Hospitals and Private Practice: US Clinical Trial Locations

Clinical trial sites in many countries are often heavily concentrated in hospitals and similar institutions. Even within the United States many health care professionals probably think that is the case for the United States as well. Data from Open Payments, the database mandated by the Sunshine Act, definitely show that a large proportion of clinical trial work is done in physicians’ practices rather than hospitals. 

As of 2015 there were 5,564 registered US hospitals, and only 22% of these participate in commercially funded clinical trials. Open Payments refers to these hospitals as teaching hospitals. A teaching hospital is broadly defined to include any hospital anywhere in the United States or its territories receiving Medicare, as well as indirect or direct graduate medical education payments.

There are any number of reasons a study may be done at an institution rather than a private practice. The study indication of course leaps out as an explanation. In-patient indications, for instance, must usually be done in hospitals. In addition there might be particular expertise or a specific opinion leader on staff at a particular hospital. In addition study conduct costs and overheads at hospitals often exceed comparable private practice costs. Open Payments indicates 80% of all investigator payments go to physicians working in private practice. Few doctors conduct clinical trials in teaching hospitals alone. The large majority do all their clinical trial work in private practice settings. Slightly over one in ten work at both teaching hospitals and private practice.

Where US Investigators Conduct Clinical Trials, 2016

Institutions Only

Private Only

Both

12%

75%

13%