What are careers like going from academic heme/onc to pharma?

[tortuga87]

This is what a dysfunctional company looks like. And unfortunately, that is most start ups, and probably most companies in general to some extent.

However, you cannot dissociate all of the toxicity from the tech. While, yes, these are personality conflicts at play, they only exist (or really, bubble to the surface) because people are under stress. People are under stress because things are not going well. And ultimately, things are not going well because of the tech.

In reflection, I cannot help but wonder how well CEO #2 would have faired in "going big or going home" if the product actually worked.

If corporate structure is poor (as was the case here), you cannot resolve these conflicts. Much like our political discourse today. There is often no incentive to fix problems, and an incentive (save your own @ss) for perpetuating it. I saw this at play again and again.

I guess I just assumed that leadership at that level would be able to figure out the obvious - the cause of the stress is the tech, therefore focus on improving the tech rather than create more interpersonal strife in the company.

They did not figure out the obvious. So you told them to focus on the tech. But they still didn't get it, e.g. the CMO basically tells you to do what you are told.

I started to think maybe the problem was me. Maybe I'm just a bad employee.

Now you are starting to question your reality because the obvious is not clicking for other ppl. As an analogy, if you see a red object, but others report that its green because they cannot recognize red, then you start questioning if you can see red or know what red is.

In reality, they just kinda stupid bro lol. Glad you left eventually, although it seems to have taken a heavy toll on your mental health

---

Members don't see this ad.

 

[dl2dp2]

About another 1/4 of the staff would be let go at a later time, and the last 1/4 or so would be expected to relocate to the new office.

Back to the question... "are you on board?"... What would you, reading this narrative (if there are any left at this point in the story) do???

I think what you decided to do wasn't a bad move, but if I were you at that point and I swap myself into your shoes, I would probably try very hard to engineer a leveraged buyout and keep the entire division. I.e. it sounds like the clinical services group was actually a great business, and I can involve an outside financing company (typically PE) to raise capital and I would then become CEO of this group which I was running anyway for two years.

Since you didn't involve PE, you'd have to start from scratch as a side business.

This of course necessitates that you leave your job, which I suppose is an outcome you wanted to avoid. This also depends a lot on your net worth. If at the time you had already had a multimillionaire net worth, it'd be a lot easier to say adios to the company, but if you were still living on salary it's trickier.

 

[gbwillner]

I guess I just assumed that leadership at that level would be able to figure out the obvious - the cause of the stress is the tech, therefore focus on improving the tech rather than create more interpersonal strife in the company.

They did not figure out the obvious. So you told them to focus on the tech. But they still didn't get it, e.g. the CMO basically tells you to do what you are told.

You are looking at a series of events from my perspective. I am certain that for most of you reading this narrative, your perspective would have appeared the same. You are NOT looking at these events from the perspective of the organization or from leadership. From their perspective, their moves make sense within their world view. Their world view is not particularly bothered by the mundane details of the product working or not working. I will summarize more on this later.

Now you are starting to question your reality because the obvious is not clicking for other ppl. As an analogy, if you see a red object, but others report that its green because they cannot recognize red, then you start questioning if you can see red or know what red is.

In reality, they just kinda stupid bro lol. Glad you left eventually, although it seems to have taken a heavy toll on your mental health

Did this take a toll on my mental health? Yes. And it will get worse before it gets better. I still see many of the past employees here and there, as industry is a pretty small community. We cannot help but recall the trauma we went through. We joke about the PTSD we all suffered, half-jokingly.

 

[tr]

You are NOT looking at these events from the perspective of the organization or from leadership. From their perspective, their moves make sense within their world view. Their world view is not particularly bothered by the mundane details of the product working or not working. I will summarize more on this later.

*cough* Theranos *cough*

 

[gbwillner]

I think what you decided to do wasn't a bad move, but if I were you at that point and I swap myself into your shoes, I would probably try very hard to engineer a leveraged buyout and keep the entire division. I.e. it sounds like the clinical services group was actually a great business, and I can involve an outside financing company (typically PE) to raise capital and I would then become CEO of this group which I was running anyway for two years.

Since you didn't involve PE, you'd have to start from scratch as a side business.

This of course necessitates that you leave your job, which I suppose is an outcome you wanted to avoid. This also depends a lot on your net worth. If at the time you had already had a multimillionaire net worth, it'd be a lot easier to say adios to the company, but if you were still living on salary it's trickier.

Interestingly enough, I did try this in late 2016 to salvage the business.

Remember that although I was making a good salary, I was only 2 years out from my instructorship (i.e, poor), and 4 years out from fellowship. So no, I didn't have any wealth to do this with. But I did get some backing and made a pitch to spin out the business as a separate entity. I proposed to allow them to retain ownership with a small budget, but they could effectively do what they wanted (focus only on tech), and not drown this baby in the tub.

Interestingly, the European leaders thought it was a good idea, but did not support it. Basically they said that I was too late, and the course was set. Had I come with this plan in March or April it would have been different. Oh well, sorry baby.

 

[gbwillner]

The final turn (pt 1)

Early 2017 started pretty well for me, all considered. My personal side business was doing well and I was seeing growing revenue and exposure. I had contracts for running a precision medicine program at a large community cancer center and even as a part-time medical director for that company I should have joined in 2015. My side hustles were now bringing in approximate DAJ-levels of revenue. I even started my own software company.

Things were moving forward in the tech development as well. Even if things weren't actually ready for production, every sprint saw improvements and additional required features being deployed. With appropriate oversight and engagement, things were going as I expected- slowly and methodically- but this is the way to make things work.

My engagement with management continued to ebb and flow. I was-then wasn't-then was again an executive. They needed my expertise and realized this and invited me to participate, then didn't like to hear my open critiques of the product or negative forecasts on completing the project to any clinical-grade of satisfaction and kick me out again. Rinse and repeat.

I had built a solid team in the NE by spring and we were quite productive. I enjoyed my trips to Europe and engaging with the dev teams there and setting direction and requirements.

But while things were moving slowly in the right direction for the product, there was no revenue. Don't forget the company thought and planned for a development would take 3 months (now at 1 year) and had a sales team sitting on their hands, selling only visions of what the product would one day look like.

And Mr. X continued his trips to Europe to advise management there. We saw how he was given more and more authority and oversight of US operations. I was pretty neutral on him at first as I didn't directly engage much with him and did not report to him. In Summer 2017 he proposed a visit to my town where we still had 2 employees (formerly like 50+) to have a strategy planning session. Due to budgetary considerations, this was held at the other employee's home.

Mr. X kicked things off by denigrating the other US employees as lazy and entitled. He stated that the only reason there was no revenue was because the US sales was lazy and had no incentive to sell because they had guaranteed commissions. I basically told him he had no clue what he was talking about and needed to stop, and explained that the product, after a year of development, was still not finished. He let it go. We then brainstormed on US direction and BD opportunities. He wanted to share his visions for how to get to profitability. He had a brilliant vision:

"I propose we position ourselves by selling clinical services to the oncologists who need the services rendered by the use of our product."

He went on to state that he predicted this path would lead to $500k in revenues by the end of the year, and $4M in 2018. This is a far cry from what we really needed, but would get us to 7 figures within 3 years.

Wow. Amazing. Maybe some details are in order? I asked how he was planning to accomplish this amazing feat when 1. The product is not ready, 2. We no longer are capable rendering clinical services since we shut down our services division, and 3. We no longer have a network of providers, and 4. The cycle time to selling our product to clinical departments was like 18 months.

"Easy!" He says. "We don't render the service ourselves. We get the service providers to use our product and we bring them the clinical business!"

If this seems confusing and ridiculous to you (given what you've read so far) then this is on par and there is probably nothing more I can do to explain it. I went on to explain to him why his plan was totally infeasible. Did I really expect him to understand it? Well, he was the "smartest man he had ever met" (yes, he said that about himself). And he went to MIT (or claimed to). To get a better sense of this character, he came to my office, and asked me what book he would need to read to become an expert on genetics, molecular diagnostics, and precision medicine. When I answered him that it would be impossible, and would at least require 12 years study for the MD, PhD, residency and fellowship training to achieve that, he laughed at me as a rube, and said that he's been able to master every subject he's ever applied himself to just by reading a book in a week.

This is what I would need to be dealing with. I could start to see why people didn't like this fellow.

The company business model had always baffled me before. Now it was beginning to make a lot of sense to me, as all the complexities were stripped away in a Dunning-Kruger inspired array of clarity.

Depression set in. I could see what we, what I, had been reduced to. And from here on out, every day seemed to be worse than the day before it.

Every day was then the worst day of my life.

It was around this time I regretted my decision to not take the DAJ. Nothing was worth this denigration. I just tried to keep my head down and do my job, hoping European management would end this embarrassment as soon as possible.

 

[SurfingDoctor]

to read to become an expert on genetics, molecular diagnostics, and precision medicine. When I answered him that it would be impossible, and would at least require 12 years study for the MD, PhD, residency and fellowship training to achieve that, he laughed at me as a rube, and said that he's been able to master every subject he's ever applied himself to just by reading a book in a week.

 

[Lucca]

me discovering this thread today at midnight while waiting for code to run

 

[gbwillner]

The pitch (final turn part 2)

By fall of 2017 my thinking had evolved. I thought in 2014 that I had joined a great enterprise with extraordinary people and little would stand in our way. By 2015 I knew the company had major obstacles, but we were smart enough to overcome them, if only I could find the right argument to set management on the right path. By 2016 I realized that the company was never going to be the runaway success I had hoped for, but at least I could be successful in it and learn from the experience. Now, as 2017 dragged on into fall, I realized this was a failed venture and that I was wasting my time. Still, knowing me (and I hope I do and some of you are beginning to learn), I wanted to see if things could be saved in any capacity. I sought the European CEO for a 1:1 talk. He avoided me like the plague, primarily because he was convinced I wanted to tender my resignation and he thought he could prevent that by simply not taking my calls, or not showing up for planned meetings with me.

One day right before I boarded a plane I was able to get him to pick up his cell phone. Instead of a "Hello," he began with "Please don't quit."

I told him that I was very frustrated and not happy with the way things were going. I told him I was tired of the circular pattern of hiring CEOs/managers who promise billions of revenue with no realistic plan, but jumble staff and processes for crazy ventures that ultimately fail and then lead to the summary firing of said CEO/manager when they ultimately fail to deliver the moon with their unrealistic plans, only to be replaced by another crook with similar pie-in-the-sky visions. The inmates were running the asylum.

I gave him an out. I asked him to give me control of US operations. "I won't promise billions in revenue in 2 years, but I will promise you that I will turn this organization around. I promise you realistic revenue in realistic timeframes for the product we are developing. I promise you we will get this organization out of the red within 2 years. I promise we will use this product as a building block to develop other services for other lines of business in the future."

I told him Mr. X is just the latest fool/patsy doing what other prior managers had done (maybe only worse), and his plans had exactly 0% chance of success. Like his predecessors, he knew nothing about either the product or it's use, and yet he was making billion dollar projections in sales. I was almost there in my understanding of this company. If Mr. X was put in control as it appeared was happening, he would only make us move backwards instead of forwards. I outlined Mr. X's vision and explained it was the Underpants Gnomes model of business. It would absolutely fail. If he wanted to avoid this, and actually turn around a successful product, he needed to finally trust me with his company.

The suspense was thick in the air as I awaited a response.

"I'll think about it," He said. "We have a scheduled on-site corporate meeting and retreat in a month. Let's have dinner together the night before the meeting starts, and I'll tell you my decision.

There was hope. I dared let myself hope.

I got back home and soon found out that the entire US sales team was let go. I also found out that my entire Medical Affairs (MA) team was also let go. One guy I had hired a mere 6 months prior and relocated his whole family from Michigan to the NE office, only to have him fired with 2 weeks severance. And no one told me. When I inquired on to who made this happen, no one could tell me who was responsible for this atrocity. The US team was now reduced to like 12 people. As you can guess, I knew who it was and the machinations behind it.

 

[ChordaEpiphany]

Early 2017 started pretty well for me, all considered. My personal side business was doing well and I was seeing growing revenue and exposure. I had contracts for running a precision medicine program at a large community cancer center and even as a part-time medical director for that company I should have joined in 2015. My side hustles were now bringing in approximate DAJ-levels of revenue. I even started my own software company.

I assume you mean revenue and not net income. You also used revenue to describe the clinical services offered by the company. This whole time, were these outfits ever actually profitable on their own? Could you have quit your main job, maintained the side hustles, and lived a DAJ lifestyle? Were you bringing in DAJ income + 80% of your I3 income?

I just ask because it seems odd to compare revenue of a side hustle to the income of the DAJ, and I'm trying to get a sense of what your options were here (and how dependent you were on I3 and the funds they had raised). It also might explain why they were so keen on shutting down a revenue generating service they didn't understand. If it was increasing their burn rate and they couldn't see a path to profitability (out of lack of understanding the field), then their decisions make perfect sense (from their flawed perspective, of course).

 

[gbwillner]

I assume you mean revenue and not net income. You also used revenue to describe the clinical services offered by the company. This whole time, were these outfits ever actually profitable on their own? Could you have quit your main job, maintained the side hustles, and lived a DAJ lifestyle? Were you bringing in DAJ income + 80% of your I3 income?

I just ask because it seems odd to compare revenue of a side hustle to the income of the DAJ, and I'm trying to get a sense of what your options were here (and how dependent you were on I3 and the funds they had raised). It also might explain why they were so keen on shutting down a revenue generating service they didn't understand. If it was increasing their burn rate and they couldn't see a path to profitability (out of lack of understanding the field), then their decisions make perfect sense (from their flawed perspective, of course).

I did mean revenue and not net income. However, for my side businesses these were almost synonymous as I had little overhead or other operational expenses (it really does depend on the line of business). For my business, I would not take any opportunity that did not yield net income. However, without going through my books, yes my revenue from my side businesses actually exceeded the DAJ income, and probably the net income as well by 2017.

However, for the European business, you are correct in that the clinical service was revenue positive but their operating expenses greatly outspent these revenues, so yes, they lost money. I explained that this was temporary and both reimbursement would improve and costs would come down with improvements I proposed, but they saw it the way you describe. "Why do even one more clinical case, " the CEO would argue, "When we lose $300 for every service rendered?"

That said, their other business (the product) drew zero revenue. So every dollar spent yielded nothing. It was like dividing by zero, or throwing money into a black hole where nothing could escape. That said, it was clear that the company preferred there to be no revenue. I will touch on this later as well.

 

[gbwillner]

The Underpants Gnomes Model of Business (UGMB, a short interlude)

In one of the early episodes/seasons of South Park, Tweek, while watching TV, looks out of the corner of his eye to see what looks to be a face staring at him from the dryer. He does a double-take and the face is gone. Apparently, there has been a rash of missing underpants in South Park. The kids investigate and find there is an elaborate network of underground tunnels that connect everyone's dryers. They follow these tunnels and stumble across gnomes working. One gnome explains that what they are doing is executing a business plan to enrichen themselves in a great presentation. He explains that stealing underpants is just the first phase in the plan.

UGBM:
"Phase 1- steal underpants."
"Phase 2- ...."
"Phase 3- PROFIT!"

Everyone gets this brilliant plan and is bought in. It's so simple and elegant. And of course, as the viewer you see it is completely absurd. But I will tell you that at it's core, this is a very accurate description of many start-up companies' business models or paths to monetization. It's so accurate it is sickening. To make it convincing, just throw enough technobabble around phase 1 and 2 without actually defining any plan with any degree of specificity, and most investors or employees will see whatever they want to see and jump like lemmings over a cliff for completely worthless ideas that have no path to success.

Here is an example.

"We have a best-in-class data management solution that incorporates all the world's knowledge about clinical trials management based on patient biomarker status."
"We seek to leverage our best-in-class data solution to explore engagements with healthcare providers and institutions to define set of criteria wherein our solution provides critical and evidence-based clinical information to improve patient outcomes.
"With integration into the clinical workflow of trial assignment, an industry with over 25M active participants, we expect $2.5M in revenues over the next 12 months and over $12M in revenue over the next 24 months"

I see this kind of thing ROUTINELY, and I can tell you there is basically no difference between the gnomes and the example above. It was clear to me this is all I ever saw at my company, and not only were people blind to it, when exposed to its fundamental flaw, most employees and management would start to rationalize.

Upton Sinclair once said:
It is difficult to get a man to understand something when his salary depends upon his not understanding it.

 

[Fencer]

I seen this in several companies before... You are making a great service to our MDPhD community.

 

[tr]

Upton Sinclair once said:
It is difficult to get a man to understand something when his salary depends upon his not understanding it.

This is so true.

Having lived in Silicon Valley for 12 y, where every Joe Sixpack is always starting a company, my impression is that in the vast majority of cases the goal is actually not to create a functioning, profitable product. It's to generate enough hype to be bought out for $$$ by one of the behemoths.

So from this perspective it's actually true that the product working/not working is of limited relevance. All they need to do is convince Alphabet/Meta/whatever that it has the *potential* to work. After that it's Alphabet's problem. In that sense, the hype is the point.

 

[SurfingDoctor]

This is so true.

Having lived in Silicon Valley for 12 y, where every Joe Sixpack is always starting a company, my impression is that in the vast majority of cases the goal is actually not to create a functioning, profitable product. It's to generate enough hype to be bought out for $$$ by one of the behemoths.

So from this perspective it's actually true that the product working/not working is of limited relevance. All they need to do is convince Alphabet/Meta/whatever that it has the *potential* to work. After that it's Alphabet's problem. In that sense, the hype is the point.

For every Facebook, there are thousands of Geocities.

 

[gbwillner]

A confederacy of dunces (the final turn, part 3)

I had to take a break from the PTSD-inducing recollection. Where was I?

I traveled for the meeting and tried to set up a dinner meeting with the global CEO but he did not return my calls. He finally told me he wanted to talk about it in the office the morning of the big meeting with Mr X and the new(ish) US CFO. I could tell it as not going to go the way I wanted.

I show up to the meeting and he tells me that I can't be put in charge of the US org on my own, but that he wanted me to help run the org with Mr. X collaboratively. This diffused my intent to walk because it was an attempt at meeting me halfway. I thought I would at least give it a go, at least try to work things out with Mr X at the retreat. However, Mr. X made it very clear to me while there that he was going to be in charge, regardless of what the CEO said. On a short walk before the meeting started, I wanted to set things straight between us. He told me I should quit the company, and just walked away from me (while on a walk with me- very weird). He clearly saw me as his adversary in his quest to climb to the top of the company through his Machiavellian machinations.

During the retreat (in Cape Cod BTW), we had a brainstorming session for laying out the immediate and long-term visions for the US org. Mr. X started by going over how easy it was going to be to get revenue and went over his laughable UGBM plan. There was silence in the room. He asked for feedback. I gave him some.

"Your plan has no chance of success and is a waste of everyone's time. We don't operate the lines of business that your plan requires, in fact, your plan does not even state how we will get revenue, it only identifies what we need to find out to make a plan that will generate revenue. Your plan is to create a plan, and yet your plan has defined revenue projections. Those projections are completely unrealistic." The other 12 remaining US employees at the retreat agreed with me. "We should focus on continuing to improve the product, and look to sell only the components of the product that are validated. Right now that is not much but it can be expanded with these engagements." I laid out a vision for the company direction that was realistic and possible given where we were. It was a lot less revenue, but the plan was sound and based on things we could actually deliver. Others started to comment and supported my plan. Within a few minutes it was clear. All other employees supported my plan, and none supported Mr. X. I could see the rage setting in his face.
"Well, my plan IS the plan. I presented it to the board last week, and they expect us to execute it. Let's figure out how we get there." So that was that. The brainstorming session was really anything but. The course was already set, and there was only the façade of agency. We then broke for lunch. We were all going to have pizza delivered to the house we were renting.
But the CFO had different plans. I could see him and Mr X eyeballing each other throughout the previous discussion. "We are going to get pizza for the group. But Mr X, gbwillner, and I will go elsewhere. We will see you in a few hours." Panic hit me. This was it. I had called out the new "boss" for his BS in a very public way, and had clearly won some sort of unintended mutiny. The way he had ruthlessly disposed of other staff that were in his way was not lost on me at this point- I was very much aware I had just sealed my fate at the company.

We went for sushi. The tension was thick. The CFO kicked things off. "We want to make you an offer," he said. "We know you are working for us as an independent contractor and not as an employee. We want to make you a full-time employee again. As a full time employee, you will be eligible for the management incentive program, and receive an equity stake in the company, as soon as the plan is approved by the board. They are meeting on it next week..." I had cut him off. With laughter. This once again did not go the way I was expecting. He went on to tell me that they didn't like the fact that I had a separate business they could not control, and they wanted me back full time. Of course, for no increase in pay, but I should be happy with the equity. Maybe they thought this would bring me in line with their madness? They were really, really wrong. I told them that I prefer to stay a contractor and I liked the current state of things. I didn't want their equity, and knew none would ever materialize- I had now been with the company 4 years and they were both relatively new and had not seen this equity dangled before their eyes as I had for so long.

While this was a push- for now- this really was the beginning of the end. Mr. X had started to play his cards and he was not very good at poker. He saw me as an opponent to remove from the board. What a way to live! I knew my time would come as soon as Mr X could justify my firing to the European management, who still had a very favorable opinion of me (for now). The games were about to begin, and I could play them as well as anyone. I would try to fulfil my obligations to the company as required by contract, but I would no longer provide them with my sweat and tears. Those would be reserved for my growing businesses. I would hold on to the revenue from this job as long as possible so that it would serve as a runway for me to set up my own operations.

 

[gbwillner]

Cold Firing and the end of the road

In Europe, as some of you may know, it can be very difficult to fire someone, particularly if they have a long tenure with the company or are Sr. Management. One way to get rid of these people is the "cold firing," where you don't terminate employment for the individual, but instead, make their life intolerable through a series of progressive humiliations that include loss of control of or exclusion from their operations, demeaning tasks, and shunning from corporate life and events. This company was well versed in this process, and they would attempt it on me.

I'm at the airport and have a long delay so I thought I'd share a story of what it was like at this company at this point in time.

A few months after the "retreat" I was at the US HQ in the NE as per my routine. Mr. X decided he wanted to have dinner with me one night. Sure. We head out to some restaurant. Now, although I have gone on and on, I have obviously left out a lot of details, one being that we were constantly at risk of having all our funding pulled by the global company and the investor. Because we didn't have any money allotted beyond the calendar year budget (and then a 6-month budget) we were constantly living with the fear that we would find ourselves unemployed at a moment's notice. As you can imagine, there was a very large emphasis placed on saving wherever possible, and operate within an ever-shrinking US budget. Who was in charge of said budget and now of slashing that budget? Mr. X.

He picks the restaurant and we walk there. As per our restrictions, hotel budgets are now meager, and now all expenses most be approved by Mr X. First class tickets to Europe are a thing of the past. We order our meal, and as usual, Mr. X gets a $200 bottle of wine. Our conversation shifts to healthcare in the US.
"You know what's wrong with the US healthcare system?" He asks. I don't know where this is coming from or where it's going.
"There are a lot of issues with it," I respond.
"The major issue," He says, "Is that doctors make too much money. I'm smarter than any doctor I've ever met, and I make less then most doctors." He then went on about going to MIT, and how dumb most doctors are. I am not joking he did say this to me. A doctor. Close your eyes and envision yourself in this situation. This person, making these statements, controls your organization and your future. He has cut off all communications from your organization to the European global office and all communications go through him. He has tightened control of the US organization in a crazy power grab that has no bearing on the product, or delivery of services, or the least bit to do with patients. And he is a buffoon. A buffoon that is jealous of your salary. You just know what is going to come next.
The meal ends and I am glad to be back at my hotel room. The next day at the office I am confronted by the CFO. He asks me to enter his office. He starts to see that Mr X is using the US company as his personal fiefdom, but says he has no choice but to do what he is told. He tells me that the company can no longer afford my contract, and will be looking to restructuring it.

I get a call a few days later from Mr X.

"You know," He says, "We have a big financial crunch at the company right now. The European office has slashed the US budget and now we unfortunately can't keep your current contract." The CFO was also on the call. "We are going to need to slash your compensation by 50%. You have a side business, so you will be OK. Everyone is taking a cut. We will cut back your time as well by 10%." So I reduce my time by 10% and salary by 50%. "You have until Monday to accept these terms." I inquired how much of a paycut they were receiving, and to no one's surprise, it was none (in fact, I heard Mr. X was getting a raise).

"OK, just put it in writing." I respond. Sure enough, a few days later I get an email outlining the new provisions. On Monday I respond:

Mr. X. Thank you for the consideration and proposal for the new agreement. I respectfully decline.

I instantly got a call from the CFO telling me I had to accept. I laughed and asked him why. I had a contract. If they wanted to terminate it, they could. This lead to legal threats, demeaning tasks outside my job description, and eventually, not receiving payment for services rendered. It got REALLY ugly. I won't go into more details, but eventually, with mercy, they did terminate the agreement several months later. And the Cold Firing continued. Of note- no one was exempt form this craziness, as one by one, staff were treated like garbage before being fired. The CFO actually was shown the door before I was.

Eventually, as expected, Mr. X was unable to generate any revenue from his stupid plan and was universally disliked by all. In the end, he was a perfect fall guy for this company, and was let go in the same manner as how he let others go. Without pity or remorse.

I will say that I was very worried about the end of this employment for the issues I mentioned before. But when the end came, it was actually a liberating experience. It was the best possible outcome- in hindsight I only wished I had the foresight to end this debacle 1 year earlier, because I really didn't get much out of being there except pain for the last year or so.

Of note, this company still exists, and as I predicted, it took them about 3 years to get their product ready for the market with all the specifications I set initially in 2016. I think it actually works pretty well.

 

[gbwillner]

What I learned: a 4-year reflection

Obviously things ended pretty badly and it was a pretty deflating experience at that company. But as I mentioned- I learned A LOT about how start ups and industry operates. I learned that I was naïve when I took the job in my assessment of the company and it's chances of success, despite the fact that I was right about everything in my assessment about the company as I saw it.

Some lessons learned:

• Strong, competent leadership is essential and should not be overlooked. A monkey can run a company when it is firing on all cylinders and it's printing money. Good leadership gets you through when things aren't working, and eventually all companies have issues that they need to work through. Poor leadership allows fiefdoms to develop, it allows misalignment of incentives to develop, it allows toxic cultures to develop.
• Corporate culture is important and must fit with your personality. There is not one "right" culture, but there are those you fit into and others you don't. Some are downright toxic and should be avoided.
• There must be alignment in corporate goals. This was a huge problem that could not be overcome in this company. Not everyone wanted the same thing in this company. The US org business was not the same as the European business, and at some point these conflicted.
• Open, transparent communications are critical. One of the reasons goals did not align was because the European leadership was never honest with US employees about what the goals of the company were. They really did see the US org as a façade. It may have been more effective to be clear with the US team about what European goals were, and then we may have served those goals better (or at least had an open discussion about why they should be realigned). As it was, there was a lot of skullduggery by the European leadership we could never understand.
• There must be accountability in order for a company to move forward and learn from mistakes. The founders of the company and CSO were untouchable. They were to blame for much of what transpired, but never took any heat for anything. This is why they kept hiring fall guys to recycle. In the end, very little to nothing changed. These people did not see a problem with their creation- it was the world that was wrong. Nothing was done to change that mindset.
• There is such a thing as too much money. Overcapitalization isn't something you hear a lot about, but it can be a huge problem and clearly was in this company. One of the reasons my sensible solutions fell on deaf ears was that they were sensible. This was a zombie company that blew through $300M+ in a few years and had 300 or so employees and at one time had 40ish salesmen. They were never going to be satisfied with a product that made $2M in revenue. But that's basically all their product was going to bring in. They needed crazy projections from buffoons to keep the investor and the board from pulling the plug. Had the company only had $10M of capital to begin with, and the same product, $2M in annual revenues would have seemed great.
• You can't fix stupid. There were a lot of red flags early on, but I really thought that I, the lone subject matter expert, could convince an entire company to do the right thing. They got to do the wrong thing through a series of bad decisions. I wasn't wrong to give it a shot. I was wrong when that didn't work, and I tried again and again. As I said before, although I collected a paycheck, I got little except misery out of my last year with this company.
• Plan your exit, and don't be afraid to pull the trigger. Sometimes being unemployed IS the better alternative.
• The world is not a fair place. This company by all rights should have died a hundred times if it was under normal corporate conditions. But nothing killed it. Sometimes a great product and company never makes it to market. That's how it goes.

On a personal level:

• Industry is a great place to make a network and lifelong colleagues. Be nice to everyone and treat EVERYONE with respect. You never know when a simple acquaintance will save you later down the road. I became pretty chummy with most of the US sales force. Guess what- they all went on to other companies. Some of those companies needed SMEs. Some needed Directors or SVPs. or CMOs. They hooked me up with all sorts of opportunities down the line. It worked the other way as well, and I did what I could for everyone that needed a job or reference or off-the-cuff free consulting (or advice). Mr. X will have a pretty tough time finding a job in this my industry.
• On a corporate level- same as above. Treat people with respect. The European company was used to the difficult legal situation overseas with laying off employees, and IMO, they saw the legal standard as the moral standard. In the US, there are significantly fewer protections for employees. However, most companies go out of their way to treat their employees with respect when they are let go, with good severance packages and lengthy notice periods. One of the difficulties this company had in securing business is that they treated a lot of employees badly- as you can guess, employees who are treated badly rarely have good things to say about the company.

With these lessons learned, I moved forward. I decided to focus on my businesses, and that I would not work for another similar enterprise. However, my experience lead to a LOT of additional opportunities. I probably had 3-4 unsolicited interview offers per month. Though my own contracts with companies I maintained and grew my exposure in my field. At first these were lateral moves to the Executive Medical Director role I had, often with lower salary. Sometimes they were for similar roles with larger, revenue-positive companies (or behemoths) with a higher salary range. Some were premier academic institutions. But none would really allow me to keep my medical services company and software company that I developed, and I wasn't going to give that up. Additionally, I had done the Medical Director bit and didn't want to do that again. As my standing and exposure grew (through my services and consulting), the offers did as well. I saw SVP and CMO positions, typically for start ups. I definitely did not want to go that route again. I really did not want to be an employee again, and did not seek opportunities, but also did not shy away from them either when they presented themselves.

Eventually I did get a few offers I could not refuse. One was an academic role for a Senior Administrative Director role for a major cancer center that was very exciting. It really drew me in because it would allow me to be creative and try to forge a new field of medicine (precision oncology) at a brand new facility centered around this premise. However, the timing wasn't going to work out as they wanted me to relocate right away, and I was in the middle of some projects I could not abandon. The second offer I could not pass up and it did work out. My current role as CMO allows me to use all the scientific rigor of my PhD and the clinical judgement of my MD. In a way, even though it is a role I never thought I'd have when I was in training, it is a perfect use of my MD/PhD training. Although I am once again an employee, this environment is very different in almost every way- the company is supportive, they listen, they are functional. I now run a rather large medical affairs division and take the time to impart a good culture in my group, with open communication. I am thankful every day that I have such an important and impactful role, even though I had to go through hell to get here! I probably get CMO offers (sometimes from pretty big-name places) about 2-3 times per month, but I think it would be very tough to leave my current role.

/end

 

[Fencer]

As I indicated previously, thank you for sharing your journey thru a start-up company...

 

[JoaoMoutinho]

At least for me, this has been one of the most helpful threads I've seen here.

Thanks @gbwillner for sharing!

 

[CheGuevaraMD]

Great thread! These experiences echo the stories that my former classmates had about startups (though more dramatic). I talked to one alum who ended up becoming a multi-millionaire from a CMO position, but I think that's about as likely as winning the lottery.

 

[gbwillner]

Great thread! These experiences echo the stories that my former classmates had about startups (though more dramatic). I talked to one alum who ended up becoming a multi-millionaire from a CMO position, but I think that's about as likely as winning the lottery.

To be fair, most people at the CMO position will become multi-millionaires. That's not a high bar. The question is how quickly you become one (and if you mean by net worth).

 

[SurfingDoctor]

To be fair, most people at the CMO position will become multi-millionaires. That's not a high bar. The question is how quickly you become one (and if you mean by net worth).

A vast majority of physicians will become multi-millionaires if looking at net worth. Heck, that even includes pediatricians... and we are the bottom feeders in salaries.

 

[CheGuevaraMD]

To be fair, most people at the CMO position will become multi-millionaires. That's not a high bar. The question is how quickly you become one (and if you mean by net worth).

Okay, you know what I meant -- coming into $10-20M in your 40s. Not a 401k millionaire, which is basically all white collar professionals in the US.

 

[gbwillner]

A vast majority of physicians will become multi-millionaires if looking at net worth. Heck, that even includes pediatricians... and we are the bottom feeders in salaries.

As I am now firmly in my mid-40s, it is surprising how fast wealth starts to accumulate once you have a nice nest egg.

Okay, you know what I meant -- coming into $10-20M in your 40s. Not a 401k millionaire, which is basically all white collar professionals in the US.

I was being pedantic- I get you meant Rad Onc money.

 

[SurfingDoctor]

As I am now firmly in my mid-40s, it is surprising how fast wealth starts to accumulate once you have a nice nest egg.

Thank god for index funds and a robust market.

That being said, I think a class or two in graduate school on how to invest and do it wisely would go a long way. It wasn’t until residency that I got that lecture and honestly, it’s really the only one I remembered.

 

[Lucca]

What a ride, look forward to the Netflix adaptation

 

[Neuronix]

@gbwillner Thank you for one of the best life experience post series in the history of SDN. I wish I had been along for this ride sooner. Oddly enough, I was also flirting with industry during your series of posts. I just turned down an offer for 2x my former assistant professor salary last month. I got that offer around the same time as my R01 summary statement. The University increased my pay because of that offer and the R01. Not 2x, but a decent amount. It no longer was worth it to leave academics.

But, there was something else afoot. You are 100% right about the lack of protections US companies provide their employees. The contract I received at the end of a long negotiation was atrocious. So much that was discussed verbally would not be put into writing, and they could just change the contract around on me or fire me with short notice. So what was that contract even worth? They weren't even offering me equity, and I do strongly suspect they're heading towards IPO. So the upside really was not there. I was not willing to give up the security of academics at the end of it.

A lot of the same things you posted are things I saw as an outsider or was told to me by people on the inside. MBAs who think they're smarter than MDs and that MDs make too much money? Check. Excessive focus on irrelevant things that are not revenue producing and may actually be revenue damaging? Check. Products that don't make a whole lot of sense to someone who actually does this for a living? Check. International types who have no concept of the US market? Check. Also, treating people with respect or getting a bad reputation is absolutely right. I found several people who had formerly worked there who had bad experiences or ended it in lawsuits. Why join a situation like that?

In the past I had explored a stable industry opportunity in rad onc with a large, well known company. The pay would have been at the rad onc instructor level with no clear way to ever get to clinical academic levels. Sure there were stock options for the mediocre performing stock, but the total compensation as VP of X was not impressive. People seem to think industry is a ticket to big money. It can be, but it's not automatic, and it's often risky. Directorship and VP positions are absolutely often terminal. If you want to make it to the C-level and bring in the big bucks, you either need to get very famous elsewhere and get recruited at that level, get in early and take big risks, or start your own company.

But also on a personal note, I now understand why a certain academic institution you used to work at interviewed me for a 100% clinical position and told me I wasn't allowed to write a K08 because it was a "money loser". Aren't you a major research institution? Aren't you strong in this and similar research? Don't you want to support me to do this work? I'm not even asking for a big salary? I was perplexed about that until I read your posts. Thank you for the clarity. I also interviewed at your "#4" (sorry it's enough detail to know exactly who that is), but they never called me back. Everyone I interviewed with refused to answer a single e-mail or phone call. Was it something I said? Well, that was in December of 2019. I'm kind of glad that they never called me back.

I don't see the point of making half the pay of my peers in clinical medicine so I can run a rag-tag group of graduate students publishing 3-5 low impact papers per year and constantly stressing about funding.

Don't knock it till you've tried it.

I went to an MSTP with a big name business school. A sizeable minority of the med school class did the MD/MBA program. All those types were constantly telling everyone about internships and opportunities with X hedge fund or consulting organization. Many of them took time out of med school or didn't pursue residency initially to go work in the business world. They all ended up back in clinical medicine eventually. I can't think of anyone who stayed in business. They're all practicing clinicians now. The grass is always greener my friends...

 

[SurfingDoctor]

Ha… when I got a renewal RPG… I didn’t get any raise. All I got was “Nice. So when’s the next submission?”.

 

[pazzer2]

Hello all,

I'm an MD and have been working in the pharma industry for over 20 years. My story has been chronicled in another thread in the MD-Business forum here. After reading the excellent novella by @gbwillner, I thought I'd add my perspectives. I've had my share of experiences in small, medium and large companies.

First to go back to the OP's original question, there are a variety of timepoints that MD and MD/PhD applicants can enter the pharma industry:

1) After finishing residency (preferably after fellowship) - Associate or Assistant Director level
2) After working in a related job for 3-4 years (FDA, CRO, PI at a research site) - Director level
3) After being tenured, Chair of Department, well known international KOL - VP level

Again a lot of this depends on your prior research background, and connections. Biotech is a little more forgiving, and the big pharma companies are more conservative. Medical device companies focus more on your specific experience with their products. Having an MD/PhD certainly puts you at an advantage compared to MD/DO candidates. But having the research experience is essential. The PhD part of your training puts you in a good spot to have good publications by graduation time. But I've known many MDs without a PhD who have loads of research. Myself in particular, I have over 300 posters/publications, and my H Index is 52. This far exceeds most MD/PhDs that I know. But the point is that you need to demonstrate that you are a serious researcher. Publications is one way of gauging that. Once you get into the role, the pressure to continue to publish is much less. But it certainly gets noticed, especially at the ivory tower companies (Merck, Pfizer, etc).

More in next post about culture, etc....

 

[pazzer2]

One of my first jobs out of residency was in a small-medium sized company. I was the only MD, and was responsible for medical monitoring -- which involves being in regular contact with the PIs around the world and answering their questions about the protocol. I'd also review events for safety. My immediate line manager was a non-MD (statistician). Since she had no knowledge of clinical medicine, I really couldn't go to her for advice on how to handle individual patient safety related issues. She had somewhat of a chip on her shoulder. And felt that she knew much more than physicians -- and hence was a perfectionist and micromanager. Her behavior drove everyone crazy. It was difficult to deal with her. I eventually transferred over to a different department in the same company just so I could get away from her. But management tolerated her because she cranked out the NDA applications and got them approved.

At this same small company, they would often fire someone at the drop of a hat. For stupid silly **** like getting into a disagreement with your boss. Several times I saw security come by to escort someone out of the building because they were fired on the spot. This made everyone uneasy. I had two small kids at home and job security was a big concern. After two years there my phone was ringing off the hook from headhunters. So I made for the exit as soon as the next opportunity came along.

My next experience was at one of the big pharmas (fortune 500). Here, I had a lot of autonomy. And physicians ran the show. We drove the strategy for the study designs, interacted with health authorities, presented the posters and generally took most of the credit. I interacted with operational and regulatory colleagues to help deliver the strategy. Everyone on the team around me deferred to my judgment just because I had MD next to my name. We also took the blame when a study failed. Even with a perfect drug, you're bound to have a failed study once in a while.

At the big pharma company, it took a lot of personality skills to rise to senior management. So micromanagers and narcissists were quickly weeded out. The main issue was the huge bureacracy. It took dozens and dozens of meetings to get everyone aligned. Everything had to be run up the chain to senior management in a series of never ending meetings. When presenting the research strategy you'd often have to present to senior managers who would derail the conversation. We'd spend endless hours in pre-meetings so that each of the smart alecs could have their own time. They were just trying to be helpful, but sometimes a little knowledge goes a long way in creating a huge diversion. I'd estimate conservatively that it took 2-3x longer at big pharma to arrive at a consensus vs my small company.

Regarding compensation - my thread from 2005 still holds true today. My 2021 all in compensation is approx $750K USD. This includes stock/options/RSUs/cash bonus and pension. I'm hopeful that I'll be promoted to the next level, in which case my compensation would take another bump -- probably an additional $200K per year. My stock options hold value of over $1M USD, and I'll hold until they expire, plus another $2M in RSU. My compensation in the pharma industry vs staying in clinical practice is no comparison. If I stayed as a clinical MD, my salary might have been higher for the first 10 years. But the additional incentives (options, bonus, dividends, pension) quickly eclipses that.

The other thing to add is that your salary will generally increase year over year in pharma (cost of living 2-3% per year plus promotions). In clinical practice the salaries generally remain flat, or decrease. The CEO of Novartis is an MD. His annual salary + stock is upwards of $30M per year. So overall I'd say that at medium-large size pharma companies the compensation is better than staying in clinical practice.

 

[gbwillner]

The other thing to add is that your salary will generally increase year over year in pharma (cost of living 2-3% per year plus promotions). In clinical practice the salaries generally remain flat, or decrease. The CEO of Novartis is an MD. His annual salary + stock is upwards of $30M per year. So overall I'd say that at medium-large size pharma companies the compensation is better than staying in clinical practice.

If I may ask- what is your current title?

I think it is worth repeating that there are high paying jobs in industry/pharma. But there are high-paying jobs in private practice as well. Where can you make the most money depends on you. IMO, in Pharma and Industry you have to get to Sr Management level to do as well or better that the typical PP job, but those are rare jobs to get and require management skills that not everyone has- there are only a handful of such jobs per company and you may never get them. In PP you have a much better sense of what your income will be as an employee, but you can also own your own practice and make a lot more. I am sure very few private docs out there make as much as the CEO of Novartis, but there are a lot of private docs who own their own practices or are partners in large groups that make a lot more than even most Sr. Managers in Pharma/Industry.

 

[pazzer2]

If I may ask- what is your current title?

Senior Director

 

[pazzer2]

I agree that rising to senior management in a pharma company is not so easy. There are loads of physicians in my company who have spent a decade or more at the director level and never got promoted. But many of these folks preferred it that way. Being a people manager is somewhat of a headache. Having to deal with all the HR issues, doing year end evaluations, making everyone happy is not so easy. If you have a good bedside manner, and know how to work in a team environment, you'll do well in Pharma, and eventually rise to the top. There is a lot more stress and pressure at higher levels -- but that goes with the increase in pay.

From entry level (Asst/Assoc Director) to Director takes typically 3-4 years. Then from Director to Senior Director 5-8 years. Then Senior Director to VP about 8-10 years. VP and above is quite variable. Can climb the ladder more quickly at a smaller company/biotech. Also have to keep in mind the office politics (schmoozing, small chat, public speaking)...these little things often matter more than your clinical knowledge when it comes time to promotion.