Breaking Into Pharma and Biotech as a Physician Leader with Dr. Nerissa Kreher

In this episode of the Startup Physicians Podcast, Dr. Alison Curfman sits down with Dr. Nerissa Kreher, MD, MBA—a pediatric endocrinologist who transitioned into biotech and pharma and went on to serve as a four-time Chief Medical Officer with multiple IPOs.

Nerissa shares how an unexpected career setback opened the door to the pharma industry, what medical affairs and clinical development roles actually look like, and how physicians can build the business and regulatory skill sets needed to thrive in biotech. She explains how to communicate across cross-functional teams, design clinical trials, and navigate both the highs (like successful IPOs) and the lows (like program shutdowns).

Alison and Nerissa also dig into imposter syndrome, confidence, humility, and why physicians must embrace learning and ask for help—just like they do in clinical practice. Nerissa also highlights her work developing first-in-human transfer RNA therapies and discusses her coaching program, Pharma Industry MD Coach, which supports physicians exploring industry roles.

This episode is packed with tactical insights and mindset shifts for any physician curious about biotech, pharma, or leadership roles beyond clinical medicine.

00:00 – Introduction to Dr. Nerissa Kreher
01:08 – A Career Pivot That Changed Everything
04:01 – Entering Pharma + Early Mindset Shifts
07:14 – Building New Skills Beyond Medicine
11:23 – Clinical Development & Designing Trials
13:59 – Moving Through Companies & Becoming a CMO
16:18 – Handling Setbacks in Drug Development
18:27 – Mindset, Imposter Syndrome & Asking for Help
23:05 – Inside the IPO Experience
28:04 – What She’s Building Now
29:35 – Supporting Physicians Through Coaching
30:57 – Closing Thoughts

Pharma Industry MD Coach Website: www.industryMDCoach.com

IG: PharmaindustryMDCoach

LinkedIn: https://www.linkedin.com/in/the-industrymdcoach-b501301ba/

Transcript

Alison Curfman (00:01.1)
Hi, everyone. Welcome back to the Startup Physicians podcast. This is your host, Dr. Alison Curfman, and I am joined today by Dr. Nerissa Kreher, who is a pediatric endocrinologist turned startup CMO multi-times over. So she has very interesting story about her career transition into biotech and pharma and multiple IPOs. So Nerissa, thank you so much for joining me today.

Nerissa Kreher, MD, MBA (00:28.624)
Thank you for the invitation.

Alison Curfman (00:31.256)
So we met at an event a few weeks ago at the Peter Kim's Passive Income MD Conference, which was a great event. anyone who's listening, highly recommend that on your conference circuit for next year. I think we have multiple colleagues in common, and they were like, you have to meet Nerissa. She has been doing so much work that is so cool in startups.

Do you mind, Nerissa, starting a little bit with your clinical background and where your path took you?

Nerissa Kreher, MD, MBA (01:08.654)
sure. So as you mentioned, I'm a pediatric endocrinologist. I trained at Riley Hospital in Indianapolis and had completely considered that I would be an academic clinical researcher for my entire career. I did a master's in clinical research. I conducted a prospective study during my fellowship and published and was moving for family reasons to the Boston area, but it was through a match process for my

husband. So we were interviewing, I was asking for jobs in places that I may or may not actually be. I think luckily for pediatric endocrinologists, there aren't many of us. And so there were opportunities in the places we were interviewing was sort of promised a job. And we matched in Boston, and I was supposed to have a job at Mass General, and the job fell through.

So they did ultimately offer me a job, no offense to Mass General. It was an academic role, seeing patients day in and day out. And I knew that I didn't want to do that. I didn't enjoy it during fellowships. So one thing, I'm very grateful that I knew that early on and didn't just accept the role with something I didn't really want to do.

So a sales representative who was a growth hormone sales rep at a company called Serono asked me to share my resume with her. And I laughed at the time and said, I don't know why I'm doing this, but I'm happy to give it to you. And it turns out there are roles for physicians in the pharma and biotech industry. And I was able to land one of those as a medical affairs director for

which is a recombinant human growth hormone at this company called Serono. So that was my first role in industry. I had no idea what I was getting into frankly, but 20 years later, I'm glad that I took that first role.

Alison Curfman (03:03.116)
Yeah.

Alison Curfman (03:08.173)
Yeah.

Alison Curfman (03:12.268)
Yeah, and it's funny because it's usually like not always good things that cause a career change. Like I think most people I've talked to on this podcast and myself included have had things happen in our careers that were not the plan. that, it's like I wasn't planning to have my program shut down or you weren't planning to have your job fall through or there's other people who I have talked to that

you know, ended up at a crossroads that wasn't really of their choosing, but led to some sort of opportunities that they may not have considered previously.

Nerissa Kreher, MD, MBA (03:51.126)
Absolutely. You really do have to keep your eyes open and try to see things as opportunities instead of negative sometimes.

Alison Curfman (04:01.28)
And I think there can be a lot of kind of negative connotations about the pharmaceutical industry. I'd love to hear more about like your mindset when you were transitioning to this new role and what the role entailed and how you made that decision to move in that direction.

Nerissa Kreher, MD, MBA (04:19.726)
Yeah, so it's true. And even at my program, the pharma industry was not looked upon incredibly favorably. So I was actually scared to tell my program director that I was taking this role. It turns out she was very pleased for me and has continued to be a great champion. So, you know, again, like getting out of our heads about what we think about other people.

So I started in this medical affairs role. Medical affairs is probably the closest, meaning not doing sales or marketing, but you're working closely with sales and marketing. And so

When I started my role, I had a lot to learn about sales and marketing. I'm a full on, you know, science major, biology straight through to med school, not done anything business related. But I actually found that it was fascinating day in and day out because I was just like a sponge learning new things, new words, new acronyms that I had never heard before across

again marketing but finance and you know non-clinical development animal studies so there was just so much and it fed that side of I think many physicians of just being a forever learner and wanting to continue to learn new things and I think that's been the case across the 20 years of my career in biotech is I've had an opportunity to learn new therapeutic areas so I've

moved well away from pediatric endocrinology. I still touch on it here and there, but I've worked in muscular dystrophies. And so it just opened up this world of opportunity for me as a physician that had I tracked in a clinical research role, probably wouldn't have been the case.

Alison Curfman (06:15.818)
Yeah, it is interesting how you enter the space on your specialty background credentials. But then as you start to add more and more skills in the space and more perception of what sorts of things need to happen for the company to succeed and you learn how to do that, then some of the opportunities that you grow into aren't

They're not all limited to your own specific medical specialty. Like I certainly have done work outside of pediatrics. I obviously still really enjoy doing things related to pedes and kids, but I think that a lot of people have the option to start exploring things that are like very specific to their specialty that are in industry, but that there's like a lot of options beyond that as you start to grow.

Nerissa Kreher, MD, MBA (07:14.02)
Right, right. You're just building out your skill set and it starts to be sort of bolt-ons. Like for me, a great example is regulatory affairs. So, you know, moving into clinical development, which I did, which ultimately has moved me to this clinical or chief medical officer role. Regulatory affairs is a great example of something we don't get much training, if any, in medical school and fellowship and residency and such. But now, you know, this

is an area of expertise that I can apply across a number of different therapeutic areas.

Alison Curfman (07:52.098)
Yeah, so during that first role, what do you think were some of the most important things you had to learn?

Nerissa Kreher, MD, MBA (07:59.63)
Yeah. I think.

recognizing who your audience is and learning how to speak to different audiences. So I think in medicine, we're often, I talk to clients sometimes about we're often speaking the same language. You know, we're talking medicine to people in the hospital setting, in the clinic setting. In the biotech and pharma industry, you're speaking to people who speak very, different languages, you know, going back to marketing, going back to finance, well,

They all have their own languages and you have to figure out how do I explain my clinical trial design to someone who comes from a marketing background or a sales background or a completely different background and really tailor that. So that was a really important learning that I think, you know, maybe as a physician, I was pretty sheltered from that standpoint. The other is

really recognizing in pharma, unlike and whether this is completely true anymore or not, but you you're not

the decision maker always, you're on a team. And so there's a huge amount of cross functional teamwork that happens in biotech and pharma. And I think that's very different for a physician who might, you we're, pretty high on the totem pole of decision making. And so learning how to work within a team, learning when it is your voice that

Nerissa Kreher, MD, MBA (09:36.292)
has a lot of influence and when maybe your voice should be a little softer. So a lot of those leadership type learnings.

Alison Curfman (09:46.894)
That's such great insight. I think that some of the things that I really challenge physicians that go through my trainings, I have them really try and assess when you're thinking about something like is your feedback related to quality and safety and health equity? Because if so, those are the things that you want to be the loudest and the most insistent on. If it's related to something else like about

messaging or user experience or something about a prototype and how functional it's going to be or the size of a clinical team or something like that. I really try and put it through that lens for the work I do as well as like quality and safety, number one, like we always want to be, I consider us as physicians like the defenders of that, because especially as we're trying to develop

all these new and innovative ways to do things. It's like, how do we protect the patient in the midst of all this change? We're trying to, everyone's trying to make something better, something more effective or unique or a better experience. And we're the ones that can really have a voice for like what could be unintended consequences. How do we make sure that the patient is still getting the best care possible? But

You know, kind of got learn when to be quiet too. You're right. You're not like the ultimate decision maker for a lot of things. So that's an interesting experience for some physicians.

Nerissa Kreher, MD, MBA (11:21.486)
Yes, for sure.

Alison Curfman (11:23.63)
And so as you grew in that role, I actually had a question about were you designing the clinical trials? Like I know you had a very scientific background. Is that something that you were doing is like building out like how you were gonna measure the effectiveness of these drugs or what was that like?

Nerissa Kreher, MD, MBA (11:46.796)
Yes. So as I transitioned to the clinical development role, much more of that design of clinical trials, medical affairs, I did sort of redesign a phase four registry, but medical affairs was more about messaging, meeting with physicians, talking to them about clinical trial results and educating. So lots of CME events and things like that, that were my responsibility to organize. So much more around that education.

piece. Moving into clinical development, yes, it is full on designing clinical trials, working with

statisticians, know, lots of different team members again, to think about what is the best trial design you're thinking about with your physician knowledge, of course, clinical trial endpoints, safety, as you mentioned, you know, that is really the physician's remit is making sure that you're designing a clinical trial that is measuring safety of a drug that maybe you don't completely understand yet.

So full on that piece. But then also a lot of education still meeting with physicians that are treating these patients to get their opinions. So there's a lot of back and forth with my clinical colleagues still, whether they're in academics or in the community.

Alison Curfman (13:13.206)
Yeah. Yeah. And I think that that sort of work is often very appealing to people that come from a very academic background. We sometimes tend to think of research as being completely consolidated in academic institutions, but these skills are needed in other industries as well, whether it's pharma, where you're designing a clinical trial, or even some

ventures and startups that I work with, may need to create a validation study because they really want to prove that the thing that they're building actually works because that's how they're going to get traction.

Nerissa Kreher, MD, MBA (13:53.806)
Right, definitely.

Alison Curfman (13:55.662)
So what was next for you after that first role?

Nerissa Kreher, MD, MBA (13:59.362)
Yeah, so I mean, I've worked at a number of different companies. This is something that's different too, is that that sort of half life at a company for a physician and anyone in pharma, you can move through companies, you know, every two, three, four years. And I have done that for new opportunities for, you know, advancement in titles. And just to be very frank, there are times where you can be kind of stuck at a company and the opportunity to move to a more

senior role with more responsibility requires going to a different company. So I've moved through multiple companies and about halfway through my career was at a startup. It was a public company. We ended up with a very devastating safety signal of a patient death and we had to end up closing the clinical program. So we stopped the development of this drug.

And I was leading that program. So I kind of joked with the CEO at the time that I'm pretty sure my name was at the top of the list of people who were going to be let go of the from the company because we were no longer working on that drug. And this was a smaller company, probably 50 people or so. So

You know, again, I talk a lot about network and making sure that you're never burning bridges and you're building relationships with people. So the company that was the major venture capital firm funding this company had two board members and one of the board members, I, you know, I think saw my talent and brought me into one of his startup companies as chief medical officer. So that again was about halfway through my career.

And so I was in a private startup company. literally were housed in the VC office for the first say year. I think I was employee number seven. So that was my first chief medical officer role. And that is a role where you are then responsible for clinical development, medical affairs, safety. So, you know, there are specific safety physicians within pharma regulatory.

Nerissa Kreher, MD, MBA (16:18.512)
patient advocacy, there are a number of different things that I was responsible for either leading consultants or rolling up my sleeves and doing myself.

Alison Curfman (16:28.994)
Yeah, that whole story may sound sort of intimidating to people listening about the negative outcome and the program you were running. What did you learn from that or what would you tell people about?

Nerissa Kreher, MD, MBA (16:45.466)
Yeah, I do get this question about sort of reliability of roles in pharma and can I get laid off and things like that. And I mean, frankly, the answer is yes. The pharma industry, it's a business and they have to make business decisions. At the same time,

Physicians are very much needed in pharma. It can be hard to find and hire physicians and especially as you gain experience. So we're not typically at the top of the list, although this time again, I think I was just because it's a small company in the program. But what I learned is one, external communication and how to do that. think generally we managed it quite well.

But that is something where, you know, we were dealing with patients on a drug and having to talk to families about taking them off of a drug that was working actually. And so a lot of that sort of external communication and messaging and how to deal with that. And then also just realizing that, I mean, the drug development industry is a risky one and, you know, many, many drugs fail.

but we just have to keep moving and keep continuing to look for novel therapies, novel approaches. And I was able to do that by moving to this other company and start working in gene therapy, which was new at the time. So you're just always looking for how can I build new skill sets.

Alison Curfman (18:27.512)
Yeah, I think there's two things that people can do at any time in their career, whether they're like a resident listening to this podcast or if you're like nearing retirement, you can keep learning. So whether you're doing this more passively, listening to podcasts, taking courses, just keep expanding your knowledge base and your opportunities and like you said, skill sets. And then two is continuing to grow your network strategically.

It's all about having a lot of relationships with a lot of people that could provide a lot of pathways for you because there's not one correct pathway. There's not two or 10. There's infinite pathways. And so I think that as soon as people start to have this more abundant mentality that like, there's so many options for me. I could do so many things. It releases them from this phase of

feeling stuck. And I know you do some coaching too, so I'm sure you've heard this a lot from people you work with.

Nerissa Kreher, MD, MBA (19:35.236)
Definitely. I think the mindset piece for physicians is really critical. And what you said about there are endless opportunities. It may not always feel that way because we may not have been exposed to variety of paths. Your podcast is doing that for physicians, luckily. But I do think that if people are coming in with an

I can't or I don't type of attitude, that will be picked up in any sort of experience or interview that you have. So you really have to change that around and think about, can do this. I do have this opportunity or I do have this skill set. The other piece I think is worth saying is there have been many times in my career that I have

sat at a desk or you know at a table and thought my gosh I have I really have no idea what I'm doing here but I don't stop there right I say okay maybe I don't have this experience but I bet I know someone who does and I can go and ask for advice I can ask for help and I think that's a strength not a weakness

But as physicians, again, trying to sort of do everything on our own and feel like we have to be the smartest person in the room, you have to let go of some of that in some of these more innovative endeavors as physicians and really be able to seek advice and ask for help.

Alison Curfman (21:14.636)
Well, we do that all the time, right? We call it consults. So if you are seeing a patient and they start to have problem that's out of your scope of expertise, I mean, I am an ER doctor, so I am a pro at calling consults. I figure out what body part it is and call the expert on that body part. So I think the core of asking for help and knowing what you don't know is something that is actually trained into us as physicians and it's just applying it.

in a new way. So I think that's really good feedback. And I certainly see the same sort of imposter syndrome that you have been mentioning. see, and it's, you know, what's really interesting is when I speak to a lot of my colleagues in venture and I describe to them what I'm working on and the sorts of people I'm working with. And I described to them that one of the biggest challenges I see in the

physician population that I work with is imposter syndrome. They're like, what? Really? Like, what? And so I think that sometimes we just have to get out of our own heads, you know?

Nerissa Kreher, MD, MBA (22:22.39)
So true. I mean, I think physicians are very much, we can be stereotyped by people who aren't physicians. They think that we're conceited or we know everything. And my experience actually is very much the opposite for the vast majority of physicians. And so there has to be a middle ground where you can't be completely conceited and think you know everything, but you do have to come into

any conversation, discussion, etc. with a bit of self-confidence around all the years of training and experience you have and give yourself credit for that.

Alison Curfman (23:05.069)
For sure. And I think that was like part of the talk that I gave at the conference that I met you. It was like the mistakes that physicians make. And one is being on one end of the spectrum, having too much imposter syndrome, not having enough confidence in their skillset and all of the expertise that they have, all of the value you bring to the table with your unique background. And two is on the other end of the spectrum, like having too much pride or hubris to

be willing to come in and be like, I don't know about a lot of these things. I know the medicine side really well, but I don't know the finance side. I don't know how to do business development. I don't know how to do marketing. I'm very open to learning. Please teach me. I say this all the time as a joke, but I was literally reading startups for dummies while sitting at a desk at a top private equity firm.

I was like, no, I just like really need some, like all the help I can get. And so, it is actually like, it was a very useful book. Like it gave me some, some insight. but obviously the best, you know, skill development I got was from all the people around me who were willing to invest time and effort and energy into bringing me up to par on those skills, which has led to this career. So I think that,

Asking for help, being humble enough to recognize what you don't know and to recognize that as a physician, one thing that you have proven that you really, really good at is learning stuff and mastering it. So that is something that you can still master new skills. And then also just being confident in the skills and the expertise you already have. Tell me a little bit about the IPO experiences that you had. That sounds fun.

Nerissa Kreher, MD, MBA (24:58.768)
Yes, very fun. So IPO stands for initial public offering. Some people may not know that, but that's basically when a company is going from private to being available on the public markets. so, you know, there's a whole process around it of getting documents in place for the securities, SEC. And so writing these massive documents that talk about whatever it is the company is doing, a huge piece of that is

typically medical and clinical. So being able to be involved in that, thinking again about messaging, we've used that word a number of times. But then also sitting in front of investors with my CEO, my CFO or chief financial officer, and then, you know, depending on the company's chief scientific officer, et cetera, but a whole team of chief officers, really pitching what you're trying to accomplish.

And you know, this is a place where you have to know your stuff, but you also have to know when you should say you don't know because investors in this space, the specialty investors are very, very smart. Oftentimes they might be MDs, they might be PhDs. They've seen a lot. And so

I found that to be incredibly invigorating because again, it's like, okay, here's something else I can learn because they may ask me a question that now I need to go and look more into the answer for that. But road shows where you're going to New York City and other cities and just bouncing from meeting to meeting in front of investors, a lot of that cross-functional teamwork where

You have to know, okay, the CEO runs the show. He delegates the questions. You typically are getting into a really cool groove with your teammates. Maybe the CEO just is tired that day because it's quite a slog.

Nerissa Kreher, MD, MBA (27:05.108)
and misses something and you're adding into the one thing or then he or she might say, well, hey, Narissa, could you cover this a little more? So it's just this great dynamic of teamwork. And then luckily I've

been able to participate in two successful IPOs. And, you know, it's a huge celebration when you're sort of closing the money coming into the bank and really being able to bring that money in to further the development of a therapy that could totally change someone's life.

Alison Curfman (27:39.694)
That's very cool. And I know as a founder that I'm sure the founders of your companies were really proud at that point that they had made it to a successful exit and then saw a path ahead to keep growing what they had built. that sounds like it was a really fun and cool experience. So how are you spending your time now? What are you working on these days?

Nerissa Kreher, MD, MBA (28:04.462)
Yes, so I'm in my fourth chief medical officer role. I joined this company in January. I did take a year off last year and so I exited one company, took a year off, did some consulting, but also like took a van trip for a month out to Santa Fe, New Mexico and spent a whole month driving around with my dog in a van. Highly recommend if somebody has the opportunity to take some time off and really think about what they want to do versus just jumping into the next role.

So, started this role in January. We're a private company working on a novel therapy that's never been in humans. So, it's a transfer RNA therapy as opposed to many people have heard of messenger RNA or mRNA therapies.

So this will be developed for inborn errors of metabolism. specific to, know, adults of course have these diseases, but they're typically genetic diseases like phenylketonuria, organic acidemias. So we are in the throes of moving the company from non-clinical into the clinic. So I'm leading all of that work, designing clinical trials, talking to physicians that are expert in these inborn errors of metabolism.

as abstracts, publications, et cetera. So totally steeped in this inborn errors world right now.

Alison Curfman (29:30.296)
Very cool. And can you tell us a little bit about the coaching business that you have as well?

Nerissa Kreher, MD, MBA (29:35.832)
Certainly. So it's called the Pharma Industry MD Coach. I started this around the beginning of COVID actually through being a part of a coaching group and just being so astounded by the positive impact of coaching.

and recognize that as so many things were happening in the midst of COVID, there were so many physicians losing jobs, very unhappy, dealing with a lot of different things. I couldn't go into the clinic or the ER and help them, but I felt like I could help by letting them know there were other options and opportunities. And so I just started putting educational pieces out there and decided I would see what kind of traction I got.

So now, know, more than five years, I've coached upwards of 100 physicians. Many of them have successfully transferred into the pharma industry. And so it's been great fun. I coach either individually on a one-on-one basis, which I have actually paused through the end of this year. And then I also have an evergreen course that people can join and sort of it's self-led.

that has some coaching in a group setting with me as well.

Alison Curfman (30:57.998)
Very cool. Well, it's wonderful for you to be sharing your expertise with everyone and really demonstrating for us what it looks like to transition into this type of a pharma biotech role. And sounds like it's become a very fulfilling career for you. So congratulations on all of your success. And I just want to thank you again for joining us today. And for those of you listening, we'll make sure to put her links in in the show notes, as well as information about

her coaching program. So thank you, Nerissa, for joining us.

Nerissa Kreher, MD, MBA (31:31.408)
Thank you.