Last September, a group of authors from Johnson & Johnson published a peer-reviewed essay that lays out different roles that physicians can play in a large pharmaceutical company.^[1] The paper reviews the structure of a pharmaceutical organization while highlighting various corporate roles and contrasting careers in clinical medicine with those in industry. Retina specialists with an interest in the business world could benefit not only from reviewing such written resources but also from listening to the personal reflections of colleagues who already have made similar career changes and who may provide a broader overview of opportunities, which can range from commercial product management to independent consulting to venture capital investment. Here, 3 retina specialists share valuable personal insights based on their own experiences and offer advice on transitioning to rewarding roles in industry.

Thomas A. Ciulla, MD, MBA, chief medical officer and chief development officer of Clearside Biomedical, describes the path toward his current role as one that developed slowly and somewhat serendipitously. Before taking steps to begin a second career in industry, Dr. Ciulla trained at Harvard and Tufts, and then codirected the retina service and ocular angiogenesis research lab at the Indiana University School of Medicine, where he continues to serve as a volunteer clinical professor. An interest in clinical trials gradually led to a series of leadership roles in clinical research, including principal investigator, scientific advisory board member, medical safety monitor, and data safety monitoring committee member. His work on more than 100 national clinical trials spurred a deeper interest in using scientific innovation to meet unmet medical needs.

“I felt very privileged to have been involved with anti-VEGF innovation, and to have participated in trials such as those for Macugen, Lucentis, and Eylea,” says Dr. Ciulla, “Then, after more than 20 years of academically oriented clinical practice, I found myself stagnating, with an ever-increasing number of repeat injections in clinic. I felt the need to somehow help retina patients in a potentially more sustainable and exponential way, with a more direct role in therapeutic development. I was curious to explore beyond the lab and clinic, so I returned to school to earn an MBA.”

After earning an MBA from the Indiana University Kelley School of Business, with a focus on the business of medicine, Dr. Ciulla accepted a part-time opportunity at Ophthotech Corporation (now Iveric bio), which eventually led to the full-time role of vice president of clinical strategy.

“From there, I had the great fortune to assume a VP role at Spark Therapeutics,” says Dr. Ciulla, “where I assisted in the approval, launch, and commercialization of Luxturna, a once-in-a-lifetime opportunity to work on the first US gene therapy for a genetic disease, and to introduce gene therapy to my peers.”

After defining and leading medical strategy to support the development of Luxturna (voretigene neparvovec-rzyl), Dr. Ciulla transitioned to his current role at Clearside Biomedical, a biopharmaceutical company that specializes in suprachoroidal therapies. He points to the gradual evolution of his own second career in industry as proof that it’s not necessary to take an either/or approach to transitioning to industry from clinical practice.

“If you’re interested in exploring possibilities in industry, there are a number of different ways to dip your toe in the water while continuing to practice medicine,” says Dr. Ciulla. “For example, I served part-time on a data safety monitoring committee where I was involved in reviewing safety events from various trials. In that role, you examine safety signals from ongoing trials and determine, based on your clinical and research experience, whether it is safe to proceed to the next dose of a drug or to the next stage of a trial. I also have performed similar work as a medical safety monitor and have served on scientific advisory boards for various companies as well as on writing committees for scientific manuscripts. These opportunities allow you to explore new industry-related roles while continuing to practice.”

A self-described lifelong learner, Dr. Ciulla notes that on-the-job training and professional growth involved in various corporate leadership roles not only can open new doors in the business world but also can be immensely exciting and rewarding in themselves.

“At Spark, for example, I learned volumes from global experts about molecular biology and gene therapy, which did not exist when I was in medical school,” he says. “And launching the first gene therapy came with multiple challenges that required solutions, ranging from educating the medical community on novel gene therapy concepts and unfamiliar clinical trial endpoints, to implementing surgery training programs for newly-formed ocular gene therapy treatment centers. As another example, most of the retina community had never been involved with genetic testing, so we developed and launched a whole program on genetic testing called ‘ID your IRD.’ That involved working cross-functionally with diagnostic, medical affairs, and legal teams, as well as external genetic counselors and labs. These efforts introduced genetic testing to the broad retina community outside of academia, and heightened awareness, as the field began moving closer to precision medicine.”

Tackling the problem of reimbursement for the novel one-time therapy likewise involved taking on multiple roles and also proved to be a rewarding learning experience. “The reimbursement scheme for a one-time gene therapy was problematic because payers typically acknowledge the value of a therapy by reimbursing one pill or one injection at a time,” says Dr. Ciulla, “but the system may not properly value an innovative therapy that delivers long-lasting benefits in one dose. As we developed cost-effectiveness models and value-based reimbursement programs, I worked with health economists and had the opportunity to present at CMS (Medicare) and the Institute for Clinical and Economic Review. I ultimately learned a great deal about health care economics and came away with a deep respect for the teams of experts who are so committed to providing patients access to potentially life-changing therapies. In many small biotech companies, including Clearside Biomedical, there can be a steep, but gratifying, learning curve, as physicians assume multiple leadership roles and address a wide range of challenges, from preclinical drug development to clinical trial oversight to medical affairs.”

Nurturing Early Talents

The skills that Michael B. Rivers, MD, uses in his current role as the director of EMA Ophthalmology at Modernizing Medicine evolved gradually, long before he began to think about pursuing a corporate role. He began to nurture a talent for computer programming while pursuing an undergraduate degree in chemical engineering at Princeton University, and further honed this talent by taking advantage of a unique pathology database (called PathMac) and related programming coursework offered at Weill Cornell medical school. While still a resident, Dr. Rivers developed a computer database to automate an ophthalmology practice and manage patient information electronically — a database that was later adopted by the University of Iowa Hospitals & Clinics, where he was a surgical retina and vitreous fellow. Twenty years after joining the Retina Group of Washington, he was given a life-changing opportunity to explore the world of electronic health systems.

“When our practice began to investigate electronic health systems, members of my practice looked at my backgrounds and said, ‘Rivers, you run with this.’ After exploring the various options that were available at the time, I chose the EMA EHR system. So I began my relationship with Modernizing Medicine as an end user of the one of the company’s products.”

Not long after Dr. Rivers expressed an interest in working for the company, he transitioned from retina surgeon and managing partner to full-time executive at Modernizing Medicine, a role he found more intellectually challenging. Drawing on his years of clinical experience, as well as his experience as an end-user of the company’s ophthalmology platform, Dr. Rivers now interacts with physician users of the ophthalmology platforms, listening to their needs and communicating them to the organization’s product development, customer support, and sales and marketing teams.

“Our product is software,” says Dr. Rivers, “so a primary focus is the continual development and beta-testing of software to ensure that new software reflects the needs of our clients. Along with 4 other ophthalmologists in the company, who continue to practice medicine while writing code, I provide support to programmers, add new medical content when appropriate, and interface directly with our customers.”

Sales and marketing is another primary function of the business, to which Dr. Rivers devotes a larger percentage of his time. “In this role, I respond to media requests, introduce our clients to new products, such as our new software for ASC ophthalmology, or present new initiatives such as our telehealth solution, so that potential clients will understand their value. This is a unique role that differs considerably from standard sales and marketing roles.”

Dr. Rivers also focuses on anticipating and understanding all of the software solutions that might help a medical practice to run more smoothly. “I collaborate with the teams that produce reminder software, or practice management or revenue cycle management software,” says Dr. Rivers, “I also interact with our data services team, which works on data integration with other companies, and other kinds of business development, including partnerships and acquisitions.”

Customer support is another area of focus for this surgeon turned technology executive. “I devote most of my time to customer support, on multiple levels,” says Dr. Rivers. “In this role, I reach out to clients regularly to see how they’re doing. If I find that they need, for example, additional training, I’ll not only make sure they get it, but I’ll examine why they need additional training, and see if we can develop training systems that are more functional for them, whether these are delivered in person or automated. One initiative we developed to address exactly this type of issue was modmed University. In a software company, a primary focus is not only on acquiring new business, but making sure our clients are happy, and customer delight is a huge part of that.”

Building on the Science of the Visual System

Grace Chang, MD, PhD, chief medical officer at Notal Vision, began her career by pursuing a passionate interest in basic science. She studied chemistry, and then electrical engineering, at Stanford University, and it was not until after she earned a PhD in computation and neural systems from the California Institute of Technology that she decided to attend medical school.

“During my early years of training, I don’t recall having an interest in the business world,” says Dr. Chang, “I was always primarily interested in the brain and visual pathways. I pursued my master’s in electrical engineering in order to obtain the tools I felt were necessary to study vision on the systems level, and I studied the primate visual system while working toward my PhD. During that time, I realized that I wanted to focus on work that was more translatable and that would involve directly helping people. In medical school, I found that I was drawn to surgery and I was particularly interested in the retina, one of the most fascinating parts of the visual pathway.”

After completing her ophthalmology residency and vitreoretinal fellowship, Dr. Chang accepted a faculty appointment at the University of Washington. While teaching residents and regularly seeing patients, she also had research interests in imaging technology.

“I was drawn to the idea of helping a large patient population through the development of imaging devices,” said Dr. Chang, “although I didn’t yet understand the process of bringing a conceptual idea to fruition. I was interested in learning how to develop an idea into a product, since I was working on an imaging system that I believed could be beneficial if I could bring it to a broader market, but I wasn’t sure where to begin. And I also realized that it would be very difficult to pursue work of that kind in a purely academic setting. So that’s when I began to talk to various companies.”

Dr. Chang was already an end user of products that had been developed by some of the companies she approached, which helped to open some doors, including at Alcon, a subsidiary of Novartis. She launched her business career there, in strategic roles that allowed her to understand how products are developed within the structure of the company and the various roles available to physicians.

“The company may consider partnering with a physician who is developing a product, or who wishes to enter into a licensing relationship,” says Dr. Chang, “Physicians also may propose investigator-initiated trials involving company products that are already out on the market. In addition, there may also be opportunities on advisory boards, and Alcon has scientific and medical advisors in both the R&D and commercial areas.”

Dr. Chang notes that at Notal Vision, both the structure of the company and available roles are different. “Notal is a home diagnostic services company,” says Dr. Chang, “And we are a much smaller company, compared with a corporation like Alcon. Currently, physicians have a number of different roles in our company, including board of directors and advisory board roles. Physicians on our advisory boards give us input and advice on our products and business strategy, and they help us to assess the pulse of the market. We also have a number of clinical trials for our upcoming products, and physicians participate in those as well. The physicians we work with are mainly practicing full time while offering us their insight and expertise. Conversely, I have the privilege of being a full-time employee at Notal Vision, and yet still practice.”

The company’s infrastructure and dynamics are unique. Although some may think of the company as a medical devices company, it is a diagnostic services company, says Dr. Chang.

“While we do have an AI-enabled home-based monitoring system for the early detection of the onset of wet AMD, and we are also currently developing a home-based OCT system, these are supported by a much larger infrastructure which includes the Notal Vision Diagnostic Clinic (NVDC). The NVDC is a regulated, full-service clinical entity providing engagement, education and support to physicians and patients. Because it is directed by physicians, this is another way that physicians can play a role in our company.”

When to Transition to Industry

The best time to transition to a career in industry can vary significantly, depending on an individual’s unique background and experiences. For some, a corporate role may be rewarding at the very beginning of a career, while for others it may be most gratifying as a satisfying final chapter.

“I didn’t make the change until I was in my late 50s,” says Dr. Rivers. “I had practiced medicine for a long time, and had had the valuable experience of helping to build a large practice. At that point in my career, I also had the financial flexibility to explore a new role, including one that might provide less income than I might earn as a full-time retina specialist.”

Dr. Rivers adds, however, that there are plenty of opportunities in the business world for retina specialists who wish to pursue corporate roles right out of training. “I’m a firm believer that you have go to work every day at a job that makes you excited. Being a physician gives you a unique voice in a number of business enterprises. At any stage of your career, there is an opportunity for you to offer your unique experiences to solve corporate problems that involve understanding how doctors think and what is most important to ophthalmology practices and patients.”

Dr. Ciulla agrees that the timing of a transition depends on the individual. “You might have more value to a biotech company, with a bigger impact, if you have some preclinical research and clinical practice experience, so that you can properly assess unmet needs, assess complex scientific and clinical data, and communicate to internal and external stakeholders,” says Dr. Ciulla, “However, I have been told that there are physicians who happen to be leaders, and leaders who happen to be physicians. People who fit into this latter category — even somebody right out of fellowship — might successfully transition early, depending on his or her maturity, communications skills, ability to work well with others in cross functional teams, and willingness to learn.”

A physician who continues to practice can provide value to a company, too. “I still see patients,” adds Dr. Ciulla, “and every company I’ve worked for has approved this clinical work, because it keeps me clinically relevant and grounded in the retina community, with fresh insights into clinical problems that potentially can be solved by industry.”

Dr. Chang likewise doesn’t believe that there is a single pathway to success in business. Unique work and educational experiences can influence decisions, she says, and sometimes whether a job appears that matches your interests and background can be a matter of luck.

“I’ve known people who have gone into industry right after medical school and have ended up being successful,” says Dr. Chang, “And I happened to attend a medical school where we were encouraged to pursue interests in addition to medicine. So, some of my peers earned an MBA or a JD or a PhD, and some became involved with startups early on — all while continuing to pursue an MD. And then there are others, like me, who ended up in industry a bit later in their careers.”

Dr. Chang adds that retina specialists who have an interest in exploring industry should consider reaching out to companies directly. “Before you contact a company, I’d recommend being knowledgeable about the company’s products and keeping an open mind about potential roles within the company,” she advises. “Rather than express a narrow interest in working on only one particular product or within one division of the company, it’s helpful to convey an interest in learning about where you may make the best fit for the needs of the company.”

Still Helping Patients

The knowledge and skills that retina specialists acquire through training and clinical practice almost always continue to inform their roles in industry, and even specialists who decide to leave clinical practice entirely can find roles that involve a dedication to improving the lives of patients.

“I miss my patients, and I hear from time to time that they miss me, too,” says Dr. Rivers, “But I am still helping patients every day, indirectly, in my current role. If I can help other physicians to run a more efficient business, if I can provide them with tools that allow them to concentrate on patients rather than on the drudgery associated with running a practice, then I am helping them help their patients by providing their patients with higher quality care. That’s why I am here. I don’t want to be out on a golf course. I get enormous satisfaction from knowing that I am supporting the larger community of physicians. Every doctor only has so much bandwidth, especially in ophthalmology where the number of patients each clinician is seeing continues to increase. If I can give them more time to spend with their patients and produce software that helps them run their business, then I am helping them to be better doctors and in turn I’m helping their patients.”

Dr. Ciulla says that while he loves clinical ophthalmology and surgical retina, he can help many more patients in his corporate roles. “I still see patients on a limited basis, which is satisfying and helps me to stay on top of important clinical issues,” he says, “But I’ve found that as a clinician begins to assume leadership roles in the business world, he or she may be helping patient less and less in a hands-on way, and more by addressing important unmet needs related to a disease or therapy, and by doing so the clinician has an opportunity to help patients exponentially. In my role at Clearside, where I am overseeing preclinical development and clinical development and medical affairs teams, I am not just helping one patient at a time. Instead, I am working with colleagues to address an entire disease process and develop a therapy that has the potential to help thousands of patients.”

Dr. Chang says that she is aware that sometimes drug companies and other corporations are given a “bad rap” and perhaps can be perceived as having less than altruistic goals, yet during her time in the corporate world, she has devoted her energy toward improving the lives of patients.

“Throughout my career, a very fundamental driver for me has been the desire to find a way to help the most people I can with the skills and knowledge I have,” says Dr. Chang. “While I find it greatly rewarding to continue to help patients by performing surgeries and training fellows, in my industry role, I am also now part of a larger team of very smart people with specialized skills who are devoted to helping patients in a necessarily collaborative way. It takes an army of people with significant know-how and expertise, working together, to develop sight-saving drugs or technologies, and it’s not easy. A drug that may take decades of development could save vision for millions of people. The same could be said of surgical instrumentation or various surgical systems. I am motivated every day by the potential to help such a large number of people by being part of a large team of highly skilled experts devoted to improving the sight of patients.”

Reference

1. Sweiti H, Wiegand F, Bug C, et al. Physicians in the pharmaceutical industry: their roles, motivations, and perspectives. Drug Discovery Today. 2019;24(9):1865-1870.