Doctors in the House

"I really want to work in the pharmaceutical industry. I'm taking CME courses focused on clinical research and am getting involved in clinical trials whenever I can. But none of the companies that I apply to will even return my phone calls."

-45-year-old internist

"We have 13 unfilled positions for physicians and just can't seem to find any qualified candidates. The only prospects we meet are older doctors who are burned out and are trying to find any way they can to get out of practice."

-Pharma executive

A growing number of physicians are expressing interest in working in the pharmaceutical industry. Many are motivated by the desire to get as far away from managed clinical care as possible. Others want to broaden their sphere of influence in healthcare-to move from treating one patient at a time to helping an entire patient population. Still others are excited by the chance to participate in well funded cutting-edge innovation or are influenced by colleagues who have moved into pharmaceutical medicine and are vocal about their enhanced career satisfaction.

Despite all that interest, many pharma jobs for doctors remain unfilled. And turnover is unacceptably high because competitors go to great lengths to steal qualified physicians from each other whenever possible. Pharma companies say the reason for the shortage is that there are simply not enough qualified physicians-with three to five years of industry experience, plus the right academic pedigree and publication history-to go around.

Yet physicians seeking to enter the industry find themselves in the same catch 22 as young college graduates: How can they get a job that requires experience when no one will give them even an entry-level opportunity to accumulate the requisite industry skills? This article provides insight into the dilemma and the factors fueling it and offers pharma companies practical approaches for solving it.

The Doctor Dichotomy

Developing better relationships with physicians through improved recruiting and retaining practices will benefit pharma companies' competitive interests for the following reasons:

• Physicians control or influence more than $800 billion in annual healthcare expenditures. They are also the target audience for more than $5 billion in pharmaceutical advertising each year.

• Even the slightest competitive edge is crucial to being first to market with new products, and physicians know how to talk to, work with, and influence their peers-a notoriously challenging task for pharma companies.

• Physicians' knowledge of basic science and clinical medicine-representing, on average, a $500,000 investment in medical school and postgraduate training- is critical to the success of new pharma products.

As a group, doctors have certain traits that make them highly desirable employees: Typically, they are smart, possess valuable intellectual capital, work hard, are driven to succeed, and don't go home until the day's work is done. But some can be challenging to "manage." The stereotype of physicians as arrogant, egotistical, entitled, independent (not team players), and possessing an inflated sense of self-worth is legendary-and often true.

That profile was such a prominent and consistent theme in a recent series of MD IntelliNet interviews with pharmaceutical executives that researchers coined the term "cultural impairment syndrome." Many employers believe the syndrome is so deeply rooted that physicians can never successfully adapt to new roles and work environments.

But stereotypes seldom change as fast as the group they apply to, and the research suggests that is the case here. More than 60 percent of the 3,300 physicians profiled say they would be interested in working for three to six months for little or no pay in an apprenticeship as a way to learn more about a new industry and to assess potential career growth opportunities. Unfortunately, they are unable to find such training opportunities.

Research also suggests that by carefully selecting physicians and providing them with the right orientation and training, pharma employers will find that the vast majority of MD professionals can learn to modify their work styles to succeed in a nonclinical work culture.

Steep Learning Curve

Corporate recruiters and human resource directors agree that when any new employee is hired, 20 percent of the likelihood of her or his success in the new job relates to technical skills. The other 80 percent depends on how well the individual's behavior fits with the organization's culture. Most doctors find themselves on a steep learning curve in both the technical and cultural arenas for the first two years of their transition into pharmaceutical medicine.

It's a flaw in the training of US physicians. Those students are not required to study pharma sciences during medical school and internships. Few, if any, doctors entering the industry have had standardized training for their new careers. Consequently, it is difficult for pharma employers to know precisely what technical competencies entering physicians have at the time of hire.

Physicians coming into the industry must learn or enhance their existing knowledge about a range of technical skills relating to drug development; drug safety; and clinical trial design, documentation, and monitoring. Some continuing education courses provide such training, but not knowing which competencies they need to develop, most physicians tend to select programs haphazardly.

They must also learn how the industry works. Many executives and recruiters say that technical training alone isn't enough, that actual hands-on experience is necessary for even entry-level hires. That presents an essentially insurmountable barrier to improving the current physician shortage, because industry internship or apprenticeship opportunities are rare.

Although doctors spend much of their first two years acquiring technical and industry-specific knowledge, most new hires also spend a significant amount of time figuring out how to function effectively in a corporate environment, a dramatic cultural change from their former practice or academic research setting. Moreover, pharma companies often expect physicians' age and experience to qualify them to be managers. Yet many doctors have never had significant personnel management responsibility.

Physicians new to the industry frequently describe their entry experience as being "thrown to the wolves." Many admit to a sense of floundering and frustration as they try to figure out what competencies they need and how to obtain them in the absence of any structured learning curriculum, clearly defined development objectives, or practical feedback from supervisors and mentors.

Strategic Solutions

There are several practical steps the pharmaceutical industry can, and should, take to maximize its return on investment in physician employees.

Preparatory training. Physicians and pharma companies alike would benefit greatly from a "development pipeline." That pipeline should consist of a standardized training curriculum with both didactic and experiential learning that would prepare doctors for a certifying examination.

The majority of the nearly 1,000 physicians who work in the UK pharma industry have been trained in that model through the British Association of Pharmaceutical Physicians and have received a diploma from the Faculty of Pharmaceutical Medicine. The International Federation of Associations of Pharmaceutical Physicians (IFAPP) advocates such standardized training and certification on a global basis. The "faculty" is also working to develop a specialty certification process for pharmaceutical medicine similar to that of other medical specialties.

Similarly, the American Academy of Pharmaceutical Physicians (AAPP), a member of IFAPP, strongly advocates the standardization of training in the United States and the development of a specialty certification process for pharmaceutical medicine.

Formalized training for that specialty will establish a more robust pool of qualified candidates, and the physicians' competencies would be clearly known to those who hire them. As a side benefit, that standardization is also likely to help reduce press and public skepticism of the industry's clinical research efforts.

The seeds of that pipeline have already been planted. Pharma companies can now direct grant money to the AAPP Education Foundation, a 501(c)(3) tax-exempt charity, to support and develop its recently established Pharmaceutical Medicine Fellowship program.

Marketing. During the past decade, the number of physician trainees pursuing clinical research careers declined significantly. Between 1994 and 1997, first-time physician applicants for National Institutes of Health (NIH) research grants dropped 31 percent. From 1992 to 1997, physician postdoctoral trainees supported by NIH through individual fellowships and training grants plummeted 51 percent.

Several factors contributed to the trend, including income disparities between specialist clinicians and researchers, rising medical student debt, difficulties obtaining grant funding for patient-oriented research, and the pressures on academic faculty to see more patients and generate more revenue, leaving less time for research.

Perhaps more important is the fact that few medical students or residents are guided toward, or even consider, pharmaceutical medicine as a professional pathway. For the most part, they don't know any physicians who work in the industry or have any role models who have pursued such a career.

To address the problem, pharma companies need to establish an aggressive direct-to-students, -residents, and -faculty marketing campaign that highlights industry career options. Ideally, the target audience would be provided with general information about the various roles physicians play in the industry, specific information about how to prepare for those roles, and opportunities to meet physicians who have successfully transitioned into them. Such a campaign would be well received and would probably attract some of the best and brightest scientists from top medical training institutions. Currently, the only contact that most medical students and residents have with pharma is when a sales rep brings pizza into the hospital at lunch time; the exhausted, famished trainees sit through a product pitch just so they don't feel guilty when they grab a slice or two.

Selection. Most companies still believe that physicians are moving into the industry simply to exit clinical practice. Although that is true in some cases, making that assumption can limit the candidate pool. Even mid-career physicians can be highly motivated and committed to pursuing pharmaceutical medicine for the "right" reasons.

Providing interested physicians with a clearly defined transition pathway allows them to both prepare for their new career and demonstrate their commitment to it. Mid-career physicians who demonstrate a willingness to retrain and move to the bottom of the corporate ladder are clearly not burdened with "cultural impairment syndrome."

Pharma companies would be wise to use a proven approach to selection: Develop a success profile of doctors in their employee and use it as a guide when assessing new candidates. An effective success profile will not only assess why a candidate is motivated to move into pharmaceutical medicine but will also identify the characteristics that correspond to a likely behavioral and cultural fit with the company.

Pharma companies may also want to consider establishing several entry pathways for potential physician employees. By creating low-grade physician trainee positions that lie somewhere between internships and traditional employment, executives will have the opportunity to directly assess the individual's ability to adapt, learn, and fit into the corporate culture. Those who excel can be confidently hired into traditional roles and will have a jump start on the learning curve.

Integration. Although in-house training is standard for most other pharma employees, it is relatively rare for physicians. Some hiring managers assume that physicians are already so well schooled that they need no further training. Unfortunately, some physicians make that assumption as well. Yet, in-house training in some unfamiliar areas can be very valuable in successfully integrating staff doctors into the new corporate environment and their new roles.

Some companies offer courses focused on business, financial, and interpersonal skills, as well as diversity training and team building to other employees but not to physicians. Interpersonal skills training, for instance, can teach physicians useful alternatives to their traditional habit of giving orders in patient-care settings.

An effective selection strategy is the first step toward the successful integration of new physician hires. In addition, companies could make integration even easier by providing training not only to the new physicians but also to the key employees who will regularly interact with them. Understanding is a two-way street, and such training on the company's side helps alleviate the professional jealousies, antagonisms, and biases that doctors report are sometimes palpable enough to cause them to leave the company.

Career Development

Doctors are highly achievement oriented and eager to master the requisite success skills. But like other employees, they need clearly defined learning and performance objectives, access to training opportunities, and structured performance feedback at regular intervals.

Opportunities for learning include in-house or outsourced training, focused reading materials, online forums, executive coaching, and mentoring. Companies should structure the learning framework according to individual career stages and areas of performance mastery. Target competency areas should extend beyond the technical and regulatory to include management.

Some physicians, no matter how bright, well trained, or seasoned, are simply not suited for management careers. Nor would they choose to become managers if any other promotion tracks were available to them. But because they can see no other way to advance in their organizations, they often accept roles for which they are ill suited. Ideally, all pharma doctors should be assessed for management abilities and interest, then tracked accordingly. Those identified as well suited for management should receive additional training to help them successfully move into those roles.

Every physician needs a personalized career development path. To address that need, some organizations have developed alternative career development tracks for experienced doctor-scientists, allowing for incremental promotions outside of management but at parallel levels.

Another approach is to design management roles so they are shared by a team: One person-often a nonphysician-manages administrative and personnel issues, and the other-typically the physician-focuses on the technical ones. Burroughs Wellcome used that technique during the development of Zovirax (acyclovir). Given that the program resulted in expeditious FDA approval and 17 years of unopposed patent life, the company and the individuals involved view it as an extremely successful approach.

Talent Turnover

Retention of a company's best and brightest physicians is notoriously challenging. Although research indicates that industry physicians turn over, on average, every four years, the doctors interviewed by MD IntelliNet report that within a month of assuming their first industry position, they begin receiving calls from recruiters seeking to entice them to join another company.

The cost of that turnover, including replacement, training, vacancy, and sometimes severance pay, is estimated to be one-and-a-half times the position's average salary of $262,000. It is difficult, however, to capture the full costs of lost productivity when considering that each week that a patented major drug is delayed results in $11 million in lost revenue.

Many industry executives simply shrug and accept physician turnover as inevitable because of their belief that everyone can be bought for a price. But there are plenty of countervailing incentives that can help retain valued and talented physician employees.

First, companies can optimize the recruitment process. If the fit between the individual and the employer is solid, the employee is unlikely to jump ship the first time a recruiter calls. Assessing the fit early in the recruitment process-by using a well conceived and developed success profile-must go beyond evaluating credentials and technical skills to include the behavioral and cultural elements of the match.

Second, human resource managers can conduct exit interviews with all physicians who leave to join a competitor. It's important to not make the mistake of believing that such defections are only about money. People have good reasons to leave that transcend salary. Getting their feedback is a smart offensive tactic for developing and improving retention strategies.

Third, companies must recognize that physicians-like other high-level professionals-greatly value ongoing learning and development. One reason they leave clinical medicine to join the pharmaceutical industry is their belief that doing so will provide more opportunities for career growth. Therefore, the pharma employer that supports and values career development for its staff doctors will reap the benefit of reduced turnover.

Long-Term Benefits

Physicians are a unique form of human capital, and, as competition intensifies and time-to-market becomes more critical, they will become an increasingly pivotal element in the drug development race. Selecting the right candidates for employment, carefully integrating them into a company's fabric, and facilitating their career development are well worth the investment in their intellectual capital. Companies that do it well are likely to engender both loyalty and high performance.

In addition, the world of physicians is small. Satisfied employees are known to seed powerful viral marketing campaigns among peers, resulting in great-er recruitment success and reduced recruitment costs. Pharma companies that recognize and address the special needs and opportunities associated with this unique employee group will enhance their competitive position in the global marketplace well into the future. z

For their generous efforts in reviewing the manuscript, the author would like to thank Ira Isaacson, MD, MBA, director of Life Sciences Practice for Spencer Stuart; Ronald Keeney, MD, executive vice-president and chief medical officer for MoliChem Medicines; and Professor Peter Stonier, president, Faculty of Pharmaceutical Medicine RCPs, UK.