The problem is not your expertise. It is how your expertise is processed.
You are doing the work. The analysis is rigorous, the recommendations are grounded,
the trade-offs are real. But the weight your input carries in the room does not reflect
any of that — and working harder will not change it.
The structural reality
Senior executives make decisions under real pressure. Time is short, the room is full, and no one can fully work through every layer of reasoning behind every recommendation they receive.
So they compress. They form rapid judgments about whose reasoning they can rely on — not through careful analysis of the work itself, but through the structural cues available when full evaluation isn't possible.
Medical Affairs sits in a particularly exposed position in that process. The function's value is often preventative — it shows up in what didn't go wrong. Its authority is advisory, not executive. The reasoning it produces is genuinely complex, spanning science, regulation, commercial strategy, and ethics at the same time.
Those are exactly the characteristics that get discounted when decisions move fast.
The result is a gap — between the quality of the work and the weight it carries when direction is actually being set.
What this looks like in practice
The pattern tends to show up in one of two ways.
Sometimes it's a meeting that leaves you mildly unsettled. Your recommendation was heard. The room acknowledged it. And then the conversation moved on in a direction that didn't really reflect it. You can't quite identify the moment it happened.
Sometimes it's simpler and more frustrating than that. You had the analysis. You had the reasoning. And they just didn't listen.
What both experiences share is the gap — between what you brought into the room and the weight it carried when direction was actually being set. That gap is real. And in Medical Affairs, it is structural rather than personal.