Becoming a Medical Science Liaison: A Clinician's Guide of What to Expect (Part 3 of 3)

The first part of Dante Alighieri's?Divine Comedy?describes his journey through the Nine Circles of Hell. In each Circle, he meets progressively worse sinners. Dante finds liars, fraudsters, and falsifiers in the Eighth Circle. The Eighth Circle is next to the last Circle of Hell. It is safe to assume these are pretty bad people. These people sowed discord, misled, or committed fraud. Said differently, these are the people who misrepresent information to benefit themselves.?

We all know that you can encounter dishonest people from all walks of life and in any industry. However, watch any movie or TV show set against a corporate backdrop, and there is commonly a protagonist willing to lie, cheat, or steal their way to success. This character is not some stereotype fabricated by Hollywood. These people exist in the real world.

In Part 2 of this series, I highlighted some benefits of the clinician "pigeonhole." One of these benefits is some built-in job and salary protection. For example, if physicians have their bonus lowered for not prescribing enough generics, they cannot blame the nursing staff and have them punished. Another example is a pharmacy tech cannot become a pharmacist by getting another pharmacist fired. Without the appropriate education, training, and licenses, it is impossible to start in the mailroom and work your way up to Chief of the Medical Staff in a hospital.?

As clinicians, our training emphasized the great lengths we should take to document our patient care decisions in charts to "Cover Your Ass" (CYA) from litigation. You likely never considered the "CYA" efforts to protect your job and livelihood from co-workers. When you join pharma, you enter a corporate environment where the "pigeonhole" protections do not exist. If you spend enough years in pharma, you will likely encounter the stereotypical corporate protagonist that is out to win at all costs.?

To be clear, I'm not trying to plant the seeds of paranoia and say you should always be looking over your shoulder. The vast majority of people you will work with are trusting, believe in the same mission, and are not out to get your job. That does not mean you should not develop the skills and mindset to minimize your risk. Also, being in pharma gives you options to avoid these environments, which are not always available to you as a clinician.??

Step 1:?Develop a close relationship with your manager and keep them closely informed of your activities.

When I was a Clinical Director, I had several pharmacists that directly or indirectly reported to me. The last thing I needed to know was how many patients they saw and the details on their clinical recommendations. They were the experts. The clinical operating core of health systems functions because each profession has clear responsibilities. As a director, I recall only one instance when someone complained that a clinical pharmacist had overstepped their role. It took showing that physician his prescribing patterns and two pieces of primary literature for him to realize his practice had not been in the best interest of patient care. The pharmacist had been right in their recommendation. In pharma, the lines of responsibilities can sometimes seem gray, especially in cases where medical affairs and commercial collaborate on initiatives. While medical/commercial collaborations are possible, each team member must stay compliant. When involved in these collaborations, it is essential to keep your manager closely informed on all aspects of what you are doing. If you have a good manager, you can take comfort knowing that your proactive feedback may be more valuable than questionable feedback from others. You never want your manager blindsided by how you collaborate with others.??

Step 2:?Make some "best friends" at work.

Many of us prefer to draw very distinct lines between work and personal relationships. Having "best friends" at work can be one of the more challenging steps because it means opening up in ways that we may not want to at the workplace. However, a few trusting friends at work can help you learn the ins and outs of the political environment of your employer. They can give you insights into the motivations and personalities of other co-workers. They can provide insight into who you should never speak with one-on-one without witnesses. They can provide insight into when you should document certain communications through email or text. For your mental health, they can serve as a sounding board for expressing your emotions without repercussion. Until I worked in pharma, I'm not sure I ever worried about what I should or should not put in writing, who I should or should not talk to, and I certainly didn't worry too much about my job affecting my mental health. These are some of the realities of moving from a clinical position to a corporate setting. I've received two sound pieces of advice around these topics. First, if you are talking to a colleague and it doesn't "feel right," chances are it isn't right. Second, never risk your job for the sake of someone else's job. If someone ever asks you, "just do this for me," chances are they will throw you under the bus at the first chance they get.??

Step 3:?When all else fails, be prepared to change jobs.

Every company in every industry wants to believe they have a unique culture. If you are part of the clinical operating core in a healthcare provider organization, your job as a licensed clinician is a commodity. In my experience, after working with dozens of healthcare provider organizations over the years, cultures vary minimally from one to the next. When you transition to pharma, cultures between companies are often drastically different in ways you likely never knew possible. Some companies promote competitive environments that lead to internal conflicts and politics. Some promote a more collaborative environment, with little tolerance for personnel conflicts. There are big companies where you can show up, do your job, and live under the radar. There are small companies where everyone knows who you are. Making a job change is a very personal decision that requires careful consideration of many factors. However, if you find yourself in an environment where you lose trust in those you work with, leaving is often the only option. And, with all the different company cultures in pharma, it is possible to find a place to work where you can thrive and succeed without worry.

The views expressed in this article are those of the author and do not reflect the opinions of the author's current or previous employers.