What exactly does a medical monitor do?


Pharma can be very confusting when you’re exploring nonclinical jobs.

What exactly does a medical monitor do? How about a drug safety officer? Or an MSL?

We never learned about these jobs on Sesame Street. And when people describe what they do, it can leave you scratching your head.

You’re hesitant to ask them questions because you don’t want to sound stupid.

Today you’re in luck because Dr. Kelly Curtis is here to demystify the position of medical monitor. Dr. Curtis is a board-certified oncologist who worked at Mayo until he transitioned into his current position as Senior Medical Director and Medical Monitor for Syneos, a Contract Research Organization (CRO).

CROs run clinical trials for pharmaceutical companies and can be a good entry point for physicians interested in pharma.

If you’re curious about a nonclinical career as a medical monitor, please read on!

What made you decide to leave practice and transition to a nonclinical career?
There were several factors. I primarily enjoyed the research aspects of my academic career, but the demands of clinical medicine increasingly crept into my protected time for research. There was never any true “protected” time to do research, as I was always being asked to squeeze in extra patients during this time or tend to other clinical demands.

Despite my focus on solid tumors, I was being asked to take call for the Hematology service when there was a lack of coverage, which I found particularly distressing as I was not an expert in Hematology. Other dissatisfiers included the inane demands of the EMR, having to straighten out scheduling snafus, managing conflicting opinions among specialists on how best to care for a cancer patient at the end of life, call, and long hours.

I explored non-clinical careers for several years before making the transition, and once a job opportunity presented itself that did not require relocation, I took it.

How did you find your first nonclinical job?
I worked a lot with Heather, discussing my interests and what would be a good fit. She helped me develop my resume to better highlight my research experience, making it attractive to recruiters and industry hiring managers. We worked on a LinkedIn profile. I attended the SEAK Non-clinical Careers for Physicians conference, where the value of creating a LinkedIn profile was reinforced. Ultimately I was contacted by a recruiter through LinkedIn about my first (and current) non-clinical job.

Can you describe what you do as a Senior Medical Director and Medical Monitor?
“Medical Director” is a common job title for physicians in non-clinical careers and can mean any number of things. In the contract research organization (CRO) world and pharma in general, a “Medical Director” typically is a physician who provides his/her medical knowledge and expertise to the day-to-day operations of clinical research studies. My company relies on my knowledge as a physician to answer medical questions from our study sites and our internal team. Common questions include:

  • This patient is having an adverse event to the study medication; has such an event been seen among other patients on the study? What do we do with the study medication – hold it, stop it, reduce the dose?
  • This patient has a pre-existing condition that might mean they are ineligible for this study. Please advise us on whether the patient may enroll in the trial given their condition.
  • This patient is supposed to be seen on day 10 of the study but can’t come because of a scheduling conflict. Will the protocol allow the patient to come a day later or a day earlier?
  • This study site is writing an informed consent form (ICF) and needs to know more about the study drug’s mechanism of action and potential side effects. Can you help us summarize what is known about the drug for the ICF?
  • This patient is taking medication x for y Is this drug allowed to be taken with the study drug?

Other duties include reviewing study data to look for trends and to ensure data are entered accurately from a medical perspective (e.g., a drug such as atorvastatin is entered in the record as being given for high cholesterol, not allergies). We use tools like Excel spreadsheets and other electronic data interrogation software to do this.

On many occasions, we are asked to provide input to our pharmaceutical company sponsors about the design of their study and how they can improve it to better recruit patients to the study. We help our sponsors and our internal team to find sites and principal investigators who are interested in conducting the studies. We help with business development activities, where we meet with sponsors who are in the process of selecting a CRO to run their study and want to know why they should choose us as their CRO partner (a meeting called a “bid defense”).

What is a typical day like?
One of the things I like best is that no day is exactly like another. In clinical medicine, every day felt the same – same number of patients to see each day, same cancer diagnoses, same drugs to prescribe, same types of questions to answer, over and over. Variety is the name of the game in my current job. I oversee about 7 to 10 studies, in a variety of different cancer types, and on any given day, I might work a little on each of the studies, or not at all on some but a lot on one or 2 others.

To give an example, some days I might be heavily involved in data review for one of my studies, other days are spent reviewing patient eligibility forms for a study and answering questions from a site, and some days preparing for upcoming bids and/or talking with a medical counterpart at a sponsor about how a study is going. Each day can be a mix of all these. I can work at my own pace. If I want to work in the morning, be available by phone but away from my computer for a while in the afternoon, and then go back to my computer to do work later into the evening, I can.

The job also involves a lot of conference calls over the Web, anywhere from 1 to 5 per day, for an hour or 2 each.

What do you like the most about your job?
The flexibility to work remotely and for the most part to set my own schedule. As long as I am available by phone for anything urgent, attend my conference calls, and get my work done, the day is mine to work in whatever else I need to.

What do you like the least about your job?
We often put a lot of time and effort getting ready to present our company and our ideas to a client when they are looking to hire a CRO, but we may not be selected to run the study. It sometimes seems like a lot of work for nothing.

What kind of transferable skills do you use from practicing as a physician?
Knowledge. What I am bringing to the table is my knowledge of Internal Medicine and Oncology as it is currently practiced in the US. The job allows me to fully use this skill that I spent years developing. I don’t have to worry about clerical tasks like entering orders into a computer or calling an insurance company, tasks that aren’t why I went into medicine to begin with and take away from one’s enjoyment of the profession.

What are some of the other roles that physicians have in your company or at a CRO in general?
Some physicians who did not pursue post-graduate training work as clinical research associates (CRAs) or project managers, roles in which they have a lot of hands-on responsibilities with the day-to-day operations of a trial. They might be visiting study sites to do monitoring (as a CRA), or overseeing the study as a project manager to ensure the various teams working on the study (data management, pharmacovigilance, medical monitoring, clinical operations, vendors) are operating within expected timelines and on budget.

Other physicians work in safety roles, where they primarily review serious adverse events that occur among patients enrolled in a study. They help write Investigator Brochures and annual reports to FDA that detail everything known about a drug in development, including what is known about the drug’s safety.

Do CROs hire primary care physicians, such as FP’s, internists, pediatricians, and OB/Gyns? Absolutely. Our company has a General Medicine Business Unit that employs medical directors with such backgrounds. We also have a few pediatric Hematologists/Oncologists who work on adult Hem/Onc studies.

Why go to a CRO for your first industry job instead of a pharmaceutical company?
There are pros and cons. A plus working for a CRO as a first industry job is that you get broad exposure to a lot of different drugs and drug company sponsors within a few short years. You get to see how different companies approach similar problems in different ways and gain valuable experience that way. A downside is that you are not just working on one drug or compound, and you don’t have the final word on how the study will be designed or carried out.

Working for a pharma sponsor, you will become intimately knowledgeable about the drug you are working on and know a lot about how the company you are working for approaches drug development from early phase to approval, but you might find the drug to which you are assigned not particularly interesting, or it could prove not effective and the project might end (meaning you will then be reassigned to another drug, or potentially terminated).

What kind of physician would do well in a CRO?
CROs typically like to hire physicians who have some background in research. It is not mandatory, but it would definitely help one’s chances of finding a job as a medical director at a CRO.

In addition to research experience, one needs to have good communication skills and be able to work in teams. We interact with a lot of different people, from those on our internal team to the study sponsor. Being able to communicate well is a must. We need to be able to explain medical concepts to those on our team with limited medical knowledge.

Flexibility is key. The drug companies we work with own the drugs, so ultimately they get to call the shots. We can advise our sponsors, but cannot dictate. So, it helps to have a personality that can adapt readily to change, e.g., if a sponsor wants to change the design of a study or rework the process of data review. We sometimes (not often) get asked to travel with very short notice, and that can be hard if you have obligations lined up. Flexibility and patience are virtues that serve a CRO physician well.

How is the compensation for a medical monitor at the medical director level?
Coming from academia, it was not a large drop in compensation when I transitioned to industry. I took about a 15% pay cut. It would have been a much larger decrease had I come from private practice. But to me, the cut was well worth the improved quality of life from not always feeling pulled in 20 directions every minute of every day at work.

A salary of $225 – $275 is a reasonable expectation at this time.

What can a physician do who does not have clinical trial/research experience to be a candidate for a CRO?
If you don’t have a lot of clinical trial experience or publications, position yourself as an expert in a particular area. Your clinical knowledge and expertise are what is most needed to develop and oversee clinical trials at a CRO. For example, if you are a primary care physician working in private practice, you may have extensive experience managing diabetes or hypertension; sell yourself as an expert in those areas. Another example would be a Neurologist in private practice who has treated a lot of dementia patients or MS patients; highlight your extensive experience managing patients with these diseases. A Vascular Surgeon might be able to highlight his/her experience with devices. Being able to tell a team what will and won’t work for a study because you have “been there, done that” in practice goes a long way.

Do you miss patient care?
At times, yes, but then I talk to my former colleagues who are still in the clinical world and I hear how things are only getting worse, not better. I know if I went back, I would still have the same frustrations and stress.

Anything else you would like to add?
I noticed within about 2 months of starting my new non-clinical career that I felt much more energetic. I no longer started my workday already feeling exhausted. I did not dread Monday morning anymore. I didn’t realize how run down I had gotten in my previous job. I don’t regret making the move at all.

A big thank you to Dr. Kelly Curtis for his excellent, in-depth interview! I hope you got a lot out of reading about his transition and what it’s like to work for a CRO.

If you missed the last blog post, Telemedicine as an Independent Contractor, you can read it here!

Be back soon,



Latest Posts

Find what you're looking for:

Heather Fork


  1. Anu Jai on January 9, 2020 at 2:01 pm

    Thank you. Very inspiring.

    • Heather Fork on January 9, 2020 at 2:08 pm

      You’re most welcome. Thank you Anu, for reading and commenting!

  2. Navpreet Sahsi on February 25, 2020 at 6:57 am

    Fantastic blog. Thank you.

  3. Heather Fork on February 25, 2020 at 2:07 pm

    Thank you kindly for reading and for your enthusiastic feedback Navpreet! I will share your comment with Kelly Curtis. I’m glad you found the content valuable.

  4. Farhang on January 20, 2021 at 7:32 am

    Very informative and helpful to understand the role of Medical Monitor,
    however there is one question, for this position as Medical Monitor do you need to have US licensing and board certification??
    or an International Medical Graduate can also apply without US licensing for entry level or with appropriate experience?

    Thanks for fantastic blog

    • Heather Fork on January 20, 2021 at 1:20 pm

      Hello Farhang, thanks so much for reading the blog and your wonderful comments! I agree, Kelly did a great job with providing a lot of helpful information. His particular role, which has the title of Medical Director, does require US licensure. Some companies want board-certification, others do not require it. Pharma can be very confusing as so many of the roles have the title of “Medical Director.” This is true in nonclinical jobs as well. In his role where one of his responsibilities is monitoring how patients are doing medically, and making clinical care decisions does require US licensure for this reason. There are however roles with the title of “Medical Monitor” where the person does not need to by a physician and is typically not. These individuals help with the day to day operations of the trials. As an IMG, there are definitely opportunities for you in pharma/CROs. Drug safety is one area to consider. There are roles that do not require a US license. Once you get that first job in pharma it is easier to move around to different positions. When you search on sites like indeed.com, go straight to the “Requirements” section in the job description to see if a license is required or not. Good luck!!

  5. Thomas Cao on October 25, 2021 at 2:17 am

    Can you find my practice a practice monitor? Thomas Cao, MD

    • Heather Fork on October 25, 2021 at 2:22 am

      That sounds like a great potential role Thomas! Maybe you are on to something here!

Leave a Comment


"Heather’s approach was great! She would listen to me and helped me appreciate who I am."

I remember when she said ‘do your resume before our next meeting’, I was about to push back but she gently nudged me along and I’m glad I did exactly what she wanted me to do. We also did interview prep via Zoom and I was offered a great job in UM. She has continued to follow up even after I was offered this job, helping me with pointers about negotiating. I will totally recommend the Doctors Crossing and Heather to anyone feeling stuck like me and looking for a great coach! Thank you Heather!

- Modupe Oladeinde, MD

Family Medicine
Tim O

The coaching I have had with you has been life changing."

You helped me find the courage to seek out leadership positions and become a medical director as well as a physician advisor. I am grateful we crossed paths and am a different person because of it. You have inspired me to "believe" in spite of my inner skeptic. I consider you one of my most important mentors and am proud to also call you a friend. This says a lot given the apprehension I felt when I took a chance with our first coaching session. Even though I have already made a successful transition, I still value your ongoing mentorship and can enthusiastically attest that the value of your services is tremendous!

- Tim Owolabi, MD

Family Medicine
Lynette Charity

“I was at a crossroads in my medical career. I asked myself, "Do I stay or do I go?" 

I met Heather at the SEAK conference. She and I revisited this question.  Did I want to quit being medicine completely? She helped me to identify my needs, wants, and my vision for my FUTURE, not just in medicine, but in life!!!

She was able to listen to my "ramblings" about becoming a stand-up comic, lounge singer and voice-over actor and translate them into action steps.  I chose to become a composite of all of these. Now I am a more confident, healthier, happier person. I credit this in its entirety to the tutelage I have received and continue to receive from Heather.  She cares. She listens. She was there for ME.  She will be there for YOU!

- Lynette Charity, MD

Gail Miller

“I am forever grateful to Heather for helping me to recognize, I am more than just my M.D." 

Heather helped me understand that I am more than just a doctor and that my experiences in clinical medicine are valuable in so many arenas.  As a result I realized that there are other ways to use my background, still be able to help people and continue to challenge myself and grow.  To that end I discovered coaching - specifically health coaching.  I am on my journey becoming a health coach and truly loving it!

- Gail Miller, MD

OB/Gyn physician

“Thank you, Heather, for helping me transform my career, my faith and my life."

What started out as an initial thirty-minute consultation call turned into an amazing four-year journey that transformed my life, personally, spiritually and professionally. 

Heather helped me to discover my passions...by doing so, I discovered I still had a calling for medicine but it now came from a place of truth...

Today...my wife and I are opening our first concierge medicine clinic in a community we love. I’m actually excited to have the opportunity to practice medicine the way I believe it’s meant to be, with a focus on the doctor-patient relationship and an emphasis on faith. I know if I had not reached out to Dr. Fork, my life would not be where it is at today.

- Steve Lapke, MD

Papillion, NE
Sue Zimmermann

“Heather gave me the confidence to create a new livelihood by following my heart."

She is incredibly knowledgeable about the range of careers available to physicians and provided me with advice and connections which I would not have found on my own.  From the start she encouraged me to step out of my comfort zone and try different things.  I was laid off unexpectedly in early 2017, and Heather gave me the confidence to create a new livelihood by following my heart and making decisions based on trust, not fear.  Now I am enjoying working part-time in a clinical setting in addition to teaching and writing.

- Sue Zimmermann, MD

Orthopedic Surgeon
Devki Patel

After months of struggling to find a non-clinical career that matched my values and passion, I stumbled upon Heather's website which truly changed my life."

Heather's insightful and personalized approach to career coaching made me think outside the box since she took the time to evaluate my personality, values, interests, and preferred lifestyle.

Through her encouragement, practical advice, and professional connections, I was able to find a non-clinical position at a state Medicaid agency that aligned with my passion for population health and serving low-income communities. In addition to her coaching sessions, Heather has built a community of like-minded physicians through her blog, and I feel honored to recommend her to friends and colleagues who seek to make positive changes in their professional and personal lives.

- Devki Patel, MD

Jay Macregor

Working with Heather ultimately helped me leave my job in corporate healthcare and find a path that was much more fulfilling."

My career was going reasonably well but I couldn’t shake this nagging feeling I could do better; or at least find a better long-term career fit.  

I was able to find a surgery job that better aligned with my goals and professional interests.  Additionally, Heather helped me start a consulting business which has allowed me to pursue a true passion: helping medical students, residents, and attendings surgeons navigate the challenges of high-stakes standardized exams.    

If you are reading this as a “Type A” surgeon who doesn’t think coaching is for you, I would encourage you to give Heather a shot.  I’m very glad I did!

- Jay MacGregor, MD

Colorectal Surgeon

“I gained the confidence in myself to develop an action plan that blended the best parts of my experiences and interests into a cohesive career." 

Through our work, I learned to trust myself to make good decisions for my own future – something I hadn’t realized I was struggling with because as an emergency physician, I make life-changing decisions with patients every day. 

By feeding my creativity and interests in other realms of my professional life, I’ve found renewed compassion for my patients and myself, making every shift an opportunity to actually care for people. Thank you Heather. I really couldn’t have made these changes without your help!

- Liz McMurtry, DO

Emergency Medicine Physician

The simple truth is - Heather Fork totally helped me change my life."

I never would have had the courage to make the changes I’ve made without her unwavering support, wealth of knowledge and commitment. 

When I first started working with Heather, I was downtrodden...I’d been practicing medicine for 20+ years and yet had never quite found my place.  During the first year I worked with Heather, I left the practice I’d been working at, and recreated an entirely new professional purpose.

I’m now an executive and leadership coach, a university professor, and a Brené Brown Daring Way facilitator, and I have never looked back.  I love what I am doing more than at any other time in my professional life and I credit Heather with seeing in me what I was never able to see in myself, until now.

Don’t hesitate, don’t doubt yourself, schedule your time with Heather as soon as possible- she can help you reconnect to your purpose and reinvent your life.

- Amie Langbein, DO

Family Physician
KB Karen Barnard Photo

"After 30 years in academic medicine, I wanted a career change but had no idea where to start. Medicine was all I knew."

I signed up for coaching with Heather and it transformed my life. She helped me get clear on what I wanted my life to look like. We reviewed my skills, values, and strengths. She instilled hope in me that change IS possible after 50 years! 

The outcome is that I have created a life I love! I practice endocrinology part-time and own a life coaching business! Coaching with Heather is one of the best investments I have made in my life. 

- Karen Barnard, MBBCh, MPH

Endocrinologist and Life Coach

"Heather was my source of hope during a time when I felt stuck and confused. She gave me the permission and confidence to reach higher than I believed I could."

After graduating from residency and starting a family, I lost sight of why I became a physician. I struggled to convince myself to stay in a career that was clearly the wrong fit for me and my family. My anxiety about work was at an all-time high when I reached out to Heather. She provided something that my mentors, friends, and family could not – rather than just offering career advice, she changed the way I think about my life so that I could understand how my career would fit into it. I realized I wasn’t ready to give up on medicine and eventually found a job in academic medicine. I finally feel that excitement for medicine that I used to feel when I was in training. More importantly, I feel like I can be the role model to my young daughter who may one day also face similar challenges between career and family. Thank you, Heather, for all your kindness, support, and skillful coaching! The experience was life-changing!

- Yuri Shindo, MD

Internal Medicine Physician
Camille Gardner-Beasley

"As a Physician, your personal and even professional needs are often overlooked. I learned how to prioritize my career goals by working with Dr. Heather Fork."

She taught me how to put into practice what I knew in theory, that taking care of myself was a priority. I learned to give myself permission to make the career choices that would give me the work-life balance I desperately craved and needed. The process of confronting fears and insecurities was a bit scary, but well worth it in the end. I am now a happier version of myself with a non-clinical job that I truly enjoy!

- Camille Gardner-Beasley, MD

Family Medicine
Anna testimonial

"After 10 years in outpatient family medicine I felt stuck and knew I needed a change but I didn’t know where to begin. Thankfully I found Heather and she guided me every step of the way."

She helped me carefully assess my interests, strengths and passions while also providing me with constructive changes to implement in my job search and resume. With Heather’s help, I just landed a fully remote UM position and I am also exploring coaching as well. Now I feel like the possibilities are endless and I’m excited for this next chapter in the nonclinical world! Thank you Heather for changing my life for the better.

- Ana Jacobellis, DO


"I'm truly thankful to have had the opportunity to be coached by Heather, she is not only a resourceful mentor but a wise and supportive friend. I'm honored to recommend Heather to all my friends and colleagues."

I had been a practicing Internist for 20 years when I reached a point when I needed to make a serious change in my career path. While I enjoyed seeing patients, I was not satisfied with my life-work balance. My job was taking me away from my family and left me little time and energy to do other things that are important and meaningful to me. I came across Dr. Fork's podcast; The Doctor's Crossing Carpe Diem Podcast, it is such an informative and enjoyable podcast for any physician who wants to do more with their career and life in general. Then I had the pleasure to get career coaching from Heather, it was truly an amazing experience. Heather has broad knowledge of all the different career paths that are available for physicians, she is so insightful and very easy to talk to. She helped me clarify my goals, examine my own mindset and definition of success. Together we developed a clear plan and actionable steps to reach these goals. I eventually made a career transition to a remote non-clinical position that allows me to do meaningful work which aligns with my personal and professional goals and priorities. 

- Abbey Awad, MD

Internal Medicine

"There have been a handful of people who have come into my life and changed it, and Heather is one of those people."

From the very first interaction with Heather, it became abundantly clear that she possessed a systematic approach and a methodology firmly rooted in my focusing on my goals and aspirations. Heather's coaching sessions helped me dismantle limiting beliefs and unearth the capable woman, mother, and physician within me. Under Heather's guidance, I began to dream again. I rediscovered my passion for writing, found the courage to share my stories, and even launched my own coaching practice. Today, I specialize in helping others conquer imposter syndrome and overcome burnout, empowering them to lead meaningful and fulfilling lives. Working with Heather fundamentally shifted my perspective and allowed me to show up authentically in every facet of my life, resulting in a profound sense of fulfillment.

I am deeply grateful that I can continue my work in the emergency department and serve my community as a physician as well as a coach. Working with Heather was a transformative gift that enabled me to rediscover my true self, find clarity in my life's purpose, and unlock my full potential. Through her guidance, I not only reignited the powerful, confident, and bold version of myself I had lost sight of but also realized the boundless possibilities that lay ahead.

- Maria Dominguez 

Emergency physician and coach