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Historical Interviews
This month the Epi Monitor is
publishing an exclusive interview with Pat Koslowe,
an epidemiologist who started her own consulting firm, EpiStat,
specializing in epidemiology in 1985. We have been interested in
reporting on the status of private consulting in epidemiology for some
time, and Dr. Koslowe kindly agreed to be interviewed for this
purpose. Her remarks provide insights into the realities of private
practice in epidemiology today and will be of interest to all readers
who are considering or who have ever thought about launching their own
careers in the private sector. We encourage other readers of the Epi
Monitor who may be engaged in the private sector to write in and
comment on Dr. Koslowe’s observations.
[Editor’s note:
Patricia A. Koslowe, Ph.D. is president of EpiStat. She holds a B.A.
from Harvard and a doctorate in epidemiology from Johns Hopkins
University. She has ten years of experience dealing with a wide range
of epidemiologic and public health issues, and has held positions at
the National Institute of Allergy and Infectious Disease and the
National Institute of Neurological and Communicative Disorders and
Strokes. She has completed projects for government agencies including
the National Cancer Institute, the National Institute of Child Health
and Human Development, and the Maryland State Department of Health.
She has also provided epidemiologic consulting to private corporations
and law firms.]
Epi Monitor:
Dr. Koslowe can you give us a brief description of your business?
Koslowe:
Epistat is literally a cottage industry located in a cottage behind my
home in Silver Spring, Maryland. I am the only full-time person but I
have a group of associates with expertise in allied areas who provide
support on an as needed basis. Since it is basically a one person
operation, I am responsible for the marketing, project management, and
business administration.
Epi Monitor:
Can you tell us what you perceive to be the advantages of being
self-employed in this way?
Koslowe:
Flexibility and diversity are the major advantages. Although EpiStat
is not yet a thriving enterprise, it also offers the potential for
financial gain beyond that in many academic or government positions.
Epi Monitor:
Could you expand a bit on what you mean by flexibility and diversity?
Koslowe: By
working out of my home and making my own hours, I don’t have to be
confined to a 9 - 5 position and worry about transportation time to
get to work. For myself, this is important because I have five
children and it’s meant a lot to me to be available to go to a school
play or be at home when someone is not feeling well. As far as
diversity is concerned, it has provided me with an opportunity to work
at the federal, state and local level and to work in both the public
and private sector. I have met many more people than when I was
working as an epidemiologist at NIH.
Epi Monitor:
What about the disadvantages of working in your own business?
Koslowe: The
uncertainty has been the major disadvantage. Almost always there will
be a half-dozen projects pending and I am never sure exactly what is
going to come through, or if anything will come through at all. There
have literally been months when I have had no income producing
projects. That’s been a source of enormous frustration and
disappointment particularly when proposals I have worked on very hard
were not funded or when opportunities that were supposedly 99% assured
did not materialize. I hope that as time goes on these gaps will be
less frequent, but I think it is a reality in the business world.
Epi Monitor: So
would you say that starting this type of business has been harder or
easier than you had anticipated?
Koslowe: I
think it has been harder than I anticipated. I felt that as a firm
specializing in epidemiology, particularly in the Washington area
where you have so many government agencies with contracting needs in
epidemiology, that the opportunities would come more easily. Instead
what I found and perhaps what I should have known to begin with, is
that places like NIH have their own in-house epidemiologists for the
design and analysis of studies, and that when it comes to the
implementation of a study, you do not need strictly speaking a Ph.D
epidemiologist to do that. So whereas I thought that my competition
would be very limited, the fact of the matter is that I am competing
against major firms which are much larger and which have had far more
experience. I have had a lot of difficulty getting contracts, and the
opportunities for sole source work have become less than a few years
ago.
Epi Monitor:
Does your competition lie in the fact that others can design studies
or more because others can better execute studies?
Koslowe: In
terms of designing studies, other firms are probably less well
equipped, but in terms of providing support services for epidemiologic
studies, whether its tracing or interviewing or data entry, then other
firms have had more experience in this area. That is an aspect of
consulting work in epidemiology that could be fairly lucrative.
Epi Monitor:
And this is the kind of work that a person cannot easily do for
himself or herself?
Koslowe: Not at
all.
Epi Monitor:
Have you thought of hiring support staff of your own?
Koslowe: Yes,
and that would not be the problem. I have had a lot of success in
pulling together a team when I submitted proposals. The problem is
that I do not have a wealth of experience and I cannot point to
half-million dollar contracts that I have done in the past.
Epi Monitor: So
you think there’s a problem with not having a track record?
Koslowe: I
think track record is a tremendous problem. It becomes a chicken or
the egg type of issue.
Epi Monitor:
What do you think are the pre-requisites for entering into a business
such as yours?
Koslowe: Let me
give a couple of general concepts. I personally feel that in starting
out business experience per se is not a crucial requirement. There is
a lot of information out there that people can get as they need it.
Also, through lawyers, accountants, and insurance people you can get
the background information that you need to get a business rolling.
There are certain personality
characteristics that are helpful in starting out. It takes a lot of
persistence to keep marketing and to keep submitting proposals. It’s
hard sometimes when there is rejection after rejection.
I think it also takes the
ability to create a structure for yourself as opposed to one that
might be imposed on you by a regular job. That is something that I
personally gravitated to but I know that some people feel
uncomfortable with.
In addition, it is enormously
helpful to have contacts that might lead you to obtain contracts.
Epi Monitor:
You mean people you may have worked with in the past?
Koslowe:
Exactly! To know some people you could call on, some people for whom
you could perhaps do some subcontracting.
Epi Monitor:
Would you like to add any further points about pre-requisites?
Koslowe: Yes.
Although I do not believe that business experience per se is a
pre-requisite, I think that once a business is ongoing, the key person
in that business needs to have a keen business sense to know what
funding mechanisms are the best to pursue, and what contract areas
might be the most advantageous to pursue. These factors can make a
difference between a struggling and a thriving business.
Epi Monitor:
How do you assess the market for epidemiologic consultants at this
time?
Koslowe: I
think there is an enormous market for epidemiology. So far as I know
there are very few firms specializing in epidemiology, but I think the
challenge is to tap that market and to get beyond the first hurdle
when you have done significant work in the private sector. The
competition is going to come not only from the few firms in
epidemiology, but from the many firms that can offer related types of
services.
Epi Monitor:
Since you have had some difficulty in getting work, on what real basis
do you say that there is an enormous market out there?
Koslowe: If you
look at the Commerce Business Daily for example, which lists all
government contracts coming out, you will see many contracts that
would be of interest to epidemiologists that are major contracts in a
variety of different areas. In the private sector, pharmaceutical and
industry are letting out major contracts for epidemiologic work. My
experience in the private sector has been more or less
quasi-epidemiological. I have been asked by law firms to collect and
critically review papers on a particular topic. Although I have tried
to get contracts in the private sector, I have never had a contract to
actually design and implement an epidemiologic study.
Epi Monitor: So
your sense is that the market for contracts for epidemiologic studies
is large. What about the market for literature reviews, providing
expert testimony, and other such types of work?
Koslowe: Again
I think it is a large and increasing market and that type of work is
the type that pays handsomely. However, it is one thing to say that I
would like to get that type of work and another to actually get it.
Oftentimes, it is a slow process.
Epi Monitor:
How do you know about the size of that non-government market since you
do not have a Commerce Business Daily to read?
Koslowe: It is
a matter of contacts. Some people have better networks than others,
and also it is a matter of advertising. Since I have been primarily
interested in obtaining government contracts, I have not actively
pursued the private sector work. That may have been a mistake on my
part.
Epi Monitor:
Has your work as a private consultant been intellectually stimulating
so far?
Koslowe: Yes,
although there has not necessarily been a correlation between what has
been intellectually stimulating and what has been financially
rewarding.
For example, working on a
proposal can be very interesting, yet often it is not paid work. On
the other hand, lucrative contracts may involve repetitive and mundane
tasks.
Epi Monitor: To
what extent do you feel as if you have a choice in the kind of work
that you do? Do you ever turn down work?
Koslowe: I am
not yet in the position of turning down work, although people have
asked me about projects that are not at all along the lines of
something I would be interested in or able to do. It is a mixed type
of situation. On the one hand, there are opportunities for a person in
business to be very imaginative about what he or she would like to
pursue. The government for example has a program for Small Business
Innovative Research which funds ideas over a six-month period of time
for about $50,000 and a second phase funded over two years for up to
$500,000 when the project gets implemented. There are many
opportunities for someone with an interest in epidemiology to take
advantage of this program in one way or another. One has a great deal
of leeway in describing what he or she would like to do. A small
business is also now strictly speaking able to apply for grant money,
although I think the reality is that very few will get it. But I have
for example approached non-profit institutions with ideas that I had.
When they were funded I have been involved in working on the project
even though I was not the lead business, and this has been rewarding.
Obviously, the contracts that you pursue and the people you contact
initially are in areas that would be of interest to you. But when it
gets down to responding to a contract, you do what the contractor
wants you to do. I would only respond to contracts I had some interest
in.
Epi Monitor: So
to this extent you exercise some choice.
Koslowe: Yes,
but at this point in the game if someone called me up and said do you
want to do something that is not your first choice, I am anxious
enough to get more experience that chances are nine out of 10 that I
would say yes if I liked the project or not.
Epi Monitor:
Are there differences in doing contract work for the private vs. the
public sector?
Koslowe: It is
difficult to generalize, but I think a couple of things could be
noted. In general, private sector work can be somewhat more lucrative
than government work. Private sector work can also offer the
opportunity to get more involved in the design and interpretation of
the study. In contrast, government work may entail in large measure
provision of support services. On the other hand, something to be wary
of is that the private sector client comes to a firm with a decided
bias. That’s something to be conscious of.
Epi Monitor:
Have you worked out a way of dealing with this decided bias?
Koslowe: If I
had the opportunity to do a study in the private sector I would want
to be assured that I felt comfortable about the integrity of the
study. On the other hand, if I am asked to review a paper and the
person footing the bill is opposed to what the paper has come out
with, and I see some problems in the paper, I will tend to highlight
the problems as opposed to the strengths. That’s about it.
Epi Monitor:
What about the use of the information after you give it to a client?
Is this a concern of yours? Does this go beyond what you are
responsible for or can be responsible for?
Koslowe: It
depends on the issue and the circumstances. My experiences so far have
not put me in a difficult ethical position. I have provided
information and I have not been aware of what has happened to it
afterwards.
Epi Monitor: So
once the report is provided you are cut off from further information?
Koslowe: Yes, I
am out of it.
Epi Monitor: Do
you have any suggestions for people who might be considering going
into the private practice of epidemiology?
Koslowe: I will
make my comments for someone thinking about going into government
contract work since I do not have much experience in working with the
private sector. I would suggest subscribing to the Commerce Business
Daily, and requesting proposals under the Freedom of Information Act
which have been awarded contracts in the areas you are interested in.
Proposal writing is obviously an important factor in such a business
and looking at winning proposals could be useful. When a firm’s
proposal has not been successful, I would suggest requesting a
briefing to learn about the strengths and weaknesses of the proposal
and to learn from this experience. Also, a person starting out would
want to be aware of the small business set aside, would want to become
aware of the Small Business Innovative Research program, and would
want to know if they qualify as a minority business under the 8a
program. I would caution anyone starting out to either have a contract
or some other arrangement in hand at the time or work out some
transition period because you have to anticipate that there is going
to be some lag time between starting out and having income. It’s not
unusual for people to leave a government agency with contract in hand.
I was told that the ethics of doing this is a gray area, but I would
urge government employees thinking of leaving to look into this
further.
Epi Monitor: It
helps to be independently wealthy!
Koslowe:
Absolutely!
Epi Monitor:
How much risk is involved in starting a business in epidemiology?
Koslowe: When
you are starting from your home the initial expenses are minimal, but
the fact that I was no longer earning a regular salary was a
significant factor in the beginning.
Epi Monitor:
What do you see as the future directions for consulting in
epidemiology?
Koslowe:
Persons going into this field should be prepared to work outside of
the strict confines of epidemiologic studies.
Epi Monitor: Do
you think a solo practice has advantages over a group practice?
Koslowe: I
believe there are obvious advantages in working with another person or
persons such as having someone to bounce ideas off of. My own
preference is to do it on a project by project basis rather than on an
overall business basis where every business decision has to be
achieved by consensus. When persons have complimentary interests or
skills such as when one person has many contacts and another has a lot
of technical expertise that may work very well. When two people have
the same type of background, that is not particularly an advantage.
Epi Monitor:
Thank you for your candid remarks.
Published April 1988
Postscript 2000
The
Epidemiology Monitor interview that appears here was published in
1988. Twelve years later, EpiStat is still a home-based business, and
I remain the only full-time employee assisted as necessary by a
wonderful statistical programmer. Most of the comments I made at the
time of the interview still apply, but I’ll use this opportunity to
identify a few areas where my perspective has changed somewhat over
time. As a one-person operation it’s obviously necessary to combine
marketing and project work, and in the interview I think I focused on
the appeal of being able to focus on both these areas. Over time I’ve
quite honestly found it more difficult to actively market for
additional work. I still enjoy meeting new people and exploring issues
that appeal to me. But it’s hard to continually muster the effort for
marketing new ideas when there is no money associated with that effort
and the results are so often disappointing. I would be the first to
encourage others not to get totally disappointed and to point out that
often work can and does develop from connections made on proposals
that were not funded. Indeed one of the most interesting and most
lucrative projects I’ve worked on was initiated that way. However it’s
hard to constantly remind myself of that. This sort of sluggishness on
my part has resulted in some unwanted hiatuses between projects. Some
sort of affiliation with a larger firm may have mitigated that
situation, particularly if they would have had me on retainer, and I
regret that I didn’t try harder to work that out. I also regret that
during busy times I didn’t use some of the extra income to invest in
hiring help for proposal writing (particularly for Small Business
Innovative Research Grants and Contracts “SBIRs”) when I was lacking
the follow through myself. In re-reading the interview, I see that I
felt myself relatively free of potential “biases.” I would say now
that the concerns about bias are not limited to work funded by the
private sector! I referred earlier to the “flexibility and diversity”
of self-employed work, and the appeal that held for me. For me
personally the “flexibility” is not quite the advantage it was when my
children were all at home. At this point in my life, I think I would
welcome more structure in my routine and more interaction with other
people. I’m currently exploring an adjunct or part-time affiliation
with a university. I still very much appreciate the “diversity” that
has been afforded by my work as a self-employed epidemiologist, and
look forward to more interesting opportunities in the future.
Pat Koslowe
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