Monolithic pixel detectors integrating sensor matrix and readout in one piece of silicon have revolutionized imaging for consumer applications, but despite years of research they have not yet been widely adopted for high energy physics. Two major requirements for this application, radiation tolerance and low power consumption, require charge collection by drift for the most extreme radiation levels and an optimization of the collected signal charge over input capacitance ratio (Q/C). It is shown that monolithic detectors can achieve Q/C for low analog power consumption and even carryout the promise to practically eliminate analog power consumption, but combining sufficient Q/C, collection by drift, and integration of readout circuitry within the pixel remains a challenge. An overview is given of different approaches to address this challenge, with possible advantages and disadvantages.