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Several years ago, I was collaborating with a pharmaceutical industry client preparing to commercialize a new antiretroviral (ARV) regimen in the HIV space. Scientifically, they were on solid ground. Through its reputation and scientific leadership, the company had forged robust relationships with the top HIV Key Opinion Leaders (KOLs), the clinical investigators and academic luminaries who authored the pivotal studies and regularly headlined global congresses.
But as we moved into launch planning, a critical realization emerged: the people driving real-world prescribing decisions weren’t the podium presenters. They were the trusted, high-volume HIV clinicians working in community settings - the go-to sources of advice when peers had difficult cases or questions about new antiretroviral regimens.
These weren’t the KOLs we had built decks around. These were what I’ve since come to call Practical Opinion Leaders (POLs)—HCPs who, through experience, volume, and peer credibility, exert outsized influence in local care ecosystems. Not all of them are doctors - in HIV, more and more are NPs and PAs that work in high-volume practices, who see patients day after day, and who oftentimes know more than the investigators about the intricacies of dosing, tolerability, interactions, etc.
As a consultant, I proposed a formal process to identify these POLs. Through survey-based research in key HIV epicenters, we asked frontline clinicians a few simple but revealing questions:
The results were illuminating. In every market, a small set of clinicians consistently emerged as local influencers—people their peers trusted, emulated, and listened to. Often, they weren’t affiliated with academic institutions. They weren’t publishing. But they saw large volumes of patients, had reputations for clinical acumen, and were perceived as “in the trenches” providers who understood the nuances of real-world care.
Once we identified these Practical Opinion Leaders, the company developed a targeted engagement strategy. The sales force prioritized them. Field medical teams provided data tailored to their clinical questions. Educational content was co-developed to reflect their practical concerns, not just the trial endpoints. And most importantly, we equipped them to become evangelists for the regimen—answering questions, sharing case experience, and influencing their peers in organic, trusted ways.
As a result, we saw a measurable and accelerated uptake curve in those markets. Instead of trying to chase scripts one HCP at a time, we focused on the few who shaped the many. The force-multiplier effect was real. And the efficiency gains were substantial—reps knew whom to prioritize, and local ecosystems began to shift more quickly and cohesively.
This was a peer-to-peer strategy in its purest form, but with one critical twist: we had taken a systematic, data-driven approach to map local influence. And we had redefined who, exactly, was considered influential.
Pharma has long leaned on KOLs for good reason. They lend scientific credibility, help shape narratives, and guide evidence generation. But in many markets—especially those that are experience-driven or decentralized—the academic voice can carry limited weight. There’s a perception, often valid, that the top KOLs are too far removed from day-to-day care. They may not treat the complex, comorbid, non-adherent patients that community providers see every day. And they are often viewed, fairly or not, as aligned with industry in ways that may dilute their authenticity.
In contrast, Practical Opinion Leaders earn trust by being in the trenches. They treat large patient panels. They run local case conferences. They speak at regional CMEs. And their peers view them as relevant, relatable, and reliable.
Yet despite their influence, POLs often fly under the radar. They don’t show up in PubMed searches. They aren’t listed as trial investigators. Most customer targeting algorithms miss them entirely.
To close this gap, pharmaceutical companies must invest in new methods for identifying POLs. Qualitative approaches—like peer nomination surveys, referral network mapping, and field force interviews—can be highly effective. Quantitative tools such as EHR collaboration analysis, practice volume segmentation, and social network analytics can help scale the approach.
What matters is the mindset: we need to move beyond the idea that influence only resides in ivory towers. Instead, we must start asking:
In markets like HIV, where providers tend to be skeptical of pharma messaging and deeply rely on peer networks, engaging POLs isn’t just effective—it’s essential. But this insight applies more broadly. We see similar dynamics in areas like oncology, rheumatology, diabetes, and mental health—disease categories where complexity, comorbidity, and practical know-how are often more influential than publication history.
Once identified, POLs should be engaged with respect, relevance, and flexibility. Unlike KOLs, they may not be motivated by podium visibility. Instead, they value tools that help their patients, data that speak to their practice realities, and recognition that honors their role in the local care landscape.
Successful engagement models may include:
And importantly, sales teams must be empowered to engage POLs as strategic partners—not just targets. When done right, this creates a virtuous cycle: more efficient rep time, stronger local advocacy, and faster uptake curves.
It’s time we add “Practical Opinion Leaders” to our industry vocabulary. Or maybe there's a better name - I'm eager to hear from others' experience. Not as a replacement for KOLs, but as a complementary—and often more immediately impactful—layer of influence. POLs are not defined by CVs or congress appearances. They’re defined by credibility, connectivity, and context. And in many therapeutic areas, they are the ones truly shaping behavior on the ground.
If we want to meet the moment—driving impact in a more fragmented, skeptical, and experience-driven healthcare environment—we must broaden our definitions, sharpen our targeting, and elevate the voices that matter most to everyday clinicians.
Because in the end, influence isn’t always about who speaks loudest at the podium. It’s about who gets the call when the case is complicated, and time is short.
