Thoughts on Global Medical Affairs
I have had a number of posts about MSLs, including posts about MSLs driving value, posts about MSL team leadership and posts about MSLs vs. sales. However, I have not discussed MSL organization structure and staffing.
When thinking about MSL organization, it’s important to start with MSL to management ratios. Typically, the type of manager to staff ratios that work best in an MSL group is about 8 MSLs to 1 manager. There are all sorts of reasons why this could be scaled up to 12 to 1, including a fairly static therapeutic areas, MSLs that work extensively with other functions like Clinical or Managed Markets, or a team of all veteran MSLs that need little coaching. And there are all sorts of reasons you might want to scale back to 6 to 1 or even 5 to 1, if it’s a new therapeutic area for the company or inexperienced MSLs or a challenging KOL environment. But, those extremes 5 to 1 on one end and 12 to 1 on the other are the practical end limits. Much more than 12 people and it is not feasible for the manager to have a clear understanding of what their team is doing. Less than 5 to 1 and there is not enough work to occupy a full time manager and you know I feel that is important (see post here).
Given those ratios, how should the teams be formed? MSLs are inherently regional and that would lend themselves into regional organization structures, but they are also specialists often focused on a single therapeutic area or set of therapeutic areas. If the MSL group is large enough, you can do both – separate MSL groups by therapeutic area then by region within those groups. In reality, however, few organizations are large enough to organize that way. As a result, most groups mix or combine therapeutic responsibilities and build regional teams. To the degree that MSLs need therapeutic coaching, it can be provided through cross-team therapeutically aligned training and development.
Determining how many MSLs are needed starts with a clear definition of MSL responsibilities. MSLs have such a potentially broad remit in today’s environment (they could theoretically be focused on activities in support of Clinical or Market Access activities as well as MA and scientific outreach) that without a clear definition scaling can’t be done. Sometimes it’s a purely practical matter to determine this question – who is paying for the MSLs? That often clarifies what types of activities they will perform. But in many organizations MSLs routinely do work in support of functions other than the budget owner and so it really needs to be well defined.
Once the remit of the MSLs is understood, the next questions that help determine staffing are environmental. Key factors include:
Once the role of the MSL is understood and the environmental factors are clear, a good estimate of the work load can be developed and from there an estimated staffing level.
On another post I will discuss the challenge of starting up an MSL group from scratch and the buy or build decision.
What has been your experience in this area? What ratios do you follow?