The pipeline a site actually lives on is mostly repeat business, and everything else is a supplement.
October 30, 2026
6
min read
By
Julio G. Martinez-Clark, CEO, bioaccess®
Ask a room of site owners where their next study will come from, and most will describe a business development effort: conferences, cold outreach, capability decks, referral relationships. Then ask where their last five studies actually came from, and the answer changes. The work arrives through a much narrower door than the effort suggests.
We put the question to site executives directly. In a poll of site leaders in the Society for Clinical Research Sites (SCRS) community, 80% said their new studies come from repeat sponsors and contract research organizations (CROs) — the companies that run trials on behalf of drug and device developers — while conferences accounted for 20%. A peer site shared its own mix in the same discussion: roughly 50% repeat business, 40% conferences, 10% referrals. The proportions vary by site, but the pattern does not: the pipeline a site actually lives on is mostly repeat business, and everything else is a supplement.
That gap between where sites spend their energy and where studies actually originate is expensive. This article breaks down what each channel really delivers, what repeat business rewards, and how a site should allocate its effort if it wants a fuller pipeline.
The channel nobody budgets for: performing on the last study
Repeat sponsors and CROs are not a marketing channel. They are the residue of operational performance, and they compound.
Feasibility teams — the groups inside sponsors and CROs that select sites for a study — keep score. They track how fast a site completed contracting and startup, how quickly it enrolled its first patient, whether the data came in clean, and how fast queries were answered. When the next protocol in the same therapeutic area lands on their desk, they do not start from a directory. They start from the shortlist of sites that made the last study easy.
That means the highest-return business development activity available to most sites is not outreach at all. It is the unglamorous work of the current study:
- Startup speed. Sites that return budgets, contracts, and regulatory documents in days rather than weeks get remembered. Startup is the first performance a sponsor ever sees, and it colors everything after.
- Data quality. A site whose data generates few queries is cheaper to monitor and safer to defend in an inspection. Sponsors notice, and they come back.
- Query turnaround. Queries answered in 24 to 48 hours signal a site with its documentation under control. Slow query response is one of the most common quiet reasons a site drops off a shortlist.
- Honest feasibility. Sites that promise realistic enrollment and deliver it earn more trust than sites that promise the moon and screen-fail their way through a study. Feasibility inflation is the fastest way to burn a repeat relationship.
None of this appears in a marketing plan, which is precisely why it is underweighted. A site cannot buy its way onto a feasibility shortlist with a better booth. It earns its way on with the last study's metrics.
What conferences can realistically add
Conferences came second in the poll, and the peer site's 40% figure shows they can matter — particularly for sites still building their sponsor network. But conferences work differently than most sites assume.
A conference rarely produces a study directly. What it produces is a name and a face that a feasibility contact can attach to a capability statement later. The value is recognition, not conversion: when your site's feasibility response lands in an inbox six months after a summit, the reviewer has met you, heard your principal investigator (PI) speak, or seen your poster. That familiarity does not win the study — your metrics do — but it gets your response read with more care.
Sites get the most from conferences when they treat them as evidence-delivery opportunities rather than networking events. Bring numbers: enrollment by indication, real startup timelines, screen-failure rates you can defend. Feasibility teams are starved for sites that speak in data. A generic capability deck is forgotten by dinner; a one-page sheet of defensible performance figures gets filed.
The corollary is that conferences have diminishing returns once a site's repeat engine is running. If 80% of your pipeline is repeat business, the marginal conference is polishing the smaller channel. Attend selectively, present data, and let the operational record do the compounding.
Referrals: real, warm, and unscalable
Referrals — from investigators, peer sites, physicians, and industry contacts — are the smallest slice in both the poll discussion and the peer site's mix, around 10%. They are also the warmest introductions a site can get: a referred site starts with borrowed trust.
The problem is that referrals cannot be manufactured on a schedule. A site can stay visible to potential referrers, respond graciously and fast when a referral arrives, and reciprocate when it has overflow it cannot run. What it cannot do is build a forecast on them. Treat referrals as upside, never as plan.
So where should a site's effort go?
A realistic allocation for an established site looks like this:
- Protect the repeat engine first. Assign explicit ownership of startup timelines, query turnaround, and data quality on every active study. These are pipeline activities, and they should be reviewed like pipeline activities.
- Make feasibility responses fast and honest. A complete, accurate feasibility questionnaire returned in 48 hours is a sales document, whether or not it is labeled one.
- Use conferences for recognition, not rescue. Choose the events where feasibility decision-makers actually attend, bring performance data, and follow up with evidence rather than pleasantries.
- Keep referral relationships warm without depending on them. Peer sites that overflow, investigators who move between sponsors, and CRO contacts who change employers are tomorrow's referral sources. Stay in touch; do not count the studies in advance.
- Measure your own mix. Most sites cannot state their channel percentages. Pull your last ten studies and classify each by origin. The mix you discover — not the mix you assume — should drive where next year's effort goes.
The uncomfortable conclusion
The poll result is uncomfortable for sites that love business development, because it says the pipeline is mostly a lagging indicator of operational excellence. Studies flow to sites that start fast, enroll honestly, produce clean data, and answer queries quickly. Conferences and referrals open doors, but performance is what walks through them repeatedly.
Sites that internalize this stop asking only, "How do we find more studies?" and start asking the better question: "What did the last study we ran do to our chances of winning the next one?" The sites with full pipelines are usually the ones that can answer that question with numbers.
Julio G. Martinez-Clark is chief executive officer (CEO) of bioaccess®, a first-in-human contract research organization running early-phase trials anywhere from Canada down to Argentina, and of Amavita Research Services, a Miami cardiovascular research site he has operated for seven years with zero United States Food and Drug Administration (FDA) Form 483 inspection findings. He founded Global Trial Accelerators™, a podcast for medtech and biotech founders navigating first-in-human studies.