Demand for Clinical Research Associates is expected to grow annually by 1.52% (5,590 new positions) by 2018 . Many sponsors and CROs are facing turnover rates that continue to eclipse the 25% mark despite an average 7% salary spike . This is a significant concern because project team stability has a significant impact for clinical studies, affecting the quality of execution, ability to meet timelines, the amount of time and energy you will need to put into oversight, and site relationships .
Any analysis of online chatter shows that some CRAs are unhappy in their positions. Why is this? On the surface, the role appears highly attractive and Clinical Research Associate makes the list of CNNMoney's 100 Best Jobs in America 2017 .
There are three main aspects that drive motivation for any role:
- Autonomy: The role of CRA is self-directed, with vast amounts of time working independently of the rest of the study team
- Mastery: The variety of tasks that CRAs face means they are constantly learning and satisfying this need for mastery
- Purpose: Knowing that the work you do ultimately achieves treatments that can help patients all over the world is surely the definition of meaningful work
So, if these elements are inherently built into the CRA role, is there something else at play that is causing high CRA turnover? Hygiene factors are more fundamental and help prevent dissatisfaction, e.g. giving your CRA a chair will not increase motivation, but if they did not have one, their working day would become a lot more challenging! 
Hygiene factors include:
- How you are treated at work
- Working conditions
The 7% salary spike referenced by the Association of Clinical Research Professionals (ACRP) shows that increasing CRA salaries (the salary lever) achieved little success. The solution is to bring new blood into the industry, train them up, and provide the necessary support structures. However, short-term pressures mean we instead distribute the workload over our existing talent pool.
“A 2015 CenterWatch/ACRP survey of CRAs found more than one-third reported a significantly increased workload over the past three to five years.” 
“That means some CRAs are having to do more with less, even as trials themselves grow more and more complex.” 
The remaining levers are within the influence of study and CRA managers. So what can be done to help CRAs in a practical way? The working conditions of CRAs, who are often the face of study sponsors, is among the most challenging in our field. Travel is extensive and preparation for site visits and site staff questions is time consuming. We often hear the maxim, “ask your CRA”, but forget that CRA is supporting 5 studies across 2 programs with everything that entails.
Elizabeth Weeks-Rowe provides an excellent example of the importance of supervision and treating staff well in a CenterWatch article. Elizabeth recounts how, through support, one CRA was able to reduce anxiety over knowledge gaps to such an extent that “she began to trust her judgment instead of questioning her instincts”. 
2. Travel Perks for our “Road Warriors”
When you’re on the road frequently and for long periods, little luxuries that come from accrued air miles and hotel points can make being on the road more tolerable. Fast lane through security can be the difference between getting home to your family that evening or missing a flight and having to wait until the following day. Encourage your CRAs to sign up to airline and hotel loyalty programs as early as possible. Make sure that facilitation of this is high on the agenda for your travel department. Consider, in as much as possible, proactively assigning sites to minimize travel and workload. Assigning CRAs to studies based on specialized indications or therapeutic area can significantly reduce CRA burden.
3. Clinical Supports for Your CRA
Aside from a supportive working environment, make sure your CRAs have the support to answer questions from sites “on the fly”. When a coordinator calls the CRA with a patient in the clinic and asks how many blood draws should take place at visit 6, the last thing your CRA wants to do is to go through a 200-page pdf on their phone to find the answer. Technology solutions can make this process easier, or better still, install study tools that guide your investigational site staff through complex visits and procedures.
4. User-Friendly Expense Tools
Submitting expenses at most companies is painstaking at best. The collection of receipts, individual scanning, line-by-line entry, exchange rate calculations, etc. is a tedious exercise, and the level of travel CRAs undertake means they go through this exercise often. There are a range of tools available to simplify this exercise that can even be completed at the time of payment. Adopting these tools can free up CRA time and means their personal cash flow is not tied up until expense submission.
CRAs are dedicated and passionate company representatives. The commitment they show to their projects and sites would induce envy in many other industries. Support CRAs in the same way they support your studies and your commitment to them will be rewarded.
 C. Morgan, "Drug Discovery & Development," 26 10 2016. [Online]. Available: http://www.dddmag.com/article/2016/10/are-delays-clinical-trials-due-lack-experienced-cras
 M. Causey, "The Association of Clinical Research Professionals," 13 12 2016. [Online]. Available: https://www.acrpnet.org/2016/12/13/survey-highlights-growing-cra-workforce-shortage/
 B. White, "RHO," 03 06 2016. [Online]. Available: http://resources.rhoworld.com/blog/4-reasons-low-employee-turnover-is-critical-in-cro-selection
 CNN Money, “Best Jobs in America” [Online]. Available: http://money.cnn.com/pf/best-jobs/2017/list/
 F. Herzberg, "One More Time: How Do You Motivate Employees?," Harvard Business Review, 01 01 2003. [Online]. Available: https://hbr.org/2003/01/one-more-time-how-do-you-motivate-employees
 M. Causey, "The Association of Clinical Research Professionals," 17 01 2017. [Online]. Available: https://www.acrpnet.org/2017/01/17/cras-ready-hiring-bubble-burst/
 E. Weeks-Rowe, "A successful CRA is diligent and has help," CenterWatch, 23 01 2017. [Online]. Available: http://www.centerwatch.com/news-online/2017/01/23/a-successful-cra-is-diligent-and-has-help/