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Medical Affairs in an organizational dilemma

Gaining importance – losing power

  • Ines Vogel
  • Claire Terrington
  • Monday, 27. February 2023
Gaining importance, losing power
Snezhana Kudryavtseva

Medical Affairs in an organizational dilemma

Articles on the growing importance of Medical Affairs had already been written before the pandemic. Claims for an even stronger, more important and powerful Medical Affairs function proliferated during and after those intense Covid years. And rightly so. As product life cycles shorten, Medical Affairs expertise is needed at an early stage to inform development strategy and the positioning of new compounds in the various treatment landscapes.

During the lockdowns, doctors learned just how much time they could save by not having pharma sales reps in their offices and clinics and consequently restricted access to their scarce time even after the formal bans were lifted. As a result, Field Medical is often the only pharma function to get past the reception counter. Talking to Medical Affairs is often regarded as more attractive, as they bring more topic-related depth and width and less biased communication to a physician’s desk than most sales reps.

For this reason, Medical Affairs as a function gained in importance in their respective companies: headcounts stable or even growing in an overall shrinking field force, sought after door-openers for sales, and insight powerhouses warning proactively and explaining reactively. Up and down the ranks of Medical Affairs, they assured each other that they certainly are much more than just a scientific correction loop for marketing material. 

Medical Affairs on a leash?

But paradoxically, Medical Affairs has not gained any more power in the micropolitical scheme of things. In fact, just the opposite has happened – pharmaceutical companies have tightened their control over this function. Field Medical – once proud to communicate reactively on the topics their counterparts were interested in – are now confronted with priority topics they have to discuss. As the only function left with contact to certain doctors, they are expected to also deliver marketing- and sales-like punchlines. The number of contacts they have is tracked and specific data slides have to be shown. What should be insight deliverance tools are now often designed more like treadmills, aiming for quantity rather than in-depth analyses.

Outside pharma: a recurring pattern

As organizations tend to curb uncertainty, formal rules and regulations are a typical means of fencing in all too potent actors when their actions (or inactions) are too decisive for a company’s success.
IT departments have long gone through this transformation process. In the past, maintaining good relations with an IT department was crucial to get help, equipment or development in a reasonable timeframe – and all the more so as the demand for internal IT services increased and staff were scarce. One could have assumed that IT’s power levers within a company would grow stronger and stronger as the years go by. But exactly the opposite has happened. Organizations regulated this zone of uncertainty by means of ticketing systems that minimized an IT specialist’s control over how to prioritize demands. Nowadays, some of them describe their workday as like a hamster’s wheel.

In production plants these highly skilled repair crews were crucial to quickly solving machine or process problems. Choosing which machine to mend first or whether to leave the dining table when an emergency occurs during the lunch break – the ‘sacred time’ protected by a works agreement – were sure signs of growing power, especially when machine parks aged and repairing needs increased. But once again, it has to be said that these experts have not risen to become kings of the production plant. Their organizations have found means of controlling them, such as tightly timed schedules for proactive maintenance, and those ingenious problem-solving artisans are now following SAP-steered workflows as if they had become cogs in the production wheel rather than specialists who can negotiate favors from assembly line teams and production heads for solving problems fast. Organizations have again streamlined a once influential function to avoid too much dependency.

A clear path ahead?

The same pattern is already emerging for Medical Affairs – in the shape of inflexible data-slide decks, rigid contact quotas, and detailed reporting schemes that emphasize quantity rather than asking about the rationales behind the doctors’ behavior. But in this organizational powerplay Medical Affairs should use one key factor as leverage: Both their attractiveness as a partner to physicians and MAFs’ expertise in understanding and explaining the treatment landscape to their R&D and Commercial peers are directly linked to a certain level of professional legroom. The crucial performance their organizations try to achieve through regulation will most definitely be diminished if Medical Affairs is too strictly restrained. Deciding not to trust but to regulate Medical Affairs will come at the cost of the trust physicians have – that they will get less biased information from Medical Affairs and thus entrust truthful information on their therapeutic rationales to them in return.

Productive schizophrenia

A discourse-based approach to this not easily led crowd of experts is more likely to bear fruit than another round of KPIs. Pharma executives need to understand this, and Medical Affairs’ leadership needs to make their position heard. There will most certainly be no chance of re-gaining the degree of maneuverability they used to enjoy. However, any changes in the way an organization communicates with doctors, for example, should be developed hand in hand with field teams and not regulated from above. Insights need room to be discussed and reflected – not solely fed into systems.

Well-designed processes can help to ensure Medical Affairs personnel view partnership in two ways – toward their commercial counterparts in developing a stronger sense of being part of their company’s business (e.g. by knowing and understanding the revenue relevance of compounds and indications) and toward doctors when trying to more thoroughly incorporate their perspectives into a pharma company’s strategy and go-to-market model.


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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Claire Terrington

Claire Terrington

is a Senior Consultant at Metaplan and specializes in leading collaborative processes and projects on life science topics, particularly in oncology and hematology.

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