Episode 09: Dan Sfera, the Clinical Trials Guru
Dan Sfera is the Clinical Trials Guru. Dan has been publishing content in the clinical research space since 2010. Dan runs a clinical research consulting firm, operates multiple sites and also operates a CRO. The man has just about done it all when it comes to clinical research.
In this episode we discuss his beginnings in clinical research, learning when to pivot, our shared affinity for Gary Vaynerchuk, hiring for potential vs hiring for experience, and the importance of becoming a generalist.
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+ Episode Transcript
Intro: Hello, and welcome to episode nine of the Note to File podcast, a collection of interviews, best practices and candid commentary for clinical research sites today, our guests truly needs no introduction. He is the clinical trials guru Dan Sfera. In this episode, we discuss his entry into clinical research, our shared affinity for Gary Vaynerchuk, learning to pivot, hiring for potential versus hiring for experience and the importance of becoming a generalist. So without further ado, Dan Sfera all right. Dan Sfera. Thank you so much for coming on. Uh, how you doing out there in California?
Dan: Very good. Brad, how about yourself?
Brad: Not too shabby. I imagine it's a little more, a little more chill here in Oklahoma City than it is out there on the, on the West coast right now.
Dan: Yeah. It's pretty eventful with everything. I mean, at the time of this recording, June 2nd, we've got the protests now overtaking the Coronavirus and the economy was just starting to open back up. So yeah, it's pretty, pretty eventful here, but, uh, you know, I expect things to get back to normal pretty soon.
Brad: Well, very good. Well, I think pretty much at this point, I imagine anyone listening is well familiar with your content. You're a prolific, if nothing else, you put a ton of stuff out there. So, you know, I'm really kind of interested to hear, I want to hear your story a little bit about how you first got into clinical research and then maybe a little bit about what's really spurred you to start creating content at the level that you do.
Dan: Wow. Okay. Well, um, did not know the interview would go there, but that's good. Cause I don't really talk about it that often I did in the beginning, like when I did my bio, when I first started the YouTube, just so people kind of had an idea of like the context behind why I'm doing what I'm doing, but yeah, basically let's see when that it started, uh, first year of college, I was doing Pre-med and then I switched to no I'd take it back. I was doing pre-pharmacy and then I switched to Pre-med and my dad at the same time, my dad's a Psychiatrist. So my dad got involved with Clinical Research through some colleagues cause he was always into private practice and making hospital rounds. Um, he became a licensed Physician when I was 16. Uh, prior to that, we immigrated from Romania. So he was, you know, he was working to try to pass the ECFMG and all that stuff. So by the time he became a licensed Psychiatrist, I was already a sophomore in high school. And uh, pretty soon I went to college when I was in college, I was doing the Pre-med thing and he got involved with these, with these doctors who are doing clinical trials. So every summer when I would come back home from college, I went to University of Arizona. So when I would come back home to Southern California, I would take a few days out of the week, go to the office where he's working and just kind of hang out. I used to answer phones. I used to refill prescriptions, uh, just helping out in the family business. And then clinical research started, you know, like he started actually getting busier with the research. They were easy studies. They were doing like these observational studies, quality of life survey studies for patients. So it was not the typical clinical trial, but it was good. It, it like opened my eyes to the world of research.
Brad: sure.
Dan: And to me, the reason I did it was because I wanted it to look good on my resume for Med school, because I knew my grades were not good enough to probably get in which it turned out it was accurate. And the research experience didn't help me get an med school either, but it opened my eyes. So I said, you know what? Um, the next thing I wanted to do was CRA when I graduated college and I knew I had like no prayer of getting into Med school, um, CRA because I kept interacting with monitors that would show up to, to my dad's office. And uh, so started applying to CRA jobs, no re- no responses. I mean, I have so much empathy with, with the students who do our CRA Academy. Um, I probably sent out hundreds of applications and zero, zero responses. Brad, not even like, we're not interested, just nothing. It was like, you know what I mean? I'm just going to learn the business. I'm going to learn the process here. So it turns out these people, my dad partnered with, um, and this is something I learned a lot more as an adult. And I'm sure you have as well is clinical research is not for every Physician. Like a lot of these doctors who partnered with my dad, they expected quick results, quick money doing research. And when they realized that wasn't going to happen, they all left. So it was just my dad with the clinical research and he told me, Hey, you know, I'm gonna, I don't really want to do this. I want to just focus on my private practice. So if you want to do the clinical research, you find another doctor to be your PI. I'm willing to do it for a year if you want to do this, but then you find another PI or we just shut down, you know, the research and you go and find the job. And so I, you know, I said, okay, I'll do it. And I'm really glad I did really glad I did. I mean, it turns out those doctors left at the worst time possible. And this is why I always say in my videos. I mean, all the stuff I say in my videos is really based on like those first five years, those doctors left at the absolute worst time they left right before the money started coming in. And this is when my dad basically gave me the entire business because he thought there was, it wasn't worth anything either. And I didn't know. I mean, I was just, you know, I got lucky. So checks started coming in and I was like, wow, these other doctors must be super rich. They're just walking away from this. So, you know, started making good money, doing the research, had to learn the ins and outs, everything coordinating, finding. I had to go look for doctors. And then I realized that, uh, they had a lot of unpaid obligations, um, namely hospital bills. And so all that money that I made in that first year, like 80% of it had to go back to paying these hospital bills, which I wasn't even aware of. So I'm glad I didn't spend that money. And then it basically was starting over from ground zero and, you know, started learning little bits and pieces here. What's a coordinator. How do you hire coordinators, uh, how to get PI's? I mean, all the stuff I talk about to this day, um, I had, and I, you know, I really had to struggle. I mean, it was like monitors would ask me things. I would have no idea what they're talking about. And there was literally no one else there. It was my dad who knew even less than me. Um, and me and so, yeah, Google was my friend and this was before YouTube. And, um, you know, it always stuck in the back of my mind if this industry is that big, I can't be the only one looking for this kind of information. And there was really nothing out there other than paid stuff from center watch and, you know, the kind of books that they sell, that's not really helpful, but very expensive. So that kind of stuff, I mean, nothing against Center Watch, they have a decent business, but back then, that was like the only player in town and it wasn't very helpful. So yeah, I had to learn it all like just through trial and error.
Brad: Yeah. And I think that's, that's a pretty universal experience as you know, we talked to more coordinators. So I think again, that goes, a lot of that goes back, even for me, is, you know, checking out your content because also in the same boat, I started at a University, but nobody there either A) knew what they were doing or B) cared to actually show me how things were done. Uh, so just the fact that, you know, one dude was out there trying to educate people, uh, made all the difference, not just for me, but I imagine, you know, hundreds of other site level people. So I, again, I owe a lot of where I'm at and what I do to the content you've created over the years. So it's interesting to me to hear kind of how you, the story that got you to- to that place. So again, I think a that's awesome, man. and I thank you. I thank you for that
Dan: Thanks for that. That means a lot. I mean, and just to give people context. So all these struggles, you know, when I took over the, I graduated college in 2004 and then literally took over in '05. Um, I didn't make my first video until 2010 and it was only after I read, um, Crush It, by Gary Vaynerchuk.
Brad: I've always got a very gai- a Gary Vaynerchuk vibe from you. So that's actually a, it's very validating for me to hear you mention that. Cause I'm a big fan of his as well. So that's just on a side note on a side note. I'm glad that I caught onto that a little bit.
Dan: Yeah, it definitely was. Especially in the early days, not so much anymore, but uh, in the early days, definitely a disciple and uh, but yeah, five years and that's where the seeds were planted. Like, Hey, you know, all these things I struggled with, I don't know how I'm going to monetize it, but if I create videos and initially it was to create videos to get patients all right. Like I wanted, like my first YouTube video was a, "What is Clinical Research?" video And it's a horrible video. I deleted it. I'm so mad. I deleted it because I should have kept it. But like, it was so embarrassing. I got rid of it like five years ago, but basically I was trying to educate patients like, Hey, this is what clinical research is. My next video was like, what is an IRB? What is an informed consent? And what I realized Brad was like, I was trying to get patients for my site. And then I was, I was thinking that I can build a business to be like a nationwide patient recruiter because when I read crush it, that's what I saw. Okay. If I do this, like Gary says, I'm going to be able to get patients interested in research and then I'm going to be a billionaire because you know, there's a huge issue. Then there still is with patient recruitment and it turns out the only people watching were other researchers. So that's when I pivoted and that's when all my trial and error things that I, you know, all those seeds that were planted came back and I said, look, there's, there's obviously the man here for researchers, which is actually easier to make content for them and the patient think, no one's done it yet to this day. I mean, that's your (Brad:"right??") Huge Opportunity.
Brad: Yeah. But that, that's the beauty in your story too though, is that you were able to recognize, you know, where, where, and when to pivot and you know, it's like they say, you know, if you quicker, you fail the better off you are. And it sounds like, you know, from wanting to go to Med school, to wanting to be a CRA, to instead running a site, to creating content for patients to pivoting, to creating content for, for sites, you've pivoted a lot along the way.
Dan: Yes. Tons man. And I mean, I've been extremely lucky in a lot of facets of my life. I mean, extremely lucky. I had parents, immigrant parents who pushed me to go to college because if, if, if it was up to me, I probably would not have gone on my own. Um, I thank God, we did not have Uber, uh, when I was in college because I would have probably dropped out and just worked full time as an Uber driver. Uh, and then the fact that my dad literally handed me over a business. I mean, it was a failing business. Nobody knew what they were doing, but it was still like the infrastructure for a research site, which is now like the foundation for my career. So just extremely lucky, man. Like really? I, I don't, I don't, um, think that I did this. Yes. There were a lot of pivots, but luck is like, had such a big part in this.
Brad: Sure. Well, you know, being able to recognize the value in those things, even, even being handed it, you know, a failing practices, you were able to identify the value and learn your lessons, cut your teeth and turn that into something successful for you down the road.
Dan: Yeah. It's crazy. And you know what, the more I think of it now that you're asking and I'm having to reflect back, cause I really don't think about this stuff that often, but like reflecting back, I made so many decisions, like just impulsively and you know, like, okay, let's not do med school. Let's go work for my dad. And by the way, I did not want to work for my dad, but I saw that as the quickest way to get to Med school. And then I saw that as the quickest way to be a CRA I mean, all those decisions were somewhat impulsive. I did not really think much about it. I just did it. So a lot of my career has been just reacting rather than being proactive and only like in my mid thirties and now I'm Thirty-eight. Am I actually getting strategic about my decisions? It was not that it was all reactive probably until like four years ago.
Brad: Sure. Well, I mean, a lot of that goes back to a, you know, a Patrion post that you did recently. Like if you sometimes just get out of your own way and uh, you know, I find I suffer from, you know, paralysis analysis I overthink and overthink before I finally just say, you know what, just do the damn thing. So sometimes it's, there's value in that too, you know, just action. Cause you know, everyone I talked to has an idea, everyone's got an idea how many people actually follow through on that idea? It's, it's a, you know, disturbingly small amount,
Dan: right.
Brad: So I think there's even a lot to be said for, you know, what you might call impulsive is just action. Get out there and get out there and do it. And then, you know, what, if it doesn't work, what do you do pivot, you know, learn from it and turn it into something, a of value. So that's, that's a yeah, very interesting. I've always wondered again, I've listened to a lot of your content throughout the year, so, you know, I'm excited to hear more about sort of your beginnings. And I think a lot of people are sort of interested, uh, hearing about that. So it's very, very cool. Are you, how involved are you now, like with the, the sites that you work with?
Dan: So that's a good question. I'm purposely. So, you know, going back to now being more proactive about my strategies and decisions, and I'm no longer reacting, I'm reacting to some extent, but I'm like the majority of my decisions now are not reactive. Um, I'm purposefully delegating as much as I can from my day to day to staff. So like Monica right now, Monica and Chris are like my right hand man and woman. Well, I guess one is on the right. One is on the left. There's also a bunch of other people that help that don't really come on camera. Those are the two that are willing to come on camera every now and then. Um, so really our biggest thing right now is the site network that we have. So helping other sites get more studies, helping other investigators or business owners start their own sites. I almost do nothing with the sites that we actually own. And.
Brad: sure.
Dan: that is good and bad because I know that if I focused more on that, that would be extremely successful. Um, but then I kinda like having multiple things going on and I think that's, you know, going back to my reactive days, we're just seeing what the market gives and say, okay, let's go with that. And then let's do this as well. So I'm involved in the business development, I'm involved in like what the site networks bringing on new clients, obviously with the CRA and CRC Academy, bringing on new students. I'm not involved in the operations of those things. Uh, but I am involved in adding new features, adding new services. Uh, and then same thing with the CRO. If I were actually involved in any of our businesses in the actual operations, it would probably be with the CRO that we have where I'm actually doing the monitoring and the lead monitoring and the regular monitoring and pretty much everything. So the CRO reminds me of my site when I first started back in '05, it's just a different kind of learning, but it's kind of the same pathway we're taking. Um, so yeah, like probably I'm a more involved in the actual CRO and maybe the site network stuff.
Brad: Gotcha. Gotcha. Okay. Interesting. So throughout all this and your career, I mean, what would you consider, you know, some of the best practices you've picked up and maybe with an eye towards a site level work, I mean, is there something specifically you'd share with other site level employees that you really consider a best practice or something that kind of helps you get over the hurdle?
Dan: site level employees? Hmm. I guess, I guess I'll take it to the site level ownership and management.
Brad: sure, that works.
Dan: Um, and then I'll do the employees, but I guess for the owners slash management, it's a numbers game. I mean, everything is a numbers game, never settle for just one PI, never settle for just one study or one sponsor that's feeding you studies and or one indication of, of studies that you're doing. So I think more doing more when you can is best. Um, and don't rest on your laurels because I still do that to this day with the sites I told you, I'm not that involved. And sometimes I have to get involved because now all of a sudden we need a study. and so then I have to get back involved in that. So if you have a system that's constantly looking for studies, looking for doctors, looking for patients, looking for staff, building the brand for the site. Uh, I think that's the biggest advice I give to the site owners and managers, and also like for the managers and this relates to the employees, it's hard to find good, really good coordinators. So when you find one, I mean, I like to hire for potential. I don't hire, I typically don't hire a coordinator that has worked as a coordinator somewhere else. Uh, I hire for potential because I, you know, a lot of these coordinators come with bad habits from their other sites. And then you start getting into arguments. Well, this is how we did it there. And then I tell them all, this is not how we do it here. Uh, and it's, it's my business, you know? So you either go start your own site and do it, how you want it. Or if you're going to want to work for me, this is how we're going to do it. So having the potential and grooming them, how, you know, to how you want them to become is, is one thing. But then you got to keep them because as soon as you train these guys, now they become even more valuable in the marketplace. So now the trick is keeping them. And one of the things I think I've done, I've been able to do relatively well is keeping them so employee retention without necessarily breaking the bank, like we don't overpay our staff. We're probably fair. Um, maybe, maybe like high side of fair, but not really. Let's just say we're like average with that. So the way I've been able to keep them is giving them other opportunities, like figuring out exactly what they want to accomplish, even if it means starting a competing site, uh, you know, just be honest with me upfront and it takes like a good year to get them to actually see that you mean it. And you're not just telling them this so that they tell you their secrets. Uh, but once they tell the truth, you know, Hey, I want to be a CRA, I want to be a site owner. Or sometimes the truth is I don't know what I want to do, but I don't mind being exposed to the opportunities you have. That's been my selling point. So find your selling point. If you're the site, everybody has one and it doesn't always have to be like overpaying the staff to keep them, you know, it's just, I think the little things actually add up into big things.
Brad: Yeah. And I couldn't agree more on both points. So first of all, I think there's way too much of an emphasis on where can I find, you know, super experienced coordinators. Cause I, I tend to agree with you that a lot of times you don't want them bringing those habits over. I'd rather find people with the good, soft skills that can be trained. If you can invest a little bit of time into these people, I think are going to be better coordinators for you at the end of the day. And then secondly, you know, there's a lot of things you can offer your coordinators. There's look being a, coordinator's not like working on a factory line, you know, you can, uh, offer flexible hours. Uh, you can, you know, we don't even have PTO. If you need time off, as long as your work's done and there's no patients to see do what you need to do. I mean, you can offer a lot of, uh, get creative, you know, aside from just compensation.
Dan: Same,same.
Brad: And those are things that, you know, you're not going to get in an academic institution where research takes place and you may not even find a cross, a lot of other independent research sites. So there's ways to get creative and to really borrow from other industries that, you know, again, we, I just feel like research lacks, you know, far behind what other industries are doing to be creative so we can start implementing those things and it can have a big impact on recruitment and retention of employees.
Dan: Yeah, I agree. We do exactly the same thing. I mean, I don't care what, you know, we don't have hours it's salary and then we do bonuses too. And it's like, Hey, if you don't want to come in today, you don't even need to tell me. It took like five years for Monica to stop telling me she can't come in on a certain day. I told her I don't care. You know, don't tell me this. Like
Brad: people I think are used to the, the clock watcher, you know, and that's a, I've seen that across other research sites I've worked at or been in is that, you know, being in your office from eight to five, well, that doesn't do you any good. It's not generating revenue for you to sit on your ass in your office, you know? Right. If you're not then do something productive or, you know, don't, don't just sit there. You know, that's, that's not, that's not what we're here for. So I think there's, again, a lot of, uh, creative ways to help retain, retain good help. Uh, especially if you treat your treat your employees.
Dan: Absolutely. And if you train the end to give some advice to the employees or, and or to the management, if you train as generalist, right, like you can provide value in more ways than one. And you know, this is, this is an advantage for the employee because you'll now start, like if you truly get involved in, in seeing the pin points of the industry, which is inevitably what you're going to see. If you become a generalist, you're going to see the opportunities and maybe you're going to either create new streams of revenue potentially for your site. Or maybe for yourself, maybe you don't like the site you're at so for yourself. So I really think like generalist is the future. Um, you know, like specializing is great because everyone starts out as a specialist, but I think the goal for everybody should be to be more of a generalist.
Brad: Well, and I think that, that I could, again, I couldn't agree more. I mean, that's what enables people like us to do what we do. I mean, if we weren't generalists, you can't go start your own site network. If all, you know, how to do is see patients, how could you possibly know how to negotiate a budget and a contract, how to, you know, complete the regulatory process, how to do all the things that are involved. So you create all kinds of value for yourself, but I mean, let's go back. A lot of that goes back to the company culture that you're in, you know, cause I've worked in places where they, they do keep everything very siloed. So that, that can be frustrating and tricky for employees who are stuck in those situations.
Dan: Yeah. And that's exactly why I had those places. They have the highest retention issues when it comes to their staff. I mean, I'm monitoring a big AMC right now and it's like every three months, there's a new coordinator because the old one's going somewhere else.
Brad: Sure, sure. Yeah. No, that's, that's absolutely true. So it's a, it's gotta be a good, a good match. So yeah, if you're a coordinator stuck in one of those places, then get out of there as quick as you can. Right. Or use the opportunity if you use the opportunity to learn and then, then take that with you.
Dan: That's right.
Brad: Very good. So what are some tools and resources you use? I will say that, uh, we did, uh, We have already plugged your book once on one of our podcasts.
Dan: Thank you.
Brad: So you can't use that one. So, but, uh, what are some tools or resources you use, uh, you know, in your everyday.?
Dan: Tool? Okay. So let's see here. I used to be a big Evernote fan. Yeah, me too. Yeah. I still have, I've refused to like upgrade because I've been doing so much with the free version. I don't see a reason to do it. Um, I I've been using Dropbox and this thing called Intralinks, which is, it used to be a research thing, but now it's more of a financial services platform. A that's more of a virtual workspace. Uh, our sites are starting to use Creo and I imagine what this next round of new studies starting up after the pandemic, we're going to be using a lot more E-source. Uh, so Creo is the source platform.
Brad: Yeah. So I'd really like to hear your feedback on that. We use Creo as well, but we've not really cracked into the source part quite yet (Dan: "oh, okay").So I I'd be real curious to hear what your experiences are once you go down that road.
Dan: So I've only used it for one study so far. And unfortunately it was a study where we had like 20 screen failures and no randomizations well actually we had, we were going to have a randomization and we were starting to figure it out and the sponsor didn't want us to screen anymore. So I didn't actually randomize anyone on it, but very simple to use. I mean, Ray, the guy who founded this Creo thing, you know, he's built a good team. Like you give them the EDC screenshots and they'll create the source template for you. And you can even upload things like, let's say you wanted to put a Note to File in there. Um, but you wrote it by hand because the staff forgot you're using E-source. Well, you can just scan that thing and upload it into Creo. So it's like, I like the flexibility of Creo. And then for me as a business owner, I like the fact that it has a built in CTMS. So you know exactly what you're owed and all those things. So they do all that for you, which is really cool. Uh, and I heard that they're rolling out an irregulatory, but we haven't used that yet.
Brad: Yeah, no, I'm, I'm a big fan of the, uh, automated text reminders, uh, that it'll send your patients and uh, you know, we're now using their reloadable visa card system to make our patients stipends, which is obviously convenient and you're using all this stuff. We're not, so that's cool. Yeah. I, I love it, I guess. Yeah. You're, you're going the E-ource route and we're using the other
Dan: yeah, yeah. You should know their notes for sure. Yeah. I mean, it's good to know that they offer that whole, you know, and, and a spectrum of that. So that's cool. I like what those guys are doing. I like Ray a lot.
Brad: Yeah, yeah, for sure. And it's got a super robust recruitment module in it as well, where you can load in, you know, your whole patient database and basically do like ICD 10 poles. And then you can send automated text messages to all the patients that come out of that pool. So it's very, again, very cool and sophisticated for us. The trick, you know, is just figuring the damn thing out well enough to use it the way it's supposed to be used. I mean, these systems are great, but it's better. The more you use them, the better they are, if that makes sense. So the more you put in, you know, the better result it gives you, it's just finding the time and, uh, you know, processes, which to do that. So yeah, I'm on board with you. It's with Creo. So, well, very cool. Again, I want to preach, I'm sorry. I want to thank you. And I appreciate you coming on. Um, any other words of wisdom before, uh, before we go,
Dan: words of wisdom, uh, I mean, be a generalist, get more don't settle, I guess. You know, and here's, there's like a philosophical argument that I see a lot amongst site owners where it's like, should I focus on this or should I, uh, try to do more? And I think both can work. I mean, I know some sites that are wanting to get into virtual trials and wanting to become Ciro's. And then I know other sites that just want to specialize in what they do. I think, I mean, and we've seen both models, uh, you know, be, have, have extremely successful outcomes. Uh, so it really is going back to what we said earlier, like just doing it, like, you know, enough of the debating of what you should do. I mean, everybody has a preference, so go with your preference. There's a reason why you feel more comfortable doing something than something else. So maybe just go with that. That's kind of worked for me throughout my career. I'm starting to get more strategic now, but I I'm pretty sure if I were still to, uh, have impulsive decisions that I would still have somewhat successful outcomes. Um, maybe the same, if not better than if I overanalyzed something. So that's, I guess a word of wisdom, but I'm, I'm seeing a lot of that on LinkedIn. Like people debating about this kind of stuff. And I think at the end of the day, it doesn't matter.
Brad: Yup. Agree. Agree. So where can people find you online as if they don't already know anywhere you want to?
Dan: Uh, LinkedIn, LinkedIn is good. Uh, I've been, um, growing my Instagram Dan Sfera. Uh, I've been playing around with Tik Tok, but not enough. And a YouTube and the podcast basically anywhere you're comfortable. Uh, I'm probably there, unless it's like a, you know, one of those dating apps I'm happily married now.
Brad: Alright. Don't don't look for Dan on Tinder. Otherwise.
Dan: yeah im Inot on there.I Don't even know what it was called. So there you go.
Brad: Yeah. Yeah, sure. I'm sure wife's listening and she'll be very proud that you said that I'll, uh, I'll link to all those places in the show notes. And again, thank you so much, Dan. And I will see you next time.
Dan: Thank you Brad.
Brad: All right. Thank you so much for listening. Please check us out@notetofilepodcast.com for show notes, all episodes as well as full episode transcripts. Once again. Thanks for listening.