June 26, 2017

Considering Pharma? Check out the DIA 2017!

pharma reseracherLast year was a big year for pharma at the Doctor’s Crossing. Four of my clients landed great jobs in pharma and I attended the inspiring world-renowned pharmaceutical conference – The DIA Global (DIA – Drug Information Association).

One of my four clients had no prior pharma experience and she is now working happily as a Drug Safety Officer for a large pharmaceutical company. She is proof that you can get into pharma without having experience in clinical trials or research. 

In my on-going efforts to learn more about pharma, scout for opportunities for clients, and get a better feel for the community, I attended the DIA’s annual conference in Philadelphia last year. I was one of 6,454 participants and I loved every minute. There was an electricity in the air which I attributed to being amongst so many bright individuals who are passionate about improving the health of patients in profound ways. Before I share specifics about the conference, I want to give you an idea of positions open to physicians in pharma.

  1. Drug Safety Officer  (Pharmacovigilance)– involved with reported side effects from drugs, labeling, SAE’s (serious adverse events). Can include involvement in preclinical studies. clinical trials and post-market stages. Public education.
  1. Medical Monitor – advises on clinical trials, planning, and implementation. Monitors patients enrolled in trials for safety, side effects and suitability for study enrollment and completion.
  1. Clinical Trial Researcher – participates in and oversees clinical trial design and implementation. Actively involved in running trials and design.
  1. Medical Affairs Director– bridge between drug development, marketing, and public education. Involved with medical information, communication, launch and post-market strategies.
  1. Medical Science Liaison –a knowledge expert in a therapeutic area, develops relationships with KOL’s (Key Opinion Leaders) externally, resource for physicians in practice; educational and communications role. Frequent travel.
  1. Medical Writer– prepares regulatory documents, slide decks, scientific articles, white papers, covers scientific and medical conferences, etc.
  1. Regulatory Affairs Director – knowledgeable about FDA regulations, prepares and submits regulatory documents, negotiates for market authorization for drugs and devices, keeps informed regarding legislative changes.
  1. Health Economics and Outcomes Researcher (HEOR) – concerned with the cost-effectiveness of drugs and devices, value, as well as the impact of treatments on patients.

 For a more complete description of these positions for physicians, please click HERE. (Note – the job opening links are no longer active).

Click HERE specifically for the Medial Science Liaison.

Sameer Thapar (PharmD), Director of Global Pharmacovigilance for Oracle, and one of the speakers at the DIA, shared a simple way to think about the complex array of jobs in pharma. He said, “There are the Makers, the Sellers, and the Defenders.”  The Medical Affairs and Medical Science Liaison positions help to bridge these three areas (my addition).

When considering a transition to pharma, you may wonder whether or not you would miss patient care and if you’d feel like you were making a difference in a meaningful way.

Dr. Kelly Curtis, my former client who now works remotely as a Medical Director and Medical Monitor for INC Research said this about his transition, “I find non-clinical work very rewarding and feel like I make more of an impact on the future of oncology in this role than when I was in academia.” 

I personally know a pediatrician who works remotely for pharma and he does a few pedi-urgent care shifts a month to keep his clinical connection to patients.  Although maintaining some degree of patient care while working in pharma is not the norm, some doctors find ways to do this through volunteering, medical trips abroad, or attending in a teaching setting.

The satisfaction from helping an individual patient can shift to helping entire populations of patients. Dr. Larry Brilliant, who gave the DIA 2016 Keynote address, recounted his fascinating involvement in eradicating smallpox and his on-going efforts to prevent and treat blindness in millions of individuals in developing countries. You can read about his amazing life’s work intertwined with his spiritual journey in his hard-to-put-down new book, Sometimes Brilliant

Here are some of the Hot Topics on tap for DIA 2017:

  • Data/Big Data/eHealth – informatics, data integration, bioethics
  • Disruptive Innovation – innovative science, technology and therapies: stem cells, regenerative therapies, gene therapies
  • Medical Affairs – MSL (medical science liaison), medical writing, medical affairs roles throughout product lifecycle
  • Patient Engagement – patient-centric practices, advocacy, culture, tools
  • Safety – best practices, post-market safety considerations, monitoring
  • Regulatory – advertising and promotional laws, regulatory writing, document management, compliance
  • Special Populations – Rare diseases, pediatrics, women’s health, aging
  • Preclinical and Clinical Development – discovery, clinical research, recruitment, clinical trial data disclosure, outcomes, statistics
  • Value and Access – drug pricing, reimbursement, access, real world outcomes

For additional information on the Hot Topics for DIA 2017 please click HERE.

For the Agenda for the DIA 2017 please click HERE.

I particularly enjoyed a panel presentation on “Big Data” with oncologist Dr. Brad Hirsch, CEO at SignalPath Research. Dr. Hirsch continues to see patients as well as work in pharma in the areas of informatics, innovation and gene-based therapies. You can tell he loves caring for his patients, and also being at the cutting edge of finding cures for the cancers that threaten their lives.

If you’re considering pharma, attending the DIA will give you a deep dive into this area, as well as the chance to make helpful networking connections. And your attendance would be an undeniable indication to any hiring authority of your genuine interest in this career direction. This is just one of a number of ways to increase your chances to land a pharma job.

Even though my time at the DIA was beyond busy, especially since I made a point to network at all of the exhibitor booths (pens anyone?), I left energized and uplifted. Call me pollyanna, but I felt that I was among a large group of people who really care about giving patients the chance for healthier and longer lives.  As physicians, and as individuals with loved ones, we know personally how devastating having an untreatable condition is, or having a poor quality of life due to illness. Pharmaceuticals are, of course, only part of the answer to good health, but when nothing else works, the right drug is truly a miracle.

The DIA 2017 will be in Chicago, June 18 – 22. 

 

 

 

 

 

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Using Your Internal GPS for Career Change

Is your internal GPS telling you it’s time to change your career direction? Is it saying “Recalculate! Recalculate!” but leaving you stranded at the crossroads, failing to provide any further instruction?

If so, it can feel overwhelming, daunting, and confusing.

 

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Uncertainty is uncomfortable. It’s natural to wish for some kind of roadmap to guide us through a process of change.

It makes sense that we feel this way. To become a physician, we had every step mapped out for us. Yes, it was quite a climb, but even Everest has a summit and there is one way up. If you don’t give up and make it to the top, you win. There is guaranteed employment, a career with status, and a paycheck.

 

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There is a sense of security in such a well-trodden path where the finish line is visible before you even start. However, as our high physician burnout rates reveal, there is no guarantee of happiness. There is no certainty that the rules of engagement won’t change or that expectations will be met.

The shifting sand at the top of the seemingly sturdy staircase has left many considering other options. Instead of using the staircase that guided us, we now have to create our own path.

If we were wired like Lewis and Clark, we wouldn’t have gone into medicine. We’d be bushwhacking with Sacajawea by our side, discovering new lands – not practicing evidence based medicine.

But in spite of our predilections, we may find ourselves staring into a great expanse of non-clinical career terrain, wondering where even to take the first step?

Since we don’t have the prefab staircase outside of traditional practice, we have to use a different approach. Siri had the right idea. We need to use our internal GPS. We need to be able to listen to ourselves and hear our own guidance.

The connections may be a bit rusty if we’ve had to push down that inner voice in service of our career. It may take time to start hearing our true inner voice and what we need and want. When we start to listen, we might be confused by the presence of two voices, one coming from fear-based thinking (The False Self) and the other coming from trust-based thinking (The True Self). Here are some identifying characteristics to distinguish the two:

The False Self – fear-based and self-doubting

  • Sees problems rather than possibility
  • Jumps to the “What if’s” – what could go wrong
  • Is accompanied by anxiety
  • Sells your abilities short
  • Has to see all the steps before starting

The True Self – confident and trusting

  • Focuses on possibilities rather than problems
  • Is able to imagine success
  • Creates a sense of calm internally
  • Does not over or underestimate your abilities
  • Is comfortable taking steps without having all the answers

How do we turn up the volume on the True Self and mute the False self?

1. Start noticing anxious, fear-based thoughts. Write these down and note the frequency.
2. Look at the fears objectively and see if they make rational sense.
3. Take stock of all you have already accomplished and the challenges you have met.
4. Give yourself permission to accept whatever feelings you are having. Get curious about their origin, rather than judging them.
5. Practice mindfulness or meditation techniques to help quiet and train the mind so it is not so reactive.
6. Do things you enjoy and love. This will awaken the heart, which is part of the internal GPS
7. Believe in the value of your individual uniqueness. Embrace your path and don’t worry if it doesn’t look like anyone else’s.

Our Internal GPS = an awakened heart + rational, non fear-based thinking

To get started on your career transformation, you don’t need to enter a specific destination into your GPS. You can start with a commitment you make to yourself. It can be a simple statement such as:

“I want to enjoy my work.”

“I want my work to be fulfilling.”

“I want to have quality family time.”

“I want to make a difference in a way that is meaningful.”

“I want to use my creativity.”

“I want to use my brain more and be challenged.”

Your internal GPS will start to work on the initial steps, and as you gain more clarity, keep refining the destination. Staircase or no staircase, it’s OK to “recalculate” so you end up in the right place – for you.

Melissa’s Story Part II – An Obstetrician in the South Sudan

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Obstetrician Dr. Melissa Wolf  shares the second part of her great adventure. If you haven’t read Part I, you can find it by clicking here. 

“After a bit of soul searching about my medical career path, I recently decided to try my hand in international health care. I researched multiple potential options and ultimately found myself in a maternity hospital in South Sudan with Doctors Without Borders (MSF) for seven weeks. Having spent the prior months and years mired in the frustrations of insurance claims, documentation requirements, (un)meaningful use criteria, and curious nursing protocols, I viewed my time with MSF as an opportunity to practice genuine clinical medicine in a new environment. The challenge was great and I was not disappointed.

The adventures began with the simple logistics of living in a third world country. It took four days of travel to actually arrive at my field site and about a week thereafter to adjust to the ten hour time change. The weather was unfathomably hot with temperatures reaching 120 degrees some days and it took over two weeks for me to acclimate. Initially I could barely walk even short distances without having to rest and, on rounds in the hospital I could not stand at the bedside but was forced to sit down or else collapse from the heat. Not a day went by in the entire seven weeks that my clothes and hair were not completely drenched in sweat. In fact wearing dry clothing was one of the most notable luxuries of returning home.

Our conditions were very basic yet livable. There were cold water showers which felt amazing on 120 degree days, pit toilets, and a generator that supplied electricity. I had my own room with a concrete floor, bed, mosquito net, and closet. Food was provided although the options were limited and I found myself eating mostly the same thing repeatedly. We typically had rice, pasta, fruit, lentils, and sometimes chicken or goat meat. I don’t want to imagine exactly how they obtained the goat meat but several times I saw chickens strutting around in the compound that later had clearly become dinner. Breakfast was often coffee, bread, and sometimes scrambled eggs if eggs were available in the local market. There was also an eggplant peanut sauce dish that was not my personal favorite but seemed popular with the other expats.

On any given day I found frogs in my room, lizards under my bed, giant beetles in the sink, and huge numbers of bats flying overhead. One day a bird dropped the large rodent it was carrying out of the sky within a few feet of where I was standing and then scooped it back up again and flew off. The next day the same thing happened with a chicken head. At times the hospital was flooded with ankle deep water, the power was out, and supplies were limited. Even so, I was amazed at how well we managed to keep morale up amongst ourselves and how well we managed to care for large numbers of gravely ill patients.

I lived with a team of 25 people in a residential “compound” and many of the expatriates there were on six to nine month assignments. My specialty being surgical was a shorter length of time. The other expats were from all over the world including Africa, Canada, Australia, Europe, the Middle East, and the United States. Ages ranged from 28 to 65 years and getting to know such a variety of people in the context of life together in a third world country made for an interesting yet complex dynamic especially since we were all living and working closely together the entire time. Imagine going home after a full day of work to spend the evening with your office staff, eat breakfast with them the next morning, and then work with them again day after day for 7 weeks.

The medical facility was very basic yet despite its simplicity we managed to care for some of the most compromised obstetric patients I have ever encountered. There were interpreters to help communicate and the hospital was primarily staffed with local people. The local midwives handled all the “uncomplicated” deliveries including singletons, twins, breech, preterm births, intrauterine demise, VBAC patients, eclamptics, and post partum hemorrhage. I was called to evaluate the “complicated” patients including those with placenta previa, abruption, DIC, hemorrhage requiring hysterectomy, unconscious patients, vaginal triplets, ruptured uterus, and obstructed labor cases requiring cesarean. I was also in charge of managing a large ward of antepartum patients admitted with conditions such as malaria, bloody diarrhea, anemia (as in hemoglobin of 3g/dl), breast abscess, sepsis, snake bites, and the like.

I had rarely, if ever, seen or managed any of the diseases or conditions I encountered prior to my time in South Sudan. There was a basic ultrasound machine, the ability to check finger stick hemoglobin, and the ability to test for malaria. We had a rudimentary operating room (called the “operating theater”), the ability to do spinal anesthesia, and a handful of medications to work with. There was absolutely no patient confidentiality or privacy whatsoever with patients and families often crowded together at each other’s bedsides listening in on daily rounds. Charting was done on a piece of paper at the bedside. Blood pressure, temperature, and pulse were also recorded at the bedside. Diagnosis was made by clinical history through an interpreter and physical exam. Treatment was often initiated with very little information and very few options. Surprisingly patients did amazingly well and many who arrived barely conscious having literally walked in from their village after laboring at home for several days walked out a few days later in good condition. Hygiene and cleanliness were nonexistent; however, surgical wounds did not get readily infected.

Overall the medical experience was unforgettable. I treated extremely ill patients who I couldn’t communicate with, who had conditions I had never seen, in a filthy environment, with unfamiliar instruments and very few resources, and yet they managed to survive. Having no ability to communicate directly with patients except through the interpreter I could not rely on the so-called doctor-patient relationship or establish any sense of rapport. However, for the first time in many years I felt like an actual physician, not just a cog in the wheel of compliance mandates and documentation requirements.

It was difficult, confusing, and overwhelming, but also genuinely fun to think critically and see people recover well. Additionally, it was rewarding to attune to body language, facial expressions, and intuition to read how patients were feeling and what they were experiencing. On one occasion following a c/section for a life threatening bleeding previa I sat with my patient in the recovery area as she stared at me directly for at least 10 minutes. Her child had not survived, but despite three days of bleeding at home before arriving barely conscious at the hospital, she had. We sat together awaiting the completion of her blood transfusion just looking silently at each other. I can’t know what she was thinking but I was internally thanking her for surviving such horrible odds and feeling utterly amazed at her resilience and I felt she understood me well. Ultimately, I returned home feeling my medical training had actual merit and with an enthusiasm for medicine that I had long forgotten.

In general I chose to travel with MSF because their organizational values matched my personal values and this aspect was extremely important to me. The upside was that once accepted into the program I felt well guided and supported throughout my experience. The downside was that it took about six months from my initial application to acceptance, and the assignments required flexibility. Once accepted, I did not know where or when I was going or for what length of time. I had to commit to an unknown assignment at an unknown time for an unknown number of weeks. That degree of uncertainty was a bit unnerving but also added to the excitement of the adventure.

For anyone considering a stint in international medicine I would advise a strong sense of adventure, a lack of squeamishness, a courageous heart, and above all else flexibility. Certainly pairing up with a like-minded organization you trust is also of utmost importance. Both the living and working conditions are very challenging and none of the experience was anything like what I anticipated. Daily life was more difficult, medical care was more interesting, and in seven weeks I learned more about my personal limitations, intuition, and abilities than I ever could have imagined. I will not soon forget the lessons learned on this adventure, and despite its intensity, I do plan to take on another assignment with MSF in the future.”

Volunteering Abroad – Is This On Your Must Do List?

I’d never worked so hard on a vacation before, but neither had I ever come home feeling so energized and inspired. In April I went to Nicaragua with a group of folks volunteering with Austin Samaritans.  You could call it a mission trip, but it was really about being of service to others.  I don’t consider myself a missionary; I just wanted to help out and learn about a new country.

The trip lasted a week and our days were an interesting mix of activities; playing with school kids who live in the local dump, teaching English, working at a safe place for women escaping prostitution, painting little casitas Pepto-Bismol pink, touring a feeding center for malnourished kids and visiting a woman’s cancer ward, to mention a few things.

The day at the dump, which is called, “La Chureca,” was surreal. Our vehicle followed trucks carrying in loads of garbage.  We drove past rows of shacks made out of black plastic tarps and corrugated metal. Over 1, 000 people eek out a living in the dump.  Off in the distance were mountains of garbage being packed down and covered with dirt.  On foot, we wound our way through narrow dirt alleys, accompanied by pigs, chickens and emaciated dogs. We visited a medical clinic in the dump.  It sounds so strange to say that, but there it was, a small, sparsely outfitted building where many of the residents were treated for the pervasive respiratory and skin ailments, as well as other conditions.

Just as out of place as the clinic was the elementary school.  Inside the school playground, kids were wearing blue and white uniforms, playing like all kids do.  Outside the school, other children roamed around the dump like wild urchins.  The school is privately funded and free, but many parents choose not to send their kids, and it seems, a lot of kids prefer to roam. Thirty minutes away from La Chureca, was our homebase for the week – Villa Esperanza.  This is an amazing home for at-risk girls who have been taken from the dump (with parental permission) in order to provide better opportunities through education and life skills training.

One evening at Villa Esperanza we were invited to a dance party with the girls who live there.  It was quite a lot of fun to dance with them and just be around giddy girl energy.  I’m embarrassed to say I would look at them and think, “they are just like any other kids their age” – as if somehow being born in a dump they should look or be different.  But they were just normal beautiful, irrepressible kids with hopes for their future like all of us.  It is the faces of all the children that I can’t forget and will call me back to Nicaragua.

Perhaps you are feeling called to travel abroad and do some service work.  Sometimes it is hard to just get the ball rolling and figure out where to go. If you are so inclined, a good place to start is to ask yourself some questions:

1. Do you prefer a mission trip or a secular volunteer trip?

2. Where would you like to go geographically?

3. Do you foresee wanting to return and have continuity with an on-going program?

4. Do you want to be able to use a second language such as Spanish?

5. Do you want to do medical or non-medical type work?

6. What is your budget and time frame?

7. Do you want to be able to bring children along?

I preferred to go someplace close to Texas, so I could go back on future trips and have continuity with projects I had become involved in. The cost of my trip for one week was $550 plus airfare. The $550 paid for my lodging, 3 meals a day and transportation.

What are some ways to find a mission or volunteer trip?

I found my trip by Goggling “Nicaragua, Volunteering and Austin.” Interesting, in the guidebook I had for Nicaragua, they had a section in each city devoted to volunteer opportunities that were available with contact information.  I had never seen this before in a guide book and thought it was a fantastic idea.

A plethora of options will come up if you Google “Physician Volunteer Opportunities. “

Here are some additional links that may be helpful:

Go Abroad

United Planet

Serve Your World

It seems like eons ago when I went to Africa as a medical student, and way too long before my next volunteer trip (to Nicaragua), but both of these experiences were life-changing for me and unforgettable. I will not wait so long to go again.  If volunteering abroad is something that you have been wanting to do, I hope this will be the year for you.