Clinical research sites are *quietly holding all the cards*—so why are they still struggling for support, fair budgets, and real partnership?

In this episode of **Note to File**, Brad and Denali sit down with **Maria P. Ladd**, self-declared **Clinical Research Site Advocate** and co-founder of the **Clinical Research Site Collective**, to dig into the gap between sites, CROs, sponsors, and IRBs—and how we can finally start closing it.

From **budget negotiations and profit margins** to **IRB relationships** and **site community-building**, this conversation hits the real, unfiltered pain points of running a research site in 2024 and beyond.

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In this episode, we get into:
- Why Maria created the **Clinical Research Site Collective** and what "site advocacy" really means
- How sites can better **leverage IRBs** as a *resource*, not just a regulator
- The messy reality of **budget negotiations**, FMV, and why profit margin at sites should NOT be a dirty word
- How smaller and emerging sites can survive when studies keep getting more complex
- Whether we still need **local IRBs**—and what a "single IRB of record" world might look like

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Who this is for:
- Independent and emerging **clinical research sites**
- Site networks, AMCs, and research leaders
- CRAs, project managers, and sponsor/CRO folks who *actually* want to understand sites
- Anyone trying to build a more sustainable, collaborative clinical trial ecosystem

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🔗 **Connect with Maria**
LinkedIn: *Maria P. Ladd*
Clinical Research Site Collective: **clinicalresearchsitecollective.com**

🎧 More episodes & contact: **NoteToFilePodcast.com**