Pharmaceutical Physician Career Paths Explained: Pros & Cons

You’ve seen enough physician-directed advertising and probably enough direct-to-consumer drug commercials, but have you considered what things are like for physicians who actually work for the pharmaceutical industry? What is their typical day-to-day compared to physicians in traditional clinical practice?

Large Pharma vs Small Pharma vs Contract Research Organizations

The first categorization of physician industry jobs is the nature of the company. Is the company a traditional large pharmaceutical company, a small pharma/biotech company, or a contract research organization (CRO)?

Large Pharma

There are no set objective criteria to define a large pharmaceutical company, but typical large pharma include familiar players such as Pfizer, Merck & Company, Astra-Zeneca, and Bristol-Myers Squibb. One source defined large pharma by sales of $10 billion or more annually.

Small Pharma

Similarly, there are no universally accepted definitions for small pharmaceutical companies. One source uses the definition of less than 500 employees as a definition of small pharma or biotech companies. Examples of small pharma/biotech include BlueBird Bio in Cambridge, Massachusetts, or Arvinas in New Haven, Connecticut.

CROs (Service Providers)

CRO’s are the service providers for both large and small pharma companies. These services cover the entire gamut of drug development, from finding and signing on institutions and physician investigators into a clinical trial, data management, patient safety monitoring, clinical trial lab processing of blood and other patient specimens, regulatory filings, etc.

A typical entry level physician would start at the associate director level. The next level of seniority in a typical pharmaceutical company would be director, followed by senior director, executive director, and then vice president.

Let’s break down the pros and cons of both large and small pharma.

The Pros of Working for Large Pharma

1 | Big Benefits

Extensive benefits are the norm for large pharma employees. Besides generous health insurance, additional perks may include free college consultant services for the high school aged children of employees, free admission to certain museums, and even pensions (!) are still offered by some companies.

And when traveling internationally for work, most companies will allow you to fly by international business class, allowing you to enjoy the perks of a lie-flat seat to sleep on as well as the opportunity to accumulate loads of frequent flier miles that you can use for your own leisure travel.

2 | Stability

Since large pharma companies have multiple drugs in development and multiple drugs that are already approved and generating sales, the failure of one clinical trial does not automatically mean massive layoffs.

A small company that has products that have not been approved and is putting all their remaining resources into one key trial will be in serious trouble if the trial fails.

3 | Extensive Pre-Established Operating Procedures

Large companies will have policies and guidelines for almost anything, ranging from how to handle requests by physicians for supporting their own research proposals with company drugs to directions on how to report social media leaks of company confidential information.

4 | Support of a Large Network

If a physician setting up a new clinical trial wants to consider extending the study to, say,  Wakanda, there will likely be a colleague in some office somewhere who has done just that and can guide you on the appropriate next steps.

The Cons of Working for Large Pharma

1 | Bureaucracy

The extensive standard operating procedures of a typical large pharma company that can provide you guidance in times of uncertainty will, unfortunately, also slow decision making. It is not unusual for a large pharma company to take months of multiple committee meetings to make a decision that a small company could make in one afternoon.

Similarly, it is not unheard of for a seemingly straightforward decision to be made—such as which hotel in which city to hold a scientific discussion with outside academic leaders—when suddenly an obscure function within the company raises an objection to the venue at the eleventh hour.

2 | Subspecialization

A physician in large pharma may be ultra-specialized, such as a physician who only deals with early stage bladder cancer. While on the one hand these physicians really get to know the nuances of their field, they will miss out on the broader knowledge of different cancer fields or even different diseases compared to their counterparts in small pharma or in CROs.

The Pros of Working for Small Pharma

1 | Less Bureaucracy

While large companies will have endless committees and subcommittees that may take months for seemingly simple decisions, small companies are more streamlined and can make decisions much more quickly.

2 | Rapid Advancement

Unlike large companies, where there may be multiple individuals per department who have been in their position for decades, small pharma personnel and roles are more flexible, allowing the opportunity to rise rapidly in the ranks.

The Cons of Working for Small Pharma

1 | Less Job Security

Many small pharma companies have no approved drugs, so they have no revenue from drug sales. These same companies may have as little as a single drug in their pipeline. So if their only phase 3 trial fails, the company may fold.

2 | Bias From Large Pharma

If a small pharma employee is seeking a position with a large pharma company, some of the large pharma hiring managers may mentally downgrade the current title of the applicant by one level.

For example, if an executive director at a small pharma is applying for a vice president position at Acme Large Pharma Co., the Acme hiring manager may view the applicant’s small pharma experience as being only equivalent to a senior director at Acme and automatically reject the applicant as being under qualified to apply for a vice president’s role.

The Pros of Working for a CRO

1 | Variety

Working for a CRO gives you the opportunity to learn about multiple therapeutic areas. Since CRO’s often seek different disease areas from big and small pharma clients, the CRO staff may be working on a cholesterol drug for 5 years then switch to supporting the trial for a cancer drug afterwards.

2 | Lower Barrier to Entry

For physicians who are considering the switch from clinical practice to industry, getting one’s foot in the door is often the greatest challenge. Big pharma tends to want physicians who already have industry experience—if not as an employee of a pharma company, at least as an investigator in a company-sponsored trial.

The Cons of Working for a CRO

1 | Blame without Recognition

Working for a CRO may mean having to accept blame without being recognized for your success.

If you work for a CRO on a study sponsored by Acme Large Pharma, you may be the one to take the heat from Acme if there are problems with the trial, such as having a large number of patients withdraw from the trial. Conversely, if the trial goes as planned and succeeds, your masters at Acme will take the credit.

2 | Bias From Large Pharma

Similar to physicians in small pharma seeking a position with a large pharma company, the large pharma hiring managers may mentally downgrade the title and nature of work of an applicant from a CRO.

For example, there was a vice president at a CRO with decades of industry experience who was applying for a VP role in a traditional large pharma company. While this applicant’s experience was acknowledged, the hiring manager at the large pharma company informed him they considered his CRO title only to be their equivalent of an executive or senior director, so they would only hire him at the executive director level.

Physician Roles within Pharmaceutical Companies

Physicians can find a role within any aspect of the industry. There are pharmaceutical physicians with extensive basic science experience who may only do bench work for their company. Or there may be physicians with a strong business background who are involved in the commercialization of already-approved drugs.

But more common roles within industry include clinical development, drug safety/pharmacovigilance, and medical affairs.

Clinical Development

Clinical development is charged with the design and administration of human clinical trials, with the goal of generating strong safety and efficacy data to convince health authorities, such as the US Food and Drug Administration to approve your drug for specific indications. These roles can involve collaboration with basic scientists, outside academic physician thought leaders, and health agencies.

Pharmacovigilance (Drug Safety)

Pharmacovigilance physicians are tasked with monitoring the safety of subjects on experimental treatments. These physicians work closely with their clinical development colleagues to provide an independent eye for possible safety issues with a new drug.

Medical Affairs

“Medical” folks are the physicians (and sometimes nurses, pharmacists, or PhDs) who support the sales representatives. Oftentimes, they will accompany the sales reps to visit doctors in hospitals, clinics, and offices.

Medical Affairs will also be involved with setting up the so-called drug dinners, selecting appropriate speakers and handling the invitations. Medical Affairs physicians have also been called the “interpreters” between company research and community physicians.

Pharmaceutical Industry vs Clinical Practice Compensation

A starting salary in the industry could be on par with that of a primary care physician or a step down from what a surgical specialist makes.

A typical starting compensation, which includes a base salary and a bonus, as well as stock or stock options, is $300-400K. However, hours tend to be more regular than clinical practice (e.g., working on major holidays is only expected for key deadlines, such as preparing an FDA filing), and hours are much more regular than those of a surgeon.

And for those working for a small pharma company, you have the potential to make a lot of money through the appreciation of the value of the company stock or options you receive.

What Is a Typical Day in the Industry Like?

Unlike clinical practice, where you may start the day getting sign out from your colleagues who were on call the night before at 6 or 7 in the morning, a typical pharmaceutical physician would start the day at 8am or 9am, reviewing emails that may have come in overnight or reviewing their meeting schedule for the day.

Expect that a great deal of time will be spent in meetings of various sizes. You should also expect to travel, both domestically and overseas, for about 15% to 40% of your time.

How a Find Pharmaceutical Work

The greatest challenge in getting your first pharmaceutical position is getting your foot in the door. Most posted roles in places like LinkedIn and Glassdoor state an expectation of some level of industry experience.

So, for physicians contemplating a switch, there are a few things to do to gain relevant experience while still in practice:

1. Serve as a member of your hospital’s institutional review board. This will give you the opportunity to review many industry study protocols, enabling you to gain an understanding of how such trials are designed.
2. Sign on as a sub-investigator with a colleague who is already the principal investigator in an industry-sponsored trial.
3. Apply for a company’s investigator sponsored research grant if you have your own academic research interest. Consider studying that biological problem with a pharma company’s drug by reaching out to their medical affairs group and asking how to apply for one of their clinical research grants.

Additional Considerations

For physicians who are curious about jobs in the industry but are unsure, it is quite feasible to put seeing patients on hold for a few years to try it out. As long as continuing medical education and state licensure requirements are met, it is always possible to return to clinical practice if you ultimately decide the industry is not for you.

How to Determine the Best Path for You

Med School Insiders has helped thousands of premeds and medical students design and achieve their ideal career paths. Our team of physicians has been where you are now, and they became top of their class, were accepted at their top-choice medical schools, and matched into the nation’s best residency programs. And we’ll teach you step by step how to do the same.

Learn how we can help you make your physician dream a reality.