Episode 18: Esthefany Jabbour, FWD Clinical Research
Esthefany Jabbour’s research career started in early 2013, working in regulatory affairs at a site level. In the last few years, she has gained experience in multiple roles at a site level from clinical research coordinator to chief Operations Officer. Her role as a COO at a research site oversaw the site network operations, recruitment, training, business development, and day-to-day structure and management. Her passion in clinical research and business has grown over the years and allowed her to expand her knowledge in multiple therapeutic areas. Recently, she started her own multi-specialty clinical research site in Boca Raton, FL. FWD Clinical Research is data driven site that focuses on delivering quality clinical trials to sponsors.
In this episode, we discuss the challenges and complexity of starting your own research site.
+Full Episode Transcript
Brad: All right, Esthefany, thank you so much for joining us today. How are you doing .
Esthefany: Good. How are you? Thank you for having me
Brad: Not too bad. Uh, it is what is today? September 4th. And, uh, it is Friday. It's a relatively hot day here in Oklahoma and you're probably a lot hotter in Florida.
Esthefany: Oh yeah, we're melting over here, but um, hopefully it ends soon, even though it's all year long
Brad: I was just going to say it doesn't, it doesn't ever really, really end too much out there does it?
Esthefany: No, I mean, sometimes it gets a little bit cooler around November, December, but not that much cooler
Brad: Right on. Yeah. We get, uh, all the extremes of weather here. So that's, uh, one of the real fun parts about living in the middle of the country. Well very good. Uh, as I start with all my guests, uh, I was hoping you could tell us a little bit about how you first got into clinical research. I find that's always a kind of a nice place to start.
Esthefany: Of course it is. So, um, I started very similar to how others started in clinical research, by accident. I was working my way through college and I landed an entry level position at a research site. I had no idea what research even was. It was mostly like administrative regulatory position. And, um, I eventually got trained on regulatory affairs and I was able to master that very quickly. Um, and then kind of learned the business part of it very quickly. And I recall the exact moment that my former boss asked me if I was interested in clinical research. And I just remember, he asked me, are you interested in learning about clinical research and without hesitation, I said," yes, of course". And I remember he just grabbed a big sheet of paper and started drawing out everything from the sponsors to the IRB, to the sites and kind of laid it out for me. And it was interesting. I was just amazed at everything and how big things could be. There's so many, there's so much to do within research and ever since then I've been in the field and it's been quite a journey.
Brad: Yeah, I think, uh, I mean, like you say that, that seems to be a very common story that people kind of fall into it. You know, I find as I train, try to train new coordinators, just trying to explain the sort of breadth and depth of everything involved in clinical research is, is challenging. Cause you're right. It's a huge industry that I don't think it is very well understood outside of the industry. So yeah, it's, it can be a little overwhelming when you first kinda- kind of jump in. So it sounds like luckily you're able to sort of get a full education across maybe just the one site that you were at. Is that fair for you? Were there were cross training you and able to sort of get you up to, speed, across all the different kind of areas there?
Esthefany: Yeah, definitely. I thought it was, um, easier to start off with regulatory. You kind of learn about the IRB and the regulations, um, and you know, what's necessary to start off in clinical trials. So that was a good start. And then from there kind of trained, as a study coordinator, phlebotomist, data management, um, and eventually just, you know, I was cross trained on everything, which is good to have, has a site because you have backups for your other staffs that are not onsite on certain days. So that was a wonderful experience. And they were a pretty large site. They had many studies, um, they focused a lot on oncology hematology. They did a lot of cancer trials, so it was, um, pretty good experience.
Brad: Yeah. And again, that seems to be a recurring theme, the more broad and diverse sort of background and experience you can get. I think the better off you are. And I know we, and other others talk about the importance of sort of being able to generalize within the field. I feel like a lot of people sort of start not unlike yourself. Like you sort of start as a specialist, then you become a generalist and then a lot of people end up going back to being a specialist again, I think in the end, but also having a better understanding of the full context and are still able to do all the other, pieces that are involved. So I think that, again, that's super useful. That was at an independent site?
Esthefany: It was, it was an independent site.
Brad: Yeah. I'd say that makes a lot of sense that they were a smart of them to make sure people are properly cross trained. So again, I love to see when people are able to get that experience in one place, not have to jump all over, to get all the years of experience that might otherwise take to really learn the industry in a more well rounded way.
Esthefany: Yeah, definitely. And I definitely think that being a generalist and research kind of helps you and it gives you more options and kind of allows you to decide on what you want to do and you know, what path you would like to take, whether it's site side or sponsor's side. So you, you definitely learn a lot.
Brad: Yeah, no, that's fair. I think once you really know how things work on a, on a very intimate level, it really opens you up to a lot of different possibilities from there. Even if you weren't necessarily a specialist in that area. Uh, I think that again, having the full understanding is, is ridiculously valuable and not super prevalent, at least in a lot of the sites I've seen, you've got more, uh, things sort of siloed and isolated in different ways. So yeah, again, that's really can't overstate how important that is. So tell me a little bit about where that brings you today.
Esthefany: So, uh, for the last two years I've been developing my own clinical research site, uh, forward clinical research. Um, it's an independent clinical research site and we're here in Boca, Raton, Florida, and we've really been focusing on advancing, um, medicine and conducting clinical trials, different, um, multi- multi therapeutic, um, specialties. So it's been my focus for the last two years. Uh, we recently launched, uh, at a physician site and, um, we're doing cardiovascular now and eventually we'll expand to multi-specialty. So it's been quite a journey and I'm more than happy to kind of have my own site to work at and do things a little bit differently based on my experience.
Brad: Yeah, no, that's awesome. And congratulations on that. I'm a well aware of all the, uh, complications and complexity and challenges that are involved in setting up your own site. And it sounds like, I mean, I did almost exactly the same thing. I started in cardiology and was able to, you know, slowly branch out across other therapeutic areas. Are you, uh, integrated inside a physicians, uh, office? Yeah.
Esthefany: For now? Yes. So we've integrated into a cardiovascular practice. Um, it's pretty large practice. There's seven physicians, they're all board certified. They're interventional cardiologists as well. So we've had, it's a big opportunity and it's great working with them, but we're starting off. So we have a few studies and we're hoping to have some more in the next few months.
Brad: Yeah, that sounds very much like where I'm at right now. Uh, interventional cardiologists. They also have a outpatient, uh, surgery center here. So we, we should talk more offline about a study opportunities together. Of course. Very cool. So are you, uh, do you have employees or is it just you at the site right now?
Esthefany: So I have someone that's a research assistant that's part time kind of just help has needed. Um, but most of the time it's just myself, um, do the budgets, contracts, regulatories, startups, blood draws, patients, the whole thing it's just been me. So it's kinda been like a skeleton crew for a few years, um, until we kind of stabilize ourselves a little bit and then, you know, we can add to the team.
Brad: Yeah. I think that's important for people to realize. I mean, I was basically alone for the first nine or 10 months of starting out at a site and I did the same thing I did beginning to end true blood, saw all the patients recruited all the patients, uh, everything there is to do. So I think that's, uh, again, something important people need to realize when they come in is, as we know that the revenue cycle is pretty long and clinical research and that's even assuming you get a trial right off the bat, which I think most people don't have that luxury. Uh, so, you know, in the beginning, you're probably only going to be able to afford your own, your own work. Uh, so yeah, I have a lot of respect for people who can sort of grind through that difficult period. It sounds like you've got some help, which is a huge advantage. So, uh, you're even a little bit ahead of the curve, I'd say at this point.
Esthefany: Yeah. So I tried really, when I started this site, I really tried to do a lot of the work prior to launching this site, like before developing a site relationship with the physicians. So I kind of had everything developed before, um, like the SOP, the site management, the structure, the business development and networking of it prior to reaching out to physicians. So that helped a lot because I know some other site owners, so first start off with physicians and then start from there, like their soapies and developing their sites. But before I approached the physicians, I really had a site developed the whole structure and functional part of it just so I can follow them. You know, my research sites, values and models throughout the whole journey. So that was really important for me and really helped me a lot. So as soon as I had the relationship with the physicians, I think / we had a site selection visit three months later. So that was really quick on our side.
Brad: Yeah, no, I would say that's, that's perfect. That's a, you know, by all accounts that would, that would be a success to build, to get a site selection that soon. I think even for me, I found in the beginning it was sort of chicken or the egg, you know, do you go find a physician? Do you try to drum up some study opportunities first, which, you know, it's hard to do either one sort of without the other. Um, I mean, obviously it's easier to find a physician, I think, but sometimes, uh, in my experience, you don't want to leave a physician on the hook without something to put in front of them for too long. Um, so it's tough to go find a physician and say, well, uh, I've got some study opportunities maybe over the next few months, uh, you know, that can become an awkward conversation when you're trying to build trust with a new, a new physician. Uh, so yeah, I, uh, I like that you, you know, try to think through things as much as you could, I think for better or worse, I've sometimes had to take the opposite approach and sort of, uh, adjust as I move. Just knowing that there's a lot, you don't know, you know, so find a great doctor. You may not be able to find them a study for three to six months. You know, if things aren't hot, maybe in that area, if they don't have experience, uh, I find that to be a real challenge when you're, when you're sort of starting out.
Esthefany: Yeah, that's true. I think the most important thing is believing in yourself and believing in your company, on your site. And then once you have that foundation, then you can, it's easier to convince others to believe in your company and believe in your, you know, your system and how you're going to do your site. So, um, that was definitely something my, my approach, at least for the physicians. So that worked out.
Brad: Yeah. And I also think it, it pays just to be upfront with the physician and say, you know, we're to a large degree, you're sort of a victim, the, you know, what the market's doing. So if there aren't any cardiology studies going on, then it may be some time, you know? So I think being upfront about that is, you know, pay. So you don't want to necessarily oversell to the physicians that you're trying to get on board, but you're right. And you know, something that you mentioned that probably helps out a lot is that you did have resources, other site owners or other people at site levels that you can network and connect with that I think helps build some confidence in what you're doing as well.
Esthefany: Yeah. That definitely worked out for me.
Brad: Very good. What are some challenges, other other challenges you've faced as you've sort of moved throughout the process of getting up and going?
Esthefany: Yeah, so I think the biggest challenge has really been working independently on my own as a site owner, I've always thrived, working well, has a team with a company. Um, I've had leadership positions where I've worked on my own projects on my own time, but, you know, within a group or a team. So it was definitely a challenge starting my own research site independently. I've really had no direct guidance or mentoring throughout the whole process. So every day, um, and every moment was a challenge in accepting I was independent and had to make these important choices on my own. Um, and over the last few months, I've really allowed this to be an opportunity to overcome my biggest challenge.
Brad: Yeah. And I mean, and that speaks to just the bigger concept of being an entrepreneur. I mean, especially in the beginning where you are, you're on your own, you're, you're everything you're marketing your business development. You're the coordinator, uh, your accounting sometimes, you know, you're, you're the whole kit and caboodle, so that that's, that's challenging for sure. And then, especially when you're dealing in such a sort of, I think that what we work in is a fairly uncertain market. You know, you don't necessarily always know what's coming down the pipeline or, uh, what you can get it on. And even after that, you don't always know how well your trial's are going to enroll. So that adds another layer of, uh, just sort of, I don't know, anxiety on what we do. So it's particularly challenging, you know, just on top of being an entrepreneur in the first place.
Esthefany: Yeah. I agree. You definitely have to follow the trends and keep up with the research on the latest drugs and what's going on to kind of succeed in this business and has a site owner.
Brad: Yeah. I'd say it's not necessarily for the faint of heart. You gotta, like you said, you have put a lot of faith in yourself and what you're doing. Uh, and again, it all kind of ties back together. If you've spent your time becoming as much of a generalist, as you can, understanding how the business works and all the, all the different sort of moving parts that are involved, then, uh, you know, you're setting yourself up for success at that point.
Esthefany: Exactly. That's how I see it as well.
Brad: Awesome. What's a best practice that you'd share with other sites.
Esthefany: Well, one of the best practices I can share is to really focus on your company. Values as a research site. If you're a site owner building a brand or a site, and you're implementing your company values, you follow them, they define you as a leader and they differentiate your company from others. So then eventually you realize that you're impacting other patients and sponsors and in making a difference in research by focusing on why you started in the first place. So that's been very important for me, just focusing on my company values and why I started doing this. You know, I've always had a passion for research. Um, and it's, I think every day just continues to grow every day is a learning curve every day, you're learning something's new and you just have to learn how to deal with everything.
Brad: Yeah. Again, I think that's a super, uh, sort of unseen thing. You've gotta be able to sort of roll with the punches and take what you see and adjust to it. And you're right. It's especially, or this early on, it's almost daily as you deal with different physicians or different sponsors, or as you start building a staff, you know, to go back to what you said before. I think, you know, your company culture is really important. Um, I've worked at sites that, you know, they are most interested in, you know, being in the office from eight to five. And, you know, I'm trying to build a site where people have some flexibility in the work that they do. I mean, we all want to help patients. I think that's generally, you know, pretty, pretty commonly accepted. We're all here to try to try to help patients get the best care that they can and, and advance drug development. You know, also while ensuring the highest quality data and ensuring patients- patient safety. But to go beyond that, you know, how you really run your site, how you treat your staff and your company culture can make a big difference in the success of your company overall.
Esthefany: I completely agree. Um, I think leadership is a very important key here on in your company. Values is just having great leadership and having building a great team along with your company values will really help you succeed along with your team. You're, you're allowing them to succeed. So it's very important to focus on that. And really the leadership is the most important thing for me. That's it took me a really long time. Maybe two years I was developing my leadership skills. I was focusing on kind of working independently, making sure I have the right structure, just to follow something and, you know, give me some type of meaning at the end of the day. So that was very important for me.
Brad: Yeah, no, that makes perfect sense. There's, there's a lot that goes into, you know, leadership, uh, aside from process, you know, like, you know, having emotional intelligence and, you know, treating your employees the way that, you know, you want them to be treated. And, uh, again, it gets, you really can go down the rabbit hole, uh, when it comes to building your culture and then sort of the approach that you take with your business as a whole. So I'm very encouraged by seeing people like you and other people I've talked to that are striking out on their own and, you know, having an emphasis on, on company culture and, you know, trying to build something that's, that's better than what we have now. So, you know, that's something I've loved about doing this. This podcast is that I've had an opportunity to talk to people like you, who are, I mean, we're out there doing things that are, you know, a little bit different. And I think that will have an impact on the industry as we all continue to sort of build out these different, uh, networks, uh, whether it's, you know, together or, or not. But ultimately I think the sort of cumulative effect of good people out there trying to build good brands and do good work is going to have a big downstream effect on the way the industry works as time goes by.
Esthefany: Yeah, I agree. It's part of innovation.
Brad: Yeah, for sure. Which is not without its headaches, especially right now with, uh, you know, the, the pandemic and all the different sort of interesting things that's, that's brought to light. So it's a, it's a really fun time to be in research. I think even though it's a little chaotic right now.
Esthefany: Yeah, no, you know what, I think this is the highlight of our careers as researchers is this pandemic, you know, this is something we all want to be a part of, especially the vaccine trials and, uh, any other Kobe trials they have on clinical trials.gov right now, going on, which they're like increasing each day. Um, it's a highlight of our career. This is something that is part of our research career. We want to be part of this, uh, pandemic and the development of drugs. So this is probably the best time for us right now.
Brad: Yeah. I mean, this is why we're here. I mean, I think we're going to be able to look back and see the direct effect that we had on, uh, I mean, on the pandemic, on, you know, public health on the whole, the whole thing. So yeah, I think you're absolutely right. I think it's, uh, there couldn't be a sort of cooler time to be involved in clinical research. Yeah. That's awesome. Uh, what are some resources that you use? Uh, I'm always interested in hearing about any specific tools people use. I think there's such a broad array of things that can kind of be brought to the table, uh, across clinical research and especially across, you know, opening your own site. So that's a little bit about any resources that you might use.
Esthefany: So there's a lot of resources out there. You're right. But I started, I'm using just free my free resources as much as possible. The biggest and most achievable one has been social connections and social networking. When I was looking for a group of physicians to join my team, I was door knocking, emailing, sending letters by mail calling every day, following up. I mean, I did that as much as possible to get in touch with someone from the practice. And then I've also used social media a lot. I've reached out to people on LinkedIn. I think that's a great resource. And I've another big resource that I use is joining networks. Like SOCRA I have another one called HBA, which has healthcare business women's association. And this one has really helped me a lot because it within a district. So you kind of joined the organization and it's a lot of business woman's who have leaders- leadership positions within an organization like pharma companies or anything in healthcare. And this has helped me a lot with my business development and gaining, you know, more trials and that connection with others. So I've really utilized a lot of those memberships as much as possible.
Brad: Yeah. And that's, that's a great point. I think, uh, you know, sometimes the best resources aren't necessarily clinical research specific, especially again, if you're trying to really build a business. Uh, so, you know, I was applied and accepted to a startup accelerator, which was huge for me as a, trying to learn business, you know, aside from clinical research. So yeah. Tools like that are, are huge. I mean, even for just self development outside of clinical research specifically, but again, I think it makes you a better, you know, business woman or just a better leader, if you can take those skills and kind of bring them over to what you do and, you know, to go back to what you said before as well. I think that really highlights, you know, if you're door knocking and emailing and calling and sending letters, that's, that's what you have to do. I mean, you really can't ever be satisfied or content with what you've got. I mean, you, you know, obviously you can do it strategically, but, uh, like we talked about before, you need to be aware the action is, so if you, you know, if a therapeutic area is hot and you're not in it, you gotta get, you gotta get there. Uh, and that's what it takes. I mean, it's a, it's a hustle and a grind to sometimes track these, these people down and be able to pitch to them and, uh, you know, get, you're just getting your foot in the door. Uh, it takes a lot of persistence. So I think that's, again, something that, you know, people need to keep in mind as they're considering starting their own sites or kind of striking out independently.
Esthefany: I agree. And it's a long process, you know, I know some people get discouraged if they don't get any responses from sponsors sides, but you have to just be persistent and consistent, um, in this business, it's, it's definitely a long journey. I've also utilized clinicaltrials.gov a lot. It's probably my favorite website and I use it often. Um, I'm always on it trying to see the newest research trials they have posted and contacting everyone on there. It's I've used it often.
Brad: Yeah. And that's a completely valid way to get started. I mean, you don't necessarily have to sign up for, you know, expensive business development consultants or right. Yeah. Completely free, as long as you're willing to put in the work to scour it and, you know, send emails, make phone calls, track people down. I mean, you can get started just by using clinicaltrials.gov. Uh, it may be, you know, a more, a little more challenging or take you more time, but it's, it's absolutely a legitimate way to get started without costing you anything other than the time you put into it.
Esthefany: Yeah. And I know there's different vendors now that have, um, you know, you can kind of utilize to look for studies for you or CTMMS companies. Um, but I didn't start off doing that just because I kind of was a skeleton crews. I was doing everything myself. I just utilize my free resources.
Brad: Yeah. And again, that's something that you just, you have to do in the beginning. And I did the same thing. I'm able now to, uh, I do utilize some business development help. Uh, I use the CTMS, but I did, we had to build to that. Uh, it's not necessary. It can make your life easier. Uh, but you know, you gotta do what you had to do in the beginning. So every free resource that you can use is, is on the table.
Esthefany: Yeah, It works out, yeah.
Brad: Awesome. Well, thank you again so much for coming on today. Where can people find you online?
Esthefany: So you can find me on LinkedIn. I use that daily, um, or my Instagram page it's forward clinical research and my LinkedIn is my name is Esthefany Jabbour.
Brad: Very good. Again, thank you for coming on. We'll put your contact information in our show notes and, uh, again, thank you so much.
Esthefany : Thank you for having me.