There is a seemingly vast chasm dividing the biotech/pharma industry from patients, health care providers, and healthcare administrators. Medical Science Liaisons exist specifically to bridge the divide and provide more clarity and unity among all stakeholders. When reflecting on the indispensable role of the medical affairs professional much of the focus is rightfully affixed to the myriad of hats that are worn, versatile skills, and the deep insights that MSLs provide. However, it is equally as important (though not quite as cheerful) to acknowledge boundaries, limitations, and the idea that sometimes it’s acceptable—and necessary—to say “no.”
In a recent issue of The MSL Journal, Dr. Samuel Dyer published insightful survey data exploring the demographic landscape of over 2,000 MSLs representing 67 countries1. One result that was especially intriguing was that almost half of the MSLs surveyed had two or fewer years of medical affairs experience. Further, a whopping 70% had four or fewer years of MSL experience. These remarkable stats illustrate two overarching themes. First, the MSL profession is rapidly growing. Secondly, a significant number of MSL positions are filled by bright, adaptable individuals who are newer to their roles and hungry to demonstrate value. MSLs, by definition, engage and collaborate with a spectrum of internal and external stakeholders so it can be very easy for an eager new MSL to be stretched too thin or inadvertently violate regulatory and compliance standards.
Learn Boundaries Immediately:
When you land your first MSL role, it’s unlikely that you will be excited to talk with your manager about the things that you should not do and the lines that should be drawn with stakeholders, but it is crucial to have this frank, carefully framed, conversation during your onboarding process.
In the absence of international, standardized MSL compliance guidelines2, the MSL Society has published comprehensive guidelines to ensure MSLs maximize value and minimize the chance of falling short of compliance standards.
New MSLs should consider using these guidelines as a foundation and cross reference them with company standards. Don’t be afraid to review these guidelines with your manager as it relates to your company’s existing policies regulating medical affairs roles and engagements. If recent data suggests that up to 70% of MSLs have less than four years of experience, one can infer that many MSL teams, in general, are relatively new and are actively shaping their internal policies. If possible, be proactive in framing your policy—that starts by discussing it with your manager and MSL peers.
Set Boundaries Immediately:
Many times, internal stakeholders simply do not know what “medical affairs” entails. Further, some may have never worked with MSL teams before. With that in mind, stakeholders are even less likely to know what boundaries may and should exist. One proactive step for a newer MSL is to set up quick introductory calls with individuals in pertinent company departments such as commercial, marketing, engineering, etc. Admittedly, this is an easier task when working for a smaller company but initiating an introduction and directly sharing your job expectations and performance metrics with internal stakeholders can eliminate some of the “mystery” surrounding the MSL role and can foster an avenue for future collaboration.
The relationship between commercial and medical affairs is the elephant in the room that draws the most attention from a compliance standpoint. Having honest one-to-one conversations with each commercial team member within your region is an effective way to build successful, open working relationships where boundaries and expectations are set immediately–aiming to minimize ambiguity.
Consistency among the commercial team is crucial as well, to ensure that you provide your value as completely and evenly as possible. If you give an inch, it’s human nature to take a mile– so be firm, but fair, with your time and availability– especially at the start. It can be very difficult to adjust an expectation once it is set even if it proves to be unreasonable.
Extensive travel, having flexible availability, and working odd hours to meet the needs of KOLs and HCPs are essential aspects of the MSL job. Regardless, colleagues involved with coordinating such engagements should be cognizant of your professional and personal limitations. As a driven (and relatively new) medical affairs professional, one can feel pressured and compelled to grant unreasonable requests or offer limitless availability. So, it is important to be reminded that it is okay to say “no”. To be effective and fully committed to your job, your mental health and sense of well-being must be a priority. Only you can say when going above and beyond has devolved into being logistically and practically impossible. When your endpoint is met—say it unequivocally—“no”.
One helpful way to make saying “no” easier and fairer to your colleagues is to suggest a tangible, time-conscious alternative:
“Sorry, I can’t get on a plane in 3 hours the night before Thanksgiving for an unconfirmed meeting with a KOL, but I can fly down these specific days in these specific weeks. In the meantime, I’d love to introduce myself to them via email or phone.”
Naturally, a firm and cold “no” will not garner favor among your colleagues and may instill some reluctance to engage with you and leverage your talents to meet company goals. Similarly, saying something like “let’s plan something over the next few weeks” or vaguely putting the onus back on your colleague to find an alternative solution is dismissive and can plant seeds of animosity.
A timely, realistic, and firm plan as a compromise can demonstrate your willingness to meet in the middle to achieve common goals.
Overall, the medical affairs and MSL profession has exploded in size and popularity because it is increasingly apparent how important ( and multi-faceted) the role is– spanning technical knowledge, clinical implementation, and sustainable business practices. Recent demographic data suggest MSLs are diverse, versatile, dynamic, and generally newer to their roles1 which inherently means they are especially eager to demonstrate value– and do so quickly.
To accomplish that, knowing what not to do and setting boundaries early will foster a foundation for growth in your medical affairs career. Know what boundaries exist for all MSLs and know what compliance standards are set in your own workplace. Even if a request is within your “scope of practice” as an MSL, if it is impractical, logistically unworkable, or possibly encroaching within the gray area of compliance: then feel confident to say no– without guilt. To soften the blow, make sure to build human connections with your colleagues so that they better understand your decision and proactively present a workable alternative so that they more readily respect your decision. As MSLs continue to demonstrate what they can do, let’s not forget to address what they should not do.
Dyer, Samuel. “Who Are Medical Science Liaisons and MSL Managers?” Medical Science Liaison Society Journal. March 2021
Medical Science Liaison Society. “Medical Science Liaison Guidelines.” December 20, 2018. https://members.themsls.org/global_engine/download.aspx?fileid=36881C94-B6B7-4357-B7E9-CE4F5BB5782B&ext=pdf
Dr. Brandon Bosque
Dr. Brandon Bosque is a graduate of the Temple University School of Podiatric Medicine in Philadelphia, PA and completed his residency training with emphasis in diabetic limb salvage and trauma. Recently, Dr. Bosque pivoted from clinical practice into research and medical affairs to focus on his passion of regenerative medicine and preventable amputations. Among his peer-reviewed publications, Dr. Bosque is most interested in wound healing real-world data and health economics & outcome-based research. Dr. Bosque lives in the Philadelphia suburbs with his wife, toddler-aged daughter, and dog.
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