# Pay oncologists for the time it takes to enrol a patient

Source: https://onco.cc/ideas/idea-tr1-protected-physician-time-for-enrolment/  
OnCo record `idea-tr1-protected-physician-time-for-enrolment` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Discussing and enrolling a patient in a trial takes an oncologist far longer than prescribing the usual treatment, and they are not paid for it. Paying for that time would remove a quiet disincentive.

## Summary

Health systems and payers create a reimbursable code or protected-time allocation for trial discussion and enrolment (analogous to advance-care-planning codes), and sponsors' per-patient budgets include physician time explicitly rather than folding it into overhead. Academic promotion criteria count enrolment.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Practices where physician enrolment time is paid or protected will have higher enrolment per oncologist than matched practices without it.
- Rationale: Physician recommendation is the strongest predictor of enrolment, and time pressure is the most cited reason oncologists do not offer trials. Payment for cognitive services changes behaviour in other settings.
- Proposed test: A health system introduces a trial-discussion payment for half its oncology practices for 18 months and compares enrolment per physician.
- Maturity: speculative
- Actor: payer

## Sources

- Bottleneck evidence (Trials enrol too few, too slowly): Unger et al., Systematic review of barriers to cancer trial participation (JNCI 2019): https://doi.org/10.1093/jnci/djy221

## Connected records

- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)
- key papers: [Unger: most patients never get the chance to join a cancer trial, and when offered, half say yes](https://onco.cc/key-papers/paper-unger-trial-participation-barriers-jnci-2019/)
- roadmaps: [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)

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