KOL

There’s an elusive feeling that many of us seek as academic physicians, largely driven by a deep seated (if even more deeply unacknowledged) need for respect and self-affirmation. It is a feeling of ego gratification when we are wanted or desired, presumably because of our expansive knowledge, expertise, or unique perspective. This feeling can be elicited by an invitation from a hospital, medical school, society, a recruiter, or even a medical device company. The invitation provides evidence toward a reality that we each struggle to define: how do I know that I’m valuable?

In my home, I’ve got about 100 lanyards with registration badges from meetings I’ve attended over the past 25 years or so. I look at them now and it feels pitiful. What do I have to show for all of that time spent away from my family, chasing some evanescent and selfish need for validation? Did I really push the science forward? Did I teach something that no one else was capable of? Was my perspective really that unique?

I’ve learned and lectured about Imposter Phenomenon and that is certainly relevant to this conversation. But there’s another aspect to the academic hamster wheel that I find even more sinister and troubling. While some of these inviting entities really do want you to come and teach and share your expertise, I think that the pure, unmitigated, and undisguised effort by device companies to appeal to your ego is pretty disgusting.

Key Opinion Leader, or KOL, is term made ridiculous by how frequently device companies are happy to deploy to it. Everyone is a KOL (and no one is a KOL). And who doesn’t want to be one? It means that a medical device company actually thinks that MY opinion is KEY. That feels pretty good, right? It is gratifying to know that a company thinks highly enough of me and my opinion that they have entitled me a KOL.

I personally witnessed a medical device sales rep proposition a colleague of mine to become a KOL for their company; meaning, go out and give some company-sponsored dinner events to talk about their device, get paid a nice honorarium, all travel expenses paid. My colleague responded, “I’ve only used your device once,” to which the rep simply replied, “that’s ok.”

An imaging vendor invited me to their European headquarters to show the latest iteration of their technology, and to “introduce you to our engineers for an informal think tank.” A trip to Europe, all expenses paid, business class ticket…what’s not to like? The finances work out pretty well for the company: they spend $10K on my trip, and hopefully we spend $2M on a new angio suite. 

Before the cries of “hypocrite!” get too loud, I’m the first to admit that I have had more than my fair share of corporate relationships: I served on the medical advisory board for Argon, taught IVC filter courses for Cook, was a B. Braun proctor for the Convertible filter, and did some advertising for Philips’ excimer laser sheath, among other activities. I consciously chose to participate in these activities and I don’t really regret them except in one important aspect: I worry that I let my need for ego gratification overshadow my real priorities.

I would trade every invited lecture I’ve ever accepted for another day with my mom and dad. I would trade every single SIR meeting I’ve ever attended for a long weekend with my all of my siblings in Lake Geneva, Wisconsin. I’d trade all of the corporate junkets I’ve been on (including PJ-ing in for a day of skiing and debauchery at Telluride, which would be a blog post all by itself) for another day spent with our children when they were young, or even now, when they are older.

Some of you may think it is easy for me to say that, in retrospect, and I'm being ungrateful for the amazing opportunities I've been given. Guilty as charged. Some of you may think, well, this is my chance to build a career. I felt the exact same way. All I can say is that in my observations now, over decades, the vast majority of us who have “built notable careers” will probably leave little real impact over our specialty, but we will definitely have had enormous impact over our families, friends, and loved ones. For me, from my perspective today, it is an easy choice.

My best memories of life don’t include giving a lecture, going on a corporate junket, or being a KOL. And for however how long I’ve got left, I don’t think they ever will.