Episode 13: Kim Talbot, PRN of Kansas
Kim Talbot is the founder of PRN of Kansas, a multi-specialty, stand-alone research site in Wichita Kansas. Kim has a BSN from Wichita State, and has been an APRN since 2001.
In this episode we talk about the importance of developing a diverse study pipeline, what makes a good research coordinator, and the day-to-day of a research site owner.
+ Full Episode Transcript
Brad: All right, Kim. Thank you so much for coming on today.
Kim: It's my pleasure. I'm glad to speak to you about clinical trials and all things.
Brad: Yeah. It's nice to also talk to somebody eh- so close. You're our neighbor to the North up in Kansas there
Kim: That's right in Wichita. Also finally known as Do- da.
Brad: Do- I've never heard of that.
Kim: I dont know what the history of. Yeah. I don't know what the history is there something about that
Brad: Fair enough. All I know about Wichita is, uh, is at Wichita state shockers, they have a nice baseball team.
Kim: Yes. And the amazing basketball team we have coach, it's a Marshallville up here. Cause you know, coach Marshall has been around here for years. We love him. Yes.
Brad: Very nice. Well, as I like to start with almost all my guests, I always find it fun to, uh, tell me a little bit about how you got into clinical research. It's usually, uh, people don't necessarily intend to start out that way. So I like to- like to hear those stories. So please.
Kim: Yeah. The irony of it is that was one of my lowest grades in nursing school was, was research. Um, but I was working in the intensive care unit at one of the local hospitals and a cardiologist came up to me one day and said that, um, they were looking for someone who has some clinical experience to help in their clinical trial department at their cardiology office. And I, I was, I had recently had like a back injury and, and kind of was trying to go back to get my master's degree. So really didn't know what I wanted to be when I grew up as a nurse, but wanted to pursue something else. So this just landed in my lap. I said, all right, I'll go try it. And um, so I started working there and within a year they did some major administrative changes at that office. And that's when, uh, a gal that I was working with and I decided to take our, our, our process, what we're doing, they're independent. And then we formed our own independent clinical trials sites. And that way we could work with just about anybody in the city here. In Witchita
Brad: That's awesome. So you guys are a standalone site at this point?
Kim: yes.
Brad: And it sounds like you use you, or you started that out pretty, fairly soon after breaking into clinical research.
Kim: Yeah. Is that insanity or absurd confidence ? I dont know!
Brad: Either way. It seems to work out. I think it's, it's great. I think, uh, a lot of people sort of get wrapped up in these large, you know, large institutions and never see that as an option. Uh, so that's awesome. And that was, that's been quite some time now, right?
Kim: Yes. Back in 2000.
Brad: 2000?That's awesome.
Kim: You're 20. Yeah. I have to tell people. I started when I was 12 because the years kind of add up a little funky now. Lik- what am I that all?
Brad: So are you guys a multispecialty then?
Kim: Yes. Uh, pretty much the two areas that we don't dive into are psych and oncology.
Brad: Yeah. I'd say that's a, I'm kind of In the same, same boat or, you know, to me, it's just a good idea. I think to be as diverse as you can, as, you know, some therapeutic areas are hot and some aren't and it's good to have, you know, sort of hedge your bets a little bit, but yeah, I've, I've kind of same, same thing. We don't, we don't haven't broken into oncology or psych so much, which has its own. It seems like its own realm to, to some degree.
Kim: Yeah. I think both of those are very nichey and have their own rules to play by even within our crazy rules.
Brad: Yeah. And I'd be curious. I mean, I've had sponsors ask me about working in oncology and I just don't know how common it is to see like, I mean, are there a lot of independent oncologists that, you know, you wouldn't have to deal with a large institution with, because I think that would actually be very interesting for sponsors to not have to work with local IRB is necessarily, or again, sort of the bureaucracy that comes along with all these cancer centers or universities. I just don't know enough to know if that's a, is that even a common set up necessarily?
Kim: I would think that those trials that would be placed in the, in say a physician's office that would be outside of an institution would have to do with some peri oncology. Cause you're talking about, you know, chemotherapy infusions and things like that that often happen within this facility. And it's very specialized people that people are certified to administer those meds and yeah. So yeah, super niche-y I don't, I wouldn't even pretend to be an expert and I just know enough that those not our wheelhouse whatsoever.
Brad: Sure, sure. Well, fair enough now, that's I say, I love that. I love when people strike out on their own, what was, uh, what did you find to be the biggest challenge in doing that?
Kim: Um, back then, I think the challenge was just getting up on our feet and having some cashflow in that first year, because we had physician contacts, we had studies coming in, we were really energetic and going out into the community to educate people about what participating in trials would be. We went to the state fair and had a booth to educate people, sign people up so we could call them later. We did all kinds of, out of the box thinking to get the word out, but it did take a good year. I remember skipping several paychecks during that year too, as we were trying to build that up. So it was probably our biggest challenge.
Brad: Yeah. I know that's a, let's say I experienced the same thing. I think that's a, I talked to a lot of people who were trying to get started or start a network or a standalone site. So I think that's, that's a nice little dose of reality. I mean, I went nearly a year without taking any kind of pay just to get this thing up and going. And I feel like you kind of end up if you've got a great doctor, it's maybe hard to find a study for them and you get a lead on a great study. You don't have the right doctor for it. So, uh, you spend a lot of time and sort of reacting to what the, what the market's doing, which again, it sounds like you guys are staying diverse, diverse enough that we can kind of cover your bases. When I feel like there's a lot of great GI trials right now, but how long will that last?
Kim: Right. And we worked with mostly primary care doctors. We had a rheumatologist that was one of our specialties, just breaking out. The most of them were family practice. I don't know where you're at Brad, but in Wichita, the specialist, it may take three to six months to get into this, to see them. So these guys are really super busy and to add another thing to the platers, often just not even an option for them or if they think it's an option, they're delusional and they say, yeah, I can do it. And then they just are not a good investigator because they don't have that time.
Brad: Yeah. Well, yeah, that definitely happens more and more than you want is that, Oh yeah, this is great. I got a hundred patients. I got all the time in the world and then you try to start working with them and you're like, wait a minute. I know better. I know better now.
Kim: Yeah, yeah,
Brad: Yeah. I know you, you learn fairly quickly to sort of vet as well as you can vet those investigators, but sometimes you don't know until it's too late, you just have to be like, okay, well we can't go back to that, to that. Well necessarily, but I mean, I find it's difficult at least. And again, in my experience in what and what we do, I find it difficult to turn down an opportunity sometimes. So, you know, when those opportunities present themselves, sometimes you, uh, you do your best to cobble together the best, best effort you can give.
Speaker 2: Yeah. Yeah. I can think back on some of the years where the pipeline was just so, so dry that we took studies on, it's like, well, we'll, we may enroll. We may be able to enroll a couple people. And then, you know, six, eight months, maybe 12 months down the road, we still have these horribly arduous studies still on our plate. And we, we just, we could get rid of that so we could focus on these other ones would be better, but we didn't know we needed at least something to carry us through.
Brad: Yeah, no, I think, I think that's just part of the process, especially as you're growing, I mean, we've certainly had the same problem where it's like, well, what else are we going to do? Let's take this study on, but then once you start to establish and pretty soon that study's not, no, it doesn't quite get as much attention anymore because it's just not as easy to deal with. And-
Kim: You've exhausted your resources.
Brad: Exactly, exactly. And I feel the same way, sort of about a lot of phase four observational trials, kind of the same, but different, you know that yeah, you can roll a lot of patients, but it's a lot of effort for maybe not as much good or as much payoff in the end, but sometimes it helps get the bills paid too.
Kim: It does it sometimes good filler stuff. It's be nice to, to pace it out a little bit. And I think that's one of the bigger challenges too. Once now that we're established and we know we have our name in the database, who've done good work. So sponsors and CROs are coming back to us for repeat work. And we have really great doctors and relationships. And my team is stellar. I just have the best team ever is just trying to navigate the ebb and flow of the study pipeline. And I don't want to turn on-one's down, like you said, but if I keep taking them and taking them and taking them, then I have to increase my staff at some point, I can't just hire temporary staff. Tho-that's ridiculous. You know, how much training it takes, even get it to be able to touch a study.
Brad: Yeah. You could do a lot of time investing in your, in your staff, in this field to where it's not, it's a horrible loss to train somebody for, you know, six months to a year's worth of work and be like, all right, cool. Let's move on to the next person. That's just not, you hate you hate to have to do that in this field. especially
Kim: Yeah. And I've had nurse friends say, well, let me know if you need any extra help. I thought, well, that'd be great. But by the time I get you GCP train and then study specific drain damn study's over already,
Brad: By the time you actually understand what you're doing and then it's going to be too late by then sort of another interesting thing. You talk about nurses. Do you, do you find that, you know, nurses are your best resource for coordinators or do you kind of work outside of that pool of potential employees?
Kim: Uh, in my early days I had this- well, one of the business managers that I worked with, they were in this thought process that you couldn't hire nurses have a full nursing staff because it's too expensive. And so we would hire a lot of MAs and they, unless you have a good MA and sometimes the good MAs are ones that just didn't go to nursing school or whatever, for whatever reason that they are so smart and they're self-taught, and they have so much experience with that. It's almost like finding a unicorn. Nurses, On the other hand, you could find someone that has a lot of experience and that's usually your best person because you can, you know, that they're going to be watching out for that patient's safety on a level that you don't have to worry about something slipping in a patient's safety issue coming up and biting everybody in the backside. So I find that, so right now I have myself as a nurse practitioner kind of looking over all labs and diagnostics, just for weird, crazy overt things that would need to be addressed. And then I have an RN that's got eight years of research experience and then an LPN, that's got two years of research experience and then they, but before they came here, they had years and years of clinic experience. And they're very knowledgeable about what to look out for and how to communicate that. And that's kind of dynamic trio that we have right now. It's awesome.
Brad: Yeah. I like that. I think LPN might be kind of that right. Just the right balance maybe in it, you know, I've worked in places where the prevailing theory is the opposite. They think that you have to be an RN to be a good research coordinator. I don't necessarily agree with. And I've seen a lot of great come nurses that come over to clinical research and just realize that the pace wasn't, what they wanted, you know, depending on how busy you are or how many studies you're carrying you, they may not. But they felt as though they weren't getting enough patient care there, they don't want to do, you know, admin work and data entry that other be working a floor or be doing something a little more direct with the patient. So
Kim: It's not for the adrenaline junkies, is it ?
Brad: Right? No, no, it's not. Cause there's a, you know, as we kind of alluded to before, it's seems very feast or famine, you know, there's either a ton of studies and a ton of patients coming through or it can be just quiet. It can be crickets for days at a time. Sometimes. Like I say, that there's always something to do, but it's, it's just very dynamic. It's very dynamic.
Kim: Yes, definitely. I, uh, I think that's, that's just the struggle with the, on the business side of things to try to manage that. Well, cause during the, during the feast, you have money to invest in training and, uh, equipment and things like that, but you also need to be stashed in that away for the long cold winter that may be coming up. And I don't mean the season, but just the study's drying up.
Brad: Yeah. I think that that's a challenge. I don't know. You know, I've seen all kinds of tools. People put together to try to sort of match their, you know, staffing versus studies, but that's, again, I don't feel like there's a good, a real scientific way to, you know, necessarily suss that out until you're sometimes a months deep in a study till you realize, Oh, this isn't going to enroll nearly as many patients as we thought. And then occasionally the opposite where you're like, Oh, this study is actually going to take up way more of our time than we anticipated.
Kim: It's a, it's affirming to hear you say that because I've been looking for that magical equation. I don't think it exists either.
Brad: No. I mean, I've, I've had people hand me forms that have, you know, you can basically greatest study with the one through 10 and depending on what number you end up with divided by seven and that's how many, all kinds of crazy stuff. And I'm like, dude, this is a great idea, but I just, it's not, this is almost as just as much art as science sometimes to really properly staff and work a study and to do a study. Well, really it takes a certain, almost laser focus to really knock out of the park, you know? And I've worked in places where coordinators have 12 studies, you know, at any given time, which just doesn't pretty soon you can't do anything.
Kim: Yeah. And you're, you get sloppy. Your data becomes really yucky and yeah, we have a, so we have a data entry person and she's very much a control freak. So no one likes to do her job because she'll come back and make sure it's done correctly. And so there's just no point in double duty, no double working. Right. And she also does our regulatory stuff. So it helps with keeping the study coordinators focused on, you know, if they have studies that are in startup getting the logistics in order. And some of these are just so diagnostically burdens with, with all of that coordination. And then once they open for enrollment, they can focus on, you know, what, what's the enrollment challenges. And then once the patients are enrolled, keeping them safe and following up on all of the things like the labs that are triggering this, that, and the other followup assessments and things like that. And then I tell them, I say, nurse, I said, once your last subject is out of the study, it's back on my plate and Michelle's plate because that's all regulatory now it's all data and regulatory it's has nothing to do with the patient care.
Brad: Right. Yeah, no, I like that. So you, you do have sort of a centralized regulatory data entry position. Yeah. That's, that's, that's interesting. And again, I like to sort of hear how, cause everybody's structured so differently. You know, I've been in places where it's, everybody does everything and then broken up into different roles. And I think they both have their sort of strengths and weaknesses. And it sounds like you guys have a pretty tight knit team. So as long as you communicate really well, I really like that idea of having some of those roles more centralized so that people can focus.
Kim: Yeah. I think that the, having someone else doing the data entry is an inherent built in QC program because if I'm putting my own data and I sometimes get really lazy and say, Oh, I know what that is. I'll just put that in. What's clearly not documented there. You know, it's the curse of knowledge, if you will, you're just too close to what you just did.
Brad: Yeah. You take for granted that, you know, you know it, but yeah, if he ended a fresh set of eyes and they're like, they don't have the context to know, okay, what is this? Well, that's, that's very much how an auditor would probably look at it. They don't know what you assume that everyone else knows when you're, you're entering your own data. Yeah. I like that. I like that sort of built in, built in quality check. Very smart. So over the, you know, over the years, what do you really consider to be, you know, a best practice or some best practices that you guys or you kind of follow?
Kim: I, uh, as a, the business owner and I guess, you know, your leader of the pack here, the thing that have done them, the most proud of that I feel has benefited both myself and the company at large in my employees is investing in them from allowing them to, to get good training opportunities outside of the clinic, but also, uh, working on communication when we spend money, going to technical educational things, learning our craft better. And we spend zero money on communication, which is the bane of most things, both personal and business. And so when I've done that, I've, I've spent money on that kind of training and brought that into the culture. So I've in the last 10 years, especially I've worked on a culture that, um, you know, we have a core set of mantras values that we, we adhere to. And then, um, everybody that's brought in, I'm like, this is how it is. If you don't like working in this environment, then this is probably not a good place for you, but we don't like the drama so we can try to get a drama free place. And, um, so I think that's, that's my best practices from a business perspective. And then from a clinical trials perspective is really honing the process and making like when you develop your SOPs horrible process to do, but if it really mimics what you're doing and they're spot on, it's a perfect training tool. It's a perfect tool to have you stand up against monitors and auditors. And it's a dynamic document too. So it helps give structure to everything that you do every day.
Brad: Yeah. And I like that, especially if you're going back and reviewing your SOP is every quarter or six months or even a year. Yeah. Yeah, you're right. It's very much a living document. So, you know, you are constantly having to sort of reflect on the way you're doing things. Is this still the way we do it? Is this the best way to do it? Uh, you never end up with that again, places I've been where you say, well, this is the way it's always been done well, okay. That's terrible way to do it. So that's not a good excuse. You know, don't, let's, let's not do it like that anymore. And I think that goes back to what you said before. Something I'm beginning to appreciate more is really building your culture. And I think, you know, I'm still, you know, myself, I'm still pretty new in my own venture here, but I'm learning more and more just how ridiculously important it is to really establish that culture and, you know, invest in people beyond just an employee, even, you know, help them grow as humans, if you can, along with being an employee because, you know, ultimately it pays off in the end and it's just the right thing to do.
Kim: Yes. If they're happy and satisfied here, they're going to be able to withstand the rockiness, like going through this whole COVID thing. I just, just almost it's, it's very, it's very impactful to me how, how loyal these people are through all this and what they've put up with because you can't promise people a lot in this environment. We can't promise people a lot in a small business because gosh, the insurance benefits alone change from year to year. That's annoying.
Brad: Right, right. Yeah. Yeah. I've seen other sites, you know, have to furlough employees and some of them outright shut down or, you know, real close to it. So, uh, that's a, again, a very underrated, uh, aspect of actually again, building, building a good culture, building more than just, uh, a bunch of employees and building.
Kim: And as a woman owned business, I also feel strongly that we have a different perspective on, on how we, our family life with childcare and work life balance in general. So I've worked with most, most of my employees have been women and I, cause I discriminate against men cause y'all are fabulous. But, um, we have mother problems like pregnancies and sick kids and sick parents that we ended up to be the caregivers of. So I feel like then that's one of our, uh, covenants that we make with each employee here is that when you're here at PRN, you're the business and mission are our top PR and it's the top priority. But if you need to take time off so that you can go take care of your family, go do that. So that when you come back, you can keep that priority at your, at your, uh, and your focus.
Brad: Yeah. And again, I love that again, it's a lot, that's sometimes very different than what you see across a lot of research sites or research organizations where, you know, punching the clock is the most important thing. Uh, instead of, you know, Hey, we're out here to help people and get things done and work with high quality and yeah, we all have lives. We'll have things that happen. Uh, so I do, I love that. Again, just goes back to just goes back to the culture that you build for your, for your company.
Kim: We have to have a little grace with each other and his life is tough. And then you throw in a pandemic that effects your spouse's job or your kid's school. I mean, you have it in a numerous amount of logistical issues. Um, no one knows what to do, what to expect. Like I said, half of us think we're going to die. And the other half of this thing that the big conspiracy over here, we just have to have a little grace with each other as we go through this
Brad: Crazy times. Again, aside aside from clinical research society, it's just crazy times. So what are some resources you use, uh, you know, help you do your job better? I'm always looking for, uh, especially things kind of outside the box that people use, uh, kind of help them be more successful.
Kim: I think one of the most valuable lessons I've learned and this isn't something I learned on my own, but to look at other disciplines, don't just keep looking in medicine or in research in general is just look at other business practices, other art forms, even, you know, you get inspiration and different ways of looking at things by diversifying your exposure to your information. So don't just read the medical journals.
Brad: Yeah, I know that again. I think that's perfect point that we also oftentimes sort of live in this little box in clinical research. Yeah. There's taking a more multidisciplinary and approach and incorporating things that are popular in other industries. Um, you know, for me it was something sometimes something simple, like using a CRM tool to track business development. Well, and a lot of places I go or have been again, everyone is using Excel spreadsheets to do, you know, almost everything. Well, why don't we just use the technology that salespeople use this again, it's not, we're not reinventing the wheel here, but that can make you more efficient at what you do. And that's just a offhand example, but I like that the bigger point of incorporating things that are already successful outside of clinical research, even outside of medicine.
Kim: Hmm. I think one of the things that we did, we were one of those little, Oh, I don't know what you call them little, not really memes, but is a, is from the food industry. Have you ever heard of that little phrase that they use called Mise en place, it's a French thing.
Brad: I dont know, i dont really think I know about that.
Kim: So when you're working in a really high speed restaurant, you have to make sure that all of your tools, all of your utensils, everything is clean and, and, and at arms reach. So everything is placed in a place where everything is in mise en place means. And so when we are trying to set up for a really busy day, you know, we have your charts out, your labs pulled, you've made sure you got all your supplies. You have mise en place right there. And so you have, you have adapted a philosophy of a, of an industry is totally different than what you're doing, but it's a process that helps you be prepared and spot on with everything that you need to do.
Brad: Yeah. Yeah. I love that. And that's, that's, uh, probably something a lot of us do without even recognizing it. I was just, yeah, you hear it, you get your source. Document's ready. You got your lab kit, ready, got everything lined up and ready to go. Now I love that.
Kim: That's just, that's just a fun thing, you know, to kind of find that in other places. And then you're like, Oh, I love that. That's a French thing. Let's do that.
Brad: Right. All right. Well that speaks to a bigger picture of always learning, always learning and growing and incorporating that into what you do, which, you know, isn't always the case for every one. And for some people it's just a job to do, but you can really add some extra, I don't know, some extra love to what you do by incorporating your, everything. You can learn into that. So I love that. Anything else? Any other words of wisdom before we kind of wrap up to, I think we blew through about 30 minutes. So this went quickly.
Kim: Well, yeah, it's always fun chatting about what you love to do every day. Boy, I, I just, uh, I would love to hear your words of wisdom really on weathering the storms of research, but it sounds like you and I are on the same page as some of the challenges and the ways to look at it.
Brad: Yeah, no, I think we have a sounds like very similar philosophies and uh, if you want to come back and we can do this again, I I'd love to do it. I'm, I'm looking to share as much as possible with the clinical research community. You know, I think there's a dangerous lack of good resources and good, uh, information out there for people who want to go down this path. They don't have to go down it alone again. They don't have to reinvent the wheel. There's a lot of people out there who've done it and are doing it successfully. I mean, hell, I'll probably, I'll be calling you for advice here before too long. I'm sure.
Kim: We can always commiserate that's for sure.
Brad: Yeah There's no lack of that by any means. So where, where can people find you online?
Kim: Well, we have a website that's a PRNofkansas.com and then we have a Facebook page. I think I sent a link over there for that. We're not real active on that on basically any social media. I don't know. It's just not something that has done well for us. I don't know. You're probably more into that kind of stuff Brad than I am. And do you find that there's a lack of that type of connection in the industry amongst our professionals?
Brad: Yeah, probably. So in truth, I mean I'm no, I'm no expert by any means, but, uh, I can, I've been relatively successful with Facebook ads, uh, for studies, but you know what, I think that's a great topic for another podcast we should bring in. I think we should talk to somebody who's a professional at doing that. Cause I think there's probably a lot to be learned, but yeah, you're right. I think it's so it's challenging and it's not easy to do on your own. So there's probably a plus there's a lot of people that are kind of scared off by the potential regulatory issues they might create by, by doing that, getting a proper approval and et cetera.
Kim: Yeah. We have some extra restrictions that kind of makes a marketing person's job. Very boring. Yeah. For sure. You can't be artistic about it.
Brad: Right, right. Yeah. We have to, again, we sort of have to have it very So-so and not outside the box. And I like that as an idea for some potential future future contents.
Kim: Yeah. That'd be, there's a couple of good people out there, like study kick and Oh gosh. What was the other one that recently talk to that seemed like they on the, the, they had a pulse of the situation really well.
Brad: Yeah. And what we've used study, we've actually, we've used just about everything there is to use. So I'm actually, I'd like to do a series about all the different companies and sort of compare again, just for people who are, I don't know. I don't think there's a lot of good comparative information out there about using vendors like that. That'd be fun. I like it. It's a very good, I'm going to put a link to your contact information. It'll be a note note to file podcast.com. And I want to thank you so much for coming on and please come back anytime.
Kim: Great. Well, I appreciate the ability to have this conversation with you. I love this format. Thank you for doing this right.
Brad: Thanks Kim.