{"entity":{"id":"idea-tr1-protected-physician-time-for-enrolment","kind":"idea","name":"Pay oncologists for the time it takes to enrol a patient","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Trials enrol too few, too slowly): Unger et al., Systematic review of barriers to cancer trial participation (JNCI 2019)","url":"https://doi.org/10.1093/jnci/djy221"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["asco"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-trial-enrolment","b-incentive-misalignment"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":2},"route":"/ideas/idea-tr1-protected-physician-time-for-enrolment/","neighbours":{"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-trial-enrolment","kind":"bottleneck","name":"Trials enrol too few, too slowly","route":"/bottlenecks/b-trial-enrolment/"}],"paper":[{"id":"paper-unger-trial-participation-barriers-jnci-2019","kind":"paper","name":"Unger: most patients never get the chance to join a cancer trial, and when offered, half say yes","route":"/key-papers/paper-unger-trial-participation-barriers-jnci-2019/"}],"roadmap":[{"id":"trial-modernisation-roadmap","kind":"roadmap","name":"Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on","route":"/roadmaps/trial-modernisation-roadmap/"}]}}