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Why Medical Affairs Acts Strangely Sometimes

  • Ines Vogel
  • Finn-Rasmus Bull
  • Tuesday, 11. October 2022
medical affairs acts strange
© Karolina Grabowska

Medical affairs personnel often seem to operate a bit off the company track. But this strangeness can become a superpower when understood and embraced.

The medical affairs department fulfills a special purpose in a pharmaceutical company. As boundary spanners connecting drug developers to doctors and the scientific community, medical affairs personnel ensure both the necessary flow of information about and adequate participation in crucial studies of new and existing drugs. While pursuing this work, the M.D.s working in medical affairs must balance two allegiances: one to the medical profession and one to the pharmaceutical company that employs them.

Dual Loyalties

The medical profession is highly regulated, and professional organizations maintain firm control over how doctors obtain knowledge and shape their values. Once training is complete, that power is undiminished: Because of the specialized nature of the field, doctors must continue to rely on their peer group for feedback and approval. Even if they leave medical practice to work in pharmaceutical companies, these factors keep doctors firmly embedded in the medical profession.

Medical affairs personnel are often pulled in different directions by these dual loyalties. As a result, managers are often disappointed in their efforts to bring medical affairs staffers into alignment with organizational goals. Frequently, these managers find it difficult to make effective use of common organizational leverages such as hierarchical power and goal setting. Thus this dual loyalty is often only perceived as a persistent obstacle.

Acknowledging Value

It is understandable when these leaders become frustrated by the medical staff’s lack of responsiveness to leverages that keep the rest of the company running smoothly. It is easy to forget that it would actually cause the organization a great deal more trouble if the medical department was suddenly to become more malleable.

It is only through the medical staff’s resistance to institutional leverages that they establish themselves as independent and put themselves in a position to raise the organization’s street credibility with the physicians upon whom so many vital projects and economic success depend. Pharmaceutical companies hire medical staff precisely so that they will build a bridge between the organization and the medical community, and they can do so effectively only if they show themselves to be professional colleagues with both expertise and integrity who are not suspected of only funneling sales interests.

Leaders should embrace double loyalty.

Leaders would do well to embrace their medical staff’s double loyalty. Management must balance the goal conflict between possible short-term gains and the long-term preservation of trust in the medical community. If anything, doctors’ double loyalty provides a starting point for achieving that balance. Management should think twice before pushing too hard for medical affairs’ alignment and potentially alienating a set of employees who are both essential to business goals and highly sought after by other employers.

Because of these competing priorities embedded in medical affairs staffers’ professional identities, the job of managing M.D.s within a pharmaceutical organization can be a thankless one – especially when the leader in question is not a specialist or doctor at all. These experts are disinclined to respect the wishes of a supervisor based on hierarchy alone.

Leading beyond hierarchy

So what other leverages beyond hierarchical power can a non-medical or non-specialist supervisor offer? Seniority is helpful, as is expertise. But expertise can only be gained in a limited number of areas, while the leaders assigned to supervise medical staff often must guide a complex array of projects.

For a leader faced with this challenge, it is worth considering how much control over the medical staff is truly necessary, since these employees are already experts. It is reasonable to trust them, and they do not need to be micromanaged.

Avoiding conflicts by limiting the use of power.

In one real-world example, a medical executive in a global pharmaceutical company says openly that he is unable to lead through expertise. Instead, he expects the 11 medical directors he supervises to lead their teams using their expertise in rare diseases and oncology. This executive has sidestepped much conflict by only rarely using his position within the hierarchy as a source of power. Instead he gives his medical directors legroom, seeing himself as an enabler of their work and thus gaining trust to follow him when needed.

While medical professionals’ dual loyalty is expected to result in conflict somewhere, this executive has decided to place as much of the clash as possible on himself and become the person who balances the conflict within his organization.

Engaging in Discourse

In pharmaceutical companies, the medical affairs department often comes to be seen as the “squeaky wheel.” Medical professionals complain that strategic decisions are unintelligent or ridiculous because they have trouble accepting the validity of motivations outside of those in line with their professional identities and with the public-facing side of company communications. Because they often regard non-scientific motivations as inferior, medical professionals tend to have a blind spot when it comes to micropolitics and working toward compromise with other stakeholders.

This is in line with their primary role. Within a pharmaceutical organization’s division of labor, medical staff are responsible for pushing the organization toward quality, innovation and keeping an eye on the interests of doctors.

“Medical affairs staff must become more aware of their own resources.”

But to successfully do so, medical affairs staff must become more aware of their own resources within internal power games. What if medical affairs were to throw itself earlier and more deeply into cross-functional strategy development? What if these staffers were to refuse to limit themselves to explaining datasets and guidelines—instead engaging fully in negotiating for compromise?

To do that, they would first need to better understand the goals and perspectives of other departments and expand their micropolitical tool kit to influence them. If they can do that, medical professionals’ dual loyalty will prove to be a tremendous lever for success.


Ines Vogel

is a Principal at Metaplan specializing in stakeholder management within health care: from strategy development to facilitating medical discourse.

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Finn-Rasmus Bull

Finn-Rasmus Bull

is a Senior Consultant at Metaplan and an organizational sociologist. He advises clients in a broad spectrum of industries, often dealing with expert-driven organizations.

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