Unpacking the Challenges: Field Medical and Commercial Teams

In this article, let's dive into the intricate—and often challenging—relationship between Medical Affairs and Commercial teams in the field.

Here's a scenario: You’re a Medical Science Liaison (MSL), gearing up for another day of back-to-back meetings with key opinion leaders (KOLs) and healthcare providers (HCPs). You’re ready to discuss the latest data, engage and get valuable insights. Unbeknownst to you or perhaps you suddenly find out that someone from commercial was meeting with the same HCP later that day. The HCP realizes this too and cancels the latter appointment.

This happened to me years ago with a slight twist - my name and my commercial colleague are both 'Christine'.  We were both new in the region. The HCP was confused and was very annoyed that we were taking up his time.  It's easy to say that 'that's an easy fix,' but in reality, this happens more often than you think.

These parallel paths, even within the same organization, can feel like a tug-of-war. Both teams are working toward success, but the lenses they see through are different. As an MSL, you’re focused on scientific integrity and clinical value, while your colleagues in Commercial are zeroed in on market strategy, positioning, and ultimately, sales.

While both perspectives are critical to the company's success, the challenge lies in compliantly merging them in a way that doesn’t overwhelm or confuse KOLs and HCPs.

Let's dig into some of the core challenges seen in the field.

Competing for KOL and HCP Time

Access to HCPs is limited and this is why things get tricky. You might be eagerly anticipating your opportunity to discuss data with a top KOL when you discover the Commercial team has already booked a meeting around the same time. This limited, competing access often creates tension. Without careful coordination, KOLs and HCPs can be left feeling bombarded and sending the wrong message (aka, 'we are not very coordinated')—an outcome that can harm credibility for both teams.

In the field-based, compliant collaboration between the scientific and business sides is critical to ensure a united front for seamless external engagement.

Balancing Competing Priorities

For MSLs, balancing scientific integrity with commercial goals is like walking a tightrope, especially in payor presentations. Your role is to provide unbiased scientific information, but there’s often pressure to align with business objectives. You might face questions on costs or risks and benefits—topics beyond pure science but crucial for product strategy. While you’re expected to stay independent, being aware of the business context is essential.

And then, there’s the social aspect. HCPs involved in speaker programs or advisory boards may wield influence at the local or regional levels, adding another layer of complexity. How do you maintain your role as an impartial scientific expert when the economic value or cost is always, even subtly, part of the conversation?

Working compliantly is a balancing act and requires proactive, transparent communication and management.

Ensuring Medical Affairs Independence

Maintaining the scientific independence of Medical Affairs is vital to preserving their credibility as unbiased scientific experts. However, pressure to align with Commercial objectives can sometimes blur the line between science and sales, particularly in situations mentioned previously (eg, payor presentations, formulary committees, etc).

Additionally, HCPs involved in commercial speaker programs or advisory boards can also complicate matters, especially if they hold influential roles at the local or regional levels, such as on P&T (Pharmacy and Therapeutics) committees. MSLs may find themselves in tough situations navigating these ‘social politics’, adding collaborative tension in the field.

Navigating the Gray Area: Clinical vs. Business Influence

Effectively navigating the gray area is critical for both field teams. While MSLs are expected to present clinical data, they are frequently asked about its business implications, such as cost savings or market impact.

While MSLs must remain independent, it's important to be aware of how their engagement is interpreted in a broader context. This is where I think more training is needed. It’s not ‘WHAT is said (clinically or scientifically), but ‘HOW things are said’ . . . this is where business acumen becomes a critical MSL skillset that unfortunately, most MSL teams, do not train for.

Failing to understand the business implications can lead to missed opportunities or miscommunication, undermining the goals of both departments.

Geographic Coverage and Goal Divergence

Medical Science Liaisons (MSLs) cover extensive geographies compared to their commercial colleagues, often spanning multiple states or regions. This broader reach requires a different geographic strategic alignment to drive the medical strategy.

Geographic coverage differences, in itself, can create significant strain between Sales and MSLs. Sales teams with smaller territories often rely heavily on their MSLs for scientific support, but due to broader geographic responsibilities, MSLs may not always be available when needed. This lack of medical support can leave some commercial colleagues feeling frustrated, especially when product sales fall short of expectations—whether from lost payer accounts, formulary exclusions, or slower-than-anticipated uptake. In these moments, the absence of accessible MSL support is felt even more acutely, amplifying the challenges of achieving aligned goals and fostering a cohesive field strategy.

Most MSLs can tell you stories about some of these frictions, especially when team goals diverge under pressure. While the aim is always greater alignment and open lines of communication, field dynamics can test even the strongest collaborations. Proactively addressing these challenges is essential to avoid potential discord.

Conclusion

Achieving a seamless partnership between Medical Affairs and Commercial teams is crucial for driving success in today’s competitive pharmaceutical landscape, but it requires more than coordination—it demands a strategic commitment.

Competing for KOL and HCP engagement, balancing distinct priorities, and upholding Medical Affairs’ scientific integrity in a business-driven environment are formidable challenges. However, by fostering trust, open communication, and respecting each team’s unique contributions, Medical Affairs and Commercial can form a powerful alliance to improve patient care and outcomes.

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