Hey, guys. Welcome to the podcast. My guest today is Carol Heagy. She is a VP of medical affairs, and we talk about, is medical affairs doing it all wrong? So awesome conversation. You guys are gonna love this. Don't forget to follow me and connect with me on LinkedIn and check us out the 1st Tuesday of every month, typically at 1:30 PM EST for our MSL talk live, which is on LinkedIn. So you get all information on LinkedIn for that show, and, thank you for your support. Thanks for joining us.
Welcome to MSL Talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical. Hey, Carol. Welcome to the podcast. How you doing? I'm doing great, Tom. How are you? I'm awesome. I'm excited. I'm excited that we're doing this. Could be a great conversation. Yeah. Me too. These are important topics, and it'll be great to have a chat with you about it today. Oh, yeah. For sure.
So before we get into it, let's do, a quick introduction if you wanna tell everybody who you are, where you're from, all that stuff. So my name is Carol Heagy. I have been in the pharma industry now for more than a quarter of a century, although I think that ages me a little bit. I started life, carrying a bag as a sales rep, but very quickly moved through into professional education here in Canada and then, became an MSL, went on to lead MSL teams in Canada and internationally across the globe.
And most recently, I was the VP for field medical with Takeda USA. Awesome. Well, I'm really excited to have you here, and I carried a bag too. So we have that in common. That's how I started my career. Yeah. And, so real quick before we get started, quick shout out to our friends in Turkey. So we have had great numbers in Turkey over the course of the past past week. We've been consistently in the top ten in the careers category, so I wanna give a shout out to everybody in Turkey.
Also, this episode is sponsored by MSL mastery. So the MSL mastery program is brand new. It is, actually, our first program that Sarah Snyder and I started this. It's a coaching program. So by demand, we started a group coaching program. It's an online step by step how to land your first MSL position. So if you're an aspiring MSL and you're on the job market, check it out. Just go to mslmastery.com, and the program is actually called Aspire, Aspire MSL. We're really excited about it.
So this is actually our first kinda week introducing it, so check it out. And if you're interested in our coaching program, please join us. We'd love to have you. So we're gonna get into this topic. So Carol actually came up with this topic of, is medical affairs doing it all wrong? So, you know, kinda click baity, like, what is that exactly does that mean? So I'm gonna I'm just gonna throw it back to you, Carol.
So what do you let's just start with what you think like, where that came from, what you think needs to change, and why why you said that. So I I think that we are doing a lot of right things. I think that as medical affairs professionals and as in myself in the field, we're very focused on our strategy.
And when I think about are we doing it all wrong, it's not that we're doing the wrong things, but I think that we are potentially not speaking in the right language so that others can view the things that we do in the right way. So in that essence, I think we're doing a lot of the wrong things because no one knows that they really exist.
We're not great salespeople of the things that we do from a medical affairs perspective, and I think that's why there's often this counterpoint between commercial and medical organizations that we see week upon week in any of the pharmaceutical and medical affairs, media that makes it to the top. Right. Right. So you're so when you're saying, are we talking, like, both internally and externally, you're talking? Got it.
I I think we're a little bit better externally when we describe ourselves to HCPs. Mhmm. I think, you know, I can tell you from a field medical perspective that they're very good at drawing the distinction between what is a sales rep and what is an MSL. Mhmm. I think that we're very good at painting a picture of what working with a medical affairs organization can be like from an HCP perspective. Mhmm. But, I don't think we're very good at doing that internally Mhmm.
Because I I think and I would argue that in in many companies, big pharma, medium sized, small biotech, there is still a lot of confusion about these field based roles and the people who lead them. Mhmm. Whether they're just well, they're scientific sales reps. They're just sales reps that talk about clinical trials. But it's not. It's an entirely different role.
So I think, internally, we still have a lot of work to do to represent what we do in a way that's easy to be understood by our internal colleagues and stakeholders. Got you. Yeah. No. I definitely I mean, that conversation of, I'm gonna use the word value.
You you're saying x you know, I think you're saying the same thing, but I'm gonna use the word value just because any conference, medical affairs conference you go to, there's always that discussion about, you know, what is the value of field medical and how does it get communicated up through out the organization? But you said something interesting to me in our conversation recently. You said that we all work for commercial entities.
Yeah. So let's talk about that and what you mean by that and how that plays into this. So I think we're all dependent now whether you are an independently owned, and I know there's not a lot of independently owned pharma left. But if you're working for a small company that has a very tight group of investors or you're working for a massive company, top 10 pharma, essentially, we're all beholden to making a profit for those who hold shares or equity within a company.
So we do all work for commercial organizations, and we all have overarching corporate objectives that we play a part in helping the company achieve. So I I don't think that we can be sanctimonious and say, well, we're we're not commercial. We may not operate in a commercial environment, but we're still driven by an overarching corporate objective. Mhmm. And and that usually centers around share price, money, and value. Right.
Yeah. And, you know, you also said and I wanna go back to you said something very interesting about value. You said that value does not come from a transactional relationship or a number of KOL visits. So Yeah. Let's talk about that. And where do you think value does come from? Yeah. So I I I think that many times we get into this debate over KPIs and metrics. And and I think and maybe we'll talk a little bit more about this as we go down, Tom.
It's a lot about the language of how we present what we do. But how I've always tried to encourage my teams is that you can interact with a key opinion leader. You can do that in 1 of 2 ways. You can do that in in a form of partnership or in a transactional relationship. In a transactional relationship, you take yourself into the key opinion leader that you may or may not think is of value, but you want him to see a value in what you give to them.
Many of us will say, I'm there to educate the key opinion leader about our products or about our disease state. Mhmm. I would argue that what we're actually there to do is to present the company's information, to present the company's beliefs and the company's messaging, if you wanna use that word, around disease state, around disease, and around the products in order to understand what the customer, the key opinion leader, or the HCP thinks about that information.
And I think that's where the value of the teams and of medical affairs in general actually sits. So it's not in that transaction of, I give you this information, doctor. Now I can check a box to say that I've done that. The actual value is in saying, let me tell you about this information so that we can discuss that information in order that I can understand what you think of it and if it will impact your practice in patient care.
Mhmm. Because if we're not impacting the patient's outcomes, if we're not supporting the customer, the key opinion leader, the HCP, to actually be able to improve his patient outcomes, why are we there? Right. Right. Yeah. Well, you there's a lot to unpack there because I think as as I'm hearing you, there's, what are the needs of the KOL? And is that top of mind, and is that part of the agenda for the MSL? But also, what is what are the strategic objectives of the organization?
And how do those two things come together? Are there gaps? Is that, you know, is there just a gap that exists in in many interactions these days? And and, you know, that word, is there a gap that exists? Can you imagine? Can we postulate what value an organization would place on really understanding what that gap is? Because the organization that can fill that gap is really providing value. So how do we get to it, Tom? How do we get to what is that gap?
For me, identifying that gap and actually beginning to understand what could potentially fill that gap is what the medical affairs part of an organization and its other stakeholders, commercial, r and d, clinical development, all seek to try to understand. And field medical teams, medical affairs teams, I believe, are uniquely positioned to actually delve into what that gap is.
By going and having a conversation about disease, about drug, about treatment protocol, where you can say, is there a gap? What does that gap look like from your perspective? What will you do to fill that gap right now? You're actually gonna gather insights that other parts of the organization cannot easily gather.
Most MSLs, when they enter into these two way discussion partnerships with customers, actually can get information that an ad board can't bring you, a survey can't bring you, and you can see partly through social media listening and omnichannel engagement, but an MSL discussion with pointed questions and free flowing back and forth dialogue will actually yield huge insights.
And if those insights are targeted to what the treatment gap is or what the company's gap in providing for that is, that is hugely valuable. And I think that to go back to our our previous thought, I think that is actually where we then negate the need to have a KPI or metric around activity. If you're bringing truly valuable information, I I would guess and I know certainly this is how it always appeared to me, it doesn't matter how many attempts it took you to do it.
It's the value, the depth, and the quality of what you achieved by doing it. So if you're not bringing valuable information, people will say, well, how many people did you see Right. To bring nonvaluable information? But if you bring 2, 3 really truly valuable insights over a period of time, No one's gonna ask you, well, how many people did you see to achieve that Right. Fact. It changes the the discussion and the environment a 1000%. Right.
So when it comes to the never ending debate over metrics and qualitative versus quantitative, you clearly are on the qualitative side and are trying to get try to keep MSLs away from being transactional, being too quantitative and just focus on numbers, but focus on quality of interaction. Yeah. It's it's difficult because you you don't wanna say to people, doesn't matter if you only see 2 people this week.
Because if you are a skilled imacile, if you're engaging in deep and meaningful conversations with customers, if you're having this two way dialogue and you're achieving great insight, I want you to do that 10 times a week. You know, I want you to do it 10 times a week. Where we really start to get into the nitty gritty of numbers is when people aren't achieving those deep and meaningful insights, then people wanna know, well, what do I get for the money that I spend on your team?
What do you bring me for the investment I give to you in terms of salary and all of those other benefits that we have? They wanna know what they are receiving. I think it it it it really does totally change when we are anticipating their needs and providing the information that helps them to also do their jobs better. Yeah. Well and it's it is tough. You I mean, you hit the nail on the head. You said before that, you know, all companies are commercial entities looking to make a profit.
And the powers that be wanna see what is the value of field medical, and how is field medical moving the needle. And it's not ease it's not very easy to determine that. There's not there's not it's not like sales and commercial where you look at sales numbers. Mhmm. Then what do you look at? Well, you could look at the interactions, the quality of the interactions, or you could look at the number of interactions, or both.
So, I mean, I I see both sides of it, but I also realize that to your point, it's hard to be valuable to a KOL unless you bring value in helping them with their practice, with their patients. And that's not gonna be accomplished if you're just checking a box and going in and making a number of visits, but not really adding enough real value to them. So, what what other misconceptions exist in medical affairs that you might wanna talk about?
Yeah. So I I think one of the biggest misconceptions is well, it's not even a misconception. It's a miscommunication. It's how we present our work to other parts of the business. So we we fall into the trap of trying to talk in the same language as our commercial colleagues and colleagues in other areas. And that's when we fall down the KPI and metrics rabbit hole.
You know, when we are looking at, sales teams where their their KPI, their metric for interactions with customers might be 20, 25 interactions per week with a very short interaction window, 6 minutes. I I don't know what it is right now. It's probably around 6 minutes versus the AMRH MSL interaction time.
And if we look at some of the big reports from best in class and others, what we see is that interaction time between 30 45 minutes, around about that window, is not humanly possible to see 20 to 25 people in a meaningful way in a week. It's just not. And the interaction type is is not this transactional. Let me give you these glossy brochures. Let me tell you these 3 sales messages. Let me give you some sample product. Whatever it is that the sales team is doing, that's not our way of working.
Our way of working is this question and answer debate and dialogue with a customer. Mhmm. Takes a long time takes time to plan for and takes time to then analyze the information that you've received in a way that it become a cohesive insight. But it's hard then to talk to a sales organization which is used to seeing, like you said, numbers of visits, messages delivered, sales figures on the outside, prescribing data on the other side. So what do we do when we can't show them?
And I think we're getting better in being able to track outcomes of what we do as medical affairs organizations. I think our ability to look, whether it's through a system or through a lot of manual labor, at what does the environment say? So let's look at social media, what patients say, what physicians say in the social media environment, and understand what the dialogue is outside of the pharma dialogue and then be able to track what it is we are seeing through use of our systems.
What did we discuss? What was the data? What were the topics? And through use of good systems, be able to collate and analyze the insight that medical affairs and MSLs bring in to an organization. What we should hopefully see is a change in the dialogue through social media and other activities like conference listening. If we go to conferences, are we actually hearing the dialogue the HCPs are having change in response to our dialogue with them.
If we can track that over time, I think what it actually lets us do is put hard data in front of our commercial colleagues in a way that they understand. But when we can't fully do that yet, although I think we're getting better, when we can't fully do that, what we actually have to start to do is build a story of what we do so that we're presenting to them a storyboard or a story that actually says, here's the problem.
This is how we tackled it, and here's the outcome that we've achieved so far. And encourage our commercial colleagues, colleagues in r and d and everywhere else to walk that journey with us so that they understand the purpose, the plan that we had for the activity, and what we managed to provide to the organization at the end. 3 piece. So it's we've talked a it sounds like we're talking a lot about this this piece of partnership.
Partnership with the other internal stakeholders, whether it's commercial r and d. So it sounds like that should be one of the things that, as we look at the topic today, which is medical affairs is doing it all wrong, I think that this seems like a theme in that the there should be more of an emphasis on really establishing stronger partnerships internally, especially with the commercial side so that there is that true give and take and that value knowledge sharing.
And there's, I guess, not the firewall. You hear the word firewall all the time, and that you hear that word because of compliance reasons. But there's I'm not talking from a compliance perspective. I'm talking breaking down the barriers. It sounds like that's still a concern. I think it is. And I think, a lot of organizations are still struggling with how to handle this. Let me tell you my thinking. I think there is a difference between a tactical discussion and a strategic discussion.
And I think that we oftentimes will bundle these together. So if you have MSLs and sales reps having and I'm not saying we shouldn't meet go to Starbucks and have coffee. That's not what I'm saying. But if if you if whilst you're in Starbucks having coffee, the sales rep is saying, I'm really struggling with doctor Heggie. She just doesn't wanna hear what I'm saying. She never uses the samples I leave her. Could you go and present some data to her? That's gonna land an MSL in a bad place.
However, if we're having a strategic conversation 2, 3 layers above where that sales rep is maybe feeding their own information back to their leadership, saying, this type of doctor, these things that I see don't have any impact. And then at a strategic level, the organization is saying, well, why is that? Is there missing data? They can then come to the medical affairs group to say, we're having an issue with this type of customer, these types of prescribers, these prescribing events.
Maybe it's a certain patient type or whatever. And medical affairs can say, well, what does the evidence say? How can we provide better evidence to HCPs through events, seminars, conferences, publications, and other media to help the HCP understand better? When we've made those decisions strategically, the MSL can start to look at, how do I enter into those conversations with customers?
And I think then what you've done is you've created a you've removed that firewall, because now we're all looking at problem planning and then then a solution at the other end, in a very strategic way. And we've removed a lot of the risk. Now the sales rep's gonna see benefit of that, maybe not tomorrow, the way that they would if the MSL said, okay. Let me book a quick appointment with doctor Heady and go and tell her what what she should be doing.
Instead of that, it may take a little bit of time. But I think the commercial organization can see a partnership with Medical Affairs, as well as Medical Affairs going above and beyond to create enduring effect with customers and not just a, let me just quickly go and tell the guy how to do it. Yeah. Got you. So let's you had said one of the other things that you had said when we spoke was that the MSL role is a gateway role. So describe what you mean by that.
Yeah. So I I think that there are and I'm gonna use huge generalisms here, so I apologize. I think there are different types of folks that come into the the MSL role. And I think they stay enrolled or leave role for different reasons. There are people who come into the role because it affords them the opportunity to work remotely, to go talk science with really smart people all day long and get paid for it. I can remember being in the field and thinking, do people wanna pay me for this?
I would do this for free. No one ever did. Because it was such an enriching experience for me every time I met with the KOL. I walked away the better for it, as I hope they did too. But then there are other people who are, like, saying, I wanna work in pharma. I don't quite know what I wanna do yet.
And as a result of that, they come into the MSL role, and it gives them the ability to do 2 things, to see how everything connects together, to identify a career pathway that might work for them, And then oftentimes through participation in projects and initiatives, get a chance to interact with and sometimes do a little bit of those things. So they learn what MedInfo is. They learn about medical communications.
They discover the role of scientific directors, if your organization has them, versus medical directors. They learn about MSL and medical operations. And you can see quite quickly the people who are so happy just to be in a field role versus the one who are saying, that's where I wanna go. I wanna eventually be a medical director. And I think it's a really a phenomenal thing because many organizations will look at MSLs as a farm team of sorts Mhmm.
A talent pool from which they can draw very smart people who understand the customer because I would argue no one understands the customer better than an MSL when they're doing the job in a dialogue, not transactional way, who understand the organization's goals and objectives and who are already embedded with many of the stakeholders in in that therapeutic team. So for them, it's an easy, quick one to look at the MSL team.
What I don't think we do a very good job at when we think about this gateway role is letting people be open about their desire to do that and build a career pathway that lets them get there. If you think of an average MSL team having somewhere between 6 10 MSLs, big team being 10, average team being 6, there's only 1 manager. So you have a 1 in 6 chance of eventually becoming a manager on that team if your manager ever leaves.
And even if there is a career progression for the MSL, MSL senior executive, whatever that is, it's still not getting you into that associate director director role very easily. And if you're young and dynamic, as many MSLs are, they want their career to advance. So what I think we should be doing, I'm sorry to divert a little bit, is we we try to invest in MSL training. We should be investing more, much more in order to get us to where we wanna be.
But, also, we have to invest in competencies as the building blocks for the next role. And think about if you can think and act strategically, what does that look like if you wanna be a scientific director? And help people to build an educational suite of activities that prepares them to step into their next role. Not waiting for opportunity, but creating opportunity because you know what you have to do to get to your next position. So that's how I feel about it as a gateway.
Some MSLs will be quite happy. And I and I've worked with and I don't wanna call anyone out, but his name is David, an MSL at Takeda who's been an MSL for, I think, going on 20 years. And I am consistently, consistently blown away when I think about him and his dedication to his customers. And he has no desire to become a manager or medical director. He just loves what he does every day.
And then there are other young guys who come in and will be transparent and tell you, in 5 years from now, I wanna be a medical director. And I think that's important. I think what you just said is very important because I agree wholeheartedly that the MSO role is a gateway role because there's so many different things you can do. In my seat as a recruiter, I can tell you there's so many things that you can do after being an MSL. So, we don't have to go through all of them.
There's actually a bunch of episodes in this pod you know, on our podcast where we talk about that. Just had an episode with Stephanie Fish called the career lattice, and we talked about her journey. But then I've had episodes in the past where we talk about the different ways that you can transition from MSL to other things. But there are some people that are career MSLs, and that's for me too. That's totally fine. But the point We need this.
If you aspire to be something other than just a career MSO, you have to be your own advocate. You have to raise your hand. You have to be very vocal, and you have to make sure that other people in the organization know what your your goals are, what your desire is. And if you don't know, if you know you just wanna do something more, you're really not sure, you still have to raise your hand.
Because otherwise, there's there may not be a path where people might not come to you with different options. So I think that's just really important. But as as we continue the conversation here, I wanna look at the future a little bit. Because we've talked about the current state of affairs, but I'm curious What roadblocks and what challenges do you see coming up for medical affairs? So I I think that right now and everything that I'm hearing is, money is tight. Mhmm. Budgets are tight.
The ability to do novel things is tight. I think couple of years ago, we were slap bang in the middle of a pandemic. Mhmm. And and that cannot have an effect on revenue streams and everything else right now. I also think that we have this huge push towards digital, towards omnichannel engagement, but all of that requires investment. You can't just go omnichannel, go digital. You need platforms. You need materials.
You need, infrastructure that supports that, all of which is brand new for most companies and requires a huge investment. And that's not just from a medical perspective. That's also commercial. And when budgets get tight, it's oftentimes the commercial budget may not be impacted as greatly because they see this sales to to to to revenue as budgets like medical affairs may be. And and I would argue that most companies are seeing budgetary constraints.
Mhmm. When that happens, one of the biggest things that then impacts the medical budget or is it impacting by medical budget tightening is, training. Mhmm. Because if you were going to spend a couple of $100,000 on a training program for your 50 or 100 MSLs, and now you have a budget tightening, that's one of the easiest things to try and do in a different way. Do remotely. Do virtually. Do using, self learning, self paced learning.
And that can answer many of the problems, but it doesn't answer everything. It also affects our ability to put in place systems and processes that would actually be game changers. You know, I was very blessed in my previous role in that we were building and or we did build an inside collection system that I would argue is second to none and actually allows the team there to analyze what they've learned, to look for those gaps in the moment, literally in the moment, which is hugely important.
There's no more creating, 6 hours of work to pull together an insight report that no one really listens to. It's happening very deliberately as insights come in. But that takes investment. And, again, if your budget's squeezed, can you invest in that? I think the counterpoint to return to where we started is if you're really presenting value, people will give you more money to do more things that provide value.
But we're caught in this loop right now of not presenting what we do in the best way possible to create a story that shows value in order to create more investment. So I think that's the first big roadblock. I think that the other roadblock is the court of public opinion. You know, we see so often, the the firewall either not being tight enough or companies who breach what firewall they do have.
I think scandals like Purdue, what happened at Purdue, have really had a negative impact on the public perception of pharma and in turn of the medical affairs rules. And these are high risk rules. If you don't execute well as an MSL, if you don't know what your guardrails are, if you aren't really staying tightly within those, the effects of a potential misstep can be catastrophic for a lot of companies.
So I I think that we are in an environment right now where our activity is narrow, our budgets are narrow, and we aren't really creating the environment where we are encouraging more investment. For now. And and, you know, I I I agree. I I'm seeing it myself. But these things tend to be cyclical. I know that there's a lot of sentiment right now to do more with less is the way it's been described to me.
But I also know being in the industry for a long time as as you have been, you know that this is one of those things we just have to kinda get through this patch. Yeah. And then things are gonna come back around and budgets will open back up and and, things will start to to develop in a positive direction again. I mean, look. We got through COVID.
COVID was a horrendous time for so many people, and now we're going through this other this other kind of rough patch of uncertainty within within industry. There's a lot of reasons for it, but, we won't go into it. So final words, whatever you wanna talk about, whether it's it's, you know, past, present, or future of medical affairs. Final words. I here's my final words. Value what you do. Value what you do as an MSL.
Recognize that what you bring to the table really isn't able to be offered to a customer by anyone else in the organization. MSLs especially are uniquely positioned to have discussions that if other people who didn't understand the MSL role within a pharma organization could watch as a fly in the wall, would be fascinated. Continue to be curious.
You know, I had managers once when I was, working with a group in the forest in in, Indonesia and Malaysia and China who said, what is the one thing you look for in a new MSL? And I told them it's something that you can't measure, but you'll know when you see it, and that's scientific curiosity. Because if you have that, if you are curious, if you're interviewing me as I interview you, you're gonna do this with your customers.
Mhmm. You're gonna ask them what and why, and your brain will always be thinking, what does that mean and what should I ask next? Keep doing that. Do it more every day because the things that you learn have value for your organization. Talk about these things. Socialize them. Use the systems that you have or ask for better systems, and build a story of your environment, your activity, your customers that shows people how you're helping to change patient outcomes.
I think that's that would be my parting words is believe in the power of your questions because they have the ability to change everything that your company does. Awesome. That's a great great advice. That's a great way to leave it. I think it's amazing. You're amazing, Carol. Thank you for Thank you so much. Us. This was awesome. This was such a great conversation. So, guys, don't forget to share it, like it, follow it, do whatever it is that we do on social media with this stuff when I post.
Appreciate you for listening. And again, check out the MSL Mastery program. Go to mslmastery.com. And, Carol, I wish you all the best. This was an awesome conversation. Thank you again. Thank you so much, Tom. Alright, guys. Take care. 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.