From Big Pharma to specialty: why moving closer to the patient changes everything

News Career Advice Opinion: Why moving from Big Pharma to specialty changes everything July 22, 2026 | 6 min read | Thomas Kolaras Twitter LinkedIn Facebook Email Print Working at a Big Pharma has its benefits, but there are limitations too. SERB Pharmaceuticals’ Thomas Kolaras discusses how moving to a midsize company creates new opportunities for sharpened thinking and leadership. A few months ago, I received a call from our supply team. They had helped arrange for a life-saving product to be transferred from one hospital pharmacy to another hospital where a patient desperately needed it. There had been no extended review cycles, no layers of escalation, just a small group of people working through what needed to happen next in real time. It was a moment that stayed with me not because it was unusual, but because it made something very clear: In certain parts of our industry, impact is measured not in scale but in immediacy.I spent years working in large pharmaceutical companies, where I was fortunate to learn from rigorous processes, world-class training and organizations that invested heavily in building capabilities at scale. The experience shaped not just how I work but also how I think about what great strategy, great execution and great leadership actually look like in practice. Large pharma, at its best, is genuinely exceptional at all three of these pillars. But at some point, I found myself drawn to a different question: What does it look like when you are closer to the decision, closer to the patient and more directly accountable for the outcome?That pull toward greater ownership is what ultimately brought me to midsize specialty pharma, and this shift has sharpened how I think, lead and operate in ways I did not fully anticipate. Big Pharma gives you the foundation Large pharmaceutical companies are exceptional training grounds in terms of the scale of investment, the rigor of process and the breadth of therapeutic exposure. They have the resources—both financial and human—to invest in doing things well. Working in this environment shapes how you approach problems, make decisions and build teams.However, there is a limitation that becomes clear only once you leave. In large organizations, functions are tightly defined. You develop deep expertise in a lane, and the lane is clearly marked. The processes that keep a 50,000-person company aligned also inevitably insulate individuals from the full complexity of a decision. You may be excellent at your part of the machine without ever seeing how all the parts connect.This is not a criticism. It is simply a necessity to operate large organizations. The competencies that make someone highly effective in a large company are not always the same ones that drive success in a specialty pharmaceutical organization. Large companies are designed to serve broad markets across diverse therapeutic areas, usually with fairly well-defined regulatory paths and go-to-market strategies.Specialty pharma companies often operate in highly focused patient populations and unique customer environments. Success requires many of the same foundational skills and capabilities, but also the ability to develop a deeper understanding of targeted markets, specialized care pathways and the unique needs of the communities you serve. These areas of medicine involve a greater element of problem solving that I, personally, find more rewarding. What changes when the map gets smaller Moving into specialty pharma, I quickly learned that the frameworks and instincts I had built over decades were still relevant, but they needed to be adapted, not applied wholesale.In specialty pharma, success often depends on understanding a much smaller ecosystem in far greater detail: the physicians who diagnose and treat these patients, the referral networks that guide care, the hospital systems that make access decisions and, most importantly, the patients themselves. In markets such as rare disease and emergency medicine, commercial success is often less about broad reach and more about precision and knowing where the patients are, how they move through the healthcare system and what barriers stand between them and treatment.The other shift is accountability. In larger organizations, success is distributed across teams with clearly defined handoffs. In specialty pharma, you often own a process or decision end to end. There is nowhere for a decision to get lost. And that directness, while exposing, is exactly what accelerates both individual and organizational growth. The roll-up-your-sleeves mentality is not a step down One of the misconceptions I encounter most often when talking to colleagues still in large pharma is that rolling up your sleeves means stepping back from strategic work. In reality, the opposite tends to be true. The closer you are to execution, the sharper your strategy becomes.In specialty pharma organizations, professionals often have the opportunity to engage more directly with the full patient and stakeholder journey. Rather than operating within a single function, they gain exposure to how commercial, medical, market access, supply and patient support efforts work together to serve highly defined populations. That perspective can accelerate professional growth because it develops not only functional expertise but also a deeper understanding of how specialized markets actually operate.For senior leaders, the dynamic shifts, but the principle holds. The breadth is less about exposure and more about engagement. You cannot lead from a distance in a smaller organization. The roll-up-your-sleeves mentality is not optional. It is what keeps you connected to how decisions are made in practice.For both, the underlying principle is the same. The judgment that comes from owning a problem all the way through is what specialty pharma builds in you, at every level. What midsize companies are actually looking for When I think about what makes someone thrive in a midsize pharma environment, it is rarely technical accomplishments. I call it the delicate balance between IQ and EQ. What matters most is operating with humility, showing initiative and being smart in interactions with people and in decision-making. It’s the ability to see a problem that no one asked you to solve and go solve it or to have an idea and run with it without waiting for formal permission.Organizational structures in smaller companies are less rigid, which means career growth is less dependent on tenure and more dependent on impact. Individuals can move from execution-based roles to decision-making roles faster than they ever could in a large organization, but only if they are genuinely motivated by ownership rather than process.For leaders, this changes the job description. Your role is not to manage performance against a defined track. It is to create an environment where people can grow quickly, take real responsibility and be recognized for it. Waiting for formal progression cycles is a way to lose your best people. The simplest way to think about the transition In a midsize specialty pharma company, you’re able to take the foundational skills, training and strategic discipline developed in large organizations and apply them directly. Success is often defined less by scale and volume and more by precision and care: working to understand highly specialized markets, engaging deeply with focused stakeholder groups and developing solutions that address the needs of distinct patient populations.The challenge is not unlearning what Big Pharma teaches. It is building on that foundation with new capabilities that align to more targeted therapeutic areas and care environments. The question becomes how to translate broad experience into meaningful impact within a more focused setting. For many professionals, that opportunity to develop deeper expertise and to have a more direct impact on the patients they serve is what makes the transition so rewarding. Twitter LinkedIn Facebook Email Print Career advice Leadership Career pathing Opinion Thomas Kolaras Thomas Kolaras is executive vice president, chief commercial officer US, at SERB Pharmaceuticals. He is an accomplished commercial leader with extensive experience across large and midsize biopharmaceutical companies. Most recently, he served as senior vice president and general manager for medical therapeutics at Endo Pharmaceuticals. He has been fortunate to successfully lead challenging, yet profitable, hospital, retail and specialty businesses while managing various distribution channels and evolving payer dynamics.Kolaras has built his career through a wide range of roles in marketing, sales, operations, market access, analytics, government affairs, finance and business development in over 20 therapeutic categories, requiring knowledge of delivery systems in biologics, injectable and implantable products, intranasals, buccal transport and oral therapies.