Darshan
Hey everyone, welcome to another episode of DarshanTalks. I'm your host Darshan Kulkarni. It's my mission to help you trust the products you depend on. So as you know, I'm an attorney, I'm a pharmacist and advise companies with FDA regulated products. So if you think about drugs, wonder about devices consider cannabis or obsessive pharmacy is the podcast for you. Since I'm an attorney, I have to say this as always, not legal advice. And if you want more specific advice, feel free reach out to me, but also reach out to our guest today who is fascinating and I've known her for a while and I'm really excited to have her on this the first time she's doing this for us. So thank you do these video podcasts cuz they're a lot of fun. And I find myself learning something new every single time. But it would be nice to know if someone's listening. So if you like what you hear, please like, leave a comment, please subscribe. And if you are enjoying the conversation you think someone else might enjoy, please share. You can always find me on Twitter at DarshanTalks or just go to our website at DarshanTalks calm. So what's today's podcast about our podcast? our podcast, our live stream today is about medical affairs. We're going to talk about it not just at a US level, but at a global level. So if you are in medical affairs, if you are trying to figure out and level set, what is your organization doing versus what others could be doing? You care about today's discussion. Our guest today is the principal at zS in charge of the global medical affairs consulting practice. I'm really trying to go quickly so you don't have to hear the ambulance noise. But hopefully it goes quickly. But she is like I said the principal adze is in charge of the global medical affairs consulting practice. And I've known her for a while and she's incredibly brilliant, incredibly charming. So you're, you are in for a treat. Funny enough, we have friend Lynn saying hello. So our guest for today, Sarah Jarvis. Hey, Sarah.
Sarah
Hey, Darshan, how are you?
Darshan
doing? Well, thank you for asking. Thank you for coming on. How has How have you been in the chaos of COVID, because I've had a chance to catch up with you.
Sarah
You know, I think like many, many people just trying to get through, we're really busy, I would say from a work perspective, because medical affairs is growing by leaps and bounds at our clients. On a personal note, as I shared with you a little bit, it's been a really, really tough time. You know, unfortunately, a dear family member, even this week was in the hospital again, not with COVID. But one of those cases of delayed care due to due to its I know tons of people are struggling. But uh, you know, I light at the end of the tunnel, maybe I hope.
Darshan
I feel like we keep saying that, though. We said that last time, then the Delta version came. And now I was sort of seeing the impact of that. But I'm, I'm already told a case by when I read these articles that it's, there's something called lambda barian. And it's lambda and delta coming together. And there's like a new variant coming out of that. So let's see how that goes.
Sarah
Horrible sorority fraternity. I don't, I don't really know you know, all the names, but it can be a really bad movie.
Darshan
But But I have a question for you kind of intimate this when you said this a second ago, which is you you talked about how medical affairs functions are are expanding and growing. That seems counterintuitive to me because in the end, I've always thought that medical affairs you obviously there's a there's a huge component that that's based in the it's not a field force and then there's a field force itself. Are you seeing both components expanding? Or are they just changing? Is there like a new remote MSL or medical affairs force coming out?
Sarah
Okay, that was a lot of questions. are shutting This reminds me of when we used to go to da and all those conferences and sit at the table and gather people around us and keep talking. But, um, I think I personally have seen from COVID. Right, the effects of COVID on the pharma medical device overall, there's just been a shift to medical AI, I would say it's pretty much at the expense of away from commercial. Really? Yeah, for sure. Certainly in terms of interactions. But I think it's I, my personal take and I guess I should have said, I'm not a lawyer. But and I'm not representing zS. I'm representing myself here. But
Darshan
I will add those disclaimers. You can add
Sarah
all this, you even know how to do it correctly because you're a lawyer. And but you know, I think the big difference here is in COVID, and this was a trend that we were seeing, you added, this is not like bold advice. I love it. And you know it in COVID, there was a shift of we still need our questions answered. Right. And more and more people want reliable information at the source trusted advice. And I think that's where medical is really stepping in. And I would say even stepping up, I mean, McKinsey talked about a couple years ago, I think it was McKinsey who coined it, it was medical is the third pillar, right? So you have the development organization, you've got the commercial organization, and you've got medical affairs. And certainly what I've seen over the last year and a half plus at this point, is, you know, Summer of two and end of summer 20 80% of the companies we were talking to sorry, of the companies we were talking to, which is that point probably above 40, right, our backup to 80% access with chaos, and the physicians that they're interacting with. I don't have data on the commercial side, but it's way lower, way lower. And I mean, medical, from a field perspective, you're getting 30 minutes, on average, with top thought leaders. On the sales side, you're at under two minutes on average, I think in most cases, very, very different types of interactions. But I think the biggest change, because you asked a lot of questions, so I'm following up here. But I think the big thing that's here to stay is not just the field piece, but the idea of customer engagement, and medical education, and all of that actually becoming even more of a self service. So from a content creation standpoint, so the folks who are internal and medical affairs, figuring out how to digitally engage with whomever their customers might be. And you know, my own personal biases, that it's not just the top k wells, right, that there's a huge, diverse group of stakeholders, external, who would benefit from some type of engagement, whether it's self service through content, or through the field medical channels, that they would benefit from that.
Darshan
But there's so many questions just kept taking. My first question to start off with, I'm afraid to ask because each, each one of them just goes down a different rabbit hole. But let's start with the first one. Um, who to engage with, and you talked about how you're moving away from the top? That's an interesting statement to me, why would you stay away,
Sarah
I wouldn't say away,
Darshan
oh, in addition to maybe that's a better way
Sarah
is, you know, I can't I wish I had a whiteboard behind me. But I missed my whiteboards, you know, you've got a pyramid, right? national, regional local, that pyramid is, first it's going down, or that triangles going down. So there are lots more local opinion leaders. And then there's also this idea of actually turning it on its side and seeing a whole pyramid. So you've got in the US payers, you've got IDN, leadership you've got, of course nurses and other health care professionals, you've got digital online influencers, you've got a whole host of different all use the word customer in print, you know, in quotation marks, but customer groups that medical is potentially engaging with.
Darshan
So this again, as always, so many questions, each rabbit hole, okay. The thing you mentioned, is going after specific audiences, you talk about payers, it ends, nurses, digital influencers, let's start with the first one visual influencers. That's a very potentially problematic area to get into. Because Are you still in medical affairs? If you're doing it almost as marketing? How do you find them? I'm not talking about specific companies, and I'm not talking about how zS does it? But how do you find companies in general, identify these influencers? And what do you find that goal to be?
Sarah
Alright, right. Lots of questions. Again, I actually have some data. So we just, I think yesterday, we haven't gotten it out yet, but we just published our 2020 outlook report for medical affairs. And I wrote it down actually, because I wanted to share this. It's 1/3 1/3 of the over 100 people we talked to in the industry, are tracking digital online influencers 30 of the medical affairs function. They're tracking them. And they're, I think most companies are still figuring out how to engage them, but they're at least tracking them now. So what does that mean? So a digital online influencer? And I can see there, Shawn, I understand the question of it's a little scary to talk to these folks. Right? Like, yeah, and I really don't think we're talking about like the Kim Kardashian 's of the world who are just, you know, wildly texting, you know, things without clearly not paying attention to the guidance that she does. But I think that the way I look at it is, you know, I am related to a lot of folks who read misinformation online all the time, right? If you have digital influencers, maybe they're part of a patient advocacy group, maybe they are Junior physician, physician, Junior thought leaders who are at ASCO and have 15,000 followers, what if they're not? What if they don't understand and people are following them, you need to engage them in a productive and appropriate way. Like this is not marketing. This is making sure that people with really loud voices aren't out saying things that don't make sense. Does that make sense?
Darshan
So I want to ask a follow up, but Lynn has reached out. So here's the plan. So is a thought leader still the correct term? Or do we need new designation?
Sarah
I love it. And I think we need a new designation. I think most company, I think thought leader can be a portion of the overarching group that that medical affairs is engaging with. What I would love to see is also a just a blurring and forever getting rid of this notion of field medical and engagement and other engagement and just having that having a single group that's focused on how to do that best was that I think that the lines are blurring. Darshan, you've texted me, right? on the phone. We've we've even eaten together at conferences many, many years ago, right? It doesn't matter how we interact. Yeah, I've I've watched some of your podcast. Yeah. Right. And that's that's engagement, too.
Darshan
So but but there's a difference, right? Because if you're engaging in person, it's a very different feel to the conversation. Oh, yeah. The rules are different. would you would you agree or disagree? And if so, do you think that combining them? People will say, well, that's just not my job? I don't know why I'm here in this meeting. Because that's just not what I do.
Sarah
You're right. Sorry, I misspoke. And I'm not talking about combining the jobs. I'm talking about making sure that those groups are not siloed anymore. I think they should be I think med info field medical would do well to have a single lead, for example, maybe pulling in, potentially the Medicaid programs that are digital and somehow engaging.
Darshan
By the way, Lynn did say I agree. So nice. So let me let me ask you this, this other question, which is what you talked about these other stakeholders, and you talked about nurses, I obviously have a bias and that biasing pharmacy. So I'm going to ask you about that bias, because I just spoke to a individual sales, and it's a large company, and they basically came out and said that, well, they didn't come out and say but she was telling me in an informal conversation, that they're engaging more and more with pharmacists. My experience as a pharmacist is very different from that. And again, my experience is going back and maybe a little bit more dated. But the fact is that in the hospital for sure. We rarely if ever saw either MSL or commercial commercial people. And when I was in retail, I just never saw them. So my question is, are you seeing a pivot? If so what's causing the pivot?
Sarah
And yes, and I would say that that is probably dated certainly from an MSL perspective for certain teams. I mean, it depends so worried. If the pharmacist is a key stakeholder in the decision making it makes sense to make sure that they have access to Information and, you know, I I view I really view what medical affairs is doing is making sure that all the key decision makers have access where they have questions. Right? It's a it is strictly non promotional. So for anybody dialing in who isn't familiar with medical affairs, it is a non promotional role. But they have a key, you know, I view it as like a mantle, I saw an article one time with Superman, and now you're like, you've got your cape on and you've got this huge challenge to make sure that people know you're there and can ask questions and be confident that you will give accurate, non misleading non promotional information back, right. So, yes, to pharmacists, that that's already a trend that's happening. I didn't mention them. But that's only because I didn't mention all the different roles. And then I think, Oh, goodness, you asked me another question Darshan, and I've forgotten to
Darshan
ask compound questions. I don't expect we're close. As long as we close around the ballpark. That's good enough. I don't remember what I asked either. Okay. But but I'm gonna challenge you there. Because I recognize that my experience could be dated, but but I spoke to a couple of different pharmacists. And the most common response I get is, what is medical affairs? Or what are my cells? I don't know what the distinction is, when I explain it. And this is coming from someone who's actually applying for a job as an MSL and she was like I don't really want to go into industry is like, why is that? Well, I really want to use my clinical knowledge will be in medical affairs go become an MSL? Well, is that basically like, like sales? I was like, No, no, it's supposed to be non commercial. And she goes, Yeah, but but you know, really, I was like, I know it's there's no, really there's no wink wink, nod nod. Yeah, exactly. Yeah. I guess my question is, if she didn't even know what that role was, yep. And you have to explain that, obviously, that penetration hasn't been happening as well as industry things. And
Sarah
there, I think it's a very fair. I've thought for years about, you know, leaving zS and going and starting a MSL training. I never did it, I'm never gonna do it. But you know, those do exist. I you know, and I think there, there's a place for them. And the, one of the things we've been doing, and it's a teeny tiny way, but I think pharma and med tech, biotech all could get more involved in this. We've actually done a pharma overview, what is medical affairs, one on one with a couple of different pharmacy schools? Oh, okay. Just to explain, because I do think it's a huge avenue for for many candidates, whether they have pharmd, ease or PhDs, MDS, certainly in Europe, I mean, it's way more heavily MD focused.
Darshan
solution, saying I've personally seen more Clinical Pharmacy engagement, the oncology space? Um, I agree with that statement. Actually, I feel like the oncology pharmacists get far more engagement. I would say everyone else doesn't. And that's just been an experience component.
Sarah
I think that makes sense. I mean, if you look at the, also the teams, you know, the biggest teams out there, I mean, we did an analysis earlier this year. And the we, I think I've talked to you about it before Darshan, we've Oh, NDA does have student chapters. So that's good to know, when the, we should just invite Lin in. I don't know if we can do that. All right, next time next time. And the Oh goodness. What was I saying? Oh, we have we've kept track of ratios. So you'll like this starshine in 2014. The ratio of sales reps to msls was 10 to one. Now I'm gonna admit I'm not great at ratio math, but it's now eight to one. What does that mean? It means there's a closer ratio. There are fewer sales reps out there for every MSL but what we've seen especially in areas like oncology, it can be five to one. Wow. even seen two to one.
Darshan
Whoa, okay.
Sarah
Right. Um, we're talking about we're not talking to huge companies in those cases, but, you know, we've worked with over 100 different companies in the past three and a half years. So I've seen a lot of
Darshan
your small company just emerging, right? So yes, is this tiny I
Sarah
mean, like two people know, exactly. It's It's fun. We've gotten to see a lot of growth. It's it's been really cool.
Darshan
Yeah. So So let me ask you this question, which is, we talk about engagement. We talk about this, this rep to pharmacist sorry, rep to MSL ratio, if you will. Do you see a lot the pharmacist now and pharmacy school sort of demonstrate that so do medical schools, I believe pa schools as well, are now primarily, I say, primarily women? I think they do. And a lot of my friends have kind of gone, I don't want to leave my job or anything like that. I want to still be a pharmacist. But I'd like to be able to have a better work life balance. If that's true, do you think we're gonna see more of a direction towards you know, what, you don't need to travel. But you need to be available to answer those calls, like you and I communicated via texting, by emails by all these other platforms. Do we see the MSL role evolving to address employee retention, but also engaging with, with people that want to engage with you know, what I'm thinking about specifically, is the idea that people don't like getting it still, I'm still confused by the fact that people don't like picking up the phone anymore. People are like, just text me and we'll figure it out from there.
Sarah
That's that's my that's the I don't know what the millennial differences. But that's my that's my break where I'm always like, guys pick up the phone. Call someone have a conversation. Okay, again, there, Shawn, you asked a number of questions. in under a minute, I will do my best. So I my personal bias. And this is probably because I've had three kids, right, I have been on maternity leave for almost a full year and a half of my working career. So with that in mind, and then I've worked part time for many, many years. My bias a long, long time ago, was that the especially field medical role could be taken in house in parts of it. Right, that on call idea. That's a perfect potential role for somebody coming back from whatever leave. But I that that is clearly not taken off in big numbers specific to that need that I think you were raising a little bit on the work life balance piece. That said, I do have some data, and I'm going to look at it because I wrote it. Yep. So we interviewed over 200k wells. So typically the people now and you know, lend to your point, it could be thought leaders, it could be a slightly broader base, but basically people who regularly interact with msls, which is typically By the way, historically, about four times a year, because it was always in person. Interesting. We asked about 2021 for the rest of the year and for 2022 and beyond. Guess the percent of interactions that they think with MSL will be virtual. So
Darshan
I'm dealing with Jeopardy numbers. Okay, well out to get close to but not go over a limb Feel free to play along? My number is is six.
Sarah
Wait, no, I'm sorry, do your son of 100 what percent of virtual and the rest would be face to face?
Darshan
70%.
Sarah
You overshot it a little bit? No, it's about 50%. Oh, well, it's about 50% face to face. I'm getting some of the numbers a little bit down there.
Darshan
I just I just want to I just want to inform you I wasn't off.
Sarah
Alright, you know what, maybe the K wells are wrong, you guys. Now, interestingly, what, what you both pointed out, we asked industry personnel as well, what percent would be face to face versus versus virtual? What's interesting is it was actually the inverse of what you guys said. People I think this is a bit wishful thinking they're hoping to get back to face to face more than the chemistry wants
Darshan
to cram this morning that I just don't see it happening.
Sarah
Well, I'm sorry, the people who answered it are the leadership of the mess
Darshan
house. Right, right. That makes sense.
Sarah
It makes sense. But I what I think is interesting, is there is agreement essentially we have really high. Oh, Lynn, I have bad news. She has a new team. So what I was gonna say is we also asked about comfortability and pretty much everybody's comfortable. Except when they have a new team, and they don't have relationships. And that's where, you know, it's what's the heart? Essentially, we asked what's the hardest part of virtual. And it was 86% said when it's a new team that don't have established relationships really, really hard to do virtually. And that's that I think people are getting better at it. We asked about investments and tons of money going into upskilling of field teams to make sure that they're comfortable with virtual because it's here to stay. For sure.
Darshan
As you know, Sarah, this is supposed to be a 15 to 20 minute conversation, we're over, we're over. Because you are that interesting, because
Sarah
it's like it when we're at conferences, and we would sit at a table and go, we have to leave.
Darshan
It's exactly that. We get to have fun conversation. This is the best part of doing this podcast. Of course, so you know, we I'm gonna ask you for questions. Oh, yeah. Before we go there, by the way, let's tell everyone where they can reach you. Yep. At Sarah jarvis@zs.com. Yep. And what we should also point out, I'll just leave that up there, actually. So that, as you know, I'm gonna ask you three more questions. Okay. First question is, based on what we discussed, what would you like to ask the audience?
Sarah
I would love to I mean, we, we talked about a lot, but I mean, I think that key in my mind is, what does that future look like? What are you doing? or wanting to do that, that you have to make sure you feel comfortable in the future? With your collar?
Darshan
I take I take first crack at it if I can, do you have some feedback? Um, so So my first I would say that we're going to go towards remote but I think remote is going to be actually a step in that direction. What I mean by that, I think is I'm part of organizations as our as our you who are already talking about what does the step after that look like? And I'm thinking about some version of AI slash machine learning that kicks in as answers the easier questions before you get moved to the MSL? Who jumps in follows up and has those additional engagements? Because far too often, I've been in situations as a clinician, where you get the question at nine o'clock at night at two in the morning, and you're going, I can't reach anyone, but I still have a patient who needs this answer right now. Yeah. So having those answers handy, in some format would be good right now. And I hate to admit this, but what you'll end up doing is just searching Google to go. Has anyone seen this problem before? And what can I do? So having information from a quote unquote, trusted source, because that's what they're, that's what clinicians do right now, quote, unquote, prestigious industry. I think that's going to be a huge component. I think another component is going to be addressing the issue of trust. I think industry in general does some very good things, but we have bad players. And we have a responsibility to to address those issues both for MSL, but but in general for the industry itself as well. So I'd say those are the two big areas. So automation, machine learning, use use of tools, like Amazon's not going to use the word because she'll go off and know.
Sarah
Or if any Midwestern person says my name, right? They're talking
Darshan
Yeah, exactly. Exactly. I can say that because I don't have Apple but Siri, work, but you get the general idea. So I think that's going to be the next step. Do you see that happening? Or do you think that
Sarah
oh, wait on there, Shawn. That's another 30 minutes right there.
Darshan
Let's talk about layer then. How about
Sarah
Yeah, yeah, I let's set a time because that one, I might need one for that one.
Darshan
Okay, so that was that was my first question. My second question. Um, what was something you've learned in the last month the audience might like hearing.
Sarah
I have learned that I'm taking a break is incredibly important. And I took a break this week. I actually the sounds bizarre. I took off Tuesday afternoon. And all the way through to Thursday morning, my mother and I went on her belated birthday. Oh, and to Carmel, California is beautiful. I mean, I couldn't ever live there because it's so picturesque, but it was just gorgeous. We took the time. I didn't work. We just focused on each other. It was so much fun.
Darshan
Just to be clear, didn't work just just so we can level set a little bit different levels of didn't work my level of didn't work is I will check my phone constantly just to see any if anyone needs anything right now, I will try to ignore it, but I will pretend that I'm doing that. So did you actually check your phone? Or did you actually put that away as well?
Sarah
And that's a fair question. And there are times when I do not check my phone. But my teams know that in advance, I did not check my email. That's pretty good. I did check my phone for text messages, because I remember being an associate at CES 2223 years ago, and waiting for the principal to get back to you. Which is terrible. So I only had four texts
Darshan
to feel. There's the Showtime show that I always imagine your life must be like, I'll have to tell you as ice it's about this guy who who's a principal consultant, and what his life is like it's kind of it's I love the show, but I'll send you with that said
Sarah
you. Never I don't have Showtime? I don't think so. But I will say I don't know, zS. I don't know what your views of consulting are. But we're all so nice to each other. That's my favorite part about CS.
Darshan
Oh, my view of consulting is it's extremely glamorous. That's the word I was looking for. No, I guess that's wrong.
Sarah
Well, maybe even not see us. Okay, fair
Darshan
enough. Fair enough. And the last question, what made you happy in the last week?
Sarah
Oh, well going out with my mom. Good. Um, no, I think the biggest thing was my middle child, Elizabeth was able to go to camp, and she was stock size. outdoors, and they all took COVID tests and they wear their masks anytime they were indoors. And so my worry went down and her joy was just palpable. Which was awesome.
Darshan
That is awesome. Sarah, this was wonderful having you on I hope we can have you on soon again.
Sarah
Yeah, that'd be fun. Well, we've we've got our date with one and AI,
Darshan
wine and AI. That should be the title. Why am an AI? I love it. And we should invite other guests like Lynn?
Sarah
Yeah, absolutely. Well, I don't think I could do it at 9am pacific time.
Darshan
It's, it may indicate other problems. But fair enough. We'll talk soon. Thank you again, sir.
Sarah
Thank you by their son.
Sarah
This is the DarshanTalks podcast, regulatory guy, irregular podcast with host Darshan Kulkarni. You can find the show on twitter at DarshanTalks or the show's website at DarshanTalks.com