[Clinical research: enough players to get out there?]

Despite the presence of experienced and multidisciplinary staff is now essential due to the increasing complexity of clinical research, many national collective health contracts do not yet contemplate the new professional figures. This instability risks causing an alarming professional gap, especially for non-profit clinical research. For this reason, we would try to evaluate the extent to which the problem is widespread among Italian clinical research coordinators, verifying how much the Italian institutes have permanently integrated this professional figure into organic plant, through stable and specific employment contracts. In November 2016, when the Italian Government has declared for the first time its intention to prevent further renewal of contracts with atypical employment, we conducted a survey with the intent of mapping the extent of the contractual issues related to the figure of the clinical research coordinator. Two years later, we repeated the survey to see if something was changed and if it was any improvement in the employment situation. In November 2016, only a small fraction of the respondents (13.8%) was hired with a permanent contract, while the majority (73.2%) were employed with an atypical one. Regarding the impossibility to renew the atypical contracts due to the new Government provisions starting from January 2017: the 67.5% of the respondents stated that the issue would directly affect him. Two years later, the situation looks even worse: only the 11.5% of the respondents are hired on a permanent contract, while there is a very high percentage (74.8%) of atypical contracts, with even some coordinators who say they have been working for several months as unpaid volunteers. It is interesting to note that over 30% of staff with atypical contracts work in research institutes and research-related scientific societies, with a strong interest in non-profit clinical research. Adopt Clinical Trials Units officially and contractually recognized would be essential to bring back our nation on the top of the world health systems ranking, but yet the Italian research-dedicated infrastructures continue to be a ghost reality, deeply characterized by a continuous professional turnover and by the lack of long-term prospects. In the absence of a permanent solution, Italy is unlikely to reach the required standards, denying patients of possible therapeutic available options. Our non-profit research will pay the most for it.