Every nephrologist finishing training has read the same papers: SPRINT on blood-pressure targets, DAPA-CKD on SGLT2 inhibition, the vadadustat program on anemia of kidney disease. Fewer have been inside a practice where those trials were run, in the same exam rooms where the patients were already being seen. This paper is about that kind of practice: what integrated research is, how a physician-owned group of ten nephrologists makes it work, what it does for patients, and what it does for a physician's career.
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What "integrated research" means
Most clinical trials in the United States run at one of three kinds of site. Academic medical centers bring depth and reputation, along with slow contracting and investigators for whom the clinic is one of many obligations. Commercial site networks bring speed and standard operating procedures, and patients recruited by advertisement who have no relationship with the investigator. The third kind, the practice-embedded site, is a research institute owned by a treating practice, drawing participants from that practice's own patient panel, run by the physicians who see those patients in clinic.
Southeastern Clinical Research Institute is the third kind. Nephrology Associates, PC founded it more than 25 years ago, and it has since conducted more than 200 studies, Phase 1b through Phase 3, for sponsors that include Lilly, AstraZeneca, Bayer and Novo Nordisk. Every physician in the practice is an investigator. There is no research wing and clinical wing: the nephrologist who sees a patient in clinic is the one who enrolls and follows them on protocol.
How it works, week to week
The mechanics are less glamorous than the journals and they are the whole point. A weekly research meeting reviews every open protocol: enrollment against target, safety events, screen failures, new studies under feasibility. Certified clinical research coordinators pre-screen the practice's own panel against each protocol's criteria, so a CKD stage 3 patient with albuminuria on a maximally tolerated ACE inhibitor is a chart in the system, not a billboard demographic. A regulatory specialist keeps the binders. A pharmacy and laboratory manager runs investigational product and sample handling on site. A dedicated monitor room, with its own restroom, means a sponsor's CRA can work a full day without walking through clinic.
For the physician, that division of labor is what makes research compatible with a full practice. The investigator's work is the medical work: eligibility judgment, informed consent conversations, study visits, adverse-event assessment, the signature on the case report form. The coordinators' work is everything else. A new physician here joins protocols as a sub-investigator in the first year, sees study patients during a dedicated research clinic, and attends the weekly meeting. Nobody asks a first-year attending to write a protocol.
What it does for patients
A practice-embedded site cannot afford to treat its patients as subjects, because they are its patients before, during and after the study. That changes the experience of participation. The physician explaining a trial has known the patient for years and will see them next month regardless. Study care is provided at no cost and insurance is never billed. Routine care continues with the same physician in the same office. And the patients of a mid-size Southern city get first access to therapies that will not reach the standard of care for years: the CSRA had patients on SGLT2 inhibitors for kidney disease and on intensive blood-pressure targets while those results were still embargoed.
It also changes retention and data quality, which is why sponsors keep coming back. Participants who are recruited from an existing relationship keep their visits, and the investigators who know their histories catch what a first-visit screener would miss.
What it does for a physician's career
Staying current is structural, not optional
An investigator reads protocols, attends investigator meetings, and sits in the weekly research review. The result is that the practice's physicians encounter each new class of therapy in the trial phase rather than at the first sales call. Over a career that compounds: SPRINT, DAPA-CKD, vadadustat, and now the incretin, aldosterone-synthase and anti-miR programs, each learned from the inside.
The credit is yours
Site investigators are named. Practice physicians here are co-authors on the New England Journal of Medicine papers for the vadadustat program and DAPA-CKD, and a SPRINT site investigator leads the institute. A curriculum vitae built in a practice-embedded site carries publications, sponsor relationships and investigator meetings that a purely clinical career does not.
Research income belongs to the practice you own
In a physician-owned group the research institute is part of the group's economics, and its investigators are the group's owners. That is a different arrangement from an employed position where research is an unpaid obligation or a hospital's revenue line, and it is one of the reasons a partnership track matters more than a starting salary.
The work stays interesting
The honest reason most of us do it: the clinic is better when part of every week is spent on questions nobody has answered yet.
Questions to ask any practice about its research
Whether or not you talk to us, these separate a practice that does research from one that hosts it.
- Who owns the research program? The practice, a hospital, or a site network? Ownership determines who sets priorities and who benefits.
- How many physicians are investigators? If it is one or two, research is a side project; if it is every physician, it is how the practice works.
- When does a new physician join a protocol? First year, or "eventually"?
- Who does the regulatory work? Ask to meet the coordinators and to see the monitor room.
- Is there a weekly research meeting? Ask to attend one during your visit.
- Which studies are enrolling right now? A practice that publishes its enrolling studies has nothing to hide about its pipeline.
- Where does research revenue go? To the group, to a hospital, or to a third party?
- Whose names are on the papers? Site investigators should be able to point to authorship.
Our own answers are on this site: the studies enrolling now at /scri/studies, the institute at /scri, and the physicians at /physicians. If you would like to see the weekly meeting for yourself, tell us on the careers page and we will build a visit around it.
Sources. SPRINT Research Group, N Engl J Med 2015; Heerspink et al. (DAPA-CKD), N Engl J Med 2020; Chertow et al. and Eckardt et al. (vadadustat PRO2TECT and INNO2VATE), N Engl J Med 2021; Southeastern Clinical Research Institute study records, 2026.