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what's up Guru Nation let's demystify
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clinical research
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[Music]
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Guru Nation thank you so much for
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watching make sure you like subscribe
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comment share look we're also doing
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Instagram live I'll get to the comments
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later
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um this one's gonna be like how there's
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been so many people asking me and Chris
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with dscs Sweat Equity Investments we
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actually have a site Network slash
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Boutique cro consulting company slash
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really like holding company it holds
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Yuma clinical trials we're trying to do
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a lot of like
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crazy things that kind of evolved into
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this crazy idea over the years and we've
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been doing this since 2013 but
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we probably do
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seven to ten potential client calls
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every week
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and these are people that either have
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small sites sometimes they're medium to
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large sites and they just need help with
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hey we just want you guys to do our
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contracts on budgets or hey we just want
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you guys to do our source but the
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majority of the time I would say 80 of
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the time it's hey we need help getting
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studies
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and then
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probably half the time
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it's hey we need like advice on how to
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get a principal investigator
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and I think that's where you need to
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start if you're looking to start a site
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how to find a principal investigator I
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mean you can't start getting studies
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unless you have connections from
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somewhere else until you have a
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principal investigator and yes that does
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mean a medical doctor or a doctor of
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osteopathy
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they do not have to be board certified
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but board certified is preferable and
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ideal I guess but you can have a
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non-board certified MD be a pi or a deal
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so this video is going to be how to find
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Physicians that you can make your
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principal investigator and then a little
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bit about how to keep them
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and there's a lot of nuances here in
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between and we have by the way like a
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two hour video on the blueprint for
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starting a site opening a site
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maintaining a site but this is just
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going to be one little aspect which is
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the most critical aspect and it's also
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the most difficult aspect
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and it's finding and keeping a pi
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one of the reasons it's so difficult is
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because there is no real blueprint
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and the strategies are going to change
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from Individual to individual the
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strategies are going to change both from
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who you're dealing with as your
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physician that you're approaching so not
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every physician wants the same thing
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and then the strategy changes based on
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your own you the site owner
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what you're looking to do so sometimes
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you reach negotiations or you you can't
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agree on what the other wants and vice
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versa
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I think in those cases it's better just
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to move on because last thing you want
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is
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a situation where you're not getting
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what you want and neither is the other
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person or like a one-sided Arrangement
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so
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this tough this is a tough topic I don't
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know why I picked it when I didn't have
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as much caffeine as I normally do but
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maybe that's a good thing so we can like
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settle down and kind of think about some
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of these details so
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finding
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identifying right
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the best way
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is your sphere of influence so
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that yes that does include your own
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doctor that you go see I hope you have a
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doctor that you see
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uh everyone needs one even if you're
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healthy
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and let's say you don't or let's say
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you've exhausted that option because
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that's only one maybe two
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your sphere of influence okay so your
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friends your relatives who's their
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clinician do they know anyone
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um
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sometimes you might have to go a little
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bit more ancillary providers like
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nurse practitioners or physician
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assistants
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sometimes the networking goes down to
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medical
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assistance CNAs uh just whoever you know
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in the medical space
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can lead you in the right direction
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when we started here in Yuma clinical
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trials so I'll just use you I love you
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my clinical trials I think this will be
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my last site I do not because I don't
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think it's a lucrative business but
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because I've been doing it for about two
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decades and I think the next phase of my
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career is going to be in biotech but
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Yuma clinical trials it's like the
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blueprint for everything that I'm
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talking about on these videos so the way
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I found this pi
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was indirectly indirectly through my
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sphere of influence so
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my wife
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I was talking to my wife and we were
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driving around Yuma we didn't even live
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here yet but we came here to visit
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family
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and I was just telling her like hey you
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know what like we were already thinking
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about moving here
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um we were actually
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already we decided we're gonna move here
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but we didn't move yet
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and I told her you know
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um
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I mean if we can't find a doctor to do
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studies like I can just work from home
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and do the dscs stuff like I have plenty
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of stuff to keep me busy I've got these
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videos I've got the dscs client stuff
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I've got the cro thing I'm building so I
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told her you know if it doesn't happen
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like it's okay
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and I was just talking to her we were
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long road trip kind of bored
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and then she
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saw a billboard on the trip and it was
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her childhood friend on the billboard
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he's now a nurse practitioner you guys
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know him if you watch the videos Jaime
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Vayas
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she saw him I didn't know who he was I
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never met him
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and she said what about nurse
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practitioner does that work I said no
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it's not like a pi but the nurse
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practitioner could be a sub bye and
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maybe they could point in the right
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direction but why do you ask and she
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said well I know Jaime he's a childhood
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friend of mine that billboard just
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reminded me of it and uh he probably
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knows
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Physicians so we had a zoom with Jaime
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like a few days later myself and Chris
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and Jaime Jaime was interested in doing
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this Jaime was super connected in Yuma
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so he told us where to go
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looking
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and simultaneously we did use email so
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my wife
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email blasted already prior to this
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conversation with heima charity email
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blasted like almost every doctor in Yuma
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uh a few replied I'm going to get into
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some of the meetings I had with them in
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this video
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a few replied but most didn't I mean
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what do you expect when you're cold
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emailing like so shout out to my wife
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for doing that she did that I think it
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was like a hundred providers that she
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mapped out and emailed them all and a
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few replied
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well
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after we talked to Jaime he pointed Us
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in like the right direction and
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one of the doctors he mentioned who
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happens to be RPI now Dr Smith
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he mentioned him and then I told my wife
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and she said yeah I'm pretty sure I
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emailed him and she checked her list yep
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I did email him he didn't reply back
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I said okay Dr Smith let me just take a
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chance go on LinkedIn and see if I could
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find him and this is why I have LinkedIn
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premium it doesn't just help me get new
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studies but it could help me find
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new providers right in this case
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principal investigator so I took a
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chance of just LinkedIn premium message
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something really short like doctors the
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first mistake I see you guys making that
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are looking to get Physicians
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you bombard them with details the last
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thing they want at least from your
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initial conversation is a laundry list
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of like your requirements or like your
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introduction they get pitched constantly
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I kept mine really short hey my name is
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Dan I've worked I'm moving to Yuma from
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Orange County I've done clinical
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research for over a decade almost two
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decades and I really think Yuma is a
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great market for this
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it's like a paragraph
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if and then at the end I said if you're
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if you're interested let me know if you
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know anyone that might be interested let
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me know very simple sent it
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took a few weeks maybe even a month
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he replied back out of the blue I
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actually forgot I even did this
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he replied back so I was already like
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well
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let me just try this LinkedIn thing with
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the other doctors Jaime suggested and uh
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it did work with one guy and we're going
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to get into without mentioning his name
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like why we didn't work with him
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but
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during this time Dr Smith did reply back
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he just took like I think it was like
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either somewhere from three to six weeks
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to get back to me
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out of the blue like he just and his for
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those that know Dr Smith he's just very
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short with his answers so my strategy of
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like sending the short paragraph was
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good because he I know him now he
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doesn't read
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long things
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he replied back what does it cost the
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patient
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so
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I'm already thinking that even that
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short statement told me a lot about him
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he didn't ask how much is in it for him
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which by the way wouldn't have been a
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bad thing either like there's some that
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will do that and this is back to my
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point not every not every clinician's
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gonna want the same thing but Dr Smith
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was at a point where
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he's about to be retired but he's got a
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large practice that he's outsourced to
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other providers too so that it's like
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the Private Practice running itself he
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really wanted
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alternative options for his patients and
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those that get to know him you see that
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like
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patient the patient experience an
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alternative for patients and the health
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outcomes of his patients is really
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important to him and that was telling
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even from that one sentence that he
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replied back to me
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what does it cost the patient so then I
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replied back I think it was two
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paragraphs
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it cost them nothing I should have
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pulled this up prior to this video but
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um maybe I'll send it to
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um
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to Daniel and then he'll throw out the
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screenshot in there but I basically said
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cost them nothing matter of fact they
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get paid uh I can talk to you about it
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more uh and he's he was interested so he
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did a zoom and then we schedule a time
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to meet face to face
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so I'm going to come back to this
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but I'm going to talk to you about
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because in the meantime other doctors
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were replying but it didn't work out and
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let me tell you a couple of the reasons
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why
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the first one it didn't work out uh it
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was an easy one he was an employee of
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the large hospital system out here Yuma
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Regional Medical Center and they are so
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restrictive and you're gonna run into
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this issue in your errors this is why
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I'm telling you this story
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you're going to run into this issue and
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I mean this is the way Healthcare is
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headed in the United States everything's
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getting Consolidated large Health
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Systems
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we can make a whole podcast on
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the pros and cons of that
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Cliff Notes I think it's mostly bad uh
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the good news is there's still a few
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providers out there that are independent
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these are the ones you want to Target
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okay so the first one that replied back
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hey but I work for this Yuma Regional
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and they sign into these restrictive
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contracts so I don't think I can do it
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and even if I were to say yes we can't
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use the patience because the patients
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are technically their patients and and I
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already knew the hospital was like not
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going to want to work with us because
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they did their own research although
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they only do oncology and maybe in the
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future it's
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they'd be open to partnering with me but
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I I may be able to do this without them
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that's another topic
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um
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so the first one didn't work out because
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of the large medical system got in the
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way
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the point of this is you really want
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independent Physicians not just because
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if they work for a large system they're
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probably going to restrict um their
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hours and what they can do but the
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patience a lot of you guys and gals
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thinking about starting a site
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you're not giving any thought to where
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you're going to get these patients from
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let me tell you that this Dr Smith this
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is like it has a happy ending where it's
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still it's a book we're still writing
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huge Private Practice it's him and 10
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other providers but he's in charge
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we still guys they have like 10 000
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patients in their database we still have
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a hard time getting patients randomized
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for a number of reasons these Protocols
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are very
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specific when it comes to the kind of
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patients they want so if you do not get
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a pi
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if you do not partner with a physician
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that has a database
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you don't have a very good chance in my
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opinion I know other people watching
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saying no you can you can run ads
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if ads were so successful
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then why aren't sponsors just having a
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few pis and running ads the whole time
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they don't 90 percent of Trials are
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behind on enrollment it might even be
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higher because of patient accrual so
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these studies are complex they try to
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make the IE criteria of like very
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pristine so only certain patients get in
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it's really tough
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so make sure you get yourself a pi that
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has a private practice
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and it's not part of a large medical
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system or if they don't at the very
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minimum
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make sure you get yourself a sub
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investigator someone like Jaime Vayas
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who's a nurse practitioner that does
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have a private practice in our case it's
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the inverse Dr Smith has a private
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practice Jaime does not
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so you got to get the patients from
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somewhere is the point
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okay that was example number one you
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will encounter this be prepared for it
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example number two
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it it almost worked out
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it almost worked out independent
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definitely not as big of a practice as
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Dr Smith's but independent
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um
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not enough space in his office I knew
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coming into Yuma that I did not want to
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risk having a lease for a place right
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away because that sets you back a little
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bit
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so I knew I wanted a physician with a
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private practice that had just enough
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space which was really tough just enough
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space for me to get started I didn't
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need much
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I needed just an office for the
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coordinators and then a place where the
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monitors can go every six weeks when the
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monitors come
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and Dr Smith had that matter of fact
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we're still using the space we had to
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move out of our coordinator office
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because they needed it for more
00:15:58
providers they're actually growing their
00:16:00
practice so they brought in two new
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nurse practitioners that took our space
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uh
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so we have
00:16:09
we have space in the Attic upstairs I'm
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gonna do a video later give you guys a
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tour of it but we have the exam rooms
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that we can use when patients are there
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so
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I didn't need space I didn't need to
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come out of pocket and pay money for a
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lease right away when we don't have a
00:16:27
study you do not want there's plenty of
00:16:30
headwinds working against you when
00:16:31
you're starting a site so try to find a
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pi that have his own space like enough
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space for you to get started try to work
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out a deal where you don't have to pay
00:16:40
rent at least up front we're going to
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get into that right now towards the end
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this this other guy he had he had uh he
00:16:49
was Private Practice he had a small
00:16:51
database but it was some something
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doable
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but not enough space we could have still
00:16:57
done it but not enough and so he had
00:17:00
those two things going against them and
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he was also an internal medicine doctor
00:17:03
which Dr Smith was as well
00:17:06
and there were some things about this
00:17:10
person that
00:17:13
kind of rubbed me the wrong way
00:17:15
um
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attitude wise
00:17:18
like
00:17:19
not a bad person but just if I had to be
00:17:23
picky I went with Dr Smith
00:17:25
uh the other guy it probably could have
00:17:28
worked too
00:17:29
but I think I have a much better chance
00:17:32
I'm I have no doubt I made the right
00:17:34
choice
00:17:35
all right so if if something's like in
00:17:38
your gut like hey this I don't like this
00:17:40
person or I don't
00:17:42
maybe it's not that strong because in my
00:17:44
case it wasn't that strong I actually
00:17:45
liked him
00:17:47
um but
00:17:48
you know there's just something that's
00:17:50
like I can't articulate it but it
00:17:52
doesn't feel right that's kind of what
00:17:53
it was with me and this person so you're
00:17:56
gonna run into that too trust your gut
00:17:58
all right
00:18:01
last thing you want to do is partner
00:18:02
with someone that you're going to regret
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later so
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once Dr Smith agreed to come on board
00:18:09
I told him look
00:18:12
I want to eventually make you a partner
00:18:13
of FEMA clinical trials
00:18:16
which he currently he is now we made him
00:18:19
a partner about a year into it
00:18:21
but I told him I said I've done this
00:18:23
before and you've never done this
00:18:26
so you don't know
00:18:28
if you like working with me
00:18:31
and quite honestly vice versa so let's
00:18:34
just keep an independent contractor
00:18:36
relationship if you give me space that
00:18:39
you're not using I'll make it work
00:18:42
and we made it work and so I gave him
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uh I think it was 20 gross
00:18:50
so not net guys I know a lot of you guys
00:18:53
are thinking oh well let's do net don't
00:18:56
do net don't mess around with these
00:18:58
doctors right because we can manipulate
00:19:00
net the net profit we can say we're
00:19:04
spending whatever we want and then not
00:19:06
pay them anything that's not fair grow
00:19:09
in my opinion there's people out there
00:19:11
who say no it's fair okay if you can
00:19:13
make it happen it's fair
00:19:14
twenty percent
00:19:16
gross I think is fair you can go higher
00:19:20
with one of my pis I have 50 percent
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gross I think that's
00:19:26
unfair on my end I don't regret working
00:19:29
with him because he's a really good pi
00:19:31
as well we're gonna get into him next
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but I'm not going to mention his name
00:19:36
um but so we agreed on 20 with
00:19:40
the caveat that hey
00:19:43
it's a little on the low end Affair for
00:19:45
you and I was upfront with him I said
00:19:47
it's on the low end Affair for you
00:19:49
but and he did not he was not doing this
00:19:52
for money he was really doing it as an
00:19:54
alternative for his patients and he also
00:19:56
thought it was interesting
00:19:57
I said but if you like
00:20:00
the arrangement and I like you know vice
00:20:04
versa I want to make you a part owner of
00:20:06
Yuma clinical trials so we made about a
00:20:11
year into it his company up to par
00:20:14
Medical Center
00:20:16
a 25 Owner in Yuma clinical trials
00:20:21
so now he's a partner now he shares in
00:20:24
the prophets but
00:20:26
he also gets so the way I set it up
00:20:29
he introduced me to two specialists in
00:20:32
the community so far he's still
00:20:35
and one of the reasons why I like and
00:20:38
this is where you gotta figure out is
00:20:40
this the right person you want to
00:20:42
partner with not independent contractor
00:20:45
with partner like be a business partner
00:20:48
on a corporation
00:20:49
because that's more like a marriage so
00:20:52
the independent contractor thing was
00:20:53
like dating
00:20:55
the corporation was like a marriage and
00:20:57
it wasn't until we knew for sure that
00:20:59
that's where the right match that I made
00:21:02
him a partner
00:21:05
um
00:21:05
he now is incentivized to prove to point
00:21:08
me in the right direction for other
00:21:10
providers in the community
00:21:11
and so he sent me to a dermatologist I
00:21:14
went to meet with a dermatologist
00:21:16
huge Private Practice awesome dude he's
00:21:20
actually has experience with in research
00:21:23
from Academia he's still a professor at
00:21:26
UC Irvine in California he drives to
00:21:29
Yuma and stays one week working on his
00:21:33
practice in Yuma the other week in um
00:21:36
California
00:21:37
and then he has nurse practitioners that
00:21:40
kind of run his practice for him as well
00:21:43
so I met with him and
00:21:47
I told I started the independent
00:21:48
contractor thing too
00:21:51
but because he was a specialist and it
00:21:54
was Derm
00:21:56
and he had the experience so it was
00:21:58
really easy to get studies matter of
00:22:00
fact the first studies I got for you
00:22:01
mclango trials were actually for him
00:22:04
that I offered him 50 percent
00:22:06
uh gross so just any time a check came
00:22:10
half and half I paid for my staff
00:22:13
it was just split the check 50 50.
00:22:17
I did that for a number of reasons in
00:22:19
hindsight I probably went a little too
00:22:20
high but I don't regret it because he's
00:22:22
a good person to have on your team
00:22:27
it's easy it was easier to get studies
00:22:29
for him he also let us use his exam
00:22:32
rooms and we do have like drug storage
00:22:34
there but it's not enough space to
00:22:36
actually like be there on a daily basis
00:22:40
I didn't think we could get as many
00:22:43
studies for Durham as we were able to I
00:22:46
thought Durham is like okay a few
00:22:48
studies a year
00:22:49
why not you know most of my studies are
00:22:51
going to be Internal Medicine well the
00:22:53
way I work is working out right now
00:22:54
Dermatology is really hot so we are
00:22:57
getting a bunch of studies uh for him so
00:23:01
in hindsight I would have probably went
00:23:03
a little lower I would have went 40 to
00:23:05
him 60 to me but you know at the end of
00:23:07
the day it's just numbers like he we can
00:23:11
work we can have a good partnership
00:23:13
going long term
00:23:16
he also wanted to do an LLC
00:23:20
so what I did was we did a 50 50
00:23:24
LLC
00:23:26
on Dermatology
00:23:28
site in Yuma so Yuma clinical trials
00:23:32
owns
00:23:33
that LLC and then his practice owns the
00:23:37
rest so Dr Smith because I made him an
00:23:40
owner of Yuma clinical trials he owns a
00:23:43
piece of every specialist that we
00:23:46
partner with and this goes back to who
00:23:50
you should Target Specialist or not
00:23:51
specialist I really think unless you
00:23:54
have uh in your mission statement for
00:23:57
your site that you want to focus on a
00:23:59
specific therapeutic area
00:24:01
that you start with an internal medicine
00:24:03
physician
00:24:05
because they are connected to all the
00:24:08
Specialists so now you my clinical
00:24:11
trials owns not just what we do with Dr
00:24:14
Smith but half of what we do in
00:24:16
dermatology and then same exact setup
00:24:19
with a psychiatrist neurologist but this
00:24:23
psychiatrist has like zero space in his
00:24:26
office like we
00:24:29
there's barely a place to put the
00:24:31
investigational product
00:24:34
but the psych studies I have way more
00:24:37
experience in the psych so I have to be
00:24:40
a Raider Jaime I had to train him on how
00:24:43
to be a Raider those are very time
00:24:45
consuming studies
00:24:46
that
00:24:48
we went with 25 75 so the pi got 25
00:24:53
percent ownership in this new LLC for
00:24:57
CNS studies and Yuma clinical trials got
00:25:00
75. I actually think that is fair
00:25:03
considering the amount of work that goes
00:25:05
into central nervous system type of
00:25:07
studies in the Derm I think it's
00:25:10
even more you can argue it's more fair
00:25:13
50 50 because there are no like scales
00:25:17
that my staff really does it's more the
00:25:20
pi and his staff that do the skills
00:25:23
because we didn't have that much
00:25:24
experience in there matter of fact we
00:25:26
didn't have any experience in Durham so
00:25:29
that's why I think the 50 50 was more
00:25:32
fair in that case and for the
00:25:34
psychiatrist and neurologist he's
00:25:36
actually a dual specialist uh 2575 so
00:25:40
Yuma clinical trials owns a piece of
00:25:43
every specialist so far and Dr Smith who
00:25:47
started it all
00:25:48
he owns a part of all of it and now we
00:25:51
have to lease our own space and we're
00:25:54
looking from our Specialists all the
00:25:55
time we're kind of running out a
00:25:57
Specialists because of the big hospital
00:25:58
system here they're buying up all the
00:26:00
Specialists there is no independent
00:26:02
gastroenterologist here there's no
00:26:05
independent OB GYN here
00:26:07
we're gonna have to go to outside of
00:26:09
Yuma like 30 minutes outside in San Luis
00:26:13
and Somerton to try to find independent
00:26:15
people and we're going to work on it
00:26:16
we're just two years old matter of fact
00:26:18
we are two years old like
00:26:21
exactly this month
00:26:24
so that's the setup I did financially
00:26:27
um there's also this the cultivating the
00:26:30
Physicians so
00:26:32
when the pi tells you yes I'm interested
00:26:35
to when you actually get a study
00:26:38
that could be three months that could be
00:26:40
four months that could be six months
00:26:43
they can't forget about you during this
00:26:45
time so what I did I made it a purpose
00:26:47
I'm gonna have a weekly meeting with you
00:26:49
like and I know you're busy I'm just
00:26:52
gonna show up to your office once a week
00:26:54
even if it's five minutes just to say hi
00:26:56
hey here's what I'm doing these are the
00:26:58
studies I'm trying to get for you so
00:27:00
that you don't forget who I am I don't
00:27:02
tell them that but I'm telling you the
00:27:05
viewer you want to make that face time
00:27:07
matter right
00:27:09
just show up if they don't want to do it
00:27:11
just show up anyways so that they see
00:27:14
that you're
00:27:15
doing something
00:27:17
because it's gonna take three to four
00:27:18
months to get that first study once you
00:27:20
get that first study it might take
00:27:23
another one to three months to start
00:27:25
screening patients
00:27:28
so again now you gotta and now they're
00:27:30
the doctors are starting to do some work
00:27:32
like hey I had to sit for SSV now I have
00:27:35
to sit for an SIV
00:27:38
and if you if you partner the way I did
00:27:40
they're not getting paid right so you
00:27:43
want to be community over communicate my
00:27:45
strategy is over communicating during
00:27:46
this whole time hey it's going to be
00:27:48
worth it trust me I wouldn't have been
00:27:50
doing this for two decades if it's not
00:27:52
worth it
00:27:53
it's gonna be worth it
00:27:55
this and that okay finally you start
00:27:57
seeing patients
00:27:59
hopefully you have a startup fee by now
00:28:01
I just gave my new my new SPI which is
00:28:06
the psychiatrist I was telling you about
00:28:09
are his cut of our first startup payment
00:28:12
we were able to get a study relatively
00:28:14
quickly with him and we got we gave him
00:28:16
I just hand delivered him the first
00:28:18
check and I said look hopefully there's
00:28:21
many more to come God willing and he's
00:28:23
been so cool all of them have been so
00:28:25
cool so it can work well for you it just
00:28:29
takes time
00:28:32
you got to be patient you got to
00:28:34
communicate through your clinician to
00:28:36
whoever you is going to be your Pi that
00:28:39
you got to be patient
00:28:42
it could happen if you do it the right
00:28:44
way
00:28:45
and we're not done and you're not done
00:28:47
and this is kind of the blueprint I
00:28:50
think retaining them is best once you
00:28:52
find the right one
00:28:54
retaining them as best
00:28:57
by making them a business partner so
00:29:00
having an LLC
00:29:02
but only do that when you're absolutely
00:29:04
sure it's the right person
00:29:06
retention is a lot harder which is why I
00:29:08
don't do it
00:29:10
maintaining an independent contractor
00:29:12
relationship
00:29:14
so
00:29:16
figure out what they want it's very
00:29:18
important
00:29:20
but also make sure it lines up with what
00:29:22
you want
00:29:23
this is how I find a pi this how I
00:29:26
recommend you do it again
00:29:28
there's no blueprint because everyone's
00:29:30
different the pinu
00:29:33
but this is the strategy I've used it's
00:29:35
worked
00:29:36
like subscribe comment share good luck
00:29:40
catch y'all later
00:29:41
Instagram I'll talk to you right now
00:29:43
bye-bye
00:29:49
[Music]
00:30:02
[Music]
