Medical Affairs Has an Impact Problem. But Not the One We Think.

40%. That's the percentage of respondents in a recent MSL Society global survey who said their organizations measure MSL impact.

The study, published in Cureus in March 2026, surveyed 1,023 Medical Affairs professionals across 63 countries. Two other findings caught my attention:

The MSL Society was raising concerns about the disconnect between MSL metrics and value back in 2015. More than a decade later, we're still having essentially the same conversation.

But what concerns me isn't just the lack of progress. It's that we've been measuring against the wrong theory of how Medical Affairs creates value.

Think about the implications. These measures influence which HCPs we prioritize, how territories are designed, where resources go, and what MSLs are expected to accomplish. We could be investing millions in field capabilities without clearly defining the scientific questions those teams should help answer.

When I shared these numbers recently, a Medical Affairs director asked a question I haven't stopped thinking about:

Visits and events are easy for Commercial to count too. So what would Medical measure that belongs to Medical alone?

I think that's the question.

Yet much of our field model is built around a very different assumption.

It goes like this: educate the right people, they change how they practice, and patients do better.

Once you recognize that assumption, you see it everywhere. It's part of why we prioritize KOLs, count reach and frequency, and survey clinicians about their intentions to change practice. When leadership asks for evidence of impact, we try to stretch that chain all the way to patient outcomes.

The theory isn't entirely wrong. Scientific education matters.

But think about everything that determines what actually happens to a patient. Access, payer policies, guidelines, hospital protocols, referral pathways, and the patient's own circumstances all influence whether evidence translates into care.

A physician can understand the clinical data perfectly and still be unable to get an appropriate patient on treatment.

I saw this tension during last week's MAPS webinar on future-fit Field Medical, presented with ZS.

One slide illustrated how patient outcomes depend on a series of connected decisions, from diagnosis to referral, treatment, and monitoring. But earlier in the presentation, the future-state model projected greater patient impact through increased reach and engagement frequency.

Those two ideas don't fit neatly together.

If outcomes depend on multiple interconnected factors, why would we assume increasing engagement translates proportionally into greater impact?

Reach creates opportunities for impact. It doesn't establish that impact occurred.

Yet we continue relying heavily on what we can count: interactions, coverage, events, and insights submitted.

Commercial can count many of the same activities. What Medical brings is the scientific judgment to identify what remains uncertain, evaluate the evidence, and determine whether those uncertainties have been adequately addressed.

So why aren't we measuring more of that work?

What if, instead of starting our field plans primarily with who we need to educate, we started with what the organization needs to understand?

I'm talking about specific scientific uncertainties that matter to medical strategy, evidence generation, or clinical practice.

This doesn't mean turning MSLs into interviewers or making every scientific exchange an information-gathering exercise. MSLs still have an independent responsibility to provide balanced scientific information, respond appropriately to unsolicited questions, and support legitimate scientific discussion.

But a question-led approach gives the field clearer strategic direction. And it gives us something more meaningful to measure.

Two theories of Field Medical value: the traditional education model versus a scientific question-led model.

Most medical plans contain activities. Engage 40 Tier 1 KOLs. Support two congress symposia. Conduct scientific exchange on mechanism of action. Roll out the new slide deck.

All reasonable activities. But what is the organization trying to learn?

A question-led plan looks different:

We don't know how community clinicians are sequencing therapy after first-line failure in patients with a particular comorbidity. We need to understand this before finalizing next year's evidence-generation priorities.

Now the field has something specific to investigate.

One of the best places to identify those questions may already exist inside the company. Medical Information receives unsolicited inquiries from clinicians, including many who never appear on a traditional KOL list. Commercial teams also hear recurring questions, treatment barriers, and unmet needs through their HCP interactions.

These signals, when appropriately shared and evaluated, can help Medical Affairs identify where scientific uncertainty exists. But how consistently are they incorporated into field medical plans?

Say MSLs across three regions identify a similar concern. Clinicians are uncertain about treatment sequencing for patients with a particular comorbidity, and the available evidence doesn't adequately address the question.

That's a valuable signal, but three observations alone don't establish a broader clinical need. The field may need to investigate further, engage different types of experts, or compare those observations with other information sources.

Sometimes the answer is that the concern isn't widespread. That's useful too.

Unstructured insights still matter. Some of the most important observations are the ones nobody knew to look for. But if that's all we're collecting, we're searching through hundreds of notes hoping something meaningful emerges.

The point isn't to generate more insights. It's to reduce uncertainty.

Let's continue with the sequencing example.

The identified evidence gap informs the design of a real-world evidence study. A related publication moves up the priority list. HEOR colleagues incorporate the question into their evidence planning.

Now the organization has done something with what the field learned.

The outcome doesn't always need to be a new initiative. Sometimes the right decision is to hold off, request more information, or conclude that no action is warranted.

That's still evidence of a functioning decision process.

Other functions make decisions too. What distinguishes Medical Affairs is the independent scientific judgment it brings to evaluating evidence, understanding what remains uncertain, and informing appropriate medical decisions.

But this third measure is also where the operating model gets tested.

An MSL can generate valuable scientific insights, but their impact depends on whether the organization knows what to do with them.

Here's a simple exercise for Medical Affairs leaders:

Pull 15 or 20 insights submitted during the last two quarters and trace what happened to each one.

That exercise may reveal more about how your organization uses field insights than another dashboard.

We've spent years trying to demonstrate MSL impact through a simplified chain: education leads to behavior change, which leads to better patient outcomes.

Patient outcomes should remain central to why Medical Affairs exists. But Field Medical doesn't control every factor that determines those outcomes, and it can't reasonably claim the entire result.

What it can demonstrate is how its scientific work contributes to understanding clinical needs, resolving evidence gaps, and informing medical decisions. That isn't the only value of an MSL interaction, but it's a contribution we should be able to trace.

We've spent too long measuring what happens during an MSL interaction without paying enough attention to what the organization actually learned from it.

What does your organization understand, or what decision can it make today, that it couldn't before Field Medical did its work?

What scientific question is your field team working to answer this year, and could your leadership team name it without opening the medical plan?

Pharma Signal by Talmedica explores the decisions, operating models, and market shifts shaping Medical Affairs and the broader pharmaceutical industry.