Pharmaceutical medicine: making the leap

Ever considered working in the pharmaceutical industry? Dominic Smethurst offers an insider's guide

I was a research registrar in the department of dermatology at the Queen's Medical Centre in Nottingham when I made the leap into pharmaceutical medicine. For me, the main attraction was the mixture of science and business that the industry offered. But I was also beginning to feel embarrassed by the standards of NHS care, and I knew NHS research was poorly paid.

I now work as part of a team running and designing clinical trials of new drugs in healthy volunteers. I do not work for the NHS, though occasionally I work with NHS staff. I enjoy the business side of things in the industry, and unlike some NHS leavers who are troubled by the loss of contact with patients, I don't miss the clinic.

I now work in the research and development division of our company--not sales (I do not "carry the bag"). I read existing company protocols and decide how to help make clinical trials work on a day to day basis. I am trying to make them safer, faster, more accurate, and more relevant to patients. I assess ongoing trials and advise what doctors and patients might want, and, most importantly, I try to help the study team to understand how scientific findings translate to real life medicine.

What sort of doctor does the industry want?

Traditionally it's been said that the industry is full of burnt out general practitioners and "failed" medics. This is no longer true; the industry attracts all sorts of doctors with all sorts of backgrounds and skills--not unlike the NHS. Doctors in the industry range from world renowned, Nobel prize winning academics to more junior staff fresh out of membership examinations.

Hospital doctors

Most pharmaceutical jobs require a couple of years' experience in the health service, and preferably a higher examination (MRCP, MRCS, MRCPsych, or MRCPaed). New entrants tend to fall into one of two categories. The first are registrars or senior house officers opting out of the consultant pathway and entering the industry ready and available to work with research and development or the sales force. The second category is the experienced consultant or professor who is opting out of public service and using his or her specific experience at a slightly higher level in the industry. These doctors tend to enter on a particular "ticket": their expert knowledge in a field or their work on a specific scientific phenomenon.

General practitioners

General practitioners' experience counts more in the sales and marketing side of a pharmaceutical company, where a good network of general practitioner contacts can help develop research populations. General practitioners can also help guide the development of sales material and strategies. Such generic experience tends to count less in the research divisions, where a medical doctorate or key publication in a specific field is more attractive.

Job opportunities

There are lots of job opportunities in the industry and some interesting hybrids too; I will try to cover the more typical descriptions. There is no age or experience limit on entry. Job titles are not always the same from one company to the next.

Drug safety doctors juggle emerging epidemiology, basic biological science, medical literature, and clinical expertise to create safety profiles of marketed and developmental drugs. For preventive drugs the safety profile is clearly a large part of the submission package.

Regulatory doctors liaise closely with the industry regulators and exchange information about drug programmes and licensing concerns. They correspond about medical need, efficacy, competitors' advantage, and worldwide impact with policing authorities like the food and drug administration.

Trial coordinators have a very varied set of tasks: number crunching, global coordination, liaising with professors or consultants (identifying key opinion leaders), mopping up problems with ongoing trials, and recruiting patients.

Medical science advisers advise on the state of the art literature and understanding of disease, usually within a certain specialty. They advise anyone from preclinical laboratory scientists through to marketing executives and representatives--though these are often divided into separate adviser roles in the marketing and research and development side of the industry.

Directors typically manage teams of the above along with non-doctor scientists and administrative staff. Directors operate at specific levels within development, from early stage preclinical work through teams that translate that work into medical activities through to teams that coordinate large scale efficacy and safety studies.

Project doctors are strongly attached to a particular compound and chaperone it through its various stages of clinical development. This can be a local role lasting a few months for one trial, or it can be an international role lasting years during the development life cycle of a drug.

Terms and conditions

Talking frankly about money is part of business. I earn the same as a registrar at my level on a middle banding. On top of that I get a car allowance, dental and health cover, pension, life insurance, company credit card, and free access to more than £7000 a year for training and conferences. Experienced pharmaceutical doctors will tend to earn more than consultant paediatricians and general practitioners and less than interventional cardiologists or plastic surgeons. Pharmaceutical doctors will tend to work as hard but not necessarily at the same hours of day or at the weekends (although there are exceptions). Bonuses are 3-40% of salary and average around 10%--they are usually based on individual and company performance over one year. AstraZeneca's salaries are benchmarked and tend to fall in the region of other companies' remuneration policies. Competitors operating in the south east of England have to compensate slightly more than those in the north.

Career prospects

If you have ambition and interest then do not expect to be doing the same job in four years' time. You may be in the same company, but it is likely that you will have been promoted and quite possible that you will be working in a different region. Good registrars and consultants in the NHS often move around too, but in the pharmaceutical industry the moves tend to be either national or international.

Training

You will be trained in all features of the industry from marketing through to research and development and even some accounting. Training is usually combined with service provision in the industry; profit making organisations have fewer super-numerary posts. Formal training tends to take place in good hotels and fully catered conference rooms. It is often carefully thought out and professionally delivered while attempting to be as practical and non-didactic as possible. The most common focus of training is the considerable amount of "legal" and regulatory work involved in drug research. If you loathe bureaucratic legalese then this industry may not be for you. Most large companies will pay for all necessary training without blinking an eye.

Travel

Most doctor researchers will travel for about 5-15% of their time in the first few years. Trial coordinators and marketing doctors will travel more than this. Beyond about four or five years of experience you may have to travel for around 15-20% of your time. I know several people who travel for more than 30%. Travel brings with it fresh opportunities (such as experience of other health systems and cultures) but can be stressful (late night telephone calls home, dehydration, the tedium of airports).

National training numbers

Surprisingly perhaps, national training numbers (NTNs) are available in the industry. Competition for numbers is non-existent as numbers are not yet limited. If the job you are doing is important enough (most jobs in large pharmaceutical companies are) and you are doing it well enough, the college will issue you with an appropriate number. Both the NTNs and the certificate of completion of specialist training (CCST) are almost certain to be non-transferable with regards to returning to the NHS, although they are highly portable when moving from one company to the next.

Burning boats

A common worry about working in the industry is that it could make it hard to return to the NHS later in your career. Industry work still does not count towards a career in the NHS. However, returning to the NHS at registrar and consultant level seems to be easier now as long as you had reached that level before you left. Interview boards tend to find industry experience intriguing, and they may well view your newly acquired business acumen as a bonus within an increasingly fiscal NHS. I do not intend to return to the NHS. However, several of my colleagues have recently chosen to do so with reasonable success and, notably, they have done so having negotiated a better job to go to.

Making the leap

There is still a great deal of ignorance about what medics do in the industry, and this must put many doctors off "making the leap." Some will worry about a perceived loss of status or ethical standing.

But the skills and challenges of the industrial doctor are similar to those of the hospital doctor. The pharmaceutical industry is massive and there are plenty of opportunities--many of which I haven't mentioned here (such as biotechnology, contract research organisations, and consultancies). It will take strength of character and courage to launch away from an NHS job and move into industry, but most find such changes in direction worth while. If you then return to the NHS you will probably do so with experiences and insights that many healthcare professionals would envy.

A typical clinical trial problem (details have been changed) Two out of 20 volunteers develop "halter monitor" heart rates over 150 beats/min during a snooker game. This occurs in the middle of an overnight stopover during a phase 1 clinical trial. The nurses running this trial are concerned about these possible cardiac effects. A company safety doctor phones me to ask what is going on. In response I assess the data and speak to the volunteers, who were asymptomatic throughout. I discover that the tachycardia was less than 10 seconds in duration for each volunteer and that the drug reached its maximum concentration 24 hours before this incident. Circulating drug concentrations during the incident were, at a rough calculation, less than one tenth that of the maximum circulating concentration they had been the day before, when there was no tachycardia event. The drug is a "me too" competitor for a well known class of agents and is therefore not known or suspected to have any class effects related to heart rate. I tell every one I think there is no problem and sign a safety record, which is required for regulatory practices and also good clinical practice (international conference on harmonisation, www.ich.org). Just like any doctor, I take a history, make an appropriate examination, and inspect the relevant clinical data while placing these findings in the context of what I know about the trial, the volunteers, and pharmaceutical medicine. But the focus is shifted slightly as the important liability is the drug-which in some situations could make or lose a company up to $8bn (£4.50bn; €6.50bn) a year. The health of the subjects, although paramount, was never really compromised.