When Your Site Becomes Invisible: The Hidden Cost of Brokers and SMOs in Clinical Research
Written by Sergio Armani, Founder of ACG-Clinical
As kids, we were told: “Don’t let someone else speak for you.”
In clinical research, too many sites are doing exactly that.
By outsourcing sales and feasibility responses to brokers or Site Management Organizations (SMOs), sites unknowingly trade away the single most important asset they own: their reputation with sponsors and CROs.
On the surface, it feels efficient. But in reality? It’s a shortcut that can quietly stall — or even reverse — long-term growth.
The Hidden Problem with Brokers and SMOs
The pitch is attractive: “We’ll take care of feasibilities, outreach, and business development so you can focus on operations.”
Here’s the reality I’ve seen, and heard repeatedly from sites themselves:
Feasibility forms are filled out by a middleman — the answers are generic, not site-specific.
Sponsors and CROs often don’t know your name — they see the broker or SMO brand, not yours.
Relationships never form — you’re cut off from the very decision-makers who determine your future opportunities.
Instead of being positioned as a trusted partner, your site is reduced to a line item in someone else’s portfolio.
👉 If your site is already struggling with visibility because brokers control the feasibility process, ACG-Clinical can help you take back control.
The Trap: Great Marketing, Real Costs
SMOs and brokers often have slick marketing that convinces sites they’re the best option for growth. And to be fair — sometimes sites do grow under these arrangements.
But here’s the problem:
They grow while losing their identity — sponsors don’t know the site, only the broker.
They grow while losing margin — high fees eat into the revenue that should be fueling operations.
They grow while losing control — their ability to steer their own future becomes limited.
And that’s not sustainable. Successful businesses don’t hand their future to someone else. They manage their own destiny by building direct relationships and controlling the levers of their growth.
The Fine Print: Protecting Your Future
Sometimes, joining an SMO or working with a broker does make sense for short-term needs. But here’s where many sites make their biggest mistake: the contract.
If you ever engage with an SMO or broker, make sure you:
Negotiate terms that keep you in control. You should be able to independently sell into the same sponsors and CROs without restriction.
Avoid exclusivity traps. Don’t sign away the right to build your own relationships in parallel.
Be wary of non-compete clauses. Many brokers include fine print that prevents sites from continuing sponsor or CRO relationships once the broker is removed. That’s a deal-breaker.
Protect your study revenue. If the relationship ends, you should not forfeit ongoing study income you earned.
👉 Not sure how to review or negotiate these terms? Contact ACG-Clinical — we’ve guided sites through broker exit strategies and contract reviews that protected their growth.
Not All Brokers and SMOs Are the Same
To be clear — not every broker or SMO relationship ends badly. Some are reputable, transparent, and genuinely add value for the right site at the right stage.
The key is how you evaluate the partnership. Sites should:
Check the reputation of the broker or SMO in the industry.
Speak with other sites who have worked with them — ask what worked, what didn’t, and whether the sponsor relationships truly translated back to the site.
Weigh the good with the bad. Some brokers provide access to studies that sites wouldn’t see otherwise. But does that access come at the cost of identity, margin, or long-term relationships?
👉 The best sites make these decisions strategically, not reactively. They know when a short-term partnership makes sense — and when it’s time to invest in their own commercial independence.
What I Keep Hearing From Sites
I’ve heard this more than once from highly successful sites and networks.
At first, the broker or SMO was a shortcut — a way to win studies without building an internal BD process. But over time, the costs stacked up:
High fees that ate into margin.
Missed opportunities to highlight PI expertise or unique patient access.
Frustration that sponsors didn’t even recognize the site’s name.
Now, many of these sites are fighting to unwind those agreements. They’ve realized that while brokers may open doors, they also build walls — and those walls block the site’s direct path to long-term growth.
The Hard Truth
Here’s the Challenger insight:
👉 When you outsource your sales and feasibility process, you’re outsourcing your identity.
Sites think they’re saving time. But what they’re really giving up is control.
And without control, you can’t build trust. You can’t stand out. You can’t negotiate from strength.
Relationships Take Time — and That’s the Point
Let’s be clear: building sponsor and CRO relationships isn’t quick. It takes patience, thoughtfulness, and strategy.
You have to show up consistently in feasibilities with answers that highlight your PI, your operations team, and your past performance.
You need to invest in conversations, even when they don’t yield an immediate study award.
You have to play the long game, knowing that a trusted relationship today becomes repeat business tomorrow.
There is no shortcut to trust. And that’s why the broker/SMO model often collapses — it’s built on transactions, not relationships.
The Better Way Forward for Sites
If you’re a site or network leader, here’s the path I’d challenge you to take:
Take ownership of feasibilities.
Don’t hand them off. Build a library of strong answers, proof points, and stories that showcase what makes your site different.
👉 Want a feasibility library that actually converts into pre-study visits? Let’s build one together.Carve out direct sponsor and CRO relationships.
Even if you still work with a broker selectively, build your own connections. Attend the meetings. Show your face. Get your PI in front of decision-makers.
👉 ACG-Clinical coaches sites on outreach, messaging, and relationship-building strategies that lead to recognition and repeat business.Play the long game with intention.
One study from a broker is fine. But a decade of repeat work from sponsors who trust you? That’s the real prize.
👉 ACG-Clinical provides fractional sales leadership so you have structure, visibility, and repeatable processes — without the overhead of a full commercial team.
Closing Thought
Clinical research sites don’t win by being invisible. They win by being bold, showing up, and telling their own story.
If you’ve ever lost a study because a sponsor said, “We didn’t know your site,” it’s time to take the wheel back — patiently, thoughtfully, and strategically.
📩 Get in touch with ACG-Clinical for clinical research site sales and feasibility support.
Don’t let someone else speak for your site — let’s build the strategy that keeps you in control.
Be bold. Be visible. Be in control.
Disclaimer
The information in this publication is for general informational purposes only and should not be construed as legal, financial, or regulatory advice. Armani Consulting Group, LLC, doing business as ACG-Clinical, disclaims any liability for errors, omissions, or actions taken in reliance on this content. Please consult qualified professionals for advice specific to your situation.