Millennial REIs are finishing their fellowship programs and entering the workforce. With this passing of the torch, change is bound to happen, but what kind of changes can we expect? On this episode of Inside Reproductive Health, Griffin talks to Dr. Pietro Bortoletto, an REI Fellow at Weill Cornell Center for Reproductive Medicine. Dr. Bortoletto shares his thoughts on the future of REI clinics, both privately-owned and academic, and how the millennial doctors can make a positive impact on their patients and the field as a whole.
Get to know Dr. Bortoletto by visiting pietrobortolettomd.com or follow him on Twitter @BortolettoMD.
Learn more about New York’s new insurance mandate for fertility coverage by reading this article from RESOLVE.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
Other episodes mentioned in Episode 50:
Episode 41, Dr. Eduardo Hariton
Episode 1, Dr. Valerie Libby
Episode 14, Dr. Serena Chen
Episode 42, Dr. Jamie Metzl
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES: Today on Inside Reproductive Health, I’m joined by Dr. Pietro Bortoletto who attended medical school at Northwestern University; who completed his residency in OB/GYN at Brigham and Women's in Boston; who now gets to live his dream as an REI Fellow at Weill Cornell Center for Reproductive Medicine. Pietro knew that he wanted to become an REI from very early on in medical school. His interests in fellowship center around application of IVF for disease prevention and investigating novel delivery mechanisms for fertility care. He wants to take the field of REI into its next 40 years of existence, which is why he's on the show today to talk about a more inclusive, data-driven, and patient-friendly specialty. Dr. Bortoletto, Pietro, welcome to Inside Reproductive Health.
DR. PIETRO BORTOLETTO: Thanks, Griffin. And I really appreciate that introduction and I particularly appreciate the emphasis on “from Boston.” We all know what that is code for!
JONES: Yeah, and don't worry, there's no digs for New England Patriots fans... oh, but of course there is!
BORTOLETTO: I’m now in New York City, so I claim no responsibility for the Patriots anymore!
JONES: That's good. I want to talk a little bit about the interests that you have. I mean you mentioned in the bio, an interest in an REI very early on in your medical career, but I've also noticed just an interest from you in the business side. We engage a lot on social media--I see what you're retweeting and who you're engaging with. When we first met, you were already familiar with my show and some of our content, and so it clearly shows an interest in the business side or an interest in beyond what's immediately clinical. So maybe a little bit about why you were drawn to REI so early on, but also why you find the business application or the tangential applications so interesting?
BORTOLETTO: That's a great question. I think the field is going through a very active phase of evolution. The field’s only 40 years and I don't know that there are many fields in medicine that can say that something where the founders, the people who are the first at doing several things are still around and still in practice and still teaching the next generation of physicians that are going to be doing this, but also taking it a step further. And when I was a medical student, I had an appreciation for that during one of my elective rotations that we have. And I knew I wanted to be an OB/GYN and after having a short time that I did at Northwestern and Reproductive Endocrinology Clinic, I realized this is a really unique field. This is a field that, unlike some of the other areas of OB/GYN, it was really going to take off and it's going to take off in a couple of interesting ways. I think one of them is that the field can evolve from a concierge, elective, boutique subspecialty, something that’s really no longer commodity, but actually just healthcare period. It's been a couple of years now that the WHO said that infertility is a medical condition worthy of treatment. And I think we’re super slowly starting to catch up within the fields from a policy level, both state and federal, to have infertility really find its rightful place as a medical condition worthy of treatment. And I think it’s this generation of physicians were going to training now, that are going to have to make that shift during their training, but also on they’re out in practice, adapting to that changing environment.
JONES: And so where does the nexus between what’s business come in versus what just becomes the evolution of the standard of care? Because as I hear you talk about a boutique subspecialty going to the broad application of medicine, I don't always know where to draw the line.
BORTOLETTO: Yeah, that's a good question. I don't think I have an answer for that. I think it's still very much in flux. For example, New York State, just this past summer, Andrew Cuomo, our governor, passed a mandate allowing people with large group carrier insurance to have access of up to 3 cycles of IVF care in New York state. That makes New York, I think, the 14th or 15th state with some form of an idea mandate. And there's been three in the last two years! So I think it's a march towards inevitability that more people have access. We're no longer going to be able to offer small, not low level, but small volume boutique care. We’re really going to have to adapt in such a way that we can accommodate the increase access that our patients will rightfully have to take care of their infertility.
JONES: Do you think that means the boutique practice is going to go away?
BORTOLETTO: Never. Having been in New York for just a couple of months, I can tell you that there's always going to be a role for the people that are willing to pay cash for certain services and healthcare, however fortunate or unfortunate that is, but I think what I'm most excited about is that people who traditionally haven't had access to infertility care will. I think there is a whole other subset of the population that's going to have access to IVF for medical indications. Part of that mandate that the governor passed here in New York state is the Fertility Preservation Mandate. And the wording is interesting and I’m curious to see how plays out, but it allows people how to access for medically-indicated fertility preservation and traditionally, we think of that as cancer, but they can also encompass gender-conforming surgery, and then if you're really kind of pushing the limits of that, you can think of fertility preservation for medical indication is just diminish of ovarian reserve in the young 25 year old who just wants to bank eggs. I'm curious to see how it pans out at least locally here in our state, but I'm excited about the march towards 50-state coverage for infertility in my lifetime.
JONES: I want to expand beyond the increase in access to care probably in the beginning, going to how we started off this show talking about the next 40 years of what the field is going to look like. And we can talk about the next 40 years because if some of those pioneers are in their mid-70s now, that’s how old you and your cohort will be when the same amount of time has passed. The youngest REIs are now millennials. Millennials have finally entered the ranks of fertility specialists in just the last couple of years. We've had yourself, and Valerie Libby and Eduardo Harriton on the show because I'm really interested in what this will mean. At some level, we've had millennials on staff in fertility centers for the last 12 or 15 years. But this is really the first time that we’re starting to see board-certified fertility specialists because really the youngest you can be, just by the math, as a board-certified REI is about 33 years old. So now we have our first rank in the field. We have more in Fellowship right now. How is this cohort going to--disrupt might be loaded, but I'll ask it that way anyway, or if you want less loaded--change the field in the next coming decades?
BORTOLETTO: I think the very easy way to answer that question is if you have any of your reproductive age patients open up their Instagram, their Twitter, their Facebook, they’re finally getting engaged by these reproductive endocrinologists. I think one of the things that Dr. Libby and Dr. Hariton do really, really well is patient engagement. I’ve followed them for the last couple of years. Dr. Harition and I, obviously, went to residency together, but what they're doing on social media--and others like Serena Chen, the folks from Austin--there’s just some really outstanding presence that we are now finally being able to talk to patients on a platform that they use regularly, talk to them about sensitive issues related to reproduction, and I think it's bringing more people into the conversation, more people into the fold, and, I think, raising awareness in, kind of, non-traditional ways. And that’s something, I think the first 40 years of REI did not have to work on, but I think now with increase to access, I think this is exactly where the millennials come into play. It's reaching patients in a very different level.
JONES: We’d be hardly glimpsing it to say that it's just the device or the platform either, because it really changes the format of how doctors communicate with patients and vice-versa and how patients communicate with their practice. This isn't simply just one more pamphlet to be able to employ a message, it's an entirely different way of communicating. So compare that with what we've seen thus far.
BORTOLETTO: Well, I think you can look at the clinic experience for patients. I think for the first 40 years, people just wanted to get pregnant. They think that sentiment still continues, people still just want to get pregnant at the end and the way we measure success is a live birth in many of our patients eyes. But now, I think if you look at some of the newer clinics that are propping up at aren’t academically-affiliated, that have been venture capital funding behind them, they're really focusing more on the patient experience. You can walk into any REI clinic in New York City and be greeted by a cold beverage, by light music playing in the background, access to acupuncture, access to meditation as part of your IVF cycle, and I think these are things that are millennial patients are looking for, but it's also think that the millennial physicians are thinking about your patient experience. Because IVF is tough. It is really really tough. They’ve compared the stress that people go through an IVF cycle to what patients with cancer go through. And it's all encompassing--it affects their finances, their relationships at home, their productivity at work--so I think we're finally starting to take that patient experience seriously and you're starting to see some of that creep into the quality of care that we're delivering as, let's call it, millennial REIs.
JONES: I don't know if you had a chance to read Jamie Metzl’s book, Hacking Darwin, have you read that yet?
BORTOLETTO: It's on my to-do list and everyone on Twitter is talking about, so that means it’s gotta be good!
JONS: It is good and I seldom read, but thanks to Dr. Chen having him come on the show. I did read the book before he came on and there's a segment somewhere in one of the chapters talking about the REI being a barista and serving the patients a mochacchino as she goes through her PGT counseling and similar to what you talked about of the patient experience--the cold beverage in the office. And I heard you mentioned that it’s these private equity backed firms that are investing a lot heavily into the patient experience. So I want to segue that into a notion that seems to be fact--that many younger fertility doctors are choosing to join, if not private equity-owned networks, at the very least, larger practice groups and less starting their own practice, less taking over practices from fertility doctors. Is that part of it? Is it because those firms are the ones investing more in patient experience?
BORTOLETTO: Good question. I think one of the things that we had talked about before is what kind of training do we have throughout our REI fellowship to kind of understand practice management, understand the business of ART, and I think part of it, you have to look at how people become REIs. And there's about 50 academic REI training programs in the United States--and that number varies every year depending on how many programs are taking or not taking fellows--but the fellows that are going through now, are getting academic training in large part of academic centers with a subset of them seeing what a private practice, non-academically-affiliated clinical environment looks like. So when you have people like myself, like Dr. Hariton, Dr. Libby, who are finishing their fellowship training, the next step is kind of a pretty big fork in the road--it is do you stay in academics or do you go to the private practices? And there's a lot of draw, I think, in both directions and a lot of it just depends on what you want your career in REI to look like. But there's certainly things that I think make a private practice life very, very attractive to this group of millennial REI physicians.
JONES: But I consider academics versus private practice to be the old dichotomy, where I would say now, it's not a dichotomy, but rather academics, independently-owned smaller private practice, and private equity-owned fertility networks.
BORTOLETTO: Sure. There's certain things I think that you can do in some of those groups and things that you can’t. I think academic-centered will always have the edge in a couple of areas. I think for people who have an interest and an aptitude for reproductive surgery, the academic environment is really the only one that's ever going to support that. There's just not IVF money in doing fibroid surgery, in doing endometriosis surgery, in doing reproductive surgery, and that's something that you'll miss out, I think, in some of the private practice models that we’ve built. They're just there for REI--or excuse me, they’re just there for IVF. But also, I think some of the stuff that's a little bit more esoteric and stuff that’s on, kind of, the fringes of the field looking at the application of IVF for disease prevention. I think that's stuff that's going to come through academic IVF practice. Because I think we’re going to see less and less of that work being done in some of these private groups. The focus is the young healthy patient who's looking for fertility preservation, the patient who's had a couple IUI cycles and is a good candidate for IVF. I think there will still be a role for the academic center doing IVF in the next 40 years.
JONES: Am I inferring too much by assuming that you have a lean towards academic practice? You see a preference that that's where you're more likely to go after fellowship?
BORTOLETTO: That’s a tricky question. Three months into REI fellowship, I could tell you that having been in a busy academic residency program and and now a busy academic fellowship program, I think I'm definitely someone who has an academic side to me. I enjoy the research; I enjoy being able to explore esoteric areas within our field and collaborate with other disciplines in the academic setting that allow us to kind of push the boundaries a little bit further. But that's not to say that there's a lot of good work coming out of some of the more private practice groups, especially here in the United States and some of the larger ones in Europe. Some of the biggest and best data sets that are being used to publish research are coming from some of these groups that have really thought about how to put together a research component to the clinical care that they deliver in the private setting.
JONES: Well, we've talked a lot about business training for medical students, for residents, for fellows, particularly for those who are going into private practice--if they're going to start their own, if they're going to take over for a retiring owner of an independent practice, or if they're going to negotiate some sort of partnership track or even sign an employment agreement at a larger network--these are people that need to know some level of business. They need to have some sort of business academics because there--I just wrote in article interviewing a few different associate physicians that left their practices before partnership. These contracts that are being negotiated can mean several million dollars over the course of a career. So they certainly need to have some sort of business training. I don't know that I can extend the argument to those that remain in academic practice, maybe the time necessary to devote to esoteric applications and disciplines within the realm that the academy can provide is enough to fill someone’s time. Does someone that knows they're going to devote their career in academic practice need to study business and have a business training of some kind?
BORTOLETTO: The vast majority of people who are in academic REI are providing clinical care greater than 70% of the time to support their salary. I think the way that you supplement or have support to be able to do some of the research, and yet protect the time to do administrative work or leadership within the ASRM, it comes from the clinical care that you provide. And I think academic REIs understand that and they think that the thing that they bring to the table is that clinical calling to be able to support that. To your question a little bit about do REIs need business training? I think we never get formal business training. It's not part of the learning objectives of an REI fellowship, it’s not part of the learning objectives of the OB/GYN residency, so it really becomes something that you have to lean on the people that you're training with for, kind of, institutional knowledge about how to negotiate a contract, how to negotiate your first job. I think the smart ones are also looking to include lawyers and I--
JONES: By training with, do you mean attending trainings or do you mean the other fellows?
BORTOLETTO: The other fellows who have recently gone through the process. So the more junior attending, the people who are also actively looking for a job, the year ahead of you. There's a little bit of an institutional knowledge that gets passed down year to year. I think the smart ones often have lawyers in that decision making and involving their partners who not aren't always in medicine as well and helping them decide what makes the most financial sense that they embark on the next step of their career.
JONES: Let's continue with this unverified assumption has made here--that you’re going to spend the rest of your career in the academy. Let's just do it for the sake of argument.
BORTOLETTO: Sure!
JONES: I wasn’t planning on taking the conversation here, but I haven’t explored it yet, which is how will millennials--or younger REIs, or this new way of practicing medicine--be able to change the way medicine is practiced in the academy? Because as you mentioned, with private equity firms investing so much in patient experience, there’s a lot more disruption going on there. And we’ve done some work with academic groups--and the reason why I say some and not a lot or not anywhere close to the majority is because there is so much red tape to do anything!
BORTOLETTO: So much.
JONES: And there’s so little autonomy, too. It’s amazing how little autonomy the average REI Division Chief has over their division within a larger health system or university. So how do you think that the younger generation of providers, but also of support staff, is going to be able to disrupt this? Because on one hand, I just don't see the status quo laughing forever with the levels of bureaucracy that I see. I just think millennials are incapable of tolerating it. But on the other hand, I don't see it changing anytime soon. So how do you see this younger group being able to change the structure of the academy?
BORTOLETTO: Yeah, I agree. The job of the academic physician in 2019 and beyond is to figure out what their value proposition is. Why do I need to exist when someone could go down the street and probably get a very much more boutique experience for their IVF care versus coming to see me in an academic practice, and get on the waiting list to come see me, and have a more traditional experience of the healthcare provider like they’re used to seeing their PCP or someone else. And I think this is where the millennial REI informs that decision making and that 5, 10, 15 year plan for the academic practice. And then you're starting to see a lot more academic practice invest more heavily in social media. I think you're starting to see academic practices recruit younger physicians who are able to recruit patients through social media. But I know a lot of work that you do with your private practices in your marketing is working with social media as an engagement tool, but I think by nature of hiring young REI physicians, they're going to bring that to the table because it's what their friends are looking for, it’s what they are looking for, how they choose their physicians and choose where they choose to get their health care. I think you’ll see that, but not to pigeonhole millennials into just social media, which often gets done. I think one of the things that millennials have a real pulse on is customer service. As clinicians what we're doing on a daily basis, is customer service. And I think the millennial REI is very, very attuned to what the office looks like, what the office feels like, what the demeanor of the front desk staff is, what kind of responsibilities and access your patients have to you after hours or on weekends. And that's something that I think the older generation traditionally has put a lot of weight into, but I think you're starting to see that in the younger crowd, for sure.
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JONES: There's much of an impetus on customer service. Can there be as much of an impetus on customer service in academic practice? Because if, for example, in that promoter score dips too low for a private equity-backed firm, that could be a reason to make some personnel changes. In academic practice, there's more security of well, I'm gonna be seeing these patients anyway, or I'm gonna be here anyway, and not even that it's necessarily that conscious, but just the nature of a privately-owned practice versus an academic and what their angles are. Can customer service even be anywhere near as important in academic practices as it is in private practice?
BORTOLETTO: I think in order to survive, you're going to have to see some more agility on the academic side to respond to customer feedback. I think the next several years, you'll have to see the academic practice involved. If not, they will lose market share to the private practices that are opening up across the street, down the street, across the river from you. And we’re seeing it in New York--there's an influx of private practices that are coming to the greater New York area with this mandated that’s starting in 2021--excuse me, that’s starting in 2020. So you're going to have to do these academic practices take a bold step in the direction that makes those agile like a private group, but also have a value proposition that makes you--that sets you apart from what these small practices are doing without much of a track record.
JONES: Do you think that that will be anytime soon though? Because you mentioned you will have to to survive, which eventually, if we’re putting a long enough time frame on it, I would have to agree. But in the short-term, I'm not seeing anybody or I'm seeing very few people lose cycles or lose market share simply--because the overall market is growing so robustly. They'll have to change to survive, but is that going to be anywhere in the near future?
BORTOLETTO: I think it remains to be seen. I'm excited to see what happens. I think they, like you said, there's a cohort of millennial physicians that is out practicing and is starting to climb the academic ladder. They stayed on the academic side and they're starting to be involved in promoting this clinic-level decision-making and the passing of the torch is never easy. I think you'll likely see some butting of heads and people in and out of roles and in and out of practices during the transition, but I think it's an absolute necessity.
JONES: Let's talk a little bit about a preview of what you said in the dynamic of customer service, which is accessibility and I want to talk about that because you're right, it is a tenant of customer service for really timely responsiveness and greater hours of accessibility. That conflicts with a notion that we talk about a lot, that millennials certainly talk about a lot or perhaps even better said, it is pictured of millennials, which is work-life balance. And so how do you envision work-life balance, I guess, for yourself? We could start that way before we even give it a generational application, and that tension with the accessibility of customer service.
BORTOLETTO: Yeah. It's important to operate under the assumption that an REI job isn't physically hard. There's nothing--you're not standing in an operating for 10 hours, you're not wake overnight on labor/delivery dealing with patients with complications during their labor--
JONES: My sister's an overnight labor and delivery nurse, by the way, that is very physically demanding!
BORTOLETTO: So, you know exactly what that's like! That is a physically demanding job, but what I think reproductive endocrinology is emotionally demanding. With 40-60 percent of our cycles ending with a negative outcome, a non-pregnant patient, there's a lot of the emotional aspects of job that we have to somehow balance with also a personal life. Like I told you, patients are stressed, level of stress can be very, very high, and the group that we tend to serve now--and I think it’s going to be an evolving population--can sometimes be very demanding of the experience of their pain for out-of-pocket. I think the challenge that you pointed out is how do we, as the physician, and how do I balance complete access to my patients, that they have my phone number, they can text, they can call, they can send me a photo of a rash, they can call me in the middle of the night when they wake up with spotting versus the more traditional academic model where there's a person on call for our practice and whoever you get to speak to, you speak to after hours. And I think that's really, really tricky. We've heard anecdotally that there are practices that will charge you to call the answering service after hours as a way of limiting access to overnight--making some kind of cost barrier to it. And I think most of what we're trying to accomplish when we’re talking about work-life balance, I think, is probably that--is how much to make yourself accessible to patients while trying not to detract from the clinical care that you're providing, the surgical care that you're providing, your academic endeavors and research, or leadership within the society that you're providing.
JONES: At our company, work-life balance is extremely important. It’s part of the reason why I started my own company because I wanted to be able to dictate what that is. I also extend that to my employees. And I tell my employees that when you're on vacation, you're on vacation. You're not to check our project management. I want you taking off email notifications. I don't want you checking at night. Don't want you doing work on the weekends because that's the way that we do it. I know that--
BORTOLETTO: You sound like a great boss, Griffin!
JONES: I hope so! I’m hoping that allows me to have longer term employees, and I think it actually does so I appreciate that plug! But I think it works really well for retention and morale. And I know it's not always possible, if you have someone with an ectopic pregnancy, then that's urgent and important emergency, but I think there's many things that when the impetus for quick responsiveness is such a tenant of customer service, that there is a failure or less value in some of the other processes that deliver value. And what I mean by that is I have a friend who's an executive in the field, he doesn't listen to the show so he probably won't even hear this, but he will happily take a call from a client if he's, you know, at a family reunion, if he's at dinner, he’ll step away and take the call. And he does that because that service is part of what the clients like. I do not extend that to my clients. My clients know that, generally, if they just call me, that I'm not going to just answer. I'm knee-deep in somebody else's project, or I'm knee-deep in their project when someone else calls, or it's part of that family time that I've blocked off. If they text me, then I'll grab a time that’s fairly quick, but it really has to be a real emergency for me to just pick up the phone and call someone or answer them right there, which means that we have to put so much value in the other processes. We deliver because if I'm allowing the quickest speediness of my responses to be part of the reasons why people do business with me, that means it's a crutch for less value that I'm delivering in the other process.
BORTOLETTO: I couldn’t agree more!
JONES: So we're trying to build our expertise to such a level and our processes to such a level that were only operating in that quadrant of the Eisenhower decision matrix--it's important, not urgent--so that we have very few of the important and urgent categories. And clients know that if it's important, but not urgent, we're already working on it and we're gonna get to it and there's so few of those true emergencies. How do you do that in REI medicine?
BORTOLETTO: You know, I love that. I appreciate you sharing that. I think that's what a lot of us strive for in our personal lives and our professional lives. And it's one of the frustrations. I think a lot of people have within the field of REI is that patients expect a lot and patients expect to have access to you. You'll see your scores suffer on Fertility IQ, you’ll see your reviews suffer if you're perceived as someone who is hard to get ahold of, it’s hard to set up an appointment with, it's hard to discuss the outcome of the cycle. I think all of us understand the sense of urgency with an emergency--something that requires an immediate surgical intervention, something that requires a physician to help triage--but I think there's a lot of stuff that happens on the periphery. And I would venture to say that the bulk of what we do on the periphery is conversations with patients about failed outcomes, conversations about a plan, reviewing test results, in discussing next steps, or helping to clarify some of the nuances or the complexity of the decision-making that's going on over the course of their cycle. And I think what we've seen in the last 40 years, Griffin, is that there's probably not a whole lot that has changed aside from just the traditional phone call to patients. There has also been kind of the advent of email access to patients. One of the things that I'm kind of excited about these days, and you read about it in my bio, is to change a little bit about how we deliver care. And one of the things that’s irked me is how much time is spent, I mean to physically pick up a phone, call a patient, tell them their instructions for the evening, when to come back ,and give them mixing instructions for their complicated medications--that happens every single day in REI clinics all over the country. And maybe you know the answer to this, and if someone out there is listening and wants to work on this, but I'm surprised that no one has come up with a messaging system or messaging app, a service that allows the clinic to push notifications to patients with their instructions, with their dosing instructions, have an ability to ask for a call back from a nurse to review something that wasn't clear in the instructions. And I think it's another way to give patient access, but not detract the physician or the healthcare provider from the other work that they're doing, be it in surgery or academic pursuits or, frankly, delivering care throughout the day to other patients.
JONES: I think the EMRs would say that they provide that, but I think there's just so many gaps.
BORTOLETTO: Especially with REI EMRs. Most REI practices aren't using the traditional Epic, Cerner, Allscripts, Phillips, GE medical records. Most of them are using either a mix of homebrew systems or stuff that is, kind of, geared specifically towards the REI practice. So you miss out on a lot of the connectivity that happens with the Epics, the Cerners, the Allscripts. But I think the smart REI practice is the one that's looking at how to connect with patients using their EMR in a way that minimizes the burden of the physician or the nurse having to physically call a patient, but still giving patients the access that they need, that’s expected, that there looking for in a practice.
JONES: You're very right to say this is far more than the telephone call as well because we see it. We do Community Management for most of our clients, meaning we're the ones responding to their reviews, to the comments, posts to page, private messages--
BORTOLETTO: And that’s a whole other ball game! If somebody has a social media presence, someone has to be managing that.
JONES: But we see it all the time! We will see someone like that sends a Facebook message and 10 minutes later, they're sending an Instagram message and like, I called you 14 minutes ago, I sent a Facebook messages 10 minutes ago, I sent an email 30 minutes ago, and now I’m sending this Instagram message. They really have so many different channels that they're going to view as one of these has to be the answer that gets me the response that I want. And I think it's so paramount for providers and clinics to use these media platforms: video, social media, written word, perhaps even podcasting, to reset expectations. And I try to say this a lot.
BORTOLETTO: Amen!
JONES: We get clinics in the door with marketing, but marketing is really just the gateway drug. I have to use marketing as the gateway drug because so many doctors generally don't like to invest in business development. So I show them okay, but if we're doing this for marketing, then we can return that investment and your essentially, perhaps you're making more money, but what we also really want to do is make the practice relevant, increase the standard of care to patients, increase the satisfaction of patients by doing business development. Marketing just happens to be what pays for it. And in this case, it's resetting expectations. So patients are coming to us with these expectations that we very likely did not put in their heads, but for one reason or another, they have them. And we have these media and these channels to be able to reset their expectations in a way that doesn't create a firestorm in the messaging or the phone calls as you described.
BORTOLETTO: Yeah, I couldn’t agree with you more. Like I said, amen! I'm glad people are thinking about this and working on this.
JONES: I think some are, I just think that there's so much more--I think that there's still a lot being left on the table. I think we're still seeing a really elementary use of social media across the field. I believe that and I say it more and more, but it is simply the current state of media and communication. It's not just an app on someone's phone. And so there really isn't a feeling to it. So I think I hear a lot of practices say, “Well, we do social media.” And I just think what an absurd statement that is because we’re a digital agency and we don't have it all done. There's always more to do. It's an infinite feeling and I fundamentally believe that content is the solution to a lot of our problems. And that for every single one of these expectations they make, that there's the ability to address them and there's always more to nuance and to distribute, but it really is infinite.
BORTOLETTO: While you were talking, I thought about my experience a couple of months back before moving to New York City and purchasing cable. Something as simple as the internet and phone package for my apartment. And if you go in and use a big cable providers’ websites, you have access to the information online about their different packages, but then you also get a notification that Hey, there's someone available to chat online now if you have questions! Don't have time now? What about setting up a time for a call back? Oh, don't feel like talking on the phone? You can text straight bring your mobile phone and someone can help you out. And that level of connectivity, I think, speaks to how rudimentary were applying it in the reproductive medicine field and what the possibilities are and what other industries are doing and granted, I don't think that what reproductive medicine should be doing--that level of connectivity--but I think there's a lot of parallels. And you’re spot on when you say that, we are in infancy of it and there are other industries that are doing this much better than and in a much more nuanced and progressive way than what we're seeing currently.
JONES: And that’s a really good application that I see more--I see Fertility Bridge getting involved with, but also just being applied across the field. Pietro, how would you want to conclude with our audience about what the next 40 years of the field will look like, but particularly, how you want the next 40 years in the field to look like?
BORTOLETTO: Oh, that’s so good. I think the reasons why I went into REI ore that I think this field has gone a long way. Like it’s that old quote, “We’ve come a long way, baby.” But there's so much left, I think, to do. And the things that are really exciting me about what we're doing in the field are how we can make this field a little bit more inclusive. There’s going to be patients who are going to have access that haven't had access before. They're going to come from different socioeconomic backgrounds and geographic backgrounds with more clinics open up in areas that have traditionally been underserved by reproductive medicine specialists. I think the field in the next 40 years will hopefully become more data-driven. If you’re on Twitter, if you’re on Instagram, Facebook, you’ll see the conversations that happen amongst patients, amongst providers, others, this kind of surge of add-on treatments within our field that haven't really totally been validated or shown to actually have a real clinical benefit to patients, but they're being offered in practices all over the country and all over the world. And I think the final thing, Griffin, that I'm really excited about in the next 40 years what our field is going to look like is just making it a more patient-friendly specialty. We know that this is a stressful time for people. We know that the stakes are high for them. And, right now, it’s expensive and out-of-pocket, but hopefully when it becomes less expensive and less out-of-pocket for people, we can focus on the customer service experience as we get people through this tough time and hopefully get them the family building. So I think there's a lot to look forward to in our field. I'm so glad to be where I am in my training and looking into the next 40 years and I'm excited to dive in.
JONES: Dr. Pietro Bortoletto, thank you so much for coming on Inside Reproductive Health.
BORTOLETTO: Thanks, Griffin.
You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.