Hey, guys. Welcome to the podcast. My guests today are Leticia Price. She's a senior MSL with Gilead, and Dawn O'Reilly, she is a senior MSL with Daichi Sankyo. And we talk about the overlooked KOL, advanced practice providers. And it's an awesome conversation. I learned a lot. I thought this was a really interesting episode. So don't forget to follow me on LinkedIn and try to join us for MSL talk live, which is typically the 1st Tuesday of every month at 1:30 PM EST.
It does vary, so please check listings. We announce those on, LinkedIn on a regular basis. So I hope to see you there, and thank you as always for supporting this podcast. Welcome to MSL talk with Tom Caravella, a podcast specifically designed for MSLs and all things field medical. Hello, ladies. Welcome to the podcast. How are you doing? Good. How are you? I am awesome. I'm excited. So we have Leticia and Dawn are joining us today.
Guys, we are gonna talk about advanced practice providers, and it's a this is a great conversation, and so many people have actually asked me to do this over the course of, like, the past year. So I'm excited to talk to you guys about this, but I don't want it. We have a lot to talk about, so I don't wanna give anything away. So why don't we do quick introductions before we get started? So, Leticia, why don't you start? Because you're you're this is the first time you're on this show.
So why don't you go first? Yeah. Thanks, Tom. I'm so excited to be here. So I am Leticia Price. I, am a senior medical science liaison at Gilead Sciences. I've been in medical affairs pharma now for about 4 years. I'm a physician assistant by training. I have 13 years of oncology experience. I knew I wanted to transition into medical affairs. I didn't know about Tom. I wish I did. It took me forever to get in. I went back to school, got my doctorate in medical science.
I knew that made me more viable to be a MSL. And so now I've been an MSL for about 4 years. As I said, I'm with Gilead Sciences in Oncology, and I need to say, of course, that the opinions and views that I expressed today are are my own and not necessarily those of, Gilead's. And I cover Georgia and North Florida. I live in Atlanta, not really outside of Atlanta. No one lives in Atlanta. And so I'm just I'm happy to be here. Awesome. Alright. Well, welcome. And Dawn, you're back. Yeah. I'm back.
I'm really excited to be here. Thanks for having us back again. Yeah. So my name is Donna Riley. I am a medical science liaison, with Daiji Sankyo, the lung GI oncology team. I live in North Carolina. I've been at MSL for, three and a half years now in the oncology space, and prior to that, I practiced medicine as a PA for 10 years. And prior to that, I received a doctorate, PhD in molecular medicine doing research for about 10 years as well. So really excited to be here.
I also have to disclose that, you know, the the the views and opinions are expressed are my own, and they are not of, Daichi Sankyo during this podcast. So thank you. Awesome. Well, I'm excited. And before we get started, I have a question for everybody. Who is coming to Mass East this year? So, guys, we are really excited to announce this year's Medical Affairs Strategic Summit East, sponsored by Fierce Pharma, Fierce Life Sciences. It's a great event.
It's an opportunity to go to the ultimate event for medical affairs, medical communications, and field medical leaders. It's a great opportunity to connect with medical affairs leaders across pharma for 3 days, focused on learning and fun networking. So elevate your expert expertise at the FIERCE Medical Affairs Strategic Summit East this year. It's in Jersey City, New Jersey, and that's May 6th through 8th. So mark your calendars. Please try to get there. I go every year. It's awesome.
And listeners of the MSL Talk Podcast can save 25% on registration by using the code MSLTalk, no space, MSLTALK. You just have to visit www.medaffairssummit.com. That's m e d a f f a irssummut.com. So we'll see you in Jersey City. So ladies, let's get into this. Can you guys share, why is why did why are we talking about this? Like, why is this so important? Like, I know that this is such a big topic. We call this episode the overlooked KOL. So let's jump into it.
Yeah. So, Leticia and I were both PAs, and we were talking a while ago, actually, so we've been wanting to get this going for a little while now. And, you know, we think that definitely targeting, PAs and NPs are really important to focus on for the key opinion leaders. You know, when you're, planning your territory and, you know, the the teams that you routinely engage with, we definitely think we wanna, highlight these overlooked KOLs that we really don't really focus on as much as, the MDs.
Yeah. Right. Right on, Don. Don and I both being physician assistants, we know the importance of including, physician assistants and nurse practitioners in your territory planning. But for some MSLs, these may be exactly what we said, the overlooked KOL. Mhmm. So let's talk a little bit about this because I I I know me for 1, and I know so there's probably a lot of people listening to this would wanna know about the educational and training backgrounds of these APP.
So can you guys talk about that a little bit? Yeah. So, I just wanna highlight also that, you know, many of you out there may have heard different terms, for advanced providers. Maybe they've been called mid level providers in the past in your organization. Mostly now, they are called advanced providers, and then you also will have the nurse practitioner or FNP, some other degrees that may follow their name as well.
And one thing I wanna highlight is that recently, the AAPA has officially changed the name to a fish physician associate. You may have seen this on the news, but this term has not been fully adopted yet. The AAPA, has recommended for PAs to continue to use physician assistant or PA, for now as the official legal title. So education, that's one thing that you asked about, Tom. So education and training for PA specifically. Again, PAs are not assistants to the physicians.
Even though the title is physician assistant, we are not assistants to the physician. The profession started in 1967, and there's about a 160,000, PAs in the United States. PAs will have more than 500,000,000 interactions throughout the year. There are, 287 PA programs, and then, it's usually typically lasts between 27 months to 3 years long, and you receive a master's masters at the end of the education.
You do have to have a bachelor's degree prior to acceptance, and clinical hours usually around 2,000 prior to further during their clinical rotations that they do. We complete certification exams, every 10 years as well as maintaining the CME about a 100 CME hours every 2 years.
And I'm gonna look at these numbers here because, I wanna point out that according to the statistical profile, the PA profession has grew 28.3 percent between 2018 and 2022, which is huge, indicating how much we need, PAs to help serve the population of patients that we have. So that yeah. That's the education. I'll let Leticia talk a little bit about the nurse practitioner education. Yeah. Thanks, Don. And as we said before, I'm a PA. I'm not an NP, but I did fact check with the AANP.
And so there are several nurse designations, but I'm specifically going to talk about the nurse practitioners. Nurse practitioners are clinicians that have been around for more than, like, 5 decades. The first NP program was developed in 1965 at the University of Colorado, and then Boston College had one of the first masters or graduate nurse practitioner programs. And similar to PAs, nurse practitioners, they assess patients, order interpret tests, manage treatment plans, prescribe medications.
And nurse practitioners have more than 6 years of academic and clinical, experience. And so they start by getting their bachelor's in nursing degree, and then they have their registered nurse license, and then, they get their state licensure. And then they go on to get their graduate nursing education, and that's a master's of science in nursing. And those programs require, a minimum of a 1,000 supervised clinical hours.
Then they take the national board certification, and then they obtain their state licensure. And so MPs may also go on to get their DMP, which is a doctorate of nursing practice. But all MPs you know, there are several different pathways, but all MPs must complete a master's or doctoral degree program, so something that is beyond their clinical training for a registered nurse. And they're licensed in all states, all 50 states, the District of Columbia.
Since 2013, the number of MPs have doubled to almost 385,000 in the US, and most of them are practicing certified in primary care. And then also, they account for over 1,000,000,000 visits, patient visits a year. And about 96% of pace 96% of nurse practitioners are prescribing, and they prescribe on average if they're full time, maybe 21 prescriptions a day. And so as we said, the advanced practice provider, APP, is a term that's used, for NPs and PAs.
And there are differences in education, training, licensure, and physician oversight. However, both are used interchangeably in clinics, hospitals, and institutions. And with the it's hard for physicians to kinda maximize their time to see all their patients. And so APPs are like highly trained clinicians that help fill that void. And so you'll see the increased use of APPs now with this aging population or patients having cancer. And so APPs are definitely not substitutes for physicians.
They're actually an extension of the physician and the medical team. I'll tell you. I like, if we stop this whole conversation right now, I learned a lot. And, you know, I I'm not an expert at this. I thought I kinda knew a little more than I think I did, but, that was a really good download because I think there's a lot of people out there, including me, that really kinda thought that a physician assistant is is an assistant to the physician. Meaning, okay.
There's a there's a physician, there's a doctor, and then there's maybe an an old like, maybe there's patients that he's he or she just can't see. And and when that happens, then the efficient then the physician assistant steps in, or the nurse practitioner steps in and says, okay. Well, you know, doctor so and so, she's really busy right now, or he's really busy and, you know, so we're gonna send in the NP. We're gonna send in the the PA. So that's that's not it sounds like that's not the case.
So can you talk a little bit about the role? Like, how is the role carved out? Mhmm. Yeah. That that's great. I'm glad you said that. Some people, they really don't know. They think, like you said, they're just the assistant. And so APPs have a lot of capabilities. And so for me, I practiced an oncology for 13 years. The first 7 years at a community oncology center, then the the other 6 at a a large oncology institution.
And so fresh out of school, you know, everything that you do is within your physician scope, and it's really you're taught in the med school way as a PA, and then you have your on the job training. And so when I first got out of school, I would see the patients with a physician, or I'd go in and they'd see them right after me. But as I became more tenured, I'd have my own patients. I would have my own schedule. I would autonomously see the patient, order labs, order imaging.
I would prescribe chemo and any supportive medications for their adverse events like nausea, diarrhea, neutropenia. So I would manage those adverse events. I could, hold treatment, make dose adjustments. And if patients, if they progressed on their their cancer progressed, then or if they couldn't tolerate their treatment, then I can make treatment changes, according to the NCCN guidelines, the institution protocols, or or pathways.
But I would always collaborate with the physician, and they would always sign up on my, charts. I was a sub PI for, clinical trials. I also took call with the physicians. And in one institution, I worked with 3 physicians. So 3 different, 3 different treatment styles. And then in another one, I worked with 1 physician and only saw breast cancer patients. But I was the most tenured, so I saw the overflow for all of the oncologists. I also wrote, protocols for symptom management.
So those are some of the things that I did in my, what, my 28 hour day as a PA. Yeah. Yeah. Yeah. We we we we wish we had 28 hours to, to practice because, I mean, you know, I've had a few different roles as a PA, and my first role at a PA school was essentially, I was clinical research unit director of a clinical research unit that had we worked together with academic physicians on their clinical trials and provided them support for that.
And then I was actually recruited to go to lead a family medicine practice and cover this solo in my 2nd year of practice. So I was by myself out in the middle of nowhere practicing family medicine.
We started I started a new practice, through an organization here, saw patients, for two and a half years by myself before we brought another provider in, to support me because flu season about, killed me with the amount of patients that were coming in that that we needed to be seen and then the charting. So I stayed there for, a couple more years, and then I actually transitioned from family medicine into specialty where I went to cardiology.
And as a cardiology PA, I cover both inpatient and outpatient. So I would do inpatient rounds with the rounding team, working together with the attending physician. And then as a outpatient PA, I would see patients solo on my own. And that was my last role as a PA before transitioning, to medical affairs where I now do oncology, which I I really do love and have a passion for. I wanna point out also there's many, many roles as a PA that people can have.
You're gonna be in family medicine, urgent care, ER, practicing medicine, but you can also be involved in research as a PA. And then there's some, really exciting PAs and NPs that have really led the field. I wanna point out a couple people, and I have them listed here. Haley Arsenix is a PA, and she's the chief medical officer for the Space Mission 2021, which is really exciting. You may have seen that on the news.
Jackie Edwards, she was highlighted on the Today Today Show for PA week 1 week and gave a really good interview about, the PA week. Karen Boss, is a PA, and she's the mayor of LA, former member of the house of representatives. And, for nurse practitioners, Darcy Burbage is a DNP, and she spoke at ASCO, which is one of the largest oncology conferences that we have. And then Brian Lovejoy served during the, COVID 19 rapid response team.
So really, really important to note that, APPs, PAs, and NPs are are doing amazing things both in the medicine medical world and seeing patients as well as in the community out there. Okay. So I'm sold. Right? You had me at hello. Right? I'm in. I'm sold. I just to unpack the magnitude of the sheer volume of patients that are cared for, by APPs and the magnitude of, the weight, and I think the the heavy lifting that I'm hearing from all the numbers.
So I guess my question is, and I'm stumped, because why is why are they the overlooked KOL? Like, why aren't MSLs calling on APPs? It shouldn't that be a thing? So I'll let you guys take it from there, because I'm confused. I mean, that's the big question I ask with every position as an MSL I've been in. I'm like, why are we not targeting these APPs that are seeing the majority of the patients?
So our role as a MSL is to go out there and to gather insights from these key opinion leaders and these experts that are seeing the patients every single day that, you know, are seeing the patients on our trials, that are seeing the patients on a routine basis to give us their insights of what are they seeing with, you know, for me, for lung cancer, what's coming with lung cancer, what kind of drug side effects are they having. And for some reason, they are the overlooked KOLs.
Maybe I I don't I can't explain why, but I think that we need to focus on them more and more because I think they really are the ones that are gonna give us insight. You know, you know, as you know with, you know, the engagement plans that we have, when you go to conferences and things like that, like, these are the people that you definitely wanna meet with. Yeah. So I'll let Leticia talk about why we should consider them, as a key opinion leader specifically for the APPs.
Yeah. So we said everything that we've done as PAs, you you said the noted, the more notable PAs and nurse practitioners out there. And so physicians collaborate with their APPs in the care of their patients. Like, the a their APP is like their right hand. And so at times, APPs autonomously and independently see patients, prescribe, make treatment changes, manage manage adverse effects. APP serve as sub PIs on, clinical trials that their, docs are, the major PI.
They are coauthors to some of the research articles. So really, if that a if the ACP is considered a KOL, their a their APP should be considered a KOL because they know the treatment landscape, the prescribing protocols of the institution, they know that patient journey, and they can provide real world, feedback. And that APP usually does everything that the physician does.
A difference is that the APP may have more time to spend with the patient, so they can really give those details about from the patient perspective. And APPs, yeah, they're busy too, but they may be more accessible. And so if you're only seeing the physician or only trying to see the physician, you are really overlooking a key member of that medical team. Exactly. Thanks, Lakisha. Alright. So, I'm like, again, I I see the value here. I see what we're trying to do.
But let's talk to the MSL leaders right now that are making decisions. And let's just say, for argument's sake, they're like, okay. I'm on board too. So we're gonna make some changes, and we need to incorporate more, APPs as KOLs. So now what do they do to identify and now target the right APPs? And then how does the engagement plan change, if at all? Yeah. That's a really good question.
So, I'm sure many of you out there MSLs or aspiring MSLs, you can learn something from this, but we every year, we do territory planning. And, when you plan your territory, typically, what they're looking at is the MDs, the ones that are really active on, social media or digital media, you know, vocal, podium speaking, things like that, as well as their, you know, dropping a lot of the codes that indicate that they're seeing a lot of these kind of patients.
And so one way to identify the APPs is to look at those positions that are on your list and then see if they have APP with them. We have something called care teams, and so using your teams, like your commercial representatives and your administrative assistants and things like that, to ask, hey. When you go to these sites, is there a PA that or an NP that may be there that we can get connected with? Checking with the hospital company website.
So, you know, if you have a target site that you're looking at for a physician, is there an a PA or NP there that might be involved in that, field that you have an interest? Use utilizing also your other teams, like marketing, medical value liaisons, and then, you can also search the AAPA for your professional society or the nurse practitioner society as well to see if there's any, providers listed there.
The one thing I've learned too is, if you can't find a contact information for a PA, you can also look at the conference website. So, like, ASCO, for example, has a list of contacts, and that might have the email there that you can reach out to that, PA that way. And then, you know you know, engaging them, meaning, you know, approaching them and asking them, which most APPs may not even know what a MSL is, so you have to start off with, hey. I'm an MSL. I this is what I do. This is my role.
And then say you know, talk to them about, would you have any interest in sitting on an advisory board for us or any kind of interest in speaking, or any kind of interest in clinical trials with your team there? So and, yeah, really, really important to just when you plan out your territory to list out, you know, the the key opinion leader as a physician and then what kind of PAs could be involved in that in that group.
And I know, Leticia has a ultimate cheat code, which is gonna give you guys all the things you need to, to get out there. Yes. I'm gonna give you all the cheat code. Thank me later. So always inquire if the physician has an APP. Ask them outright, you know, ask the the admin, you know, just always inquire if they have an APP. Then invite that APP to that initial meeting with the physician.
And mind you, if you've met this, physician for the first time or it could be the 100th time you meet with them, inquire if they have an APP, then invite that APP to the meeting with them. 9 times out of 10, they may not be able to meet at the same time unless it's a morning, before clinic, after clinic, or or during lunch because somebody's gotta see the patients. So but still, you can invite them. Confirm their profession and title. Are they an NP? Are they a PA?
You don't wanna call them a PA if they're NP. And then are they the APP lead? Are they an APP manager? So confirm their title also. They confirm their collaborating physicians and therapeutic area. So they may have more than 1 physician. So really one app can give you insight to 3 physicians. As I said in one clinic, I work with 3. Another one, I work just about with everyone. And then also the therapeutic areas.
They may have a physician may just have one APP for the hematology patients, another for oncology, or maybe one just seeing cardiology. So the therapeutic area that they're covering.
And then as I said, initially, have a joint meeting with the physician if you can, and then meet with them alone because they may be managing adverse effects or doing things that the physician isn't doing, or maybe they have questions about maybe some off label practices, or maybe they need some data from you to present to their physician for a case to start a patient on a certain medication. And then engage with that APP just as you would engage with the physician.
You know, have your territory, your pre call planning. Know your goals of engagement. Is it to find out the patient journey, how they manage AEs? Is it to gather insights, to talk about research, maybe for advisory boards or for speaker programs? And then ask their interest. Maybe they're getting their doctorate and they they need some resources. Maybe they lead the journal club. So find out how you can be of benefit to them.
And last but most importantly, let that APP know that they are KOL and that their engagement and their insight is is very much valued. Mhmm. Awesome. Great. Awesome cheat code. I love it. I was gonna say, man, you know what? When there's cheat codes to be had, we get this like a rewind a rewind moment. Let me go back. I wanna make sure I get that cheat code. Awesome. So let me switch gears for a second because I I would I think I'd I'd have a lot of upset people if I didn't ask this question.
So there's probably a lot of PAs and NPs listening to this right now. Mhmm. And those PAs and NPs might be interested in transitioning to a career in industry as an MSL. You guys have both done that. Yeah. What's your advice to those people? Was it worth it? Is do would you encourage them to, and what advice would you give for them? So I'll start. So I think that they definitely need to do some think about it first because it is hard.
I will say it's hard to leave patient care if that's where your heart is, but I love my role as a MSL. I think, this is advice that someone gave me recently in medical affairs. He's been in forever. He said, you can continue to practice medicine and see the patients if that's what you wanna do, which is great. Keep doing it for sure. But in my role, I get to change the way these providers practice medicine and improve patient care.
It's indirectly versus directly, so it's something that you have to think about. My one advice is to network. I think networking is the number one thing that you can do, whether it be LinkedIn, informal, and I just did 1 2 days ago with somebody who reached out to me. She was a PA. She was like, I wanna get into medical affairs. Just network and follow Tom on his, podcast as well as his coaching, group that you guys have now that he developed recently with Sarah. So I think that looks amazing.
I've heard really good feedback on that as well. I'll let Leticia say what her advice is. Yeah. So definitely, following Tom. Like I said, he wasn't around or I didn't know about him. I think he I didn't know about him. So follow his podcast. There are, some aspiring MSL programs, especially, I know Tom has one. I also follow the MSL Society. Mhmm. They also are a great resource for aspiring MSLs. It's the best decision I I ever made. I loved being, a PA. I was I was good at it. I was great.
I love the patients. It was hard to make that break, but I love, now engaging with other clinicians, making sure that they have the scientific resources that they need to make the best decisions for their patients. You know, we're as everyone knows, we're not sales. You know, we're just there to provide them with the data that they need to make those best decisions. And a big thing is time management. You do have a lot more free time.
Like I said, it's not the 28 hour day, but time management, and and travel. You need to make sure that you you manage your your family and and the job, appropriately. And then also making sure that you are really into your research and it's very data driven. So I know that having a doctorate really was a a big part and a big help into getting the position as an MSL. Awesome. That's great advice, guys. Thank you for that.
And let's let's kinda finish this with there was so much really good information in here, so I kinda wanna do something a little different. And why don't we finish this by both of you just taking a minute to just share, like, key takeaways? Like, what message like, what do you wanna leave the listeners with if you had to just come up with a couple of key takeaways? So, Dawn, let's talk let's start with you, and then Leticia will go with you next.
But I just wanna see, like, what final message or advice do you have for people? Yeah. So thanks, Tom, for really having us on here. I am fully all the time promoting in my own company, that I'm part of now as MSL. Like, we have to reach out to these APPs. We have to reach out to them. They, know, the nurse practitioners and physician assistants, they are the ones that are seeing the patients. They are extremely valuable.
They can provide us with all the insights that we need, you know, for our trials, for, advancing medical progress like we're doing. So, yeah, that would be my one thing, and I'll let Leticia go. Yeah. I just wanna say that nurse practitioners and PAs are extremely valuable clinicians that can provide MSLs with an important and impactful insights. When you're doing your territory planning, make sure that alongside those KOLs that you have at least listed the APP that goes with them.
See if you can engage with them because they will really give you insight into the that institution's prescribing, their protocols, how they manage the patients. And so my one thing is definitely go out, figure out who those, KOLs who you may be overlooking. That's the nurse practitioner and the physician assistant. Well, I will say this. The overlooked KOL is no longer overlooked. Exactly. Bringing it right to the forefront. Well, thank you, guys. You were awesome.
I really appreciate both of you. This was an amazing podcast episode, and, yeah. And thank you guys for listening and for sharing the show. And for all of those that have been asking me to do this, I want you to make sure you share it with your friends. But, Dawn and Leticia, you guys are great. Thank you so much. Thank you. Thank you, Tom. Okay, guys. We'll see you next time. Thank you so much for listening to the show.
And if you enjoyed it, please subscribe so that you don't miss an episode in the future, and feel free to leave a rating or a review or a comment. Thanks again, and we look forward to seeing you soon.