Contract Research Associates (CRAs) may not be the highest paid professionals in the clinical research ecosystem, but when they quit their jobs mid-trial, the financial impact can be profound.

CRAs are the lifeblood of clinical research. They set up trial sites, liaise with investigators and study coordinators, and monitor trial performance. They also collect all of the patient data that will define the success or failure of the trial.

When they quit, any data that has been collected but not yet monitored could be lost, and the trial may be put into a state of flux as the CRO scrambles to hire and train new talent to fill that gap. In the best-case scenarios the loss of a CRA will temporarily delay trial progress. One Tufts study suggests trial delays cost $600,000-$8m per day.

This is why the persistently high rate of turnover among CRAs should be alarming to trial sponsors. A 2019 report from BDO USA found CRA turnover has been at or above 20 percent for seven of the past 10 years. In other words, at least one-in-five of your CRAs is going to quit this year. 

That is, unless you work with a CRO that actively addresses the needs of its CRAs in order to keep their trials running smoothly.

Avoiding CRA churn

There are many reasons why CRA attrition is so high. The job of a CRA is challenging, requires extensive travel to trial sites, long hours – and does not always earn a great deal of appreciation. And when other CRAs quit, the remaining team has to pick up the slack, creating a relentless cycle of burnout. Most of these issues can’t be eliminated, but they can be mitigated when CROs treat their CRAs as valued contributors to the trial process.

At Advanced Clinical, we’ve adopted a number of strategies to make our CRAs’ lives easier – and it’s paying off. Our CRA turnover is less than 10 percent – or half of industry standard.

How do we do it?

1. We respect their time. When CROs don’t have enough CRAs, the obvious solution is to pass the burden to the remaining team -- but that’s how the turnover gets started. Even if we are short-staffed, we avoid overworking our people, because we know it is easier to replace one CRA today than three CRAs in a month.

2. We make it easy to get paid. Along with paying competitive wages, we give them automated expense reporting tools to make getting reimbursed a breeze, and let them use their own credit cards (if they want to) so they can collect the miles.

3. We keep them close. Our recruiters hire CRAs in central locations around the world then assign them to trials that are close to home. While this doesn’t entirely eliminate travel burdens, it ensures they spend fewer hours in transit and more time at trial sites doing work that adds value for the client.

4. We check in. CRAs spend most of their time working solo, which means no-one is around to recognize when they need help. We touch base all the time to ask how they are doing, to get an update on the trial sites, and to make sure they have what they need to do their jobs. It’s a proactive way to prevent problems that could lead to turnover, and it sends them a message that we care about their quality of life.

5. We monitor the data. One of the risks with CRA burnout is that they delay entering data for weeks at a time before leaving the job. To avoid this risk, we monitor their visit report completion, and reach out if they are falling behind.

6. We offer them leading edge work. As a CRO that caters to innovative mid-market companies, our CRAs have an opportunity to support emerging areas of research, including cell and gene therapy, immunology, and rare disease trials. The chance to support groundbreaking projects keeps them engaged for the long term.

7. We don’t share. Unlike other CROs with staffing agencies, our CRAs work for our clients’ trials only. That means they aren’t getting shuffled around or pulled to new projects. It’s another way to let them know they are valued members of these teams.

These may all sound like obvious solutions, but it’s surprising how few CROs take the extra steps to support and nurture their CRAs. We understand that their job satisfaction translates to success for our business and our clients, and we think that’s a value proposition worth fighting for.

Sponsors who agree should ask CROs about their CRA engagement practices as part of the vetting process. CRAs have a huge impact on the cost and quality of any trial, and sponsors should be confident that their partners are doing whatever they can to keep them on-board.