A Survey of Expatriated Brazilian Clinical Research Professionals Working Outside Brazil

Abstract

We conducted a survey with 41 Brazilian clinical research professionals who worked abroad, to know more about their experiences. Most of them (68%) were female, mean age was 37.5 years, and they left Brazil on average 9 years after university graduation. The most frequent background education was in Pharmacy (58%), followed by Medicine (14%). The USA was the most frequent destination country, followed by Australia (14%). Two worked at research sites, 19 in service companies (CROs) and 19 in industries. Fifty-eight percent were in leadership positions, and 90% were satisfied or very satisfied with their professional activity. All the participants encouraged other professionals who want to work abroad. Overall, one may conclude that those professionals adapted very fast to the new environment and have experienced a successful career.

Keywords

Clinical research, healthcare professional, Brazil

Introduction

Biomedical research has a long tradition in Brazil. Since the final decades of the 19th century, Europeans and Brazilian researchers were responsible for notable scientific advances such as the work published by Carlos Chagas, which led to the description of the etiology, the vector, transmission mode, and the clinical presentation of the trypanosomiasis, now known as Chagas' Disease [1], and others related to leishmaniasis, schistosomiasis, etc. Clinical research (CR), however, especially targeting the development of new treatments, did not receive similar emphasis from Brazilian researchers. As a professional activity, CR is a relatively recent phenomenon in Brazil, as complex clinical studies—such as the international multicentric trials—only gained relevance in the country over the last 20 years. During these last two decades, many sponsors have transferred many clinical studies to emerging regions, investigative sites have multiplied in number, and specific regulations were created and enforced to cope with the new activity.

The development of the CR effort has thus followed the same steps as in countries where it has a longer tradition, and is currently an industry, per se [2]. Moreover, what used to be an activity exclusive of medical doctors now involves pharmacists, nurses, administrators, statisticians, and many other professionals who make a living from CR. They work in pharmaceutical industries, in contract research organizations (CROs), or in investigative sites located at hospitals, clinics, etc.

This multidisciplinary CR is also a globalized activity [3]. Tens of thousands of trials are implemented each year in thousands of sites spread out over all continents and countries. There are teams working on the same trial in different geographic and cultural settings, following the same procedures and universally accepted guidelines of Good Clinical Practices. This situation favors the exchange of both information and human resources, and can accelerate professional experience.

The job market for CR professionals in Brazil is virtually unknown. There are no reliable data to evaluate its size, its dynamics, or even how professionals enter or leave this activity. On the other hand, professionals in the field exchange information constantly with their counterparts abroad. This may raise the awareness and interest of many Brazilian professionals to work in another country at some point in their careers. However, the precise motivations for that move have not yet been studied. The survey presented here aims at bringing a first light on the profile and experiences of expatriated Brazilian clinical research professionals (CRP), and their recommendations to others that may be interested in following the same path.

Materials and Methods

We looked for professionals who worked in CR in Brazil, i.e., working primarily in clinical research teams either at research centers, manufacturers, or CROs, and who went abroad to continue his/her career. In the absence of a reliable database, the only way we could reach this population was by direct contact and referrals from third parties. Letters requesting referrals were sent to managers and directors from the major pharmaceutical companies and CROs with offices in Brazil, and to professional groups on www.LinkedIn.com.

Identified CRPs were contacted by electronic mail, the project was explained and their participation requested, taking appropriate care to ensure confidentiality of personal data. Those who agreed to participate responded to a questionnaire (Appendix 1) by electronic mail or by telephone interview. We tried to keep the questionnaire as short as possible to avoid confidentiality issues and to facilitate adherence. Special emphasis was given to the personal experience of the participants. Of note, there was no validation to the questionnaire. The recruitment period extended from June to December 2013.

The data collected were tabulated in a spreadsheet (Excel for Mac 2011, 14.2.3 version). Summary statistics (mean and median) were calculated where it could be of relevance. The free text questions were analyzed separately. Ideas that were most common were also reported in summary form.

Results

Forty-five professionals were identified as potential participants. All were contacted but only 42 replied and agreed to participate. A total of 41 questionnaires were effectively answered, and included in the survey. From these 41 participants, there were 13 men (31.7%) and 28 women (68.3%). Age ranged from 26 to 60 years, with an average of 37.5 years. The demographic data are detailed in Table 1.

Table 1. Demographics of Brazilian Expatriate Clinical Research Professionals

Professional background is described in Table 2. On average, the professionals were interviewed 13.9 years after graduating from university (Range: 1 to 34 years). They left Brazil 9.5 years after graduation, on average (Range: 0 to 33 years, Median: 7 years). Details of the distribution of their educational focus are laid out in Table 2.

Table 2. University Graduation

The time period out of Brazil ranged from 3 months to 18 years, with an average of 52 months. More than half of the professionals moved to the United States. Table 3 shows the data broken down by destination country. The majority (78%) left Brazil on their own initiative; 9 left following a decision taken by another family member (spouse). Ninety percent of respondents left Brazil with the intention of continuing to work in clinical research. Twenty-six (63.4%) had already secured a position in the new country ahead of departure, only 1 out of 15 was not able to find a position after 18 months. The median time to get a position was 2 months from arrival, and the mean time was 7 months.

Table 3. Destination Country

Fifty-two percent of the professionals responding to the survey were very satisfied, 37.5% were satisfied, and only 10% were dissatisfied with the first job outside of Brazil. When asked if the job was better than the position they held in Brazil, 51.2% reported their job was better, 35.9% thought it was similar, and only 12.8% considered it inferior. As for the workload, 52.5% reported that they were working less in the new position, 10% were working more, and the rest had similar workload.

At the time the respondents submitted the questionnaire (second half of 2013), the titles of positions occupied were very diverse, so they were grouped by functions, as detailed in Table 4. Twenty-four CRP (58.5%) had one or more changes of positions (median = 2 changes) since the departure from Brazil.

Table 4. Function in Most Recent Position

The summary of workplaces can be found in Table 5, together with the degree of satisfaction with the position held at the time of response to the questionnaire.

Table 5. Workplace and Degree of Satisfaction

Regarding the will to return to Brazil, 17 (41.5%) did not report any intention to return, 7 (17.1%) had already returned, and 16 (39.0%) reported the intention to go back within 3 years (1 did not answer the question).

Free text answers concerning what was better, worse, or just different about working outside of Brazil were very diverse. As for what was considered worse, "Nothing" was the most frequent answer (mentioned by 14 people); cultural differences and less proximity with colleagues were mentioned 29 times (sometimes than once). Among the difficulties at work, there have been repeated mentions about lack of knowledge of the country legislation and lower wages, compared to what they had in Brazil. As to what was better, there were multiple entries about better organization found in the destination country for all types of workplaces; less workload and/or more time for personal activities, better training, more opportunities for development, and challenging and visible positions. Better salary and benefi ts were also reported quite often. There was praise to cultural differences, and for the organization and professionalism experienced in the destination country.

On the question about what they would have done differently in their careers, there were 19 negative responses ("Nothing"). Another frequent response was "Should have had greater persistence and commitment," both in personal aspects (e.g., invest more in networking, for example), as well as professional aspects (e.g., look for opportunities in other departments, functions, instead of going back to Brazil). When questioned "What was important for your success?" there were several answers about perseverance, commitment, proactivity, and the relevance of previous experience gained in Brazil. All respondents provided advice and messages of encouragement to those who wanted to follow their path, and there were no messages with a negative tone.

Discussion

This survey has important and serious methodological limitations. It is impossible to assess the representativeness of the 41 respondents as it regards to the total of Brazilian expatriates CRP, neither qualitative nor quantitatively. For this reason, no statistical test was performed. While likely representing a larger population, academic researchers were not included because their professional career path is quite different. The questionnaire used was relatively short and, because the answers were provided electronically, there was little room for explanations. The information obtained cannot be considered a result of a careful and personalized interview. There was also no comparative data available from other populations.

CRP left Brazil relatively early in their careers, with a median of 7 years after university graduation. Higher prevalence of females (68.3%) reflects the usual state of affairs of the CR sectors in Brazil, but the mean age of 37.5 years seems to be higher than that of the average for CRP working in Brazil (personal observation). We may only speculate that the expatriates have acquired substantial work experience before leaving the country.

Regarding the country of destination, the USA was the most frequent one. This is not surprising due to the size of the American market. In this survey, Australia was the second most frequent destination, despite results from a recent local publication noting Australia as 10th place in a list of most sought destinations for workers from all areas leaving Brazil [4]. Our findings may be due to a sampling bias, or perhaps part of a trend towards a country more receptive to immigration. It is noteworthy that almost all respondents reported the intent to continue their career in CR, and most of them already had a position secured at their destination. At the time of the responses, about 4 years after leaving Brazil, 58% of respondents held leadership positions (managers and directors).

Ninety percent were satisfied with their first job abroad, and remained so until the time of the response—only 3 (7.3%) declared to be dissatisfied. The degree of satisfaction seemed to be greater in employees of pharmaceutical industries than in those employed by CROs—6 (8.4%) vs 13 (31.6%) responding to be "very satisfied," respectively.

It was interesting to note that the cultural and personal aspects of moving were the most important difficulties reported. References to interpersonal distance, missing contact with relatives, and strange habits and attitudes were quite frequent. On the other hand, the most positive aspects were related to the professional side, such as better training, better work opportunities, etc. In spite of any difficulties, it was notable that 100% of the responses were encouraging in nature when asked, "What advice would you give so someone considering leaving Brazil to work abroad?"

In conclusion, it seems that CRPs who left Brazil have enjoyed successful careers abroad. The advantages/positives have outweighed the difficulties, and they believe that, with good planning, there is room for more workers to take that route. Brazil is an emerging clinical trial market, yet many Brazilian professionals are enjoying success abroad. Moreover, does this flux of people in and out of the Brazilian market constitute a source of new knowledge for the local CR environment, or culminate in an overall "brain drain" in the Brazilian CR environment? Those questions may be of interest for future work in this field.

References

1. Lewinsohn, R., Carlos Chagas (1879–1934): The discovery of Trypanosoma cruzi and of American Trypanosomiasis (footnotes to the history of Chagas's disease). Transactions of The Royal Society of Tropical Medicine and Hygiene, 1979. 73(5): p. 513-523.
2. Rettig, R.A., The Industrialization of Clinical Research. Health Affairs, 2000. 19(2): p. 129-146.
3. Thiers, F.A., Sinskey, A.J., Berndt, E.R., Trends in the globalization of clinical trials. Nature Reviews Of Drug Discovery, 2008. 7(January): p. 13-14.
4. Maia, L.A., Burgarelli, R., Morar no Brasil é "Sonho" Internacional, O Estado de Sao Paulo, Jan. 11, 2014, p. A20.

Appendix 1. Survey Questionnaire

1. Demographics

Age, Gender, University Graduation Course, Graduation Year

2. Exit from Brazil

1. How long ago have you left Brazil?
2. Where do you live?
3. Did you decide to leave Brazil on your own, or moved by someone else's decision (spouse, parents)?
4. Did you leave Brazil with the intention to continue working in CR?

3. Relocation

1. Did you have a position secured when you left Brazil?
2. If not, how long did it take for you to get your first job?
3. Regarding your first job out of Brazil. In one word:

a. Your first job is (was): Better, Worse, Equivalent to the one you had in Brazil.
b. Degree of satisfaction: Very Satisfied, Satisfied, Somewhat Satisfied, Not Satisfied.
c. Did you start working: More, Less, Same.

4. Career

1. How many positions have you held out of Brazil (same company or not)?
2. Current title:
3. What was the mean time between a change in position, or promotion?
4. Where do you work: CRO, Pharma, Biotech, Research Site?
5. Degree of satisfaction with your career out of Brazil: Very Satisfied, Satisfied, Somewhat Satisfied, Not Satisfied.
6. What was more important for your success?
7. About your career, what would you have done different?

5. Current work

1. What do you consider better in relation to the work you did in Brazil?
2. What is worse?
3. What are the most important difficulties you face in your work?
4. What is just different, not necessarily better or worse?

6. Final comments

1. Do you have plans to return to work in Brazil? If yes: < 1 year. 1-3 years, > 3 years.
2. What would you give as advice to people thinking of leaving Brazil to work in clinical research elsewhere?

Eduardo F. Motti, MD, is Managing partner of Trials & Training Consult (www.trialsntraining.com). Dr. Motti received his MD from University of São Paulo, and a Masters' in Infectious Diseases. He has over 25 years of experience in big pharma and CROs, working in clinical development and clinical operations roles in Brazil and Latin America.

Maria Lucia C. Pecoraro, MD, MPH, received her MD from Faculdade de Medicina Santo Amaro, her Infectious Diseases training from Instituto de Infectologia ‘Emilio Ribas’, both located in São Paulo, Brazil, and an MPH degree from UC Davis. Thirty years of experience includes pharmaceutical, biotechnology, and CRO. Currently she works as a Clinical Advisor.