Out of the MDT* and into the CVT**: 5 things I wish I knew when moving into Pharmaceutical Medicine

I learned this the hard way when I started. I made the mistake of assuming (to assume is to make…you know the saying) that I didn’t need to tell anyone about it, because I was free of “clinical” medicine. I was so delighted by my foray into pastures new that I failed to do some basic research on what was expected of me and there really isn’t that much guidance around, anyway.

Key learnings:

• You must tell the GMC what you are doing. You cannot just wander like a lone wolf through the forest of industry answering to no one (despite what you might hope): you need a recognised designated body (if you want to revalidate) and I would recommend speaking with the Faculty of Pharmaceutical Medicine (FPM), however it can be someone else. The GMC website has a tool to help you find a suitable designated body: https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/my-db-tool
• Importantly, just because you are not providing day-to-day patient care does not mean you are not ‘practising medicine’ and subject to GMC requirement – there is specific wording around what this constitutes.
• Additionally, if you have no GP or specialty training status and are new to the register (like me) you will need to work under something called Approved Practice Settings for your first revalidation cycle, and you are assigned a supervisor to check on how you are doing. Here is a link to a page on the GMC website on Approved Practice Settings: https://www.gmc-uk.org/registration-and-licensing/the-medical-register/a-guide-to-the-medical-register/approved-practice-settings
• It is against GMC guidance to work without a designated body/APS status – it nearly landed me in trouble!

To be fair, I did know this information when I joined industry, but felt it was worth discussing, especially as we all know how much medics love a few letters after our name. I did ask FPM if I could do PMST with my humble 2.5 years, but I was told it was not feasible, as this is GMC-mandated, and I moved on. If you find yourself in a situation with less than four years under your belt, please don’t be put off – there are still plenty of options.

If you do find yourself in this position, one thing I would wholeheartedly recommend doing is the Post-Graduate Course in Pharmaceutical Medicine (PGPCM) and then take the FPM Diploma in Pharmaceutical Medicine (DPM) exam.  The PGCPM is a fantastic, immeasurably useful course on the whole spectrum of pharmaceutical medicine (particularly if you have been enjoying the warm comforts of medical affairs for the past few years) and learning materials that I genuinely reference and use day-to-day. I did the ‘Cardiff course’ run by the British Association of Pharmaceutical Physicians (BrAPP) and would highly recommend it, but there are other courses out there too. Oh, and passing the DPM exam satisfies that ever present hunger for letters after your name – you get three!

Whilst getting your PMST and being accepted onto the GMC Specialist Register is undoubtedly a totemic achievement, gaining breadth and depth of experience that can help you progress incredibly far in the industry. The specialty training badge isn’t required for all doctors working in our discipline, which is a big difference from the clinical world. Therefore, don’t be put off if you can’t meet the four-year figure, but think about how you could reach this before entering the industry.

When I joined industry, one of things that surprised me was learning how to redefine what I perceived to be adding ‘value’ at work. In many ways, clinical medicine is black and white: you either know how to spot an NSTEMI on an ECG or you don’t, you know how treat DKA or you don’t, you are an F1, registrar or consultant and most hospitals have predefined treatment protocols for specific conditions or emergencies. Things (mostly) fit into discrete boxes and you work your way through this neat structure at predefined intervals. It’s really what you know, and your ability to withstand endless examinations and sleep deprivation, rather than how you show up, how you integrate into your team and how you develop yourself. There is also a certain level of recognition and status achieved from simply being a doctor and all the work that went into it.

Pharmaceutical medicine, on the other hand, functions a lot of the time in the grey area. No team structure is the same, no disease area is the same and depending on the size of the company or the lifecycle of the product, you will be doing things for the first time and be expected to come up with ideas, be creative and “muck-in”.

You will be a thrust into teams with highly diverse, educated people with PhDs, MBAs, and years of experience from all walks of life that simply don’t quite care that you spent the last three years answering bleeps at 3am with only a stale digestive thrown your way the whole night shift. This isn’t to say they don’t see the value you add. Quite the opposite. It’s just that the “status” of being a medic at a specific and titled level doesn’t quite carry the same way it does in the clinical setting. Medicine is a hierarchical structure and so it should be, pharma is usually a “matrix environment” where everyone is equal and bringing something different to the table. You might find yourself being the least experienced member of the team and you won’t always have the last word or be the final decision maker. You meet all sorts of people that you learn from, who challenge you and can change your perspective.  How you work with those team members, the kind of relationships you build and how you decide to add value to your team, based on the experiences you have is key. Decide how you want to show up in any team and where you fit, leave the certificates at home (hung up in a reasonably visible place where you can sit and admire your hard work from time to time, I wouldn’t deny anyone that luxury).

I chose this last one as it has been one of the hardest things for me to learn and accept. Although there are lots of challenging aspects to working as a hospital doctor, prioritising your work is actually one of the easiest. Acting in the best interests of the patient is the overriding principle that governs our decision-making: it helps us understand what conditions we need to rule out urgently, what diagnostic imaging we need and which medication a patient should or should not receive. In addition, the process of studying medicine, adhering to the Hippocratic oath, and having the privilege of diagnosing and treating sick patients is a defining, formative experience for most medics.

No matter how long I work in industry and how short my clinical training was by comparison, I will first and foremost be a doctor, and Medical Advisor (or any other such title), second.

I try to hold this at the forefront of my work each day. Sometimes it is difficult, and you can feel very far away from patients, or hard to see that you are making any tangible impact. It can be hard to take when you are working on a project that you know will have a substantial impact on patients’ lives and it is suddenly pulled for ‘commercial’ reasons. It can be brutal and unfair, and you might risk becoming cynical. Don’t. You have just as much privilege to be working in an environment that can truly help patients – in a different way to what you might be used to, but still in a hugely valuable way. You can influence more than one life at a time whereas in clinical medicine it is the patient in front of you that is your focus. Try not to lose this perspective and keep fighting the good fight with your patients in mind. The work that you do and the progress that will be made in your field will be all the better for it.