The relationship between the academic cancer center and the community cancer center is undergoing a dramatic cultural change. Community hospitals across the Northeast are building fully functional cancer centers where they provide all the services necessary for cancer care. Community hospitals tell us that they are increasingly interested in hiring oncologists to serve as salaried employees in a hospital-based ambulatory division rather than hiring private practice oncology groups to staff the clinics, and are looking to become comprehensive in scope. Concurrently, academic medical centers are dealing with the dramatic changes in cancer treatment to more targeted approaches both in the standard of care and in the design and conduct of clinical trials. These cultural changes have created head-scratching moments when community and academic medical centers come together and the community center asks for access to clinical research. At the heart of the confusion is miscommunication between 2 teams regarding what is meant when a community cancer center asks for clinical research in an era of complex and genotype-directed trials.