For decades, the industry treated Medical Science Liaisons (MSLs) largely as a necessary ambiguity. They were the highly educated, scientifically credible field force who went where sales reps could not go and said what commercial teams could not say.
In the golden age of the blockbuster drug, their value was assumed rather than calculated. If the Key Opinion Leaders were happy, the VP of Medical Affairs was happy.
But the landscape for emerging and mid-sized biotechnology companies has shifted violently. Capital is tighter. Scrutiny is higher. And for this role to remain viable, MSLs need to become your strategic tip of the spear: the first line of defense in clinical trial site activation and the primary source of competitive intelligence.
In this guide, we'll explore the new paradigm for Medical Science Liaisons and how to manage their work.
How To Measure MSL Impact
The first and most persistent challenge is measuring the unmeasurable. Sales teams have it easy. They have revenue targets, prescription volumes, and market share data. Medical Affairs has "share of scientific voice," which is a notoriously slippery metric.
How do we quantify the return on education provided by our MSLs?
When a CEO asks about return, they are challenging the very existence of the function.
The old answer was to point to activity metrics:
- "We visited 500 doctors."
- "We held 30 roundtables."
- "We answered 200 medical information requests."
But activity is not equivalent to impact. You can visit a doctor ten times and never change their mind. The modern stakeholder is looking for a shift in belief or behavior. They want to know if the MSL’s conversation about a novel mechanism of action actually resulted in a Key Opinion Leader understanding the differentiation of the drug.
This leads directly to the second question:
What insights are MSLs bringing back from the field that can shape our clinical development or brand strategy?
This is where the narrative often breaks down for smaller biotech companies. Imagine a scenario where your MSL in Boston learns from a lead investigator that the exclusion criteria for your Phase 2 trial are too strict for the actual patient population. Two days later, an MSL in Berlin hears the exact same feedback.
In a traditional, siloed setup, the Boston MSL puts this note in a CRM. The Berlin MSL sends an email to a Clinical Trial Manager. The insights are trapped in different systems. The signal is lost in the noise. The company continues the trial with the flawed protocol, losing months of recruitment time and millions of dollars.
The solution is not just better training; it is better infrastructure. This is where the concept of a Unified Platform becomes critical. When Medical Affairs, Clinical, and Quality teams operate on a single digital backbone, an insight is not just a text field in a weekly report. It is a data point that can trigger a workflow. It transforms the MSL from a broadcaster of information into a highly sensitive listening device. The value is not just in what they tell the doctor, but in what they bring back to the company.
The Clinical Accelerator: Speeding Up the Pipeline
For pre-commercial companies, the primary goal is not sales. It is data. The clock is always ticking on patent life and cash runway. Therefore, the most valuable thing an MSL can do is accelerate the clinical trial.
How does MSL engagement correlate with faster site activation or patient recruitment in our clinical trials?
Historically, Clinical Operations and Medical Affairs lived on different planets. The Clinical Research Associates (CRAs) handled the logistics, and the MSLs handled the "science." This division of labor is fatal in a modern context. A site that is struggling to recruit patients often has both logistical and scientific barriers. They might be stuck on a contracting issue (logistics) or they might simply not think the drug is worth the effort (science).
If your MSL walks into a high-potential site to discuss the science, but they have no visibility into the operational status of that site, they are fighting with one hand tied behind their back. They might spend an hour discussing the mechanism of action, unaware that the site is stalled because of a missing delegation log or an expired good clinical practice certificate.
This brings us to the operational reality of the "Single Source of Truth." If your MSL can log into a system like Kivo and see the real-time status of the Electronic Trial Master File (eTMF) for that specific site, the conversation changes. They can say, "Dr. Smith, I see we are just waiting on one CV to get you activated. Can we solve that today?"
Suddenly, the MSL is not just educating; they are unblocking the pipeline. They are directly impacting the speed of the trial.
This also answers another key question.
Are we engaging the right Key Opinion Leaders, or just the most accessible ones?
It is human nature to gravitate toward the friendly doctors who always say yes to a lunch meeting. But a unified data approach allows management to map MSL activity against clinical output. You can see clearly that while Dr. Jones is very friendly, he has not enrolled a patient in six months. Meanwhile, Dr. Chen has huge potential but has only been visited once.
Data allows you to move from "relationship management" to "strategic targeting," ensuring that your scarce field resources are deployed where they will move the needle on trial completion.
The Credibility Firewall: Balancing Science and Strategy
There is a reason MSLs are not sales reps. The Office of Inspector General (OIG) and various global regulatory bodies have made it very clear that medical education cannot be a disguise for pre-launch promotion.
This creates a high-wire act for leadership.
How do we maintain credibility and ensure consistent messaging while supporting commercial goals?
In the early days of a biotech startup, this is often managed via email. Marketing sends out a slide deck. Medical Affairs reviews it. A "final" version is emailed to the team. Then, a week later, a "final_v2" is sent. An MSL who missed the second email might present the old data.
In a highly regulated environment, "version control" is not just an administrative annoyance. It is a compliance risk. If an MSL presents data that has been updated or retracted, the company’s credibility takes a hit. If they present off-label data that hasn't been strictly approved for reactive use, the company faces fines.
This is where the Quality Management System (QMS) intersects with the field team. A robust QMS is not just for manufacturing. It is the engine of truth for the entire organization. When MSLs access their materials through a controlled, cloud-based platform, the risk of "rogue content" vanishes. They cannot present the wrong deck because the wrong deck does not exist in their view.
Furthermore, this infrastructure protects the MSL. It allows them to say to a doctor, "I can absolutely answer that question, but let me pull up the approved medical response document to ensure I am being precise." It reinforces their role as a provider of verified, accurate scientific data, distinct from the commercial urge to "sell." It builds the very credibility that stakeholders are worried about losing.
The Digital Reality: Adapting to the Hybrid World
The pandemic permanently broke the "windshield time" model of the MSL. Doctors discovered that they could get the information they needed in a 20 minute video call without having to buy a stale sandwich for their entire office staff. While face-to-face interaction is returning, the landscape has fundamentally changed.
How is the MSL team adapting their communication style for digital-first or hybrid engagement models?
This is not just about knowing how to use Zoom. It is about the ability to share complex scientific information effectively on a screen. It requires a different type of content and a different type of follow-up.
But digital engagement also opens up new risks and new opportunities regarding coverage. This prompts the question:
What is the coverage plan for community-based physicians versus academic centers?
In the physical world, driving four hours to see a community oncologist in a rural area was rarely ROI-positive. But in a digital world, that barrier is gone. This allows emerging biotechs to democratize their medical education. They can reach the high-volume prescribers in the community who are often ignored by the big academic-focused teams.
However, scaling this creates an administrative nightmare if the systems aren't ready. Managing the schedule, the follow-up, and the insights for 500 virtual visits is different than managing 50 physical ones. This links back to the need for a system that is designed for speed. If logging a virtual interaction takes longer than the interaction itself, the MSL will simply stop doing it.
This leads us to the operational questions that keep VP’s up at night.
The Operational Backbone: Scaling Without Breaking
As a biotech moves from Phase 2 to Phase 3 and toward commercialization, the pressure on the MSL team intensifies. The team needs to grow, but growing a highly skilled team is expensive and difficult.
How do we align our territory maps and team size to maximize clinical impact without risking the retention of our high-performing MSLs?
You cannot optimize a team that is constantly churning. The market for experienced MSLs with specific therapeutic area expertise (like oncology or rare disease) is brutally competitive.
Why do MSLs leave? They leave because of burnout. And what causes burnout? Often, it is not the travel or the science; it is the friction. It is the hours spent fighting with clunky expense systems, logging data into three different portals, and searching for the right document in a disorganized Sharepoint folder.
High-performers want to do the work they were trained to do. They want to engage with peers on high-level science. They do not want to be data entry clerks.
This is where the choice of technology becomes a retention tool. A platform like Kivo, which emphasizes an unapologetically simple user experience, sends a message to the team. It says, "We value your time." When an MSL can drag and drop a document, find an answer in seconds, and log an insight with two clicks, their job satisfaction goes up. They feel supported rather than burdened.
Furthermore, having a unified data management system allows leadership to answer the headcount question with data. Instead of guessing that you need five more MSLs, you can look at the capacity data. You can see that the Southeast territory is overwhelmed not just by "visits" but by the volume of inbound medical information requests and site activation tasks. You can justify the headcount to the CFO because the data tells a clear story of demand outstripping supply.
The Future of the MSL: A Strategic Nexus
We are entering a new era for Medical Affairs. The wall between "clinical" and "commercial" remains necessary for compliance, but the wall between "clinical" and "medical" is crumbling. The MSL is becoming the nexus where these functions meet.
When a stakeholder asks, "How do we ensure consistent scientific messaging?" or "How do we quantify return on education?", they are really asking for a sense of control in a chaotic environment. They know that the science is complex and the market is unforgiving. They need to know that the team on the ground is operating as a cohesive unit, not as a collection of independent contractors.
The companies that win in the next decade will be the ones that recognize the MSL for what they truly are: a strategic intelligence unit. But you cannot run an intelligence unit without an operating system.
If you are still managing your MSL team with spreadsheets, disparate legacy systems, and email chains, you are unable to answer key questions with confidence. You are guessing. And in the high-stakes world of biotech, guessing is a luxury you cannot afford.
The transition to a unified platform—where Quality, Clinical, and Regulatory data live in harmony—is not just an IT decision. It is a strategic mandate. It allows the MSL to walk into a doctor’s office fully empowered. They know the science, they know the site status, they know the approved message, and they know that the insight they bring back will be heard and acted upon.
That is the difference between a "field force" and a competitive advantage.
The Path Forward
As your asset moves closer to launch, the scrutiny will only increase. The Commercial Director will want to know about KOL readiness. The Head of Clinical will want to know about site salvage. The Head of Quality will want to know about audit trails.
Your ability to answer these questions defines your leadership. It defines whether Medical Affairs is seen as a cost center to be minimized or a value driver to be maximized.
The good news is that the tools to answer these questions are more accessible than ever. You do not need the massive, multi-year implementation budgets of Big Pharma to get world-class infrastructure. The modern tech stack is agile, cloud-native, and designed for the speed of emerging biotech.
By focusing on the "Golden Thread" of insight generation — connecting what the MSL hears to what the company does — you can transform the narrative. You can move from defending your budget to leading the strategy.
It starts with equipping your team with the right tools. When you remove the friction, secure the compliance, and unify the data, you unleash the true potential of your Medical Science Liaisons. And that is an answer any stakeholder will be happy to hear.
Would you like to see how a Unified Platform can help you answer these questions in real-time? Explore how Kivo brings Quality, Clinical, and Regulatory together to empower Medical Affairs.
