The evolving role of MSL in startup environments
Working as a Medical Science Liaison (MSL) in a startup can be both exciting and, at times, a little undefined. There is enthusiasm, energy, speed, and a strong sense of purpose. Teams are small, decisions happen quickly or unexpectedly, and there is often more visibility into the broader strategy than in larger organizations. It can feel like you are part of building something from scratch or probably part of the future Nobel prize-winning team!
At the same time, roles are still taking shape, and you are clueless of what is going on. You may not have all the answers, but you learn very quickly how to find them.
This article explores the evolving role of the MSL in startup environments, highlighting common challenges, shifting responsibilities, and opportunities for greater alignment within medical affairs.
Wearing multiple hats: Does it really help?
In larger organizations, the MSL role is usually well structured. The job description clearly defines responsibilities, and there are established boundaries between medical affairs, clinical operations, clinical development, and other functions.
In startups, that structure is often still developing. MSLs may find themselves contributing to everything, from field medical engagement to internal scientific discussions, content review, and even strategic conversations across teams. While this can be exciting, it can also feel confusing and, at times, overwhelming.
It is not uncommon to pause and wonder: So, am I an MSL… a Medical Affairs manager… or unofficial support across functions? “
The honest answer is often: a bit of everything or we will soon find out.
This flexibility can be a strength. It allows for broader exposure and meaningful contributions. At the same time, it introduces ambiguity. Priorities shift quickly, and responsibilities expand without always being formally redefined. On some days, the role feels clearly aligned with field medical. On others, it feels like a blend of several functions, sometimes all within the same day.
Do startups really need an MSL?
In a resource-conscious environment, every role is closely evaluated. This naturally leads to a quiet but important question: Do startups really need an MSL? And are MSLs being utilized as intended?
The answer could be complex- The value is there; you just don’t always see it on a dashboard!
When external engagement is limited or internal alignment is still developing, the role can feel underutilized. There may be periods where it is not entirely clear how the MSL fits into immediate priorities. At the same time, the value of the role often becomes evident in more subtle ways through field insights, physician perspectives, and early feedback that may not surface through formal channels. The role is valuable, but only when it is clearly defined and supported.
Big vision, strong mission… slightly delayed paycheck due to funding cycles
Another aspect that sometimes comes up in startup environments is how the MSL role is perceived in relation to compensation.
MSLs are often hired for their scientific expertise, field experience, and ability to engage meaningfully with HCPs (healthcare professionals). However, when the role becomes less defined shifting between scientific exchange, internal coordination, and broader support functions can raise questions around how that expertise is being utilized.
Alignment could be bigger challenge than compensation. When the role is clearly structured and supported, the value of the MSL is evident. When expectations are less defined, it can create a disconnect between the intent of the role and how it is experienced day to day. In startup settings, where priorities evolve quickly, this alignment becomes especially important.
Everyone is aligned… just not always in the same direction yet.
In many startups, Medical Affairs operates as a combined group. Scientific communications, medical information, and field medical often sit within the same team. This can allow for faster decision-making and closer collaboration. However, it also requires strong alignment.
Even small differences in interpretation can become noticeable in the field especially when conversations move quickly and questions are specific.
The science is evolving and occasionally, so is the slide deck you saw last week.
Preclinical data introduces another layer of complexity. In many startups, early data is primarily presented by senior leadership, often in discussions with investors. These presentations are strategic and focused on future potential.
MSLs, however, engage with clinicians who are interested in scientific detail and clinical relevance. At the same time, there is understandable caution around sharing early data due to intellectual property considerations and evolving messaging.
As a result, MSLs may not always have access to the full dataset or a fully aligned narrative. In some situations, there is also a waiting period, data is still being analyzed, slides are being finalized, and messaging is still evolving.
From the field, this can feel like being ready for a conversation while still waiting for the complete story. Adding to this, the pace of change in a startup can be significant. A set of data may be shared internally, and within a short time, new ideas or updated priorities may emerge. At times, the focus of the pipeline can shift quickly, sometimes faster than external conversations can keep up.
For the MSL, this means staying flexible while also maintaining consistency in discussions with healthcare professionals. A physician may refer to a prior conversation, while internally, the direction may already be evolving. Navigating that transition requires both clarity and careful communication.
“Am I still doing field medical… or have I quietly become a project manager with a scientific background?”
In situations where access to data or clarity of messaging is limited, the MSL role can gradually shift. More time may be spent on coordinating internal discussions, following up on requests and connecting different teams. These activities are important, especially in a startup where collaboration is essential.
However, over time, the balance can move away from scientific exchange and toward more operational support. It is not always a formal transition, but it becomes noticeable. At some point, it becomes reasonable to reflect on whether the role is functioning strictly as field medical or as a broader Medical Affairs resource.
External Engagement: Where Clarity Meets ‘Let Me Get Back to You’
MSLs build relationships with healthcare professionals over time. These relationships are based on consistency, clarity, and trust. When conversations are supported by clear information and aligned messaging, engagement feels natural.
When information is still evolving or not fully accessible, interactions may require additional follow-up and careful explanation. Even small gaps in clarity can influence how conversations progress.
Trying to stand still on a moving treadmill.
The challenges described are not unique to any one organization. They reflect the demanding nature of startup environments, where growth often moves faster than structure.
In this setting, flexibility is essential but so is clarity. A few simple elements can make a meaningful difference:
- Defined expectations for the MSL role during the hiring process
- Clear guidance on what can be shared externally
- Alignment within Medical Affairs on messaging
- Opportunities for early involvement in scientific discussions
Make hay while the sun shines: if you don’t earn at least learn
Despite the uncertainty at times, working as an MSL in a startup offers something unique. There is an opportunity to contribute beyond defined roles, help shape processes, and gain a broader understanding of how Medical Affairs functions as a whole. The skills developed in this environment adaptability, cross-functional collaboration, and independent decision-making, are not easily gained elsewhere.
Conclusion-
The MSL role in a startup does not always fit into a fixed definition. At times, it may feel like a combination of field medical, medical affairs, and internal support. The boundaries may shift, and expectations may evolve.
Some days, you are in clinical ops mode.
Some days, you are talking science with KOLs.
Some days, you are the unofficial team therapist.
And some days… It’s all before lunch.
It may also involve saying, “Let me confirm that and get back to you,” more often than initially expected. At times, however, there may not be any new updates or clarifications to share when you circle back.
But when everything aligns, when information flows and conversations with physicians are supported by clarity, the role settles into what it is meant to be less confusion, less reactivity, and more meaning and purpose.
In a startup environment, the role may not always be perfectly defined but it is rarely without purpose.
About the author:
Mundayat Jyoti Raghavan, MD, MPH
Jyoti is a Medical Science Liaison and clinical research professional with expertise in Medical Affairs and Clinical Operations. She has worked across rare diseases, oncology, immunology, infectious diseases, urology, vaccine trials, and women’s health in both academic and industry settings. Mundayat holds an MD in Obstetrics and Gynecology from India, an MPH from Johns Hopkins Bloomberg School of Public Health, and an Executive Master’s in Emergency & Disaster Management from Georgetown University.
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