Interview with Dr. Linda Ho
In today's episode, Dr. Linda Ho returns to the podcast to discuss working in pharma in clinical development. And she explains how she moved into this role after starting as a medical science liaison.
During our interview in September 2018, Dr. Ho described her shift from clinical medicine to work as a Medical Science Liaison. In today's interview, she stands out as the first physician on the podcast to describe her transition from Medical Affairs to Research and Development.
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Exploring Clinical Development
Dr. Ho describes her professional journey, transitioning from MSL to a position in clinical development (CD). With enthusiasm, she explains these two areas within the pharmaceutical industry.
Drawing from her own experiences, Dr. Ho highlights transitioning to CD:
- She began learning about clinical trials at her company, even as she worked as an MSL.
- Networking is crucial, including making connections with local MSLs and sales representatives to find out about opportunities and express interest in transitioning.
- Joining a contract research organization (CRO) as a starting point to enter the pharmaceutical industry can be an option, but it may not guarantee a direct path into clinical development.
- Physician Development Programs offered by big pharmaceutical companies are an excellent way for young physicians to enter the industry. These programs provide rotational experiences in various departments, allowing physicians to explore different functions and decide on their preferred career paths. These programs are also known as Physician Fellowships, Physician Leadership Development Programs, or Pharmaceutical Leadership Development Programs.
Transitioning in the Pharmaceutical Industry
For an MD, it's a natural transition to do something that is more MD related. I use my medical background every day, assisting physicians with managing adverse events and providing insight into patient cases. While the ultimate management is up to the Principal Investigator, I can advise them on available resources and discuss the case given my knowledge about the drug and the program.
She also highlights the importance of networking and showcasing experience in team management during job interviews. Having experience in managing timelines and resolving conflicts within a team, even if it's not an official managerial position, can be highly valuable.
Summary
Dr. Linda Ho's remarkable career journey exemplifies the possibilities and opportunities that exist within the medical field. Her successful transition from Medical Affairs to Research and Development serves as an inspiration to aspiring professionals seeking growth and fulfillment.
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- How to Optimize Your Career as an MSL with Dr. Linda Ho – 051
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Transcription PNC Podcast Episode 308
Making Your Way to a Rewarding Career in Clinical Development
- Interview with Dr. Linda Ho.
John: Today's guest, in my opinion, has gone through at least two major career transitions. The first was when she went from clinical work to being an MSL in pharma. But I saw recently that she is now working in clinical development, which is to me a big switch from the MSL work. So, with that, I want to welcome Dr. Linda Ho back to the show. Hi, Linda.
Dr. Linda Ho: Hello. Hi.
John: It's good to have you back. I can't believe it. I was looking at the dates and it's been really like five years since we spoke. I always refer to your episode quite a bit because it's really a good one for people getting an introduction and thinking about moving into an MSL role because you had a lot of great advice back then.
Dr. Linda Ho: Thanks. Yeah, that was super fun. I think that was sort of at the end of my MSL gig, moving on to clinical development.
John: All right. Yeah, I think it was. And so I really am interested in hearing about what's been going on since then, but maybe you want to give us a short thumbnail, kind of explanation of why you switched from clinical to nonclinical. Just briefly, because I can refer people back to the old podcast. And then what attracted you to move from the MSL role to the clinical development role?
Dr. Linda Ho: Geez. I was working at a vein clinic for a while. I'm a pathologist by trade, but I never loved pathology. And I worked at a vein clinic for a while, and then one of my patients while I was at the clinic said that, "Oh, you would make a great MSL." And I was like, "Why? I don't, I don't know what that is." And she explained that she was a sales rep for a pharma company and explained to me what an MSL was. And I was already at that time thinking of a career transition. So, it seemed like a perfect fit.
It did take me a while to find an opening that would take a chance on someone who wasn't already an MSL. I think that a lot of people probably find that challenge when they're looking to transition. But eventually I did, and I was an MSL I think for five, six years maybe, at a few different companies. And then in the fall or late summer of 2018, I moved into clinical development.
I developed an interest in clinical trials, while I was an MSL. And also the travel of an MSL really started to wear me down. At first it was super fun. I loved racking up the miles. I loved flying here and there, but the amount of time spent in an airport was really starting to wear on me. So, that was one of the main reasons for looking for a new role.
John: That makes a lot of sense. And we talked about that last time, and that is one of the things that comes up quite a bit. And depending on the size of your territory, and I remember you had maybe at least at one point a pretty large territory.
Dr. Linda Ho: Yeah.
John: Now that was pre pandemic.
Dr. Linda Ho: Yes.
John: I'm kind of hearing now that post pandemic with everyone trying to be as remote as possible, that some of the MSLs are actually doing more of their work remotely than they were before. But that wasn't going to help you out.
Dr. Linda Ho: Yes, correct. That was a few years too late for me.
John: Yeah. Yeah. Now, what was interesting about clinical development and what does clinical development mean? I hear terms like clinical research, I hear primary investigators. I hear different things thrown out. And so, would it be right to say just clinical development means working on new drugs or new medical devices if it happens to be in the medical device company? What does that mean exactly?
Dr. Linda Ho: Clinical development falls under the research and development umbrella, the R&D umbrella. And it's really the department that generates trial data. Whether it's phase 1, 2, 3, or preclinical data, that generally falls under the clinical development umbrella.
Now, we work very, very closely with our colleagues in clinical operations, which is different. And the subtlety of that is clinical operations, they work on trials as well. However, they're generally not as involved in the data generation or clinical trial design or strategy behind it. They execute the clinical trial strategy that development creates. They have not just in-house staff, but also field staff that go to the sites where we're conducting the trials. And they go through the data and make connections with people at the site level, make sure that the data is looking good on that end.
So, it's a distinction. It's a fine distinction, but it is there nonetheless. And it can be very confusing like what's the difference between development and operations? What are these two different terms? So, hopefully that clears that up.
John: Yeah, that helps. The other thing that I think not all companies necessarily use all the same terms too, that we see from company to company, it seems like they have sometimes slightly different terminology.
Dr. Linda Ho: Yes.
John: And I spoke to someone recently who is working as a principal investigator, but she's working as I guess I could say a PI. But I think from talking to her, she's actually working for a CRO or a third party, and she's responsible for one site where the research is done. But I'm assuming in a pharmaceutical company in the R&D area, where they have a study, it could involve dozens if not hundreds of locations. And that's kind of a different level.
Dr. Linda Ho: A principal investigator to my understanding are generally the investigators at specific sites. So, for example, if we have a site, I don't know, I was just going to make up one, say University of Illinois. The physician who is at that site is the primary investigator. And you have different sites with different primary investigators, PIs, we call them. And they are responsible for ensuring the safety of the patient, appropriate management of the patient, appropriate reporting of that patient's data, managing any adverse events, that kind of thing.
John: All right. And so, in that situation, would that be considered the part of clinical operations in most companies or part of research and development?
Dr. Linda Ho: They are not hired by the company. They are a physician at that particular hospital or institution. So, doctor so-and-so who is going to be named in the study as an author, that is our principal investigator at that particular site.
John: Got it. Okay. Yeah. So you can understand why someone who's never been involved working around pharma can get super confused. So tell me a little bit more about what interested you instead of maybe going into something that was in clinical operations or medical affairs, which like I said, I kind of get the idea that most MSLs are in the medical affairs division. What was it about the clinical development that really appealed the most to you?
Dr. Linda Ho: I think you're right that most MSLs move up into either an MSL manager role where they're in the field and they're managing other MSLs in the field, or they move into a medical affairs role. Now, medical affairs is responsible for the strategy and the management of the asset or drug as a whole, as opposed to clinical development, which manages the data and the trial subjects.
Now, I did not have a lot of exposure to clinical development as an MSL. I sort of had to seek that out on my own. But I became interested when I was in my last MSL role because I took it upon myself basically to provide a tool for the MSL team to use in the field collating all of the studies that were being conducted with the asset that we had at the time.
The team was new, the department was new, so that kind of tool did not exist. But it was super helpful to have, because investigators will ask you, or KOLs will ask you, "Well, what trials do you have going on in this area? Well, what studies do you have that are looking for subjects?" These are very basic questions that an MSL gets. And it's hard to be like, "Well, I don't know." Or to be like, "I'll get back to you on that." You kind of want to have something right then and there that you can pull out and reference.
And so, I created quite a large spreadsheet to help with that. And I became interested like, "What does CTM mean? What is CPM? What is the difference? Oh, look, they're conducting this with this, they're conducting this combination in this population." And that's sort of how I became interested in development.
John: All right. So now you've been doing the clinical development for how long?
Dr. Linda Ho: Five years now.
John: Five years. Okay. Now looking back, and if you were to give advice, let's say to others who either are MSLs or maybe they're doing something else in medical affairs and they wanted to switch into what you're doing, what kind of advice do you have for them to try and get more experience or exposure to something that might help them actually make that transition?
Dr. Linda Ho: For an MD it's a natural sort of transition to do something that is more MD related. I use my medical background every day. Whether it's managing adverse events, assisting physicians, they'll send me an email like, "Oh, such and such patient had febrile neutropenia or had a grade three rash. What should I do? How should I manage that?" And so, I can give them some insight into that.
Now, ultimately, the management is up to the PI. It's not up to me. I'm not putting in orders or seeing the patient, but I can advise them on what kind of resources exist and basically talk through the case with them, given my knowledge about the drug and the program.
John: Yeah. If I think back to when we spoke and with others I've spoken in, of course, there are positions for PAs and NPs and PharmDs and PhDs in the MSL role. But like you said, for those that are MDs, DOs, that have the actual patient care background, there are certain advantages I could see based on what you just said.
Dr. Linda Ho: Definitely. There are a few PharmDs. I have known a few PharmDs. It is rare though. It is relatively rare. You have to have a very strong clinical background. I do know a few PharmDs, but yes, mostly it is MDs and a few MD PhDs that do this kind of work. Because it is very clinical.
Now as far as your previous question, your original question about the transition, it was pretty challenging for me. My prior company, they tried to get, because med affairs and clinical development are like two different departments technically. Yes, they're over the overarching umbrella of R&D but especially in a large pharma, there's definitely a separation. You kind of have to make your own opportunities. And my last company, they tried, they did try to get me there, but at the same time, they want you to do your regular MSL job, which is 40 plus hour week job.
For me, going back to the original job hunting tips that I gave before, it's really about networking and finding another person who's in development who's willing to take a chance on you. Showing your interest in development, showing what kind of experience you have with managing a team. It doesn't have to be a study team, any kind of small team, to get to achieve your goal is helpful.
And they will ask you about that during an interview. "When have you managed a team? What was your role? How did you resolve conflicts in that team? How did you make sure that everything stayed on time with the timelines?" That's very important, timelines. To have that as much experience, managing, it doesn't have to be an official managing. You don't have to have the title of manager, but to show that you've worked on a study team in some capacity before is really helpful.
John: Okay. Now you talk about networking. Would one focus, depending on the size of the company, on internal networking, in other words, working with or networking with those in the company, maybe in other divisions, in other locations, let's say, or try to network more with those outside of your current company? Does LinkedIn help with that? How do you do that networking?
Dr. Linda Ho: You want to start with internal. You have a good reputation within the company. People can speak for you within the company. So, it's always easier to start internally. Now, there may or may not be positions available depending on the company and where the assets are at. They may not have the ability to take you on. And in that case, that's when you really turn to LinkedIn as well as networking at conferences. That is really key, I found more so than LinkedIn.
Yeah. You can reach out to them on LinkedIn, make a connection, but then say, do you have time to meet up at ASCO, meet up at ASH, meet up at whatever college of whatever? That's really where a lot of networking occurs in person networking.
John: And these would be conferences that you would normally be going to anyway as part of your role at the time. And they're more general though, because they involve different members of the overall team.
Dr. Linda Ho: Correct. Assuming that you want to go into development in the area that you are currently in. Gynecology or whatever. Gastroenterology. And most likely the company that you're looking at, the development leads will also be attending, I don't know, gastroenterology meeting. And so, you can say, "Do you have time to meet up at DDW? Do you have time to meet up?" And everyone's got a little bit of time. There's downtime in between sessions, and also at lunch, where you can meet someone really quick for coffee or to grab a sandwich, find a corner and talk.
John: Yeah. No, that makes perfect sense. And particularly if you can piggyback on something that already is on the schedule, just have to make sure to verify that both of you are going to be there. That could be quite useful. Yeah, it really does build on what you said in our previous interview about not relying on some kind of electronic format of communication, which can go nowhere.
Dr. Linda Ho: Correct. Most likely go nowhere.
John: Yeah.
Dr. Linda Ho: That frustrate you and make you very depressed.
John: Any other just off the top of your head or on your list there of anything in particular that one might want to do to help facilitate that transition?
Dr. Linda Ho: Do you mean as an MSL or as a physician looking to get into industry?
John: Either one. I was thinking more as if you're already the MSL, but if there's something different from what we had discussed before, because things have changed. It's been five years.
Dr. Linda Ho: Yeah. There's just been minor things like global pandemics and things like that.
John: Yeah.
Dr. Linda Ho: If you're a physician looking to get into industry, I think the best way to move into clinical development is to A) have experience in clinical trials and B) the lead in clinical trials. The more papers and trials you have under your belt, the better candidate you are. And then again, networking. So, making connections with your local MSL, with your local sales rep, and through them finding out who the people are in the company to talk to and meeting them at conferences to express your interest in the transition.
I personally have known and helped multiple physicians get into industry through this method alone. Meeting them at meetings, talking with them, making that connection. And then when someone says, "Hey, we have an opening for a medical monitor for this particular trial", then I can say, "Oh yeah, I talked to person X, Y, and Z and they have expertise in that and I think they'd be a good fit." And that, to be honest, is more valuable if you're a hiring manager than anything else. To have someone that you know vouch for their work is far more valuable than anything else.
John: Okay. One of the things that's come up, we are kind of shifting gears a little bit, and some of the people that are trying to break into pharma are contract research organizations. I think maybe they're CROs because they seem to have a lower barrier to hiring certain types of positions, although they're not as secure because they fill in gaps like an MSL.
Dr. Linda Ho: Yes.
John: Someone I think that got in that way. They were hired by a CRO as a writer, a medical writer, and then ended up getting into pharma. So, any thoughts on that whole approach to if you've struggled to get in in other ways, whether that would be useful or not?
Dr. Linda Ho: To get into development, you mean?
John: Well, to get your foot in the door in pharma through a CRO to begin with. And then maybe from there, try and use the steps that you're talking about to move into directly working for the pharmaceutical company. Maybe as an MSL and the CRO, and then move into the MSL position in the company. And then next step is to then network and build, get into clinical development that way.
Dr. Linda Ho: That's a long road. That's a long road and not necessarily a guaranteed road.
John: Yeah.
Dr. Linda Ho: For young physicians, if you are fresh out of residency or fellowship, or maybe just been an attending for a few years, and you're like, "No, this is for the birds, this isn't for me." The best way, the very best way to get into pharma in any capacity is to do a physician's development program. The very, very best way.
The PDP program is available at many different big pharmas. I don't think any biotechs or small pharmas have these programs, but I could be wrong. I could be wrong. But the PDP is tailored and developed for physicians to kind of get their feet wet in many different functions in a pharmaceutical company. I think it's a two-year program, and basically you rotate through different departments. You'll rotate through affairs, clinical development, safety, manufacturing I think. All sorts of different capacities where a physician might belong in a pharmaceutical company. It's like residency all over again. You'll have three months here, six months there, and you'll have projects to work on and different things to work on.
And then when you finish, when you graduate at the end of your two years, you have had your toes in multiple different capacities and can say, "Oh yeah, I really loved safety. I really hated medical affairs." And you can decide where you want to go into. And the company will help you. They'll either hire you outright after you finish the program or help you get jobs at other companies. It is the very, very best program.
I honestly wish that I had known about this program when I was looking. I would've applied in a heartbeat. They are fairly competitive. When I was an MSL and trying to get into development, I learned that my company had this program and a lot of the development physicians had come from this program and I wanted to apply and they told me I was too old.
John: Yeah. I don't know that much about these, but I've heard some people have talked about so-called residency or a fellowship with a pharma company. I think it's the same thing. The terminology might be different, but they're kind of competitive, like you said. And I'm assuming because it's a full-time thing, correct?
Dr. Linda Ho: Correct. It's a full-time thing.
John: So they pay you, but it's again, not going to be like you get paid if you were actually working for the company. Is that true?
Dr. Linda Ho: This, I don't know. I'd have to look more into it. I think it is fairly competitive. Maybe not if you were in full-time in that capacity. But I don't know. Certainly they pay you enough to live and to relocate to wherever the home office is and that kind of thing.
John: Okay. All right. Before we go, I wanted to get back to the lifestyle and the other things you like about what you're doing now. I'm trying to get a sense. I usually like to ask about whether people can work remotely in the job that they're doing. Is it everything face to face? Is it 09:00 to 05:00? There is the traveling, obviously, of an MSL. So why don't you just tell me what your experience has been in terms of the lifestyle and quality of life and working in this position?
Dr. Linda Ho: Prior to the pandemic, we were in the office four days a week. You could take one day to work remote. And so, I think I chose Wednesdays or something to work remotely, and that was great. But for the most part, you were in the office. And it was pretty much 09:00 to 05:00.
Sometimes there were early days if you're talking to the EU, and sometimes there were late nights if you were getting ready for a publication or for a data cutoff or something. And those happened fairly regularly. Data cutoffs were every quarter. So at least for a week or two, every quarter it was 12 hour days.
And like you said, there was not the traveling commitment that there was as an MSL. I very much enjoyed the more regular schedule. I think in my younger days maybe I liked being out there and traveling so much. But I think as I got older that started to get more and more difficult.
John: Did that change at all after the pandemic in terms of the amount of time that you could be working remotely?
Dr. Linda Ho: I think it took them a while to figure things out. My particular company, currently, if you decided during the pandemic that you're going to be remote, you could maintain your remote status. However, they are not hiring any more remote people.
John: I don't know. I've heard things, it could be a double-edged sword too, in terms of you can kind of go crazy sometimes if you're just home all the time and not interacting with people.
Dr. Linda Ho: That's true. But you can also get a lot of work done.
John: Yeah. And not be on the road and driving back and forth or whatever it is. That's just a waste of time to some extent, plus the expense.
Dr. Linda Ho: Yes, I knew someone who was working at a pharmaceutical company in San Francisco, but during the pandemic moved back home with his parents in LA. And given the housing prices in San Francisco, it actually made more sense for him to fly back and forth weekly. It's a short trip. It's an hour and a half flight maybe. And to go fly back and forth, and pay for a hotel then to try to buy something in San Francisco.
John: Yeah, that makes sense. Heck, I was doing a 90 minute one way round trip to a job I had in the Chicago area for a while there when I was a medical director. So, that's an hour and a half on a plane and you're not even driving. You can get other work done.
Dr. Linda Ho: Yeah.
John: All right. Well, I've taken up enough of your time today, Linda. This has been very interesting. It's been really good. You give us a little more insight into clinical development and the interaction and the ways to move between these jobs. I still have a lot of people that listen to this podcast that are just burned out and frustrated. And now you've been out of clinical for quite a while, but any last bits of advice for someone who's looking at "Why do I have to go into this clinic every day?" before we let you go?
Dr. Linda Ho: I think more and more people are feeling similarly. People reach out to me on LinkedIn or wherever, and actually there's quite an active group on Reddit I found.
John: Oh, really?
Dr. Linda Ho: Yes, yes.
John: Oh, I'll have to look for that.
Dr. Linda Ho: Yeah. Reddit is pretty much totally anonymous. So, people feel safer asking questions and trying to get advice. They burn you out in residency, and you think it's going to get better after that, but it doesn't really. And yeah, you get paid a lot more money than you do when you're a resident, but the money isn't everything. It isn't everything.
I think that a lot of people are feeling more and more similarly in that the way that the hospitals are going these days, where they're run by administrators and MBAs, where they're really pushing for productivity, it's just counterproductive as far as physicians are concerned. I personally think that the PDP is a great way to go if you are trying to find out where you fit, if you fit in a pharmaceutical company sort of environment. There's a lot of other options out there.
I found out that a lot of people, they work in the legal system as an expert witness. They can make quite a bit of money doing that. And that is also a good route to go. I know that there's a conference, I spoke at it once. What's it called?
John: The annual conference for SEEK.
Dr. Linda Ho: For SEEK, yes. SEEK. Yes. And there are a lot of speakers there who have different experiences in different areas outside of regular old medicine that are also good options.
John: Yeah, absolutely. I guess a question I would have, it seems to me that the positions that are available for physicians in pharma and other industries, there's still plenty of positions out there. There's lots of job posting. So, there are options that you can do that are much more easy to do in terms of your lifestyle and not putting in 80 hour weeks and being on call every third day, all night and that sort of thing.
Dr. Linda Ho: Yeah, I agree. Hiring has slowed down though a little bit. I've heard a lot of people sort of complaining about that the hiring has slowed down as the economy slows down.
John: Right.
Dr. Linda Ho: Hopefully, that will turn around soon.
John: All right. Well, again, thank you for being with me today, Linda. This has been a good update and maybe we'll swing back around about five years from now but we'll talk before then. But I really appreciate it, this has been fun. And so, with that, I'll just say goodbye.
Dr. Linda Ho: Sounds good. Thanks for having me.
John: You're welcome.
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Transcription PNC Podcast Episode 308
Making Your Way to a Rewarding Career in Clinical Development
- Interview with Dr. Linda Ho.
John: Today's guest, in my opinion, has gone through at least two major career transitions. The first was when she went from clinical work to being an MSL in pharma. But I saw recently that she is now working in clinical development, which is to me a big switch from the MSL work. So, with that, I want to welcome Dr. Linda Ho back to the show. Hi, Linda.
Dr. Linda Ho: Hello. Hi.
John: It's good to have you back. I can't believe it. I was looking at the dates and it's been really like five years since we spoke. I always refer to your episode quite a bit because it's really a good one for people getting an introduction and thinking about moving into an MSL role because you had a lot of great advice back then.
Dr. Linda Ho: Thanks. Yeah, that was super fun. I think that was sort of at the end of my MSL gig, moving on to clinical development.
John: All right. Yeah, I think it was. And so I really am interested in hearing about what's been going on since then, but maybe you want to give us a short thumbnail, kind of explanation of why you switched from clinical to nonclinical. Just briefly, because I can refer people back to the old podcast. And then what attracted you to move from the MSL role to the clinical development role?
Dr. Linda Ho: Geez. I was working at a vein clinic for a while. I'm a pathologist by trade, but I never loved pathology. And I worked at a vein clinic for a while, and then one of my patients while I was at the clinic said that, "Oh, you would make a great MSL." And I was like, "Why? I don't, I don't know what that is." And she explained that she was a sales rep for a pharma company and explained to me what an MSL was. And I was already at that time thinking of a career transition. So, it seemed like a perfect fit.
It did take me a while to find an opening that would take a chance on someone who wasn't already an MSL. I think that a lot of people probably find that challenge when they're looking to transition. But eventually I did, and I was an MSL I think for five, six years maybe, at a few different companies. And then in the fall or late summer of 2018, I moved into clinical development.
I developed an interest in clinical trials, while I was an MSL. And also the travel of an MSL really started to wear me down. At first it was super fun. I loved racking up the miles. I loved flying here and there, but the amount of time spent in an airport was really starting to wear on me. So, that was one of the main reasons for looking for a new role.
John: That makes a lot of sense. And we talked about that last time, and that is one of the things that comes up quite a bit. And depending on the size of your territory, and I remember you had maybe at least at one point a pretty large territory.
Dr. Linda Ho: Yeah.
John: Now that was pre pandemic.
Dr. Linda Ho: Yes.
John: I'm kind of hearing now that post pandemic with everyone trying to be as remote as possible, that some of the MSLs are actually doing more of their work remotely than they were before. But that wasn't going to help you out.
Dr. Linda Ho: Yes, correct. That was a few years too late for me.
John: Yeah. Yeah. Now, what was interesting about clinical development and what does clinical development mean? I hear terms like clinical research, I hear primary investigators. I hear different things thrown out. And so, would it be right to say just clinical development means working on new drugs or new medical devices if it happens to be in the medical device company? What does that mean exactly?
Dr. Linda Ho: Clinical development falls under the research and development umbrella, the R&D umbrella. And it's really the department that generates trial data. Whether it's phase 1, 2, 3, or preclinical data, that generally falls under the clinical development umbrella.
Now, we work very, very closely with our colleagues in clinical operations, which is different. And the subtlety of that is clinical operations, they work on trials as well. However, they're generally not as involved in the data generation or clinical trial design or strategy behind it. They execute the clinical trial strategy that development creates. They have not just in-house staff, but also field staff that go to the sites where we're conducting the trials. And they go through the data and make connections with people at the site level, make sure that the data is looking good on that end.
So, it's a distinction. It's a fine distinction, but it is there nonetheless. And it can be very confusing like what's the difference between development and operations? What are these two different terms? So, hopefully that clears that up.
John: Yeah, that helps. The other thing that I think not all companies necessarily use all the same terms too, that we see from company to company, it seems like they have sometimes slightly different terminology.
Dr. Linda Ho: Yes.
John: And I spoke to someone recently who is working as a principal investigator, but she's working as I guess I could say a PI. But I think from talking to her, she's actually working for a CRO or a third party, and she's responsible for one site where the research is done. But I'm assuming in a pharmaceutical company in the R&D area, where they have a study, it could involve dozens if not hundreds of locations. And that's kind of a different level.
Dr. Linda Ho: A principal investigator to my understanding are generally the investigators at specific sites. So, for example, if we have a site, I don't know, I was just going to make up one, say University of Illinois. The physician who is at that site is the primary investigator. And you have different sites with different primary investigators, PIs, we call them. And they are responsible for ensuring the safety of the patient, appropriate management of the patient, appropriate reporting of that patient's data, managing any adverse events, that kind of thing.
John: All right. And so, in that situation, would that be considered the part of clinical operations in most companies or part of research and development?
Dr. Linda Ho: They are not hired by the company. They are a physician at that particular hospital or institution. So, doctor so-and-so who is going to be named in the study as an author, that is our principal investigator at that particular site.
John: Got it. Okay. Yeah. So you can understand why someone who's never been involved working around pharma can get super confused. So tell me a little bit more about what interested you instead of maybe going into something that was in clinical operations or medical affairs, which like I said, I kind of get the idea that most MSLs are in the medical affairs division. What was it about the clinical development that really appealed the most to you?
Dr. Linda Ho: I think you're right that most MSLs move up into either an MSL manager role where they're in the field and they're managing other MSLs in the field, or they move into a medical affairs role. Now, medical affairs is responsible for the strategy and the management of the asset or drug as a whole, as opposed to clinical development, which manages the data and the trial subjects.
Now, I did not have a lot of exposure to clinical development as an MSL. I sort of had to seek that out on my own. But I became interested when I was in my last MSL role because I took it upon myself basically to provide a tool for the MSL team to use in the field collating all of the studies that were being conducted with the asset that we had at the time.
The team was new, the department was new, so that kind of tool did not exist. But it was super helpful to have, because investigators will ask you, or KOLs will ask you, "Well, what trials do you have going on in this area? Well, what studies do you have that are looking for subjects?" These are very basic questions that an MSL gets. And it's hard to be like, "Well, I don't know." Or to be like, "I'll get back to you on that." You kind of want to have something right then and there that you can pull out and reference.
And so, I created quite a large spreadsheet to help with that. And I became interested like, "What does CTM mean? What is CPM? What is the difference? Oh, look, they're conducting this with this, they're conducting this combination in this population." And that's sort of how I became interested in development.
John: All right. So now you've been doing the clinical development for how long?
Dr. Linda Ho: Five years now.
John: Five years. Okay. Now looking back, and if you were to give advice, let's say to others who either are MSLs or maybe they're doing something else in medical affairs and they wanted to switch into what you're doing, what kind of advice do you have for them to try and get more experience or exposure to something that might help them actually make that transition?
Dr. Linda Ho: For an MD it's a natural sort of transition to do something that is more MD related. I use my medical background every day. Whether it's managing adverse events, assisting physicians, they'll send me an email like, "Oh, such and such patient had febrile neutropenia or had a grade three rash. What should I do? How should I manage that?" And so, I can give them some insight into that.
Now, ultimately, the management is up to the PI. It's not up to me. I'm not putting in orders or seeing the patient, but I can advise them on what kind of resources exist and basically talk through the case with them, given my knowledge about the drug and the program.
John: Yeah. If I think back to when we spoke and with others I've spoken in, of course, there are positions for PAs and NPs and PharmDs and PhDs in the MSL role. But like you said, for those that are MDs, DOs, that have the actual patient care background, there are certain advantages I could see based on what you just said.
Dr. Linda Ho: Definitely. There are a few PharmDs. I have known a few PharmDs. It is rare though. It is relatively rare. You have to have a very strong clinical background. I do know a few PharmDs, but yes, mostly it is MDs and a few MD PhDs that do this kind of work. Because it is very clinical.
Now as far as your previous question, your original question about the transition, it was pretty challenging for me. My prior company, they tried to get, because med affairs and clinical development are like two different departments technically. Yes, they're over the overarching umbrella of R&D but especially in a large pharma, there's definitely a separation. You kind of have to make your own opportunities. And my last company, they tried, they did try to get me there, but at the same time, they want you to do your regular MSL job, which is 40 plus hour week job.
For me, going back to the original job hunting tips that I gave before, it's really about networking and finding another person who's in development who's willing to take a chance on you. Showing your interest in development, showing what kind of experience you have with managing a team. It doesn't have to be a study team, any kind of small team, to get to achieve your goal is helpful.
And they will ask you about that during an interview. "When have you managed a team? What was your role? How did you resolve conflicts in that team? How did you make sure that everything stayed on time with the timelines?" That's very important, timelines. To have that as much experience, managing, it doesn't have to be an official managing. You don't have to have the title of manager, but to show that you've worked on a study team in some capacity before is really helpful.
John: Okay. Now you talk about networking. Would one focus, depending on the size of the company, on internal networking, in other words, working with or networking with those in the company, maybe in other divisions, in other locations, let's say, or try to network more with those outside of your current company? Does LinkedIn help with that? How do you do that networking?
Dr. Linda Ho: You want to start with internal. You have a good reputation within the company. People can speak for you within the company. So, it's always easier to start internally. Now, there may or may not be positions available depending on the company and where the assets are at. They may not have the ability to take you on. And in that case, that's when you really turn to LinkedIn as well as networking at conferences. That is really key, I found more so than LinkedIn.
Yeah. You can reach out to them on LinkedIn, make a connection, but then say, do you have time to meet up at ASCO, meet up at ASH, meet up at whatever college of whatever? That's really where a lot of networking occurs in person networking.
John: And these would be conferences that you would normally be going to anyway as part of your role at the time. And they're more general though, because they involve different members of the overall team.
Dr. Linda Ho: Correct. Assuming that you want to go into development in the area that you are currently in. Gynecology or whatever. Gastroenterology. And most likely the company that you're looking at, the development leads will also be attending, I don't know, gastroenterology meeting. And so, you can say, "Do you have time to meet up at DDW? Do you have time to meet up?" And everyone's got a little bit of time. There's downtime in between sessions, and also at lunch, where you can meet someone really quick for coffee or to grab a sandwich, find a corner and talk.
John: Yeah. No, that makes perfect sense. And particularly if you can piggyback on something that already is on the schedule, just have to make sure to verify that both of you are going to be there. That could be quite useful. Yeah, it really does build on what you said in our previous interview about not relying on some kind of electronic format of communication, which can go nowhere.
Dr. Linda Ho: Correct. Most likely go nowhere.
John: Yeah.
Dr. Linda Ho: That frustrate you and make you very depressed.
John: Any other just off the top of your head or on your list there of anything in particular that one might want to do to help facilitate that transition?
Dr. Linda Ho: Do you mean as an MSL or as a physician looking to get into industry?
John: Either one. I was thinking more as if you're already the MSL, but if there's something different from what we had discussed before, because things have changed. It's been five years.
Dr. Linda Ho: Yeah. There's just been minor things like global pandemics and things like that.
John: Yeah.
Dr. Linda Ho: If you're a physician looking to get into industry, I think the best way to move into clinical development is to A) have experience in clinical trials and B) the lead in clinical trials. The more papers and trials you have under your belt, the better candidate you are. And then again, networking. So, making connections with your local MSL, with your local sales rep, and through them finding out who the people are in the company to talk to and meeting them at conferences to express your interest in the transition.
I personally have known and helped multiple physicians get into industry through this method alone. Meeting them at meetings, talking with them, making that connection. And then when someone says, "Hey, we have an opening for a medical monitor for this particular trial", then I can say, "Oh yeah, I talked to person X, Y, and Z and they have expertise in that and I think they'd be a good fit." And that, to be honest, is more valuable if you're a hiring manager than anything else. To have someone that you know vouch for their work is far more valuable than anything else.
John: Okay. One of the things that's come up, we are kind of shifting gears a little bit, and some of the people that are trying to break into pharma are contract research organizations. I think maybe they're CROs because they seem to have a lower barrier to hiring certain types of positions, although they're not as secure because they fill in gaps like an MSL.
Dr. Linda Ho: Yes.
John: Someone I think that got in that way. They were hired by a CRO as a writer, a medical writer, and then ended up getting into pharma. So, any thoughts on that whole approach to if you've struggled to get in in other ways, whether that would be useful or not?
Dr. Linda Ho: To get into development, you mean?
John: Well, to get your foot in the door in pharma through a CRO to begin with. And then maybe from there, try and use the steps that you're talking about to move into directly working for the pharmaceutical company. Maybe as an MSL and the CRO, and then move into the MSL position in the company. And then next step is to then network and build, get into clinical development that way.
Dr. Linda Ho: That's a long road. That's a long road and not necessarily a guaranteed road.
John: Yeah.
Dr. Linda Ho: For young physicians, if you are fresh out of residency or fellowship, or maybe just been an attending for a few years, and you're like, "No, this is for the birds, this isn't for me." The best way, the very best way to get into pharma in any capacity is to do a physician's development program. The very, very best way.
The PDP program is available at many different big pharmas. I don't think any biotechs or small pharmas have these programs, but I could be wrong. I could be wrong. But the PDP is tailored and developed for physicians to kind of get their feet wet in many different functions in a pharmaceutical company. I think it's a two-year program, and basically you rotate through different departments. You'll rotate through affairs, clinical development, safety, manufacturing I think. All sorts of different capacities where a physician might belong in a pharmaceutical company. It's like residency all over again. You'll have three months here, six months there, and you'll have projects to work on and different things to work on.
And then when you finish, when you graduate at the end of your two years, you have had your toes in multiple different capacities and can say, "Oh yeah, I really loved safety. I really hated medical affairs." And you can decide where you want to go into. And the company will help you. They'll either hire you outright after you finish the program or help you get jobs at other companies. It is the very, very best program.
I honestly wish that I had known about this program when I was looking. I would've applied in a heartbeat. They are fairly competitive. When I was an MSL and trying to get into development, I learned that my company had this program and a lot of the development physicians had come from this program and I wanted to apply and they told me I was too old.
John: Yeah. I don't know that much about these, but I've heard some people have talked about so-called residency or a fellowship with a pharma company. I think it's the same thing. The terminology might be different, but they're kind of competitive, like you said. And I'm assuming because it's a full-time thing, correct?
Dr. Linda Ho: Correct. It's a full-time thing.
John: So they pay you, but it's again, not going to be like you get paid if you were actually working for the company. Is that true?
Dr. Linda Ho: This, I don't know. I'd have to look more into it. I think it is fairly competitive. Maybe not if you were in full-time in that capacity. But I don't know. Certainly they pay you enough to live and to relocate to wherever the home office is and that kind of thing.
John: Okay. All right. Before we go, I wanted to get back to the lifestyle and the other things you like about what you're doing now. I'm trying to get a sense. I usually like to ask about whether people can work remotely in the job that they're doing. Is it everything face to face? Is it 09:00 to 05:00? There is the traveling, obviously, of an MSL. So why don't you just tell me what your experience has been in terms of the lifestyle and quality of life and working in this position?
Dr. Linda Ho: Prior to the pandemic, we were in the office four days a week. You could take one day to work remote. And so, I think I chose Wednesdays or something to work remotely, and that was great. But for the most part, you were in the office. And it was pretty much 09:00 to 05:00.
Sometimes there were early days if you're talking to the EU, and sometimes there were late nights if you were getting ready for a publication or for a data cutoff or something. And those happened fairly regularly. Data cutoffs were every quarter. So at least for a week or two, every quarter it was 12 hour days.
And like you said, there was not the traveling commitment that there was as an MSL. I very much enjoyed the more regular schedule. I think in my younger days maybe I liked being out there and traveling so much. But I think as I got older that started to get more and more difficult.
John: Did that change at all after the pandemic in terms of the amount of time that you could be working remotely?
Dr. Linda Ho: I think it took them a while to figure things out. My particular company, currently, if you decided during the pandemic that you're going to be remote, you could maintain your remote status. However, they are not hiring any more remote people.
John: I don't know. I've heard things, it could be a double-edged sword too, in terms of you can kind of go crazy sometimes if you're just home all the time and not interacting with people.
Dr. Linda Ho: That's true. But you can also get a lot of work done.
John: Yeah. And not be on the road and driving back and forth or whatever it is. That's just a waste of time to some extent, plus the expense.
Dr. Linda Ho: Yes, I knew someone who was working at a pharmaceutical company in San Francisco, but during the pandemic moved back home with his parents in LA. And given the housing prices in San Francisco, it actually made more sense for him to fly back and forth weekly. It's a short trip. It's an hour and a half flight maybe. And to go fly back and forth, and pay for a hotel then to try to buy something in San Francisco.
John: Yeah, that makes sense. Heck, I was doing a 90 minute one way round trip to a job I had in the Chicago area for a while there when I was a medical director. So, that's an hour and a half on a plane and you're not even driving. You can get other work done.
Dr. Linda Ho: Yeah.
John: All right. Well, I've taken up enough of your time today, Linda. This has been very interesting. It's been really good. You give us a little more insight into clinical development and the interaction and the ways to move between these jobs. I still have a lot of people that listen to this podcast that are just burned out and frustrated. And now you've been out of clinical for quite a while, but any last bits of advice for someone who's looking at "Why do I have to go into this clinic every day?" before we let you go?
Dr. Linda Ho: I think more and more people are feeling similarly. People reach out to me on LinkedIn or wherever, and actually there's quite an active group on Reddit I found.
John: Oh, really?
Dr. Linda Ho: Yes, yes.
John: Oh, I'll have to look for that.
Dr. Linda Ho: Yeah. Reddit is pretty much totally anonymous. So, people feel safer asking questions and trying to get advice. They burn you out in residency, and you think it's going to get better after that, but it doesn't really. And yeah, you get paid a lot more money than you do when you're a resident, but the money isn't everything. It isn't everything.
I think that a lot of people are feeling more and more similarly in that the way that the hospitals are going these days, where they're run by administrators and MBAs, where they're really pushing for productivity, it's just counterproductive as far as physicians are concerned. I personally think that the PDP is a great way to go if you are trying to find out where you fit, if you fit in a pharmaceutical company sort of environment. There's a lot of other options out there.
I found out that a lot of people, they work in the legal system as an expert witness. They can make quite a bit of money doing that. And that is also a good route to go. I know that there's a conference, I spoke at it once. What's it called?
John: The annual conference for SEEK.
Dr. Linda Ho: For SEEK, yes. SEEK. Yes. And there are a lot of speakers there who have different experiences in different areas outside of regular old medicine that are also good options.
John: Yeah, absolutely. I guess a question I would have, it seems to me that the positions that are available for physicians in pharma and other industries, there's still plenty of positions out there. There's lots of job posting. So, there are options that you can do that are much more easy to do in terms of your lifestyle and not putting in 80 hour weeks and being on call every third day, all night and that sort of thing.
Dr. Linda Ho: Yeah, I agree. Hiring has slowed down though a little bit. I've heard a lot of people sort of complaining about that the hiring has slowed down as the economy slows down.
John: Right.
Dr. Linda Ho: Hopefully, that will turn around soon.
John: All right. Well, again, thank you for being with me today, Linda. This has been a good update and maybe we'll swing back around about five years from now but we'll talk before then. But I really appreciate it, this has been fun. And so, with that, I'll just say goodbye.
Dr. Linda Ho: Sounds good. Thanks for having me.
John: You're welcome.
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