Hey, guys. Welcome to the podcast. My guest today is Charlie Cook, director of MSLs at Takeda. And we talk about metrics, qualitative versus quantitative, and how the game has changed. Really awesome insights from Charlie. So I hope you guys enjoy it. Don't forget to follow us on YouTube and Instagram, and, of course, LinkedIn. I hope you guys, also check us out on MSL Talk Live on Clubhouse, which is on the 1st Tuesday of every month at 1:30 PM EST.
Welcome to MSL talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical. Hey, Charlie. Welcome. Always great to chat with you, my friend. Thanks for joining me. Hey there. Thanks a lot. I'm excited to be here. Cool, man. So, why don't we start with an intro? Why don't you introduce yourself to everybody who you are? Sure. I'm Charlie Cook, and I'm the field director, at Takeda on the IVD, GI team. So I've been here, about 6 months, which has been fantastic.
It's a great group of folks. Awesome, man. So you like it, and how's it going over there? It's going really well. Learning a lot, obviously. My background is in neuroscience, so I have a history of Lilly and Biogen being within neuroscience. So I've had to learn, what happens below the neck, you know, from a scientific standpoint, but it's been real rewarding. It's it's a lot of fun, learning something new.
I mean, that's kinda what MSLs like to do, and so I feel like I'm like an MSL right now, learning a new disease state. Well, I was excited to have you on here. You and I have history together. We've built teams together, and and and we've collaborated on on, you know, in conferences and discussions. So, I I appreciate you taking time because I know I've been hounding you. Yeah. That's great. Just to shut me up. You're like, alright. I love this. No way. This is fun.
This is better than work sometimes. Well and I'm putting you in a tough spot because we're talking about the m word. So Yep. You know? And a lot of lot of times, that's, it could be a trip tricky subject, but this metrics conversation is constantly changing. And it's it's it's a very I think it's a really good time to have this conversation because of the fact that we've we're we've been through COVID. So there's pre COVID Mhmm.
And there's post like, during COVID, and now we're getting to the post COVID. Absolutely. So let's talk about, like, your philosophy on metrics. Like, were you always a quali you know, qualitative kinda guy versus a quantitative guy? But so where do you sit, and and what's your thought process on on metrics? Yeah. So I I think I I've never been a a quantitative guy overall. Okay. I think MSLs, it's it's really what you do, not how much you're doing. Okay. That to me is really important.
Now, clearly, I understand the importance of, you know, having some quantitative metrics. You know, I think as an MSL, and depending on your territory, achieving some of those quantitative metrics can be easier or more difficult. And I think as a leader, you know, having some of those quantitative metrics that you can roll up the leadership ladder, you know, senior leaders, you know, that's what they're used to looking at. It's quick. It's easy to kinda get an assessment.
But there are some challenges with it because they're not always, they'd don't always paint an accurate picture necessarily. So that's why I lean towards really thinking about, qualitative. Yeah. And, you know, I hear that more and more, but, you know, let let's go back a second because you made me think, like, where does where does where do metrics come from? What's the birth of, you know, in a medical affairs organization?
Does it come from the tippy top and it's set in a strategy that comes from the, you know, the top of medical and then it's translated down? Or is there a certain lot of level of, you know, autonomy that a field medical team has with it? Yeah. That's a really good question. And and I think, oftentimes, metrics come from the top down. Mhmm. There's not always a lot of autonomy in terms of shaping what those metrics should look like.
I think that's a problem, you know, because I think that when things come from the top down, they're looking for a number to achieve oftentimes. You know, when you think about metrics, you can think about total number of interactions in a month. You you can look at the the length of time that you're meeting with the KOL, and you can also look at, the number of repeated touch points throughout the the year, for example. Mhmm. And and, you know, senior leaders generally want those to be high.
But many factors influence those numbers and ability to achieve that. So I think that's something that is not always taken into account. I also think that sometimes metrics are created in the absence of really understanding how they fit into the strategy. You know? Okay. I think sometimes a metric gets created like, oh, you should be seeing, you know, 25 k o l's a month. Yep. But no one's thought of, well, what's your strategy? Is that where you are in the life cycle of the drug, the product?
Is that appropriate or not? Right. And so lots of times people don't think through that. So I think that's something that needs to change. So what so getting back to the now looking at the kind of an an offshoot of that question is so before metrics should come into fruition with an organization or with a team, whether it's a new team, an existing team, or whether it's year over year, you have to look at the strategy first. What are the strategic objectives Yes. Of the organization?
Where's the product in its life cycle? And how should metrics align with the primary or even primary and secondary goals of the organization? Yeah. Absolutely. And I as I said, that doesn't always happen. And so I really think that if you understand what your strategy is, you can then start to develop, you know, metrics to align to those.
So, you know, for example, if you're in, you know, a new team that's been formed and you're, you know, preparing your your drug is submitted to the FDA, you've got a year or so, out before a potential approval, a lot of what you're gonna be doing is, potentially doing disease state education, particularly if it's a drug that's new to the field. It's gonna really kinda revolutionize treatment. There can be a lot of education that has to take place.
And so you need to understand where are you focusing your efforts. Are those with, you know, the top institutions? Are those with community folks? Where is the drug gonna be used? And, you know, so metrics around education can be very important. Mhmm. And one thing to think about is, is there a way to get an assessment, a baseline assessment on the understanding of the disease state from KOLs, from different groups, top tier to to regional or community practice, things like that.
And then you can deliver some education to them over time, and then you can look at how their understanding of the disease state has evolved. Now that's all sounds simple, but it's complex to figure out. How do you measure that? Yeah. And and and and how do you look at that? And so sometimes, you know, having more frequent touch points may be beneficial, but it's not always gonna translate into improved education.
Just because you met with somebody, you know, 2 times and somebody else has met with another person 4 times, the person that's been met with 4 times doesn't necessarily have twice the knowledge or twice the understanding. Right. So you need to really kinda think through what you're trying to achieve. Right. So you have to look at what you're trying to achieve, take all these different factors into consideration, such as, I would imagine, things like territory, number of MSLs Yes. Disease state.
So there's probably a ton of different things you have to look at. Yeah. And I think, territory is is one of the, I think, really more important things that isn't always taken into account, as metrics are are created because, you know, you think of somebody that might be in the Greater Boston area, you know, New York City, Chicago, Houston, LA, those are some of the really large metropolitans. There are many universities, potentially many KOLs there, and sometimes many top tier.
So when you think about what an MSL is doing with them, they might be interacting with top tier KOLs. Some of those may be, relevant for advisory boards and and really interacting with the home office a lot. And then you think of somebody who might be, you know, in the Midwest, you know, covering Iowa, you know, North Dakota, South Dakota. And what they're trying to achieve there in their territory is gonna be very different than somebody in Boston.
And note and the numbers when somebody says your goal is 25 interactions per month, that's not always taken into account. Right? There's travel Yeah. To and from that's much greater. You know? Somebody in Boston or LA, you know, they might be able to hit multiple people in a day, much less in a week because they're just driving or walking to the next building over.
Whereas somebody in the Midwest is seeing going to one town, seeing the local or regional KOL, having an interaction with them, and then having to hop in the car and drive 5 more hours to another city. So you it's not always apples to apples, but you can have people develop a territory plan. What are their goals within that territory? What are they trying to achieve, say, from an educational standpoint if it's in the prelaunch?
What does that look like in the Midwest territory versus in the Boston area? And that can be very different. Sure. Yeah. So that's why this is tricky. I mean, there's there's some there's tons of nuances to this. And then you had mentioned before, you have to record it. So you have to track it. Mhmm. So that becomes a whole separate thing. So but it's not to get into that part of it because I think that's a whole kind of a little bit of a separate conversation.
So I think each organization is gonna track their their roles a little differently, but it is something that's obviously very important, insights gathering and that sort of thing. Yes. But but I'm curious to learn and and, again, getting back to your philosophy. Mhmm. How do you keep people motivated? Yeah. That's a good it's a good question. I think, you know, I really, you know, try not to think about the quantitative aspect.
And, you know, when I was at MSL, you know, when I started out, you know, we did have a number kinda roughly each month we were trying to hit. And, you know, talking to colleagues, there were people that knew exactly where they were in the month Yeah. Of how many interactions they had. And when someone asked me, I really wouldn't know. I could give a rough estimate, you know, if I had several versus many versus none. Right? But I just I wouldn't be able to say, oh, I have 12.
I need to get 3 more or 10 more by the end of the month, and I got 8 days to do it. I wouldn't know that because, one, that stressed me out thinking like that. Yeah. So my defense mechanism was to ignore it and try to focus on what was I supposed to be doing in my role? What am I trying to achieve? And there are gonna be some months where I would would would hit the metric, you know, versus versus other times I wouldn't. But I I think that, to me, that's how I I dealt with it.
And I think one thing people really need to keep in mind, and this is particularly when I you know, obvious when I became a manager. Sure. There are people that have tons of interactions, But what's interesting is they're not always rated the top performer every year. They're not. And and some years they might be, but it's not because they saw the most people. It's because they did the most against the strategy of what they were trying to accomplish.
And so to me, that is, you know thinking of it through that way, really helped me rationalize my thought process of focusing on, the the qualitative aspect of the job and not necessarily the quantitative. You know, another kinda one more comment that I I I realized and I tell people is that, you know, MSLs are type a people. They're high achieving people. Mhmm. And the fact of the matter is I've never seen a metric, a quantitative metric that an MSL can achieve. They figure out how to do it.
Right? If it's a certain number of interactions, they will figure out how to meet it. And just because they're and sometimes it can drive bad behavior. Right? If you're walking down the hallway in an institution and, you know, you see doctor Jones at his desk and you wave to him and say hello and talk about their the weekend or, you know, what you've been up to, that's not an interaction, but it may become an interaction in the CRM, how it gets documented.
Right. So I think sometimes metrics can drive bad behavior Right. Which is important to keep in mind. You look for so you look for ways to keep people motivated and in line with, with trying to influence strategic objectives and not just check boxes. Absolutely. So understanding what is somebody working on in their territory if there's a key KOL or maybe an institution that they're trying to kinda get into, to meet. Right? How is that going? What are the roadblocks that they're having?
How can I help you maybe achieve you know, get into the institution, achieve your goals? And when you focus on that, one, the job is much more fun. You're not worried. It's not stressful because you're not worried about checking off a box in terms of from a quantitative number. So that's how I approach the job is really understanding what's going on in your unique territory. Let's ignore what, you know, what you're hearing from the other MSLs and maybe how great they're doing. Right?
Let's focus on what you're doing and what your roadblocks maybe, maybe be. And and and that's how you work on it. So I that that's my approach. I've never I've never liked being a quantitative person. I think it's you wanna have some level of activity. But, again, if somebody saw 20 people in a month and somebody else saw 30, the person who saw 20 may have really moved the needle on your strategy way more than somebody who saw 30.
And I think sometimes it gets completely lost, particularly when metric numbers get pushed up, you know, the leadership change change. Right. And then now we look at we're in a situation where, things are changing so much. Mhmm. So we have to take into consideration the changing marketplace, the changing dynamic. So we have pre COVID where metrics were a certain thing. Then there's were during COVID and metrics changed altogether. And some companies just did away with them, and they said, hey.
Do the best you can. Yeah. Right? So where do we go now? Like, where where do you feel like as people are starting to travel again, as we get into, is it we gotta get back to these core basics? What's your philosophy as we look into this next evolution of the MSL post I I think that's really interesting. And I think, to me, what COVID taught me is that, while interaction numbers, you know, across the board, I think, in most companies and most therapeutic areas went down. You know?
Some went down dramatically. 40, 50, 60, 80% for a period of time. But when you look at what, the company or the medical affairs organization accomplished during the year of COVID, for example, many times, they worked out pretty well, meaning they achieved their objectives. You know, maybe they were a little bit shy on certain things, you know, you know, if they were looking to to start an educational program or something, maybe that didn't get kicked off.
But but other most often, I think many companies did meet a large portion of medical affairs goals. And so that tells me that, you know, the total number of interactions is not necessarily a driver of that. And so I I think, you know, moving forward, we're gonna see, you know, a hybrid of virtual versus in person, meetings. And I think there'll be some KOLs that have really enjoyed, the flexibility with with the virtual meetings because they can do it in the evening.
They can, you know, it it can be early in the morning, for them on the drive to work or something. I mean, there's lots of different ways that it can work out that someone may like it. Now there's others that are, you know, the Zoom fatigue. Right? They're they've been doing a lot of, you know, patient visits that are virtually, and they're tired of it. And so they're longing for that in person meeting. So I think you're really gonna see a mix, but it's gonna be tailored to that KOL.
How do they wanna interact? And some of them may say, you know what? Let's meet twice a year in person, and then the rest of the time, I'm good with a virtual, meeting. And so I think we've gotta be flexible to that and understand at the individual KOL KOL level, how do they wanna interact with us? We have to be flexible as MSLs Yes. To cater to the needs of the what the key opinion leaders are looking for. Absolutely. Absolutely. But don't we also need to be flexible to the MSL?
If if as looking at the leadership community and the the organization is setting the, the goals and objectives as far as metrics. So isn't it important also I'm speaking on behalf of the MSLs here. Yeah. Isn't it important to have some flexibility as it relates to the individual MSLs and the challenges that they're facing if they are in a difficult spot, whether it's territory specific or it's just the KOLs are a little harder to you know, a little more stringent.
Yes. Absolutely. So I think, you you know, as a a leader of MSLs, you really need to understand and get to know what's going on with your individual MSLs, understand how their territory is affected, has been affected by COVID, how is it emerging from COVID. You know?
I think, you know, what we're seeing now probably is there's a lot of MSLs out there, you know, that might have been vaccinated, that feel you know, gotten, you know, more comfortable with being around crowds, maybe even going on a plane, and they're eager to kinda get out there. Some of the challenges now are that the institutions aren't opened up yet Yeah. To external visitors. You know?
Some of them are just now allowing family members to accompany a patient with them to an office visit or to a procedure. And so, they're not ready to let in, you know, you know, 3rd party groups like MSLs. And so I think, you know, that's gonna take a little bit more time, and so that's where having some of the virtual interactions, even sometimes just phone calls. I mean, there's some of those KOLs, as I said, that have been, you know, looking at patients through the screen all day.
They don't wanna have another meeting, via, you know, Zoom, for example. They they wanna talk on the phone. Yep. And so you need to have that flexibility to be able to do that. Now that, of course, presents some challenges if you wanna, quote, unquote, show them data. You know? Right. It's not as easy to do that. And so how do you manage around that, you know, can be a challenge as well.
And that's gonna influence, you know, the interaction that you have, how many touch points you may have with somebody as well. So how important in this game, in this as an MSL, and you're you're really, you know, you really wanna do well, obviously. You wanna do a good job, and you wanna meet your numbers, and you wanna make your your your bosses happy. And how important is it to be really organized and well documented? Yeah. It is. It it's very important.
So I always you know, when I meet with my MSLs, you know, we meet every 2 weeks. You know, I really wanna know what have what have they been up to the past couple weeks. You know? And it's not necessarily just tell me all the interactions you've had, but what have you been doing? Because because sometimes the activities to achieve, you know, an objective can take weeks. Lots of different types of prework that needs to happen, lots of things that need to fall into place.
And and and that's time they're spending working on it, and it may not be meeting with a KOL or it may be setting up some logistics if you're trying to get somebody involved in a in an advisory board, and there's a lot of back and forth around that. And and that doesn't necessarily show up in a in a metric number, but that's important relationship building that's taking place.
And so, from from my perspective, I need to have those conversations and really understand that because, you know, we get as we said, each territory is different. Each MSL situation is unique. And MSLs can clearly knock it out of the park. Without maybe necessarily hitting every single line item, every single metric.
But by handling their territory, being entrepreneurial, handling their territory like it's their own business and crossing every t, dotting every I, you know, going the extra mile, they can still be the top of the top. Absolutely. And as I said, I think, you know, you look at top performers that get selected each year, many of them are not the highest in terms of metrics. They might be middle of the pack, but it's kinda what have they done in their territory? What have they done with KOLs?
You know? Are there up and comers that they think really need to get more exposure? How have they gone about getting that KOL introduced to the medical team and all of that? So those are things that are not gonna show up not be very visible in just a quantitative metric. And so there's some qualitative work that you need to kinda describe. It's it's kinda telling the value story of of the MSL. Yeah. That's what the MSL needs to be able to communicate is the value that they're bringing.
Some of it will be in some quantitative numbers, but a lot of it is is more descriptive about what they're doing and achieving. So do you feel like that you know, getting back to, again, the communication aspect of it and I say documentation, but it, you know, a lot of it's just communication and relationship, relationship with your manager. Yeah. And being able to really show proof of value.
Yep. That might not necessarily be tracked on a spreadsheet or in, you know, an a a database or or or whatever it might be. Yeah. Absolutely. I mean, I think and that's where, you know, the onus becomes on an MSL manager that you've gotta be responsible for your people and understanding what they're doing, what they're achieving, because, you know, if you're simply kinda not fully engaged and don't have a good understanding, then you're just gonna look at numbers. You know?
And that's never that's never gonna be fully indicative of what someone is doing. And so I think that from a manager perspective, it's so important that you really know your people, you really understand what's going on, and you can share that story with with senior leaders so that they understand, you know, if somebody might not be having lots of interactions, but they're here's what they're doing. And look, they are achieving the objectives.
They you know, we wanted to meet, say, with more community physicians. And look, this person's found, you know, the top kinda regional or local expert in these two towns and is now you can tell they're wanting more education. They're we're clearly educating and and and, honestly, influencing. But through education, we're influencing the care that's being provided, in that small town, for example, or with that KOL. So that that's important.
Sure. No less important than meeting with the top KOL somewhere else, you know, that's already top in the field. Is there anything else that the MSL of the future really needs to know? And what I mean by that is we don't know what's gonna happen next. We assume that everybody keeps using words like hybrid and, you know, we you know, virtual and, there's you know, we're we're in this paradigm shift. But Yeah. Like, do we switch completely back to where we were Right. With only live interactions?
Is it truly gonna be hybrid, or what does the MSL of the future really kinda need to do to prepare themselves? I think it's gonna be a hybrid. I really do. I don't think, you know, I don't think we can go back and just say you can only we only want you engaging in person with these KOLs because many of them, don't necessarily wanna do that all the time. Mhmm. You know?
I think one of the advantages of of having, you know, access to virtual technology is that you can, quote, unquote, be in 2 places in one at once. Meaning, you know, as an MSL, if you're covering, you know, several states, you know, you could fly to Atlanta, you know, meet with a couple KOLs. But oftentimes, you know, those meetings may be spread out with several hours or maybe on separate days.
Well, historically, that meant that you would I don't wanna say you wouldn't do anything, but, like, that free time would be used differently. Now you can set up a virtual KOL meeting with somebody in Florida, in Miami Sure. That was interested in meeting. So you can see how, you know, in some sense, maybe you get a little more efficient. You know, and it does depend on your territory and who's willing and wanting to meet virtually.
Mhmm. But those are things that I think MSLs have historically not thought about. You know, kinda, oh, while I'm in this city, maybe I could have an interaction with somebody else in another city. It's just it it wasn't practical. So use the tools in your toolbox. You got a bigger toolbox now. Use the tools. Yeah. Absolutely. Absolutely. So I think there's a lot more that MSLs can accomplish. I think at times, they could be more efficient.
And by but, you know, one thing when I say more efficient doesn't necessarily mean more interactions. You know? Just because you you're you're, you know, at home for a day, just because you don't have travel associated with going to meetings doesn't mean that because of that, you're gonna have exponentially more KOL meetings. You know? You still have the the the age old challenge of MSLs trying to get appointments and meetings, and and that's getting, I think, harder.
Yeah. You know, it's not getting easier, with physician time. It's so limited. You know, I think some of these physicians as well will continue with, you know, some virtual meetings as well. I mean, it was you know, just prior to this call, I was on a on a virtual meeting with my father who had recently got out of the hospital with his cardiologist. And this was this the virtual appointment today was the soonest meeting we could get.
If we wanted to be in person, it would have been 3 weeks from now. So you can see how, you know, his doctor's managing her schedule a little bit differently. There's set times for virtual, and then there's gonna be in person. So I think physicians are gonna be doing that, you know, from a from a patient standpoint, and I think that'll just translate into, you know, us as MSLs, you know, having to really be flexible in terms of how we meet with them. Yeah. I mean, I think that that's the key.
I think it be it really comes down to as MSLs, you really have to be good listeners. You have to utilize your your skills of emotional intelligence and and making sure that, okay, even though I have certain metrics and and there's things that were kinda outlined for me that I need to follow, I kinda need to let the KOL dictate to me how we react to that. Absolutely. Absolutely. And I I think when you're when management understands that, I think that that everything works, more smoothly.
The environment is much better to work in if if you don't have that weight of a of a monthly quantitative metric sitting on your shoulders. Because as I said, MSLs are smart. They're type a people. They don't like to not achieve, and MSLs will figure out how to do it. But in the end, are they are they doing the right thing? Are they accomplishing, you know, the the the the the the goals? And I don't think that's always the case.
I mean, I think if you talk to many MSLs and, you know, including myself, you know, at the time, we all know which KOL is very friendly and always willing to meet. Right? Mhmm. And, you know, sometimes that that's not always a good thing. Right? Just because they're willing to meet with you and and chat for a while, so you get that interaction. But in the end, if you didn't move the needle on what you're trying to achieve from a a strategy perspective, that's kind of a wasted meeting.
Sure. Not a value to the the company. Value to yourself because it checked the box that you got a number. But that's where I think companies need to to, let's say, back off, but really understand the territory and talk to the MSLs and and and give them that flexibility and that permission to say, you know, yeah. That goal that we set for total number, I'm not gonna achieve this month, but let me show you what I've done Right. Qualitative standpoint.
And and and that very well may be much better than achieving a number. Well, and it's funny too. I mean, that's that's often some of the conversations that we have on the recruiting side is that, yeah, you really do want to track your progress as an MSL.
Yes. So as you are organized and you continue to maintain good records of what you've accomplished and how you move the needle, not only does it help you as it relates to your relationship with your manager and those above and as it relates to your metrics. But it also gives you some really good information and material to later document in your resume if you have to make changes. Yeah. Absolutely.
Absolutely. And I I think that's you know, I encourage the team to kinda document for themselves the kind of qualitative accomplishments that they have each month, which are designed to meet the strategic, imperatives. If you do that, then you really have a story about what you've done. You know? And you can start to bucket your accomplishments in terms of, you know, what was your influence on the team within the team?
What kind of educational you know, are you the the the topic champ for the disease state? Are you the the, you know, the technology champ? You can start to see what your influence is within the team, and then you think about how are you influencing the organization, and and that's oftentimes by working with your KOLs to help influence the organization.
And so there's lots of different ways that a MSL can create that value story, and I think we need to be open to that, of of looking at it differently from just strictly numbers. That's great advice, Charlie. All about the value. Absolutely. Good stuff. Well, we're gonna leave it there. I appreciate you taking the time. As always, always love talking to you. Totally awesome information that I think a lot of people are gonna get a lot out of. It was a pleasure.
I really appreciated having the opportunity. And, you know, it's a it's a great role for many people, and I think it's ever evolving, which which keeps it fresh and new. You're the best, Charlie. Thanks again, my friend. Yep. Take care. Bye bye. See you. 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.