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Acting between the poles of organization and profession

Chamaeleon and flower, coloured X-ray. This is a bird of paradise (Strelitzia reginae) flower

Why Medical Affairs in Pharma acts strange sometimes.


The medical affairs department fulfills a special purpose in pharmaceutical companies. As boundary spanners to doctors and the scientific community, medical affairs personnel e.g. ensure both the necessary flow of information about and adequate participation in crucial studies of new and existing drugs. These staffers are required by law to maintain a strong connection with the medical profession. As these physicians put their expertise to work for pharmaceutical companies, their continued involvement with the medical community can be a source of conflicts and misunderstandings – and it is the beginning of the answer to a question often posed in the hallways and conference rooms of pharmaceutical companies: “Why does Medical act strange sometimes?”

When the Profession Hits the Organization

From a sociological perspective, professions are a special kind of social institution with a highly regulated right of access. They are characterized mainly by three elements: (i) decisions on what qualifications are necessary to become a member are made by the profession itself; (ii) the quality of work of a professional can only be evaluated by a member of the same profession; and (iii) professional work is concerned with individuals in a professional-client relationship and is therefore unsuitable for standardization.

In the medical profession, these characteristics are evident. Medical training follows a set of highly regulated standards, and in many countries doctors are required to become members of a medical association. Medical professionals are not dependent on their clients’ satisfaction as are other service providers; they do not need to deliver successful healing to get paid. In addition, a doctor’s work aims at treating individuals, and every patient is different. While there are guidelines on how to treat certain diseases, individual treatment decisions are made based on each doctor’s judgment in a process that evades thorough standardization.

Clearly, these practitioners are deeply immersed in their peer group, belief systems and self-governed rules. At the same time, medical affairs professionals are also members of pharmaceutical companies, which expect them to pursue different, parallel priorities. This coexistence of two guiding principles is an underlying source of behavior, sometimes perceived as strange, that organizations cannot easily eliminate. In the case of pharmaceutical companies, it fosters specific points of tension that can be observed in many cases. Here, we examine three of those challenges in greater detail and explore how organizational leaders could navigate them successfully. 

1. Divided Loyalties

The Challenge:

Medical affairs personnel are often pulled in different directions by their dual loyalties to the medical profession and to their employers. As a result, managers are often disappointed in their efforts to bring medical affairs staffers into alignment with organizational goals. Often, when dealing with medical staff, managers find it difficult to make effective use of common organizational leverages such as hierarchical power and goal setting.

For example, when a pharmaceutical company designs a drug trial geared primarily toward obtaining a bigger patient share, rather than to find out which subset of patients may actually benefit, the medical affairs department plays a vital role. It is up to them to reach out to physicians in the field and convince them to participate in the trial, but if the medical affairs professionals don’t believe that the trial can create true innovation, they may become conflicted. To ensure future cooperation from other doctors, they need to preserve their professional reputation and the trust they have earned, and they may be therefore unlikely to pursue the project with their full capabilities.

Leaders would do well to embrace their medical staff’s double loyalty.


It is, of course, understandable when a leader within a pharmaceutical company becomes frustrated by the medical staff’s lack of responsiveness to leverages that keep the rest of the company running smoothly. It is easy to forget that it would actually cause the organization a great deal more trouble if the medical department was suddenly to become more malleable.

All boundary spanning functions in every industry tend to incorporate the vested interestes of the environmental field they are dealing with – and therefore require a certain room for maneuver to do their job properly and funnel back those external perspectives on goods or services. This division of loyalty only grows if access to the relevant environment furthermore requires being an accepted member of the same profession. It is only through the medical staff’s resistance to institutional leverages that they establish themselves as independent and put themselves in a position to raise the organization’s street credibility with the physicians on whom so many vital projects and economic success depend. Pharmaceutical companies hire medical staff precisely so that they will build a bridge between the organization and the medical community, and they can do so effectively only if they show themselves to be professional colleagues with both expertise and integrity who are not suspected of simply funneling sales interests.

A Possible Pivot:

Historically, pharmaceutical leaders have continued to frame medical departments’ independence as a problem—even though in reality it has greatly benefited them.

Leaders would do well to embrace their medical staff’s double loyalty. Medical personnel are valued for the many kinds of connections they maintain to their professional sphere as well as their own expertise in the field. When organizational leaders try to disrupt that vital and deep-seated orientation, it is not only harmful but futile. Instead, management must balance the goal conflict between possible short-term gains and the long-term preservation of trust in the medical community. If anything, doctors’ double loyalty provides a starting point for achieving that balance. Management should think twice before pushing too hard for medical affairs’ alignment and potentially alienating a set of employees who are both essential to business goals and highly sought after by other employers.

2. Leading Medical Personnel from Outside the Specialized Profession

The Challenge:

The job of leading medical personnel within a pharmaceutical organization can be a thankless one – especially when the leader in question is not a specialist or doctor at all. As discussed above, the quality of a doctor’s work can only truly be judged by peers within the medical profession, so a non-medical leader is ill-equipped to evaluate the decisions made by his or her subordinates. And because of competing priorities embedded in their professional identity, these subordinates are disinclined to respect the wishes of a supervisor based on hierarchy alone.

So what other leverages beyond hierarchical power can a non-medical or non-specialist supervisor offer? Seniority is helpful, as is expertise. But expertise can only be gained in a limited number of areas, while the leaders assigned to supervise medical staff often must guide a complex array of projects.

If this area of conflict goes unresolved, it can become difficult to guide the work of medical staffers toward the fulfillment of company goals. Perhaps it doesn’t seem particularly threatening or even that uncommon if a medical professional complains about the inferior expertise of his supervisor. But if this occurs frequently and openly, it can undermine an organization’s ability to formally set goals and achieve them.


For a leader faced with this challenge, it is worth considering how much control over the medical staff is in fact necessary.

Every doctor on staff is guided by the knowledge and cultural orientation they gained during medical training and through continued involvement in the medical community. These doctors are already experts and have a sense of how to do their profession-related work. It is reasonable to trust them, and they do not need to be micromanaged.

A Possible Pivot: 

Leaders of medical teams must accept that their position within a company’s hierarchy is not sufficient to command their staff’s compliance or trust. Instead, in the early stages of establishing themselves in the role, they must communicate other legitimizing factors to the doctors under their guidance, and they must clearly define each person’s role.

These leaders are in a unique position to decide where and how in an organization goal conflicts between professional orientations and organizational requirements should play out.

In one real-world example, a medical executive in a global pharmaceutical company says openly that he is unable to lead through expertise. Instead, he expects the 11 medical directors he supervises to lead their teams using their expertise in rare diseases and oncology.

This executive has sidestepped much conflict by only rarely using his position within the hierarchy as a source of power. Instead, he gives his medical directors legroom, seeing himself as an enabler of their work and respecting his team’s expertise.

While medical professionals’ dual loyalty is expected to result in conflict somewhere, this executive has decided to place as much of the clash as possible on himself and become the person who balances the conflict within his organization. In this way, he can step back and let his doctors be doctors and do what they do best. When necessary to maintain this framework, he pushes back on demands by the sales and marketing departments. In other instances, when necessary, he presses his medical staff to do what’s needed, leveraging the acceptance he has earned with them by previously insulating them from demands he deemed less essential.

3. Loyalties to the Medical Profession Can Constrain an Organization’s Room to Maneuver 

The Challenge:

Every organization must navigate differences between its display side – what it shows the outside world – and the internal realities. These differences serve a purpose and allow an organization room to maneuver between varying expectations. When these differences clash with the professional orientation of medical affairs staff, they can become dissatisfied and increasingly cynical and even leave their roles for positions in R&D or at organizations that have built their brand around prioritizing scientific innovation over profit.

Within an organization, the medical department often comes to be seen as the “squeaky wheel.” Medical professionals complain that strategic decisions are unintelligent or ridiculous because they do not accept the validity of motivations outside of those in line with their professional identities and with the public-facing side of company communications. Regarding non-scientific motivations as inferior, medical professionals tend to have a blind spot when it comes to micropolitics and working toward compromise with other stakeholders.


Medical personnel’s lack of engagement with strategic directions does not interfere with their primary role. Within a pharmaceutical organization’s division of labor, medical staff are responsible for pushing the organization toward quality, innovation and satisfying the interests of other doctors. To successfully do so, medical affairs staff should be more aware of their own resources within internal power games.

A Possible Pivot:

The divided loyalties of medical professionals and the ways this conflict can disadvantage the organization are rarely discussed openly – a lack of communication that can make tensions worse and increase organizational dysfunction.

What if medical affairs were to throw itself earlier and more deeply into cross-functional strategy development? What if they were to avoid holding themselves aloof and refuse to limit themselves to explaining datasets and guidelines – instead engaging fully in negotiating for compromise? To do that, they would first need to better understand the goals and perspectives of other departments. And they would need to understand how their medical expertise and ties to the community could be used to forward their professional interests – from gaining sponsorship for additional trials to achieving changes in trial design. If they can expand their micropolitical tool kit in this way, medical professionals’ dual loyalty will prove to be a tremendous asset.





is Senior Consultant at Metaplan. The political scientist is specialized in questions of health care systems and stakeholder management within them – as well as strategic crossfunctional planning in the pharmaceutical industry and facilitating scientific medical discourse.


is Senior Consultant at Metaplan and an organizational sociologist. His field of research comprises of Post-Bureaucratic Organizing. He advises in a broad spectrum of industries often dealing with expert driven organizations.

Ein Kommentar zu “Acting between the poles of organization and profession

  1. Ines Vogel   28. September 2019 at 17:51 - Reply

    As we were asked, if it could be a potential blindspot not mentioning that a Medical Affairs department consisting not only of MDs but PhDs or PharmDs also und if the same professional standards and behaviors apply – here some additional remarks:

    We thought about PharmDs und PhDs in the Medical Affairs departments but decided to leave them out to not complicate the matter further. But you are absolutely right to remind us!

    What all three subgroups have in common, is that they work as boundary spanners to the medical community. Therefore they tend to incorporate the vested interests of their assigned external realm and bring them into the pharmaceutical organization – with all the benefits and conflicts coming with that. PharmDs, MDs and PhDs as highly trained experts also need less direction and more legroom to bring their expertise into good use.

    But only MDs and PharmDs are members of a profession in a sociological sense as we defined in the article. And of the two only MDs still operate dayly within their profession as part of their job within Medical Affairs (contact to pharmacies often delegated to other departments). Therefore the inherent pressure to maintain ‚street cred‘ and live within the professional concepts of excellence is doubled in this special constellation.

    We of course welcome any other questions, remarks or objections. Please post them in the comments or send them via E-Mail or LinkedIn.

    Ines Vogel
    inesvogel@metaplan.com, https://www.linkedin.com/in/ines-vogel-98983b12a


    Finn-Rasmus Bull
    finnrasmusbull@metaplan.com, https://www.linkedin.com/in/finn-rasmus-bull-b147aa142/

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