Site growth

How to grow a clinical research site: a practical playbook

By TrialNotice · Updated
Two clinical research site staff members reviewing a growth plan together in a bright office
Short answerA research site grows by building a track record sponsors can verify: meeting enrollment targets, starting studies quickly, and keeping screen failure low. Sponsors reuse sites they know, and Tufts CSDD found repeat sites complete startup 9.9 weeks faster than new ones. The fastest way to build that record is a patient pipeline the site controls, and a local physician referral network is the pipeline most sites never build.

What do site leaders say matters most?

When the Society for Clinical Research Sites asked sites what they most need to improve for long term success, recruitment ranked first at 65%, followed by finding study opportunities at 49% and getting properly paid for services at 42% (SCRS). Growth and recruitment are the same problem: sites that enroll get more studies, and sites that get more studies can invest in recruitment.

65%
of sites rank recruitment as the top area to improve
49%
rank finding study opportunities
9.9 weeks
faster startup for repeat sites than new ones

How did the site landscape get here?

For more than two decades, Tufts CSDD has tracked high turnover among principal investigators. Ken Getz reported that since 2006, 40% of North American investigators had not conducted another trial (MedCity News). A Duke and FDA survey of 201 investigators classified 54.2% as one and done, and almost half of those said they wanted to conduct another trial but lacked the opportunity (DaVita Clinical Research).

The exact size of the problem is debated. One industry analyst argues methodological issues inflated the figures and that the true one and done share is likely below 20% (Clinical Leader). Either way, the pattern holds: many sites do a study or two and never become a sponsor's regular site.

Why do sponsors keep going back to the same sites?

Because familiar sites are faster and more predictable. Tufts CSDD found 28% of engaged sites are new relationships, and repeat or familiar sites complete site initiation 9.9 weeks faster than new ones (Tufts CSDD). Every study a site enrolls well makes the next award more likely.

What is the six step growth playbook?

  1. Know your numbers. Track enrollment against target, screen failure, and time to first patient for every study. Sponsors track them, so you should too. See the metrics sponsors track.
  2. Control your patient supply. In a typical trial, 37% of sites under enroll and 11% enroll no one (Tufts CSDD). Sites that depend only on their own records run dry. A physician referral network keeps refilling the funnel.
  3. Win the right studies. Take studies you can fill. See how to decide which trials to take.
  4. Start fast. Do recruitment work during startup, not after. See first patient in faster.
  5. Expand therapeutic areas deliberately. Each new area needs new referring specialists near your site.
  6. Protect your finances. SCRS reports 38% of sites saw profits decline in 2023, and 37% have less than $1 million in gross revenue (SCRS). Budget negotiation and study selection matter as much as enrollment.

Every step points to the same asset: patients you can reliably reach. See how to build a physician referral network.

Get your study in front of the right local physicians

TrialNotice builds a physician referral pipeline around one active study. We identify relevant local physicians within driving distance of your site, send study aligned direct mail, follow up by email and LinkedIn, track engagement with recipient level QR codes, and route warm responses into your site team's workflow.

Talk to TrialNotice

Sources

  1. Society for Clinical Research Sites, 2022 Site Landscape Survey White Paper
  2. MedCity News, "Is clinical trial design complexity behind the high turnover rate for principal investigators?"
  3. DaVita Clinical Research, summary of the Duke and FDA investigator survey (Contemporary Clinical Trials Communications, 2017)
  4. Clinical Leader, "The One And Done Investigator: A Clinical Trial Story"
  5. Tufts CSDD, first comprehensive clinical site initiation benchmark (2018), via GlobeNewswire
  6. Tufts CSDD, patient recruitment and retention practices study (Jan 2013), via Fierce Biotech
  7. Society for Clinical Research Sites, Site Finances White Paper (2024)

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