The Patient Recruitment Debate Nobody's Having

By Dan Schell, Chief Editor, Clinical Leader

You know the type. The panelist who shows up at every conference with a polished deck, a collection of buzzwords, and just enough confidence to convince you they’ve solved patient recruitment once and for all.

Then there’s Paul Ivsin.

I’ve crossed paths with Paul enough to know that conversations with him rarely stay at surface level for very long. He’s quiet, analytical, and about as far from a “conference personality” as you can get. But ask him a question about patient recruitment, and within minutes he’s talking about fragmented ecosystems, governance failures, vendor rhetoric, and why the industry still struggles to explain what actually works.

I recently interviewed Ivsin after he made an observation on LinkedIn that stuck with me. He argued that, to many sponsors and ClinOps professionals, “all patient recruitment vendors look and sound the same.” Coming from someone who spent years inside patient recruitment organizations before recently becoming an independent consultant, the comment carried weight.

And honestly, the more we talked, the harder it became to disagree with him.

One of Ivsin’s core arguments is that the patient recruitment industry has done a poor job differentiating itself. According to him, many vendors rely on the same broad language around patient centricity, engagement, and innovation, while offering very little measurable evidence explaining why their approach is actually different or better.

“I could pull the next six LinkedIn posts from different patient recruitment companies out,” he told me. “I could de-identify them, put them all out there, and then put some logos up here and challenge people to mix and match. Even people in the industry would, I’m pretty confident, fail.”

The Questions Most Vendors Don’t Ask

That observation has become something of a recurring theme in Ivsin’s recent writing. Since launching his Substack, First Patient In, he has increasingly positioned himself as a public critic of the enrollment industry’s habits, assumptions, and marketing rhetoric. Unlike many industry commentators, he is not simply promoting a service or defending a platform. He is openly questioning the underlying logic behind how the industry talks about recruitment itself.

That includes asking uncomfortable questions many vendors avoid. Do patients really need “high-touch” relationships with recruitment vendors? Are awareness campaigns actually necessary for rare disease recruitment? Does faster site follow-up truly improve enrollment outcomes? Are referral numbers being confused with actual recruitment success?

Ivsin does not always claim to have definitive answers. What makes him interesting is that he insists on interrogating the assumptions in the first place. That mindset came up repeatedly during our conversation. At one point, he challenged the industry’s almost reflexive use of the term “patient centricity.” Like I always say, I think many companies are using this as marketing jargon. After all, nobody wants to say they are not patient-centric. But Ivsin explained it even better, questioning whether the industry has become too reliant on emotionally appealing language that often lacks operational clarity. He offered a deliberately provocative comparison. “I don’t have a close relationship with any of my healthcare providers,” he said. “I’ve never been to a cookout with my primary care physician.”

His point was not that patients should be treated coldly or impersonally. Rather, he questioned whether every clinical trial interaction truly requires deep emotional engagement, or whether some patients simply want a straightforward, efficient path to trial participation.

That kind of comment is pure Ivsin. He is not trying to be inflammatory for the sake of it; he is trying to force people to think harder about why they believe what they believe.

An Industry Still Struggling To Define Success

Despite years of investment, the patient recruitment sector remains surprisingly fragmented. Ivsin pointed out that barriers to entry are relatively low, allowing new recruitment firms to emerge constantly, often operating as lean, outsourced “virtual” companies. That churn makes it difficult for sponsors to determine which vendors are actually effective and which are simply good at marketing themselves.

The result, he said, is confusion at the buyer level.

Ivsin described situations where sponsors issue RFIs to 20 different recruitment providers simply because they do not know how to narrow the field. In other areas of clinical operations, markets eventually consolidate around a handful of dominant players. EDC systems are a good example. Recruitment, however, has never fully matured in that way.

In his view, that is partially because enrollment success is far more situational and difficult to scale. A strategy that works for one sponsor or therapeutic area may fail completely somewhere else.

But he also believes the industry has not done enough to measure and communicate performance rigorously. One of the more consistent themes across his recent Substack posts is the industry’s weak relationship with ROI and operational transparency. He repeatedly argues that recruitment efforts should be tied to measurable outcomes rather than vague claims about engagement or awareness. That extends to sponsor oversight as well.

Ivsin told me many biotech companies still treat recruitment as a black box: hire a vendor, spend some money, and expect patients to appear. He believes that approach fails because sponsors themselves often lack the governance systems needed to properly evaluate enrollment performance. “The first thing to ask is, ‘Do we have our act together so that we can actually manage enrollment?’”

That may not sound revolutionary, but it gets at a deeper issue running through much of Ivsin’s commentary. Recruitment problems are rarely caused by a single failure point. Sponsors, vendors, sites, CROs, and technology providers all influence enrollment outcomes, often temporarily assembling around a single protocol before dispersing again once the study ends. “Clinical trial recruitment is less a machine and more a constantly shifting ecosystem,” he said.

The Debate The Industry Isn’t Having

That complexity is one reason he believes the industry lacks meaningful public debate around recruitment philosophy. While patient recruitment tracks exist at nearly every major conference, he argued there are very few forums where competing approaches are openly challenged against one another.

For example:

• Is database-driven recruitment better than de novo outreach?
• Should campaigns prioritize awareness or hyper-targeting?
• Is “high-touch” engagement genuinely necessary?
• Are some patient interactions fundamentally transactional?

Ivsin believes those conversations could help sponsors make smarter decisions while also forcing vendors to explain themselves more clearly.

Personally, I appreciate that about him. Clinical research has no shortage of polished messaging. What it sometimes lacks are people willing to step back and ask whether the industry’s accepted wisdom actually holds up under scrutiny. Paul Ivsin does that constantly.

And while conversations with him occasionally leave me feeling like I just got schooled on the deeper mechanics of patient recruitment, I’ve come to appreciate something else too: If I ask him a question about the industry, I know I’m going to get the unfiltered answer, not the rehearsed one.

I also know that he's probably going to disagree with a bunch of the statements I've made about him in this article. Classic Paul.