outcome liaison or the publication team or, you know, teams that are working in medical affairs.
Not only when there is an internal meeting that is structured, but also just this openness to understand what they are doing, what their plans are, what their discussion points are. That will help in the way that you're speaking to the physician because you know exactly what the other teams are speaking what about with the same physician in the end.
And it will also help our more omnichannel focused future self because we have to understand what else is happening in order to be most productive and effective in meeting with the physician. So from the yes. Perspective, that's what I would love to see. It's a bit more, you know, broader perspective on the ITP communication. From the European colleagues, I'd rather see a more strategic and a bit more, not gonna say narrow approach, but more strategic. So what exactly do we wanna communicate?
What exactly do we want to learn from the physicians? Versus just going in and having this meeting and, like, yeah, I'm gonna discuss x, y, zed. Well, make sure that x, y, zed fits with the strategy. And it's not something that you are interested in or the position is interested in. And you can add this, of course, anytime, but keep track of you delivering what the company expects. Got it.
So you mentioned omnichannel, which is a big buzzword right now as you know and as everybody listening right now. This isn't I it shouldn't probably be the first time you've heard that term. As a matter of fact, we had an episode recently about omnichannel engagement. So let's talk about that just for a second. Is that a European thing? Is that a global thing? Is that a US thing? Like, where where did you know, what's your perspective of omnichannel? It's definitely a global thing.
It's just happened because we all had to move to more digital ways. Well, that's not the reason, but it just you know, it happened way quicker and faster than we anticipated. And I think it's a it's a global thing. And, often when we think or say or think omnichannel, we're thinking about a lot of digital tools and and virtual platforms. But in the end, what it means is that we are communicating with our physicians in a seamless way.
So every interaction should be informing the next communication or vice versa. Every communication I'm anticipating should be informed by what happened in the past. But that means from a physician perspective, you know, we are one company. So we have to work closer together across teams to be aware what else is happening. And that's why I'm saying to have this broader perspective and also interest in what our colleagues are doing.
This will help us in this, omnichannel approach and the communication the physicians are expecting from us in any in this world. Yeah. It's such an interesting concept and it's such a big topic. So if if there's anyone listening to this that isn't 100% comfortable with what Omnichannel is, you should definitely check it out. I I learned a lot from my podcast with Donnie Wooten, a couple of months ago, I wanna say now. So, yeah, definitely check that out.
So what where do you see areas for growth? Maybe this is a 2 part question. Where do you see areas of growth for US MSLs, and where do you see areas of growth for European MSLs? Or is it the same thing? I was gonna say, I think, currently, in the environment we are in, it's very similar. I think we have to learn or keep up with the changing environment. The omnichannel is a big part of it.
I can see basically every company every company where I'm talking to colleagues on a regional or global level, they're all working across this topic. And and it expects from us that we maybe plan better ahead of what we're doing, receive more information from all the other colleagues communicating with the physician, and learning from each other. And let me speak about this for a moment. Because I heard and this is I'm finding this interesting.
So I'm I'm I heard from a country team that they cannot do omnichannel because the the field team is too old. What's that to do with anything? Yeah. Exactly. I mean, what? Okay. So that's not the only doesn't mean digitalization or or MS digital MSL only. It just means, you know, seamless communication. Okay. So then the the answer to this, to their issue was, well, we're gonna rejuvenate the team. And I'm like, oh my god.
Does that mean you're just hiring, like, 20 years old your old colleagues? No. That's not a good idea. So what I think, and where people can grow and and the team leads are a bit challenged and is you have to bring all of this together. We have to bring in the experience from our and myself that have been in the field way longer. They actually know how to get access to a physician in a clinic.
I mean, physically actually walking into a clinic, you know, getting access versus the digital affinity and ability of the younger colleagues who can easily navigate all the, you know, social media tools and all this stuff. And we have to bring this all together. We have to learn and we have to grow ourselves so that we can actually show up towards a physician in a way they expect us to communicate, like, as one from a company.
But also what they see outside of our communication, their private light, they're really getting used to this easy access of information, 247 information, self-service idea. And I feel like when we develop now, we have to grow into a spot, a sweet spot, so to say, where we can navigate this and deliver best to our physicians. Well, I think well, a couple of things to unpack there.
First of all, I agree or I think that it should be said that you certainly can teach an old dog new tricks for any of those that are looking to oust all the old old folks. That's me speaking because I'm an old dog, and I'm trying to learn some new tricks myself. I think we all have to evolve.
I think it's their responsibility for the organization to have a strong enough training program and leadership to be able to bring their teams to the next level, whether that means omnichannel, artificial intelligence, whatever. You know, being strategic, whatever that might mean. So I I do agree and believe that there is a need for evolution, especially now, because things are moving so fast.
But I'm gonna get where I'm gonna get back to that word strategic because that has come up a couple of times in this conversation. And you and I spoke about how important it is for MSLs to be strategic. So can you talk about that a little bit? Because I know that that's a big topic for you. Yeah. It it's true. It is. And maybe just because I wish to see more of this. Strategic to me means plan ahead and know what you're doing.
So we do have usually, we have a friend plan in a company and part of this or a separate medical plan. So you have a medical plan from plan for medical affairs in place. And what I see too often is that what the MSL do in the field can be not connected disconnected to this medical plan. And strategy to me means I have I have put a lot of thinking and effort into developing a plan because I understand the patient pathway. I understand physician's needs. I understand my product.
I understand my pipeline. So there's a lot of planning going into this. And there are some aspects that I want to achieve. Some goals I have as a medical affairs team. And the MS and we should be breaking down the medical affairs plan into an MSL plan. So one of this plan can be fulfilled by the MSL team. And from there and you can discuss this as a team. You know? It some things are better done by an office based team. Some things are better done by field team.
And this will also determine your key, KPIs, key performance indicators. You have a goal. You're gonna work towards the goal, and you wanna make sure that you're achieving your goal. And that also so I'm coming back to my planning, and I'm actually not the person's planning. So I'm I'm used to be the person of, oh, I'm going there. I have kind of an idea what I'm talking about. Yeah. That you can do that, but you're not gonna be as successful or effective.
So once you know exactly what the goal is, what the MSL plan is, what the field plan is, you break it down for yourself, for your physicians, and make sure that you're not holding whatever an educational meeting just for the sake of holding a meeting. You wanna know who should be attending this meeting, who needs to hear the information. If they are missing this meeting, but I want them to hear the information, how else can they get the information?
So basically, I'm following up my physician's path so that by the end of the year, whatever your planning period is, I make sure that they've heard exactly what I think or know they want to be hearing or need to be hearing in terms of education or whatever other information versus saying, I'm holding 5 educational meetings. Yay. And I do this and I just check it off.
And then at the end of the year, I'm real realizing that important physicians, especially when you think about launch preparation or yeah. And rather new product in the market, I'm realizing they have not received information they need to know in order to treat their patients appropriately or speak to a treatment to their colleagues. And where do you think the responsibility lies for this strategic need? Is it the responsibility of the MSL?
Is the responsibility of the organization, the leadership? Like, where where does this start and and where does it end? Well, my experience, the most successful is if it starts with the medical director or the TA lead because they usually have the medical plan in hand. Right? And if they speak to the MSL lead, and how to break this down for the MSL team or what parts of this plan can be fulfilled by the MSL team, I think that's a good way forward.
And then the MSL team lead breaks it down to the individuals. And, well, some of this, they have to do themselves. So the more and also how depending on how you set your metrics. This for anyone. The the way that you, that your objectives are set up or your metrics are set up, this is what you're gonna do. Right? You follow your objectives, basically.
Yeah. Yeah. And it ultimately comes down to the MSL's responsible ultimately to carry it out, whether it starts, in you know, from the medical director, it starts from leadership, whatever.
I think what the difference between top performing MSLs is is their ability to carry out the plan and to cross every t dot, every I, and make sure that they're moving the needle the way that they need to for their territory, and and and carrying out that strategic whatever the strategic initiative or whatever that goal is. So you also said and talked about the importance of involving others. So I want I want you to explain what that means.
And if there are differences again, I said we're having this discussion, global versus US, so to speak. Is it different in in in different areas of the world, or does everybody need to have the same philosophy when it comes to involving others? I would say philosophy, Different philosophy. I don't think there's a different philosophy. It might often depend a bit more on your team size. Well, actually, no. There is a different philosophy. Okay. So let me give you an example.
One example that I really liked in terms of involving others, and this was going even beyond the country team. So, at one point, we were preparing a lounge, and we had to approach physicians that we hadn't been working with in the past. So we needed access to physicians. And we had this list, of physicians that we felt we really need to speak to. And not everyone was open to speaking to us, which is it's a normal situation that happens. Right?
So after our planning, we were left with a list of, I think it was, like, 8 physicians that was super important but did not wanna speak to us or did not we didn't have access. Right? So what we did, we actually were we we looked at all of those physicians and were wondering from what we know what would make them interested in speaking to us. So there was one physician who was publishing a lot. So we were thinking, okay. Maybe we can get our publications team.
And this country that I'm speaking about was a medium sized, country, so they didn't have their own publications team. So we're reaching out we're reaching out to the global publications team saying, hey. We have this physician, this is the experience. Is there any way you can involve this physician? Or something similar with someone who was very big in studies. And if I remember correctly, out of those 8 positions, we found for 6 of them, we found a way to work with them project based. Right?
But this is a mindset. And this is it's work. It's actually it's work. You're reaching out to others you might not even know internally. And I've seen this happening more in Europe or in Japan. For example, versus the US. On the other hand, US teams are generally bigger. I guess you have, you know, internally in your country, you have enough people to reach out. Did you have a publication team? You have big study teams?
But this is something that I would always recommend if you're having or if you, yeah, coming across access issues to see who else, of course, might be in contact with the physician, but could also be, benefiting from having contact to the physician on both ends for the physician, but also from the company perspective. I mean, it makes total sense. Being collaborative and sharing information, sharing knowledge, is has to help. Whether it's US or global, it has to help.
If you know more about the physician and their practice, their, you know, needs, likes, dislikes, and and what the hot buttons are, it can only help, you know, whether you're talking about the MSL versus the commercial counterparts or whoever else might be involved. Right? So when you do in your experience, when you when you look at the whole access issue, is it any more difficult in the US versus Europe, for example? That is a very good question. Awesome. I didn't think about this. So, yes.
There are countries who have way more issues with access. For example, the Nordics, like, Finland, Sweden, very restricted access. They allow, you know, like, one company person per quarter to access the clinic. Well, that's not a lot. You have to be very creative to find ways of providing value, having them invite you. So that's very well, it's very open in terms of access. Right? You know exactly what the rule is, but you have to be smart enough to find your way in, basically.
I think that is a huge difference. I've seen physicians in the US, they accept everyone. And I'm like and they are overwhelmed by the the people talking to them from a company where I was wondering and sometimes asking, so why do you allow everyone in your office? It's still your office. You know? So there is a there is a difference. I find the US physicians very open. I have to say, in general, I find physicians very open. But some countries have more restrictions as a country, as as a rule.
And then, of course, there's some clinics who are very strict and some physicians who just don't wanna talk to us. Mhmm. That's interesting. And I think that that puts into perspective for a lot of MSLs that are in the US listening to this that are having access issues. I think it's really important to know that it could be worse. Oh, yes. Right? It could always be worse. So do you what can you tell those folks? Do you have any tips, tricks?
What can USMSLs learn to help with access that maybe folks in other areas of the world are, you know, best practices that that they might be used to that are helping them with access? It's really about being very individual as the individual physician or clinic. So understanding what they are interested in and taking this into consideration as a starting point, maybe more of what than what we are interested in. And again, seeing who else has access.
Sometimes it can be even another company that might not necessarily have a competitive product, but might be in the same area, that can help you with access. And then try to approach a physician outside of the clinic. Congress is, as you know, is awesome. And it sometimes, it's actually sometimes funny to watch some company representatives waiting for a position, you know, to talk to them. But this is a way to do it, and be as casual as you can.
And and just even speaking at the coffee party of someone that you don't know, sometimes, just saying sometimes. Right? Can lead to an awesome connection to a physician. One thing, speaking about congress, that comes to mind that was, a very successful move from one of our team members was, sitting next to the physician, at the congress in the audience. I think it was more almost more like an accident.
But because, you know, you're sitting next to each other, you just start doing some small talk, and that was an awesome connection. What I I guess what I'm saying is find these moments where you can have easy access. You don't have to go there and right away, you know, introduce yourself, and this is me, and this is my job. But sometimes it's more a relaxed environment. Of of course, adhere to your company rules and regulations, and you know all this and the compliance things around this.
But I think being creative, proving value, being clear on what you're communicating, also, if you get this one time chance, you wanna have your 2, 3 sentences ready that you wanna speak to the physician, that they know how you can bring them value. Yeah. Well, it's funny. And, you know, you could accidentally on purpose just wind up sitting down next to a KOL that you're that you're that you've been wanting to see.
And I, you know, I did a I had done a podcast with Andrea Johnson a while a while back, and she talked she had a term. It was like it was like tactful stalker or tactful stalking or something where it's like Yeah.
The strategic stalking initiative where she would, you know, try to find her KOLs outside of the office, whether it's at conferences or, you know, you know, on their way to the coffee shop, get to know their their practice, their habits, where they're gonna be, and and know what they look like, know who they are, and just kinda wind up being in the same place at the same time. But and she talked about it again. You know? It was a term like tactful stalker.
But I I think that what you know, creativity is a big thing, and putting yourself out there and showing up makes a big difference. And I know a lot of people don't feel comfortable doing that, so I totally get it. And there's always the compliance issues, and some companies are, maybe a little different about that. But I love I love that idea, and I think that that is something that, really successful top performing MSLs get really good at.
So, as we close-up, what other, you know, kind of final words of advice do you have for MSL? Whether it's US, global, as you look into the future and where things are going, what might you tell people? I think what we currently all need is flexibility and openness to what's what's there to come. I this is like it's it's changing for some more than for others.
But currently, if I'm hiring someone, I really be looking for flexibility, and the openness to learn something new as we discussed earlier. And, yeah, and praise and praise your role. And by the way, that helps when you're saying not feeling comfortable. And and praise your role. Think about your role, what the company expects of this role, and then really embrace it and live it.
And that takes I'm I'm finding it it makes it easier even with those parts of the role that you're not so comfortable with. Embrace your role and live it. I love it. That's awesome. That's a great way to end it too. It's so there were so many quotable moments. I was, like, taking notes. I have a lot of stuff that we can, that we can quote from this episode. So thank you, Maya. I appreciate you. I appreciate you coming on. Thank you for having me. It's an honor.
I mean, everyone's listening to your podcast. I'm listening, by the way. So it's an honor to be here. It was really, really wonderful. Thank you for the opportunity. Thank you for saying that. It means a lot. And thank thank you out there, everyone that listens to this show every week and and makes it what it is. I really appreciate you all, and I will see you next time. Thanks, Maya. Thanks, everyone. Thank you so much for listening to the show.
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