How to cite:
Smith, E (2021), ‘Out of the MDT and into the CVT: 5 things I wish I knew when moving into Pharmaceutical Medicine’, Faculty of Pharmaceutical Medicine blog, 30 September 2021. Available at: https://www.fpm.org.uk/blog/out-of-the-mdt-and-into-the-cvt-5-things-i-wish-i-knew-when-moving-into-pharmaceutical-medicine/ (Accessed: <date>).
*MDT, multidisciplinary team
**CVT, core value team
A personal reflection by Dr Emma Smith
It’s safe to say my move into the pharmaceutical industry was a leap of faith. I first discovered there were roles for doctors in the sector only four months before I set aside my stethoscope and picked up my ABPI code of practice.
I came across an exciting opportunity for a clinician early in their career to embark on a development program in Oncology Medical Affairs within a large company. Dissimilar to some of my more measured, head-over-heart decisions, I made the choice to move with no specialty training under my belt and only two-and-a-half years of clinical experience. Despite this and against the startled advice of some of my friends and family, I dove in headfirst, and I can say with complete honesty that it was the best decision I have made.
That said, my experience in industry over the last few years, which has taken me from a UK to a European role, has not been without its fair share of lumps, bumps, and hurdles. Some were down to my own ignorance and lack of research and some were due to having a distinct lack of commercial nous. But at the time, I felt like there was nobody who had taken the decision to move out of clinical medicine after “all those years of study”, who could give me some hints and tips to keep me on the straight and narrow. Therefore, after 3.5 years working in the dynamic, fast-paced, competitive world of pharmaceutical medicine, I thought I would share my “five top tips” for anyone joining or considering joining the industry; or as a trip down memory lane for those experienced pharmaceutical stalwarts:
1. Just because you are not laying your hands on patients, does not mean you are outside of the remit of the GMC
I learned this the hard way when I started. I made the mistake of assuming (to assume is to make…you know the saying) that I didn’t need to tell anyone about it, because I was free of “clinical” medicine. I was so delighted by my foray into pastures new that I failed to do some basic research on what was expected of me and there really isn’t that much guidance around, anyway.
- You must tell the GMC what you are doing. You cannot just wander like a lone wolf through the forest of industry answering to no one (despite what you might hope): you need a recognised designated body (if you want to revalidate) and I would recommend speaking with the Faculty of Pharmaceutical Medicine (FPM), however it can be someone else. The GMC website has a tool to help you find a suitable designated body: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/my-db-tool
- Importantly, just because you are not providing day-to-day patient care does not mean you are not ‘practising medicine’ and subject to GMC requirement – there is specific wording around what this constitutes.
- Additionally, if you have no GP or specialty training status and are new to the register (like me) you will need to work under something called Approved Practice Settings for your first revalidation cycle, and you are assigned a supervisor to check on how you are doing. Here is a link to a page on the GMC website on Approved Practice Settings: https://www.gmc-uk.org/registration-and-licensing/the-medical-register/a-guide-to-the-medical-register/approved-practice-settings
- It is against GMC guidance to work without a designated body/APS status – it nearly landed me in trouble!
2. If you want to do PMST (Pharmaceutical Medicine Specialty Training) then you need at least four years of clinical experience.…but it’s not been the ‘be all and end all’ from my perspective
To be fair, I did know this information when I joined industry, but felt it was worth discussing, especially as we all know how much medics love a few letters after our name. I did ask FPM if I could do PMST with my humble 2.5 years, but I was told it was not feasible, as this is GMC-mandated, and I moved on. If you find yourself in a situation with less than four years under your belt, please don’t be put off – there are still plenty of options.
If you do find yourself in this position, one thing I would wholeheartedly recommend doing is the Post-Graduate Course in Pharmaceutical Medicine (PGPCM) and then take the FPM Diploma in Pharmaceutical Medicine (DPM) exam. The PGCPM is a fantastic, immeasurably useful course on the whole spectrum of pharmaceutical medicine (particularly if you have been enjoying the warm comforts of medical affairs for the past few years) and learning materials that I genuinely reference and use day-to-day. I did the ‘Cardiff course’ run by the British Association of Pharmaceutical Physicians (BrAPP) and would highly recommend it, but there are other courses out there too. Oh, and passing the DPM exam satisfies that ever present hunger for letters after your name – you get three!
Whilst getting your PMST and being accepted onto the GMC Specialist Register is undoubtedly a totemic achievement, gaining breadth and depth of experience that can help you progress incredibly far in the industry. The specialty training badge isn’t required for all doctors working in our discipline, which is a big difference from the clinical world. Therefore, don’t be put off if you can’t meet the four-year figure, but think about how you could reach this before entering the industry.
3. Decide what kind of industry medic you want to be
When I joined industry, one of things that surprised me was learning how to redefine what I perceived to be adding ‘value’ at work. In many ways, clinical medicine is black and white: you either know how to spot an NSTEMI on an ECG or you don’t, you know how treat DKA or you don’t, you are an F1, registrar or consultant and most hospitals have predefined treatment protocols for specific conditions or emergencies. Things (mostly) fit into discrete boxes and you work your way through this neat structure at predefined intervals. It’s really what you know, and your ability to withstand endless examinations and sleep deprivation, rather than how you show up, how you integrate into your team and how you develop yourself. There is also a certain level of recognition and status achieved from simply being a doctor and all the work that went into it.
Pharmaceutical medicine, on the other hand, functions a lot of the time in the grey area. No team structure is the same, no disease area is the same and depending on the size of the company or the lifecycle of the product, you will be doing things for the first time and be expected to come up with ideas, be creative and “muck-in”.
You will be a thrust into teams with highly diverse, educated people with PhDs, MBAs, and years of experience from all walks of life that simply don’t quite care that you spent the last three years answering bleeps at 3am with only a stale digestive thrown your way the whole night shift. This isn’t to say they don’t see the value you add. Quite the opposite. It’s just that the “status” of being a medic at a specific and titled level doesn’t quite carry the same way it does in the clinical setting. Medicine is a hierarchical structure and so it should be, pharma is usually a “matrix environment” where everyone is equal and bringing something different to the table. You might find yourself being the least experienced member of the team and you won’t always have the last word or be the final decision maker. You meet all sorts of people that you learn from, who challenge you and can change your perspective. How you work with those team members, the kind of relationships you build and how you decide to add value to your team, based on the experiences you have is key. Decide how you want to show up in any team and where you fit, leave the certificates at home (hung up in a reasonably visible place where you can sit and admire your hard work from time to time, I wouldn’t deny anyone that luxury).
4. Learn to love networking
It will feel awful at first – soul destroying cringeworthy, but it’s worth it, and quite honestly vital if you want to get ahead in your career. It will feel frustrating; you have worked tirelessly to get to where you are through hours of revision and painstakingly listening to the tortuous clinical histories of 80-year-old diabetics with infected foot ulcers. You have got to where you are with tenacity, a strong stomach, and a lot of highly caffeinated drinks you’ve advised your patients not to drink…so why should you need to network?
Everyone should know who you are and revere you! Again, unfortunately this doesn’t count so much (see point 3) and you really have to put the leg work in to get yourself known and heard.
Sometimes it really is not what you know but who you know and (again, see point 3) how you conduct and handle yourself with colleagues, rather than what you contribute that sticks. This doesn’t have to mean awkward schmoozing over cheap wine and nibbles introducing yourself with three interesting facts Bridget Jones style (unless that’s your thing). In fact, the post-pandemic remote working world that will surely persist to some extent might be a godsend to us (stereotype-alert) introverted medics: put some 1:1 zoom time in the diary with someone outside your team who you respect and want to get to know, or who has a role you might want in the future. Or, put your hand up for a “company-wide” project and events like an annual company conference or community outreach, these will allow you to interact with people you wouldn’t normally work with. You could also seek membership of a committee or working group outside your workplace to get to know new people. Joining the FPM EDI Forum has given me the chance to get to know (and exchange war stories with!) other pharmaceutical physicians working in diverse roles.
Top tip: Humans are pre-conditioned to respond when asked for help, so don’t feel scared about asking for help and guidance, particularly informally over a cup of coffee.
Ask lots of questions, understand how they navigated their careers, ask their top tips for someone in your shoes. It gets easier the more you do it and you might find you enjoy it. Either way, smile, act confident and do it anyway; it will pay off.
5. Appreciate the balance between working as a doctor and working for a business
I chose this last one as it has been one of the hardest things for me to learn and accept. Although there are lots of challenging aspects to working as a hospital doctor, prioritising your work is actually one of the easiest. Acting in the best interests of the patient is the overriding principle that governs our decision-making: it helps us understand what conditions we need to rule out urgently, what diagnostic imaging we need and which medication a patient should or should not receive. In addition, the process of studying medicine, adhering to the Hippocratic oath, and having the privilege of diagnosing and treating sick patients is a defining, formative experience for most medics.
No matter how long I work in industry and how short my clinical training was by comparison, I will first and foremost be a doctor, and Medical Advisor (or any other such title), second.
I try to hold this at the forefront of my work each day. Sometimes it is difficult, and you can feel very far away from patients, or hard to see that you are making any tangible impact. It can be hard to take when you are working on a project that you know will have a substantial impact on patients’ lives and it is suddenly pulled for ‘commercial’ reasons. It can be brutal and unfair, and you might risk becoming cynical. Don’t. You have just as much privilege to be working in an environment that can truly help patients – in a different way to what you might be used to, but still in a hugely valuable way. You can influence more than one life at a time whereas in clinical medicine it is the patient in front of you that is your focus. Try not to lose this perspective and keep fighting the good fight with your patients in mind. The work that you do and the progress that will be made in your field will be all the better for it.
Now to my last word. Despite some of the challenges I have faced joining the pharmaceutical industry, I really have learned more about myself, my values, and my potential in the last few years than I have throughout the whole of my 20s, slogging away at two degrees and running around the wards like a headless chicken.
I would recommend the industry to anyone with a passion to affect change on a large scale, who has a curiosity to develop themselves and those around them and wants something a bit different from their medical career. I hope my insights can help you navigate some of the uncertainty along the way.
If I’m the person you feel you’d like to ask more questions of over a cup of coffee or a zoom chat, you can get hold of me by e-mailing firstname.lastname@example.org