After six years as a business development manager with pharmaceutical companies in Germany and France, and after completing an international executive MBA program at RSM Erasmus University, Fahd Ramdhani was ready for a new challenge. In 2011, Fahd and a business partner orchestrated a management buyout of Benecke, an Amsterdam-based company that provides continuing medical education (CME) programs to physicians in the Netherlands and a growing number of countries in the Middle East. Fahd, 40, grew up in Leiden and now lives with his wife Mariam Alloul and three children in Valkenburg. [A profile of Mariam Alloul also appears at www.theysaidwhat.co.]  

“I am an owner of a medical education company that provides continual medical education to healthcare specialists.” Fahd is business development director at Benecke, and together with managing director Clynn Kraag constitutes Benecke’s management team.

“I started with [Benecke] in 2011. Before that, I was working in the pharmaceutical industry on a commercial level … In 2011 I met the current partner in the business, and we were talking about what we could do, how we could combine our skills in order to build new business. At that time I was doing an executive MBA. At that time we thought, ‘let’s take over an existing company.’ During that study we came up with the idea to take over a company called Benecke.The company was founded in 1985 by Ludwig Benecke, a Dutch physician and economist, who remains a general partner.

“The founder of the company at that time wanted to take a step back. So we posed to him the idea of taking it over as two young ambitious entrepreneurs. And he understood that and he wanted to participate. So we actually executed a management buyout. So in 2011 we started with that.” 

“I had a business plan in order to make sure that the business in the Netherlands continues as it is, but the growth should come from outside the Netherlands. And due to the previous experience I already had at the pharmaceutical companies, especially in sales, we decided to target countries that have an infrastructure. Or at least the will or the need for an infrastructure, to educate their own healthcare specialists similar to what we’re doing here in the Netherlands. Therefore we targeted the Middle East. Because we knew that they have the resources, but they didn’t have the experience and skills.”

“We started with the United Arab Emirates, and then we shifted over to Saudi Arabia. Because we found out very soon after we started in the UAE that the market there is too small. And through contacts that we made we understood that Saudi Arabia has a much bigger market share, and also a more mature market with regard to healthcare. And a lot of international pharmaceutical companies were already located there. So for us it was a much better strategy shift to move toward Saudi Arabia and start a business there instead of the United Arab Emirates.”

“However, it’s very difficult to get into Saudi Arabia. To establish a business. But actually also to access the country. You need visas and you have to be invited. Otherwise you cannot enter the country … What I did is try to find the right contact on a healthcare level that is also responsible for a certain disease area. So through a contact I had in the UAE, a cardiologist, I met [another] cardiologist from Saudi Arabia who seemed to be a very popular and important cardiologist in the country. He had a lot of contacts with the ministry, for example. He was working with the national guard. So after the first talk I had with him there was a click, and he believed in the ideas that we had. So he started to support us in getting into the country.”

“Starting from there we started to roll out the programs that we had in mind. First of all you need to meet the right people, the decision makers. So our modus operandi is to speak to important people within healthcare … So we targeted presidents of the Saudi association of cardiologists … [and other] various disease areas in order to understand their need and also to understand the needs of the local doctors. Because at the end that‘s what we are targeting. We need to deliver something that they can benefit from.” Benecke provides CME programs in a wide variety of disease areas, including cardiology, oncology, dermatology and rheumatology.“Any disease area apart from surgery. Every speciality other than surgery.”

Benecke partners primarily with scientific associations in the Netherlands and Saudi Arabia, and with pharmaceutical companies. “The main business is targeting medicine. The pharma component is very important. Because in order to make this possible you need sponsorship or you need resources in order to execute this project. So that’s the business model. A pharmaceutical company has a portfolio of products in the different disease areas, and the only objective they have is to make them as visible as possible to the doctors so they can prescribe them for the patients. And obviously there is a lot of competition between the pharmaceutical companies. One of the ways to target and to access the doctors is to provide them with medical education, to share with [doctors] information on the product that the [pharma companies] have available. New medications. It’s up to [pharma companies] to inform [doctors] why their medication is better than the other ones.”

“And the doctor is only interested in the scientific part of it. The doctor wants to help patients. If indeed there is a product that helps the patient, then [the doctor] would definitely prescribe it. But in order to do that they need to be independent. The [pharma companies] cannot talk about the products. But they can talk about the working mechanism on a scientific level. Because otherwise they are biased, and it’s like making advertisements for their own product. Which is not allowed, especially in Europe and the Middle East.”

“That’s how we come in. We are an independent consultant. And what we do is we understand the need of the pharmaceutical company with regard to their product line and marketing and medical objectives. And so what we do is we try to create an educational program that we can roll out for the doctors there. We only work with academic professors … in the Netherlands, the U.S., the U.K. Internationally renowned [doctors]. Thought leaders.”

“Indeed, it is very difficult to have a professor fly over from the U.S. to Saudi Arabia. So we have to find an alternative concept. So what we’ve been doing for many years in the Netherlands is [bringing] reviews of international congresses in the U.S. to the Netherlands. Because a lot of doctors in the Netherlands are very busy, and they don’t have time to visit all these important international scientific congresses. What we do is we select a couple of opinion leaders from the Netherlands to travel over to the U.S., attend the full congress and then do a peer review.”

“And a lot of information [presented during scientific congresses] is also relevant for all doctors internationally. Such as the latest information concerning clinical trials. However, the doctors who are not able to attend the congress would miss this information … So what we do is we facilitate it in such a way that the doctors that are [attending a congress] can review the whole congress with their peers colleagues [in the Netherlands]. Therefore it’s what we call distance learning. Without traveling you receive the information in a very convenient way by attending here a local congress. Because we gather 50 doctors in one hotel room, we set up big screens with video stream and cameras are pointed on the moderator and the audience. And then they can have a discussion like they are there. And we do the same thing in Saudi Arabia.”

“We have online e-learning … a physician can go to the [Benecke] website and follow a full module on a specific topic and then get a certificate. Because all the doctors in the Netherlands need to have accredited education … they need approximately 40 CME hours every two years in order to maintain their license. And they have a lot of programs to choose from. We are a company that provides medical education programs for these physicians.”

Business is expanding: “To the Middle East mainly. We’re expanding to Africa. Egypt and Algeria, maybe also Morocco in the near future. But our core business currently is Saudi, and then a bit United Arab Emirates. We’ve been to Iran and to Lebanon, but that’s on a very small scale. But the same concepts obviously have been executed there as well. It all depends, of course, on how big the country is. The more people you have, the more healthcare you require. So there is a higher chance to provide medical education. And, of course, the resources. Saudi Arabia is, of course, a rich country. Egypt to a certain extent is not. But there are a lot of pharmaceutical companies there. So we have to understand their needs. But they will be similar in terms of education. Because if someone has cancer he needs to be treated the same way in Egypt as in Saudi Arabia.”  

Most rewarding aspects of his work: “What I really like the most about the current work I’m doing is the contribution that I can make with regard to improving healthcare. It’s an indirect result of the efforts that we are doing. Because a good education obviously has a positive effect on the healthcare system. That’s what I think is rewarding for me. Because we actually are contributing to that … spreading information, and the right information by the opinion leaders that you have the contact with. And you actually facilitate that because previously [it wasn’t possible for] these opinion leaders to speak to the local doctors. Not because they didn’t have the resources, but because they didn’t have the possibility or an agency that could help them the way that we can. Because [local doctors] could invite [a leading doctor from another country] to come over, but normally they wouldn’t because of the distance or they didn’t have the time, etcetera. Now through this concept they are able to have this interaction in a very convenient way.”

The work is not without frustrations: “The main frustration I would say is different business ethics. If you compare Saudi Arabia with the Netherlands they do things differently from a business perspective. And by that I mean time management is different, communication is different. For example, if I have an appointment with you at 1PM [in the Netherlands] I am 99% sure that the meeting will take place at 1PM. And I’m 99% sure that if it can’t take place that I will be notified in one way or another so that I’m aware that I don’t have to wait. In [the Middle East], it’s very common that the meeting is supposed to start at 1PM and he will arrive at 1:30. And you should be very relaxed about that because that’s how things go here. That’s mainly what you get and they’re used to it. And it’s ‘oh, c’mon, take it easy we’re not Germany’ they say (laughs). I had a difficult time adapting to that.”

“A lot of companies that try to do business in those regions … stop doing business because of those things. But I thought that, well, you have to have some patience. You have to understand their differences. And maybe also because of my Arabic background I could better understand their way of thinking. Despite the fact that I’ve actually been here all my life, so I’m completely Dutch in my thinking and doing. But I found the balance, I think. You have to pick the best of both worlds and try to find a consensus … So that’s one part of the frustration I have. And maybe also the traveling. Because I do a lot of traveling. However, I’ve always been traveling since I started working.”

Staying ahead of the competition: “If we talk about the Netherlands I would say there is competition. However, Benecke is a full-service company. So we’re not limited to one specific area or service. So if we do a program it’s from developing the content to executing the program to booking the meeting rooms and catering, etcetera. So it’s a full package. If we’re talking about competition, then we’re mainly talking about a specific area. So the competition would be like a company that is only focusing on oncology and only online. Or cardiology and only physical meetings. Or dermatology but just with hospitals. So that’s what our competition looks like. It’s not an actual company that has the same portfolio and the same services that we have. And we want to diversify our portfolio. And that means that our core business is project management, development of medical education and marketing. Marketing is important in order to invite the doctors. In order to be successful and to have a well-attended meeting you need to understand doctors and their interests.”

The importance of personal connections: “I think that’s key in order to make business … The network is very important. And at the end, of course, the quality … As you can imagine, we are dealing with … the opinion leaders, the professors and academics. They need to be approached in a certain way. They need to feel that they are treated in a respectful manner and considered as very important. They have this ego that needs to be stroked. That also requires a way of communication. On the other hand, you have a pharmaceutical company that also has objectives and needs. They are in need of someone or a company that is able to take away all the issues that they would have in order to organize such meetings … Because pharma cannot influence a doctor whatsoever … The only thing that a pharma can do is to set a date and a budget in order to make things possible, and within the disease area that they’re interested in. Then it’s all up to us.”

Pharmaceutical companies are not permitted to directly influence physicians: “In our experience everything is very well-regulated … Doctors are not allowed to be treated like they were treated 20 years ago … And we as Benecke have to comply with all these regulations. We cannot give them any additional fees … The doctors are also aware that whether they like it or not medical educational programs need to be funded. On the other hand they are aware this is not a cash cow for them … So it’s highly regulated and doctors are really respecting that….the government and the regulations are constantly on top of them. All our programs are accredited. We don’t offer any non-accredited educational platforms, both here and in Saudi.”

“Over the years you learn, of course. I didn’t have this knowledge when I started in 2011. Because I come from pharma. But now I’m actually providing a service to the pharmaceutical industry and becoming an intermediary. What is very important for us is to ensure the independence of all the educational programs. Despite the fact that you are an agency, and there is a business model obviously, we always make sure that all the programs are independent and are focusing on the disease area of interest for the doctors that you want to present it to.”

Information about Benecke is available at www.benecke.nl