For decades, clinical trials have been concentrated in large academic medical centers, leaving community-based clinical trials far less common despite their potential to bring research closer to where patients already receive care.

These institutions built the infrastructure, regulatory processes, and coordination teams that multi step protocols require, so sponsors naturally continued returning to them. The result is a research map that clusters opportunities around major academic hubs while leaving many community clinics and private practices on the sidelines.

This concentration affects patients as much as it affects physicians. When trials are only offered at distant tertiary centers, many people who would be interested in participation never realistically have that option. Their primary physicians may be clinically capable and willing to be involved, but without a clear operational model, research feels out of reach.

The Access Problem

When a trial is only available at a large academic hospital in another city, the burden falls heavily on patients and families. Travel for frequent visits can be expensive, time consuming, and physically demanding, especially for individuals with chronic or advanced illness. Time away from work, childcare responsibilities, and transportation limitations all become quiet disqualifiers.

These barriers are not evenly distributed. Patients in rural areas, lower income communities, or regions without a nearby academic center face the steepest obstacles. Even when they meet inclusion criteria on paper, the practical realities of distance and cost make enrollment unlikely. That, in turn, affects who ends up represented in study data. If most participants live near major academic centers and have the resources to travel, trial populations may not reflect the broader communities that physicians serve.

Bringing trials closer to where patients already receive care helps reduce both travel and socioeconomic barriers. When participation can be integrated into routine visits at a local clinic, more patients can realistically consider enrollment, and trial data can better reflect real world populations.

Why Community Physicians Are Essential

Community physicians already have what many trials need most: established patient relationships, continuity of care, and detailed knowledge of local populations. They understand which conditions are common in their practice, what resources are available locally, and what types of visit schedules patients can reasonably keep.

For patients, the ability to consider a clinical trial with a physician they already trust is often crucial. Informed consent conversations become an extension of ongoing dialogue rather than a single high-pressure discussion with a new specialist. Continuity of care can be preserved, and clinical decisions remain grounded in a long-term understanding of each patient’s circumstances.

Community based research also creates an additional treatment option inside the familiar clinic setting. Trials frequently provide more structured monitoring, diagnostics, and follow up than routine care alone. When that level of attention is offered locally, patients gain access to advanced care without losing the security of their existing clinical relationships.

Growth of Community-Based Clinical Trials

In recent years, sponsors and research networks have shown growing interest in decentralized and community-based models. These approaches aim to integrate trials into routine care workflows, use existing data systems more effectively, and reduce the operational burden on both patients and clinicians.

Clinically integrated trial frameworks now emphasize simpler operational requirements and focused protocols that can fit within busy practices. External coordination and site enablement services are also more common, which helps address the administrative and logistical work that once made research feel exclusive to academic centers.

The result is a landscape in which trial participation is no longer limited to large institutions. A wider range of practices can contribute, provided they have the right operational support and clear expectations about roles and responsibilities.

What Holds Practices Back

Despite these shifts, many physicians and practice leaders still see clinical trials as something that belongs “somewhere else.” Common concerns include the administrative workload of a parallel research operation, uncertainty about compliance and inspections, and worries about financial exposure if budgets do not fully cover coordination work.

There is also a perception that research requires building extensive new infrastructure or assembling an in-house research department. In reality, many early barriers are more manageable than they appear, especially when practices use structured readiness assessments and access dedicated coordination support.

Conclusion

Research does not have to remain confined to academic centers. With thoughtful planning and the right operational support, community-based practices can make clinical trials available closer to home, improving access, convenience, and representation for their patients.

In our next article, “What Does It Actually Take to Run a Clinical Trial at Your Practice?”, we will look practically at the operational requirements, common misconceptions, and how much infrastructure you truly need to begin.

To learn how Milestone One can support you in navigating complexity, taking on additional studies, or getting started with research for the first time, reach out to the Milestone One team.