By Jim Kremidas
By 2026, the clinical research industry will look markedly different. This won’t come from a single breakthrough, but because of a collective shift in how Sponsors, sites, and partners choose to work together. Across the Association of Multisite Research Corporations (AMRC) members, a clear message emerges: the era of experimentation is ending. The era of strategic choice has begun.
Sponsors are under exceptional pressure. Rising costs, crowded pipelines, and an explosion of point-solution technology have made the traditional “build and break” site model increasingly unsustainable. As Patricio Casillas, CEO of Rovia Clinical Research, put it, “Pharma will stop experimenting and start choosing who to build with. The winners will be organizations that can reliably deliver speed, quality, and scale across multiple therapeutic areas.”
That shift has profound implications for Multisite Clinical Research Corporations (MCRC). In a world where sponsors are consolidating vendors and principal investigator (PI) lists, MCRCs are no longer just delivery vehicles but are becoming strategic infrastructure.
Defining quality
Despite persistent cost pressure, exacerbated by manufacturing reshoring and tariff dynamics, quality is not optional. As Kurt Mussina, CEO of Paradigm Research, observes, Sponsors may talk about “all of the above,” but in practice speed and cost dominate conversations, while quality is simply assumed as table stakes.
Casey Orwin, Chief Commercial Officer of Alcanza, expects Sponsors to increasingly prioritize master contracts and long-term relationships with networks that can deliver consistency and quality across geographies and therapeutic areas, predicting that MCRCs will overtake CROs as the preferred solution for site identification and performance.
Regulators and payers leave little room for compromise. All of this points to one conclusion: MCRCs are gaining influence precisely because they sit at the intersection of these demands.
Therapeutic winners and losers
Therapeutic priorities are also rebalancing. Oncology remains the dominant driver of trial starts, joined by rapid growth in cardiometabolic and obesity studies driven by GLP-1s and next-generation incretin therapies. CNS, particularly Alzheimer’s and movement disorders, continues to attract investment, while vaccine research, once a growth engine, has become volatile. Jeff Kingsley, Chief Development Officer of Centricity, is blunt: vaccine work has been “too unpredictable and too detrimental to site organizations,” pushing many toward more stable chronic disease portfolios.
This evolution is placing new strain on the workforce. Experienced investigators and coordinators remain in short supply, while the industry simultaneously demands new skills in data science and AI. Nick Spittal, Chief Operating Officer at Velocity Clinical Research, describes a growing bifurcation between digital natives and tenured professionals struggling to keep pace with change, creating both urgency and opportunity for training and upskilling across MCRCs.
The role of AI
One of the strongest accelerants of change in the clinical trials industry is artificial intelligence. What was piloted cautiously in 2024 and 2025 moves firmly into production in 2026. Mona Alqam, US Country Head of Pratia expects “AI-native clinical operations” to define the year, with feasibility, pre-screening, and risk-based monitoring driven by models embedded directly into electronic health record and site workflows, rather than layered on top as add-ons.
Nick added that this shift will extend all the way to the patient interface. “Voice and chat AI for patient pre-screening will become routine,” he notes, reflecting how quickly both organizations and patients have normalized AI-mediated communication. The differentiator, members agree, will not be who has access to AI, but who integrates it into everyday clinical operations.
2026, the year of consolidation?
At the same time, consolidation is reshaping the market. Site networks continue to roll up, CROs combine to differentiate by scale or specialization, and technology vendors face an increasingly unforgiving environment. Kurt expects many clin-tech platforms to “consolidate or evaporate” as buyers tire of “the next shiny new thing powered by AI”. The crowded vendor landscape is giving way to fewer, more integrated platforms that can actually deliver operational value.
In 2026, scale alone will not be enough. The market is rewarding governance, integration, and the ability to plan, not just place, clinical trials. For MCRCs, this moment represents a shift from participation to leadership in shaping the future of clinical research.
