WHAT? Even without the debate on drug prices, some pharma companies are headed towards extinction. Bureaucratic processes, designed to protect jobs and establish territories, and a failure to change the work environment is going to take its toll. Bigger is not better.

This week a very talented medical person with 15 years of experience was interviewed by a top 10 pharma company via the phone. The interview was as phony as they come with staged and uninsightful questions that left the candidate bewildered and thinking, “there is no way I would ever work for them!”. Not once, during the interview, did they ask her about her background or experience. Unfortunately, this has become standard for big pharma.

Smaller companies have a tactical and strategic advantage. Instead of automatically chasing growth by hiring more employees and taking more risk, you focus instead on getting progressively smarter, more efficient, and more resilient over time. If you plan on staying small forever, you can then focus on growing your revenues without growing your headcount or the need to constantly develop “me too” drugs.

On the other hand, big pharma is inundated with a bureaucracy that is slowing them down and leading to the need to develop drugs that only add value to the balance sheet. As one Oncologist recently told me, “there are just too many new drugs that don’t demonstrate longevity in patients.”

But let’s step back a second. Even if pharma were developing groundbreaking new drugs, their bloated organization structures would still be limiting product sales. A great example is salespeople. If only 2 in 10 doctors see a pharma sales rep, why in hell are there still so many?

Then there are the bloated processes of getting something approved. It took me over five months to get a simple change in website navigation changed. In addition to M L R teams, there were internal people who all had to comment even though they had no stake in the website.

To succeed and ultimately excel as a small company, you need the right mindset and a real underlying purpose that resonates with your employees. Pharma has lost this. Your purpose is how you put your personal values into action in your business and careers. The purpose of really helping people could not be more rewarding, but we too often focus on ROI and sales. If pharma can run their businesses so that it aligns with your purpose rather than blindly chasing growth, not only will the right people respond but they will get more enjoyment and satisfaction out of their work which will surely lead to a better business, Define growth as doing more of what counts not just on Wall Street.

Of course, there are some progressive managers who are trying to move things forward, but they are often overwhelmed by players and people who are keen at gaming the political system. Pharma CEOs need to put Wall Street aside and tackle these issues NOW or else their companies will be forced to change, which will result in a LOT of layoffs.