INSIDE REPRODUCTIVE HEALTH PODCAST

Ep. #37 - Confessions of an IVF Marketer, An Interview with Griffin Jones

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We’ve flipped the script on this episode of Inside Reproductive Health and interviewed our esteemed host, Griffin Jones! Stephanie Linder interviews Griffin, founder of Fertility Bridge, and learns the mission of Fertility Bridge and why he chose to help the field of fertility. Griffin also shares his thoughts on who is doing well and what clinics could be doing to reach more patients and make their mark on the field as a whole.

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.

STEPHANIE LINDER: Hello everyone and welcome to Inside Reproductive Health. Today our guest is Griffin Jones, who is the founder of Fertility Bridge. After seven years of internet marketing across several business categories, Griffin Jones started working with a local fertility clinic in his area. Griffin quickly learned that the infertility community is a tribe of people like no other. Rather than operate with outdated and generic healthcare marketing advice, Griffin began to re-engineer the entire process of how someone dealing with infertility goes on to select their fertility specialist. And for this reason, he founded Fertility Bridge, which is a communications and digital media firm addressing the unique needs and choice factors involved in selecting fertility services. On top of all that, Griffin also is the author of the Fertility Marketing Blog and an amazing ebook called The Ultimate Guide to Fertility Marketing. He's a proud sponsor of Resolve, ASRM--which is the American Society of Reproductive Medicine--and the Association of Reproductive Managers, ARM. He's also a recovering Buffalo Bills fan and a consummate student of human behavior. So, Griffin Jones, welcome to your own show! How does it feel to be on that side of the mic?

GRIFFIN JONES: It feels like I'm probably out of a job now. The last thing that I had totally down was being the host of the show and I feel like you just yanked it from me. So thank you for interviewing me on my own show, Stephanie Linder. I want to introduce you, too. I'm happy to have this opportunity that you would offer to interview me for my own show, but it's sort of a bit of a homecoming for you because you did help get Inside Reproductive Health off the ground.

LINDER: I did. Yeah, it is kind of a full circle! And I remember the original discussions about this, and some of the plans, and I remember you telling me what you were going to do--”I'm not just going to do another podcast that talks about patients or advocacy work.” And as wonderful as those are, when you were telling me this idea of talking about the business side, I was like, “Man, that's actually a really good idea!” And I know! I mean, I've been in fertility for almost eight years. I worked at a fertility pharmaceutical company, I worked on the tech side, I actually worked for you for a little bit when I was traveling and freelancing doing some marketing and content writing. And then now, I'm actually working for a fertility clinic. So I've seen several different sides of the business. So I feel like that lends me to have a really good conversation with you!

JONES: So the audience might think this is just going to be a therapy session and you’re the qualified therapist because you've been all those corners of the field, and you're seeing a lot of different sides of the dynamics and the relationships, and I think you're qualified to ask the questions, and for us to just go down the rabbit hole like we do on the show. But I'm excited for it!

LINDER: I am, too! We did a little bit of an intro talking about how you got into fertility, but I remember first meeting you at ASRM--I think it was the one in the city--and seeing you. So there's not many guys in this fertility space at conferences that are seemingly 30 and under, and you were wearing bright red pants and definitely had a unique sense of style. And I asked Angie Beltsos, “Who is that guy? I haven't seen him before!” And she's like, “Oh, he runs a fertility marketing company!” And that had to be at like, the very, very beginning, because I know you guys have been around for like 5-ish years. So I know a little bit of your story about how you got into fertility, but I'm super curious if you can share with everyone how you got into this side of the business? And where your passion comes from? Because I know every time I've talked to you about the business and fertility, I can definitely sense how enthusiastic and excited you are about it.

JONES: We did the same thing in that we quit corporate America, and then we went and lived in South America. I just had done it a little bit earlier. I was in radio ad sales for five years, and then I did just a bit of freelancing with social media marketing in my city, and then I went down to South America. I volunteered and lived at an orphanage and it was actually from there in Bolivia that I started the company, but mainly just because I had let almost all of my clients go from freelancing before I went down except for a couple. One was a Lasik eye surgeon who would refer me to the REI that we ended up working with while I was still in Bolivia, which is where I realized the remote possibilities were open, that this person didn't care that I was in Bolivia. So then why would someone else in the country care that I'm in Buffalo when go back, if I could specialize in what they were doing. But ultimately, just as a marketer, I knew that social media, or AdWords, or SEO, are all pretty irrelevant concepts to most business owners, unless they're applied to the bottom line of that particular business. So, the jeweler doesn't really care what I did for the car dealer. The beverage retailer doesn't care what I did for the jeweler. The Lasik eye surgeon didn't really care what I did for the beverage retailer. And all of these categories that I was working with, the REI only sort of cared about the Lasik eye surgeon, because they knew each other. But I knew that I needed to focus on one category, if I want to be really relevant. Everybody is supposed to be the best marketer there is. Why isn’t everybody just a billionaire if that's the case? And it’s because there's a lack of application in one particular focus. So I knew that that was the case, then on top of that, I wanted it to be recession-resistant. I wanted it to be high-growth. Those were the business requirements. I'm still wasn't sure what it was going to be. I knew it wasn't going to be car dealers. I hated working with them. That is a backwards business that I can't wait--

LINDER: I imagine!

JONES: I can't wait to drive down whatever the strip is and your suburb--whoever's listening--to see abandoned after abandoned car dealer in 10 years. I didn't know what it was going to be, but when I started working with this one fertility center, started seeing people come onto social media saying things like, Dr. So-and-So is the most wonderful person we've ever met. Dr. Such-and-Such is the kindest--we think of him every Christmas. And they post pictures from the holidays and they post pictures, sometimes, from the delivery room on the day of delivery. And there was this overwhelming joy that I felt like I was a part of because I was the one getting this going. This particular fertility center didn't have any social media presence before and all of a sudden, there were hundreds of people over the course of the month that were commenting and talking with each other in this community we built. Well that really blew me away and too late to make a long story short, but I started reaching out to all of the people that were not having success on their journey after that. I emailed every result support group leader in America. It's how I became friends with RESOLVE because they emailed me to say stop doing that, but it was too late, because I had already had already talked to a couple dozen people. And I just told them, “Listen, I'm a marketer. I'm thinking of starting a business in this field. I don't know anything about your problem. I don't know anything about medicine. I have no background as to biology.” And I was just blown away by how much people wanted to talk to me and share with me, made me feel really valued which, you're a marketer, that's like one rung on the scumbag totem pole in the public's eyes very often, like one rung up from investment banker. And so just to have--and that's not who I am. I'm a person that has to feel useful. So to have people really grateful that I would talk to them and want to share with me about what I was doing was important. I just decided, this is it! Before I even moved back to the United States, I planted my flag in the fertility field.

LINDER: So you decided to go back to Buffalo, which is your hometown.

JONES: Yeah. Yeah. I moved back to Buffalo. So, by the time I even moved back to the United States, I already had a couple clients in the field. I couldn't have any more than the two or three that I had before I moved back, because the Bolivian internet was so lousy and it was--I still had my volunteer job down there. But, I think I moved back on like midnight on a Saturday morning and 7:00 a.m. Monday, I was making cold calls right into it.

LINDER: I've been in sales for a while and cold-calling--I give the most respect for people who could do it well and successfully, because that's not for the faint of heart at all. But it worked out clearly!

JONES: It's not the way to sustain a business. I absolutely don't believe this, it’s part of the reason why I left radio is because that was their MO, which it is cold-call, cold-call; the customer's always wrong; just get somebody to buy; don't invest anything into the actual delivery’ quality value of the service or product. That's why I left radio, but for starting all of us have to start somewhere, and I'm super sensitive when I meet young people, I meet people that are starting in our field. I make sure that I just say hello to them a little bit, I talk to them a little bit, right? Because you never know who is actually bringing it. Like, who actually is going to be the next particular person. And I know that there are, I imagine that there were people that probably just thought that you know, I would be gone in a couple months, or that any given person would. But, everybody's gotta start somewhere. If you can just help a little bit along, a successful person’s going to be a successful person. But if you can be one of those people that just gave them a little bit of a nut job as opposed to ignoring them. I learned that pretty acutely from my first year or two in the field.

LINDER: Yeah. One of my favorite podcasts, besides Inside Reproductive Health of course, is How I Built This by Guy Raz, and there was one about Yelp. And Max Levchin, who is one of the founders of PayPal, gave the guy who is building Yelp like a million dollars. And Guy Raz was like, “That's a lot of money to give someone--of course for 40% equity.” And he's like, “Yeah, I'm Max just believes, like, he just wants people to get together and get their ideas and he knows they’re probably going to fail, but he thinks those failures will help us come up with something else.” And I really respect that, because it really is so much about the people and believing in them. And you could tell people that are going to be successful, even if they did our initial idea is not, likely those people will go on to have success in something else. So, I like that that's your mantra as well. Or at least it seems that way from what you said.

JONES: I largely believe in that. I wish I had that risk tolerance and that entrepreneurial talent that I could put a million dollars against 40% equity for people. But at the very least, I could say hello to people and introduce them and at least give them a little bit of advice.

LINDER: Yeah, of course. I was to the podcast that you did with Nicole about EMR, and one of the things you said, from the marketing side, you would love if a clinic would bring you in before they even have a name. Got me thinking, like how did you come up with the name Fertility Bridge? It makes sense, but I'm sure there's lots of other names. Was there any reason or inspiration behind it?

JONES: In that respect, I pretty much agree with Gary Vaynerchuk that the name really doesn't mean that much.

LINDER: Interesting.

JONES: It's funny, because I own my own agency that does branding and creative. And you know, the things that are important to my creative director, it’s why I hired her, because I'm a minimalist in general, but it also does come in my marketing philosophy. In general, I don’t think names are important. The reason why I made that comment with Nicole was because there are so many places that have multiple names, because that's--they’re Smithtown Fertility, but overhere, they’re Smithtown IVF, and they’re Smithtown Advanced Reproductive Associates, but across the street, there's Smithtown Advanced Reproductive Endocrinology and Infertility. That was the reason why I do think for our field, that if I was starting a new, I do like some of these newer centers that have names that are completely distinct from names like that. If I were starting a brand-new, for anybody listening, I'd not have a name of that older generation name for that reason. But for me, I could have called it Connect Fertility. I could have called it Fertility Link, or something. I just knew that the fundamental thing of what we do is that patients are over here, and a clinic specialist that, what we call apart from that we also call the industry side, are pretty apart in terms of what they're looking for and what they're expecting. Our job is to bridge that gap. So I think Fertility Bridge does convey the purpose and values of the company, but I also don't think in-of-itself, it's so important, our name. Or at least in the beginning. Once you build it, then it is. It's what you make of it and once people know it. Now people say, “Griffin, Fertility Bridge,” because I hammer--and I have hammered even back when it was just me--it's not just me. It's Fertility Bridge. And know that there actually are people in leadership positions and the team is much bigger than it was. Now it’s really Fertility Bridge. But even from the beginning of me getting back off that plane to the United States, my mind was always Fertility Bridge and not “Griffin is just a freelance marketing consultant.”

LINDER: I mean, I like names that just tell you exactly what things are. So people don't have to overthink it or get confused in any way possible. That kind of leads into my next question. You know, I know a lot about Fertility Bridge, I'm sure half the people listening do, but I think maybe there's a handful of people that don't know much about your company. And like I said, I'm a fan of things that are kind of straight to the point. So if you could kind of sum up what Fertility Bridge is in whatever way you want, let's say in like 30 seconds-ish.--your best elevator pitch, if you will. How would you summarize Fertility Bridge?

JONES: Fertility Bridge is a creative agency and new business development marketing firm that helps fertility centers and businesses in the field of reproductive health attract and retain the right patients.

LINDER: Well done. It's pretty straightforward. I love it.

JONES: So what you and I were just joking about--you and I are really plugged into the entrepreneurial community, the millennial content creator, and how we really love this cohort, but also sometimes, I think they just get so far up in the clouds. And one of the big trends in that space is to say, “Don't tell me who you are or what you do? Tell me who you help.” And so I went to an internet marketing conference over the summer that was with these folks--the cool bloggers, the cool YouTubers and influencers--and every person I would talk to, when we were talking about what we do, they’d say something like, “I help single women find their passion through in-depth analysis,” like really abstract explanations. And I just told people, “I’m marketing agency for fertility centers,” and they got it. They understood what I did, who I help. So I think that anything can be taken to an extreme. Anything that’s the cool zeitgeist or buzzword or--you’re very often going to find me having a contrary opinion.

LINDER: Hey, I hear you! I know that was a good conversation, I actually had the other day outside of this recording. Just about this entrepreneurial community--and I myself spent about two years traveling and freelancing--and as much as I was inspired by it, I also found, maybe not to a huge surprise, but a lot of people just not having anything tangible. I think secretly, a lot of people living off maybe some savings that they had saved up prior to traveling, or maybe have a side hustle that was stable like teaching English, but this entrepreneur--this business that they're actually building, I don't think it was actually in existence. So it's interesting to see you go to things like this. You probably meet a lot of people with their heads in the clouds, but also you have something that you literally built from the ground up. We've talked about this before how you've never taken--you've done it all yourself, which I give you the most respect for because that is that's the hardest way to do it.

JONES: Well, thank you very much for that compliment. But you made me think of something why else we have “Bridge” in the name is I just feel like that's core to who I am. Politically, I'm very Centrist, not a moderate, I'm a very calculated Centrist of which issues and which parts of issues I think are important. If we're at some sort of party and there's a group over here and there's a group over here, I'm usually the one that can communicate with both of them and sort of be like an intermediary. I've always been that way. And in our field, one of the biggest gripes that I often have is that we don't think big picture enough from a clinical operations perspective. On this creator content side, one of my biggest criticisms of them is that they don't think measured enough or tangibly. And I just feel like when I'm over here with the Creator Crowd, “Oh here comes the business guy with his very specific KPIs, putting the damper on creativity!” And with our field, I sometimes feel like, “Here's the guy with the haircut the red pants with his crazy ideas!” And I just think, I wish that I can have both of you in a room together, so you could see how freaking reasonable I am!

LINDER: You are pretty reasonable. I can attest to that. So when you say marketing companies--there are so many facets to marketing, right? And I learned this even more so actually working for a fertility clinic now. When I was on the outside, I was like, “Oh marketing is getting new patients.” Like that's all I thought about, right? But now it's not only getting the new patients, but it's different events that you have to coordinate, working with the referring providers and making sure they have a good perception of your clinic, making sure your call center is even saying the right verbiage. How, as a fertility marketing company, how are you guys good at so many different things? What are your strategies around that?

JONES: Prioritize! You have to prioritize. I’m glad that you brought this up. You mentioned that you really saw this from the clinic side, but you also know, from being on the digital side that there’s SEO, there's paid Google Ads, there’s paid social ads, all of a sudden there’s a new social ads platform--like for using Instagram stories--all of a sudden the way we use those ad change. There's content writing. There's video, there’s a million different platforms for how you distribute, how you post video. There's themed websites, custom-built websites. And that's just the peppering of the top of the digital side. You mentioned the things that are on the clinic side. Sometimes have prospective clients come to me and say, “Hey, what would it be if we wanted everything?” And I say, “I have no idea! Tens of millions of dollars? I have no idea.” We never do everything, especially when I'm being approached by a single-physician, 10-person practice. Even with the larger groups, however, you can't do everything. So, the first thing that we do is we ask what is the goal. And we have a process for how we flush out what the goal is, because you're talking about all of these different things that have to happen in the center in order to know which ones are the most effective and necessary. We need to know what effective and necessary means against the purpose that it's trying to serve. And very often--this isn't just true for our field, this is true for local businesses--anyone whose job is not being, like, the CMO and the different marketing kpis of their job, but anyone who is a business owner, for example. When they start a marketing effort, very often when they choose an agency or buy ads or do a campaign, it's very often just to see, “Well, we heard somebody else just did this or we think that we can get this result and can we just get more patients? Can we get more customers if we're a different kind of business? In our case, it’s patients. Ultimately, can we get more money?” is what someone thinks as a business owner and if the question is that open-ended, it's “Of course, but what needs to be done in order to do that?” So, we actually slow people down in order to speed them back up. So we slow people down by making sure that the whole leadership team is on board with this is where we are going as a clinic. Part of the reason why we specialize in one category is so that we can talk about it in these terms and not talking about it in terms of just revenue or profit, but let's talk about same-sex couples, let's talk about egg freezes, let's talk about retrievals, new patient visits, what your IVF conversion rate, is what your retention rate is, what your percentage of patients that you have referred by word of mouth, or referred by an MD referral. Looking at all of these different key performance indicators and then say, “Where are we trying to go?” Now, let's put a dollar value on that and then are we going there, yes or no? Regardless, if you never talk to Griffin Jones again, or you never talk to Fertility Bridge again, are you going to go there? Because if the answer is no, then it’s not strong enough of a goal for us to get engaged with, but it's also not strong enough of a goal for any business to pursue. At Fertility Bridge, I'm looking at my whiteboard right now, we've got a revenue goal, we’ve got our employee goal, we’ve got our profitability goals. The team knows that, I know that, we agree. It doesn't matter if we--like something happens in the course of the year, that's still the goal. That's where we're going towards. So then when we get approached by different fertility conferences and they say, “Hey, do you want to sponsor this?” Or we think we're building out our own marketing plan. We're able to make those decisions based on if it’s going to get to that goal. The first thing that people have to do, Steph, it doesn't take that long, but it does take a couple hours with your team sitting down and agreeing to, “This is where we’re going.” Regardless of what agency you choose, regardless of what campaigns you do, but having the goal as the north start. That is the first step of the system.

LINDER: I like it. You clearly said, you can be very reasonable, like a very logical reasonable plan and starting point. When you say that I think about my current job and the biggest stress I have to imagine with that is getting everyone that is so busy and inundated with so many things coming at them on a daily basis. How do you get them all in the room and to agree to be on the same page and stick to that same plan? I feel like you would have to be partial therapist in addition to being a badass marketer!

JONES: That’s no small part of what a good account manager, I think, is, or any good consultant. The therapy of helping people get those thoughts out is no small part of it. For anybody who thinks that that's too fifi or too fluffy, it will come back as a bigger problem later--I promise. So eventually, the other partners--if someone is actually a key stakeholder, at some point they're getting involved. Do you want them getting involved at seven months when you've been doing something else? Or in a year and a half or wherever it might be and having them once something that is very different from what you have going on in place? Or do you want to sit down with everybody and say, “Okay, this is where we're going. This is who we are allowing to be the singular point of contact. This is how decisions are going to be made.” And just brokering those terms in the beginning based on where you all agreed the business will go, as opposed to then having to agree on all sorts of arbitrary decisions that pop their heads up along the way.

LINDER: I mean, I totally agree. And I think in sales, sometimes I know in the past, I've been too afraid to push to get all the right people up front because it is a lot more work. But I've learned the hard way how that comes to bite you in the butt down the road. You have to do the work and if you have to say no to the customer because they're not willing to get everyone in that room, then it's worth it to say no, in my opinion. I don't know if you have a different opinion about that.

JONES: There's way more things that can collapse the sale. Yeah, it is harder to close the sale if you're trying to get everybody, as opposed to if you're just trying to get a little piece of something, and that maybe a Marketing Director or Office Manager could just sign off on. But, I don't want happy prospects. That doesn't mean anything to me. I want happy clients. I want people that have worked with me for years to be able to say, “What they do is really valuable and have a great process, and they're bought in.” Because if I can’t get someone to buy in in the beginning, I really am not going to be able to help them. That's what people are buying us for if they understand what they need us for is our process. If they just want some marketing firm to do different things--there are literally thousands of marketing agencies that one could Google and a lot of them can do things cheaply and quickly--if you just want one of those, Google those. But people know when they're approaching us, they know they're attracted to us because we only serve this field. I do need to slow them down and show them that it's a process though. That yes, it's our process that we built this unique system. And if you do that up front though, if you do the goal first, if you do goal, strategy, project after the strategy that's the most effective, and then continuous improvement and you don’t bundle it altogether, it's very organic how the relationship develops. But also your setting yourself up for success. And that's the order that it needs to go through. So, if there are people that aren't interested in that in the beginning, then they aren’t interested in that process, and it's just better to flush that out for us--and for them--if we know that in the beginning and not later.

LINDER: Yeah, I mean, it could genuinely just be bad timing for the clinic or the person and you'd rather know that now and say, “Okay, we’ll reconnect in six months.” So, I remember when we were first actually talking about setting up the podcast and you are saying that, “I want to push the boundaries a little bit, ask really tough questions, and be a little controversial,” which I really respected about you. So I want to ask you some questions in which will love your honest answer.

JONES: Now, have I done that in your estimation?

LINDER: On other podcasts? Pushed the limits? Well, I have not listened to all 20-something, I'll be honest with you, but some of them more than others, for sure! I wouldn’t say every single one though are you guys pushing the boundaries and really asking tough questions.

JONES: And if you think I’m being too loosey-goosey with somebody, I want you to text me and say, “You took it too light on them!”

LINDER: I will! We’ll talk after. Part 2 we’ll talk about it! But who, in your opinion, who either a company, like a technology company, or clinic, who is actually doing things the right way? Whether or not they’re Griffin Jones customer, Fertility Bridge customer or not. But I also want to talk to you about, who do you think--if you want to be specific or not--who drives you absolutely insane with the ways that they won’t change and what are those ways? So it's kind of a two-part question.

JONES: Well, the answer to that question is probably 75% of the field. As long as we're smacking hornets nests right now, let me go and do that. To the first question, I would like to give some of our clients shout outs without--I have to be careful in how I do this because (and they won't all be Fertility Bridge clients)--but I have to be careful ideas because I don't talk about anyone's strategy. But I will suffice it to say, maybe I won't say their names, but there is a clinic that we work with in Arizona that we just really like the type of people that they are. And they were the position that most clinics are in where they're not a larger clinic, where they really could have fought us and been resistant. And given the realities of running a practice that size, they have really been open to just change, and updating the practice, and serving the current patient demographic, and learning new technology, and going through that uncomfortable sort of learning. And my team loves them for it. Their patients love them for it. And so I just think of somebody like that. There's another group we work with that, I probably shouldn't mention them by name, but they know who they are, and I'm totally fine with that. They are a larger group, that's in a large network, and they taught me that this idea that we sometimes kick around of, “anyone who's the large group in the large network is the baby factory.” And a lot of independent practices and small practices sometimes rest on those laurels, and for these folks that's definitely not the case. They are really caring people, they have a really great culture, they’ve got really good morals. It showcases with how we work with them. So they showed me how like you can scale that culture and have a bigger-- For some of the folks that we don't work with, I think just culture wise, I will give a shout out to VIOS. It’s no secret we do want to work with them and people like them because they just have a pretty--it's very much guilt for this demographic. There are a lot of practices that are adapting, and some better than others. And it’s just so much in their DNA and I really respect them for that. Kindbody, I don’t really know a lot about yet. Gina's going to be on the show later, or maybe she will have already been by the time this episode airs, but I'm looking forward to talking with that about her, because I also see them very much focused on an innovative model that is requisite for this term demographic. So I'm okay with giving those people a shout out. For the ones that I feel like aren't, is just that anybody that's just not understanding that this is the world that we live in. Right now, I'm holding my cell phone. Everything is about adapting to this world and the next one which might be on our wrist, and the next one which might be in our eyes, or any other interface that we have in our homes, in our automobiles, this is the way we acquire information, the way we make purchases, the way we make decisions, the way we communicate. And if we are not diligently adapting and learning those, then we just become that old office that never got a fax machine because they couldn't figure out how to hook up. Or never got a website because they just didn't ever figure it out. And this world is moving even faster than those two examples. So anytime that I see just sort of a resistance, that does bum me out a little bit, because I think that, guys, it's not my problem. I didn't invent this. This is your problem and I can help you with some of that. Otherwise, there are plenty of people coming from Silicon Valley or Wall Street that are just happy to bypass the whole thing with a new infrastructure. So I guess anybody just doesn't understand the gravity because they don't want to put in the learning.

LINDER: Do you think that's just healthcare in general versus the rest of the industries? Because in my opinion, it seems like--and this isn’t an excuse--but it seems like healthcare is always a little bit behind as far as like keeping up with current technological trends.

JONES: So yes, it is healthcare-at-large, without a doubt, because they've been able to hide behind things like regulation or really large bodies for a while. But I'll take it even more broadly than that. It's humanity. It is a very human thing to just be okay with the status quo and not think about the next things are coming, because what you have right now is working. To learn something new is painful, especially when almost all of the folks that we’re talking about do not have extra time. This is something that would be new, that something else would have to get cut out or change, and that's a pain in the neck. And so that is a very human thing. I think I'm just super sensitive because I'm from the city of Buffalo, which was a city that got decimated by being okay with the status quo. I'm a Catholic and I see nobody but people with hair that's a lot grayer than mine and over age 70, because that was an institution that didn't want to change. And I'm really sensitive to how it just sort of sneaks up on you. I think, for those people that are a year out from retirement, you're a year out from retirement, what can I change? But for those folks that are only 10 years out from retirement or more, just look how much the world has changed in the last 10 years, and you think it's going to be more or less to the next ten, you think it's going to be slower or faster?

LINDER: I would say faster just a crazy guess there. To add on to that though, and be a little bit defense of the health care providers. I think now, more than ever, doctors are also learning to be business people, right? Both nurses and physicians go into medicine to genuinely take care of people and now they have to worry about, especially in private practice, like reproductive endocrinology, which is very different than maybe some other specialties that are getting purchased up by big healthcare systems, now they have to think about optimizing processes and all these--how to potentially make sure that the patient is happy with a portal because they’ll judge a whole practice based on the fact that they can't access an EMR portal on their phone. That's usually not what's in their DNA, so I can understand why maybe some facet of health care has been slow to change, but with that being said--and the other half of me is just, “Too bad, you kind of just have to deal with it.” That's why you hire a good CTO, CEO, a good CMO, a good marketing agency. You delegate when you know what your weaknesses are, that's part of being a good leader, but I kind of want to just stick up there and they're sure my opinion with the fact. I went into business and marketing and sales because I love talking to people and I love networking and I love all that that encompasses. But if someone then said to me you have to be detailed project manager, I would be crappy at it and it would be really hard for me, so it's another thought I wanted to throw out there.

JONES: I totally agree with that. The reason why I wrote that series in 2018--I wrote a four-part series of just why the fertility practice is no longer sufficient on the model of the 20th century--and that's no small part of it. Because essentially the REI practice of today--we're talking about the second generation, these are the folks that left in the mid-90s, they left the universities and the health system started their own REI practice--they inherited the general healthcare practice model of the early 20th century, which is doctor owns the business, doctor hires an office manager. They hire some nurses and some front desk folks--that's the business. And that's the model it is built on. And right now, it's like imagine that's the model and we're all playing flag football. And the rules have been, we take the flag and there's no tackling, and then a group of monsters comes onto the field and just starts pacing people because they're playing tackle football. And we can say hey, we don't play tackle! They don't care! They’re playing tackle football and then taking our flag and the ball and running over the field. And I totally understand if that isn't the life for someone. I could never do my job, and then see patients and understand all these cases, and do two hundred retrievals a year. I never could, in a million years. It's already a rare enough skill set to be an entrepreneur. I bring that up partly in defensive of when we talk about these fellows coming out of fellowship and say, “Oh, they don't want to take over a practice because they're not entrepreneurial.” No! They don't want to inherit the model that you've inherited because they understand how the game is being played today. By game, I simply the competitive landscape of serving patients in the ways that they are now demanding to be served. And so I completely agree with you that if anybody sells equity of their practice or for those fellows that don't want to go into owning their own practice, I will never fault you for that. That's completely reasonable. For those of us that are saying, “Yes, we are going to own our own businesses for the next however many years, then this is the game that we're playing or the landscape that we are in.”

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LINDER: I agree. It's the way the world is moving and if you like it or not, you just have to keep up with it if you want to be if you want to be positioned as the best and brightest clinic. Other people don't always want to be in that position though. I think we talked about that severally as well as that some clinics want to grow up this rapid rate, and others are very comfortable just growing the standard 3 to 5% a year, which is the natural increase of population that needs fertility treatment. So it's very interesting to see people have very different goals and desires on how to grow their practice.

JONES: Yeah, and everything that I've said for the last five years, most people still aren't hurting yet. I think we're starting to see more people come to us where we're looking at their volumes and starting to see ok, now you're starting to hurt a little bit and economy is really good at should be a bulb going off, but I think most of the folks listening are still probably doing pretty well and they haven’t adapted at all. And it's simply because the demand for fertility services is through the roof, and the supply of providers and clinics that can serve them is much smaller. Even though the largest groups and the new players are gaining share very disproportionately, I still don't think it's hurting most providers.

LINDER: Yeah, I would definitely agree with that. What are some of your thoughts about anything, especially on the West Coast, the huge influx of patients coming in from Asia and from overseas. How do you see that, if at all, change in the dynamics of the market?

JONES: Well, it has to be changing the dynamic of the market somewhat, right? My hypothesis of how it would be changing would be that it's probably sucking up more doctors to that area because there's more demand. So California is already a high-demand state or, excuse me, is already a high-recruiting state and probably even more so for that reason, especially because not only are there more patients and more cases, but also relative to each case, typically more profitable because you have these International patients with so many needs. So that would be my guess. I’ve never looked in to see if that is actually the case. From a public relations standpoint, I do think that we really shouldn't ever be doing anything that we can't justify in front of a press conference and also haven’t justified for a long time. In other words, if somebody finds out about us doing something, they should be finding out about it from us and we should be able to justify that in our own hearts because we think it's the right thing. And so that might very well be the case for a lot of these groups that are serving certain populations. As long as they can do that, fine. And I think they should because the alternative is, “Wait. Hang on a second IVF costs $20,000 a year here, because you're bringing all of these patients? And there's an eight-week waiting list because you're helping someone have a specific sex? Or you're providing them services that are illegal in their country? And we can’t even see a specialist or if we do, we’re paying our life savings and putting on a second mortgage on our house?” So I do think that any of these things that we do in our field, we have to be able to say why we're doing it. And so I put people on notice for that. And I don't know if that’s necessarily a change, I'm just always expecting The Huffington Post, or the New York Times, or the LA Times to run some controversial story about our field, about one of my clients, about one of my friends. I'm just always expecting that. IfI feel a lot better knowing that I have already answered any of those objections morally to myself, to my patients, to my community, and I do see that as being a snare that could get somebody caught up.

LINDER: I think that's a completely fair statement. It's a good life role in general, right? Even nowadays, you know, you see people's text messages now, somehow if they’re involved in a scandal now, they're all over the news media and you’re like, “Man, people should really remember that there's text messages or whatever and all the things that you just said as well. If they're put on in front of the public, how would that make you feel? Or do you always feel like you're doing the right thing? Just a good life rule, Griffin. Thank you for that.

JONES: It's the way I behave at a lot of the social events in our field, right? There's nothing that I'm doing that if I saw it on video that I would be like, my family, my friends, my clients, they already know that I'm a fun guy! I like to dance, but I have never, ever gotten any kind of drunk to where I’m out of control. I do not put my hands on other people. I really behave a certain way and I think that's because I'm just always counting on somebody putting something on the Internet. And if I have to say to my grandma, I was on the dance floor getting down to Uptown Funk at a social event, I'm totally okay with that! She knows that I do that! My employees know that, I do our clients know that I do that. But if there's something where like, “He's a different person than he portrayed over here,” I guess I’d probably be naive to say that I could accomplish that a hundred percent of the time, but I am hyper vigilant of it.

LINDER: I think that's a smart thing, in general. You talk to-- I always see at, like we were saying earlier, at RESOLVE, at ARM, at ASRM, you always do a nice job of going to the conferences and doing a nice job networking. You obviously have multiple clients, multiple friends in the industry. As a fertility marketing expert like, what do you think will be the trends and what will be the fertility landscape in five years? Or ten years, let’s say? Whatever time frame you want to choose. What will be the major things that are different from what's happening today?

JONES: So when I make predictions, I try to just look as opposed to saying, “Hey, here's what's going to happen.” I say, “Here's what I'm seeing now that doesn’t show any signs of slowing down.” So one thing that--I think it was 2016 or 2015--I wrote Instagram is the thing that you need to figure out. It wasn't because I just had a feeling about Instagram, it was because I looked at how patients were using hashtags and I looked at just how that community was growing and I said, “Here it is. This is where they are.” So for the next five years, what I'm seeing now is that we finally have a group of doctors that are native to social media. It is in their DNA, it's how they communicate with people. And in my opinion, they're already the thought leaders of the field to the public. They might not all be the ones that are on stage at ASRM, or those handful of people that we associate with the thought leaders that have been around a long time. But in the public's eyes, they already are and so I see more of that happening. We were just looking at them, and they’re all female that I can think of. Maybe there will be a couple that I just haven't thought of, but my team and I were looking and wow, this is a hundred percent female list right now. So I do see that also happening, as long as we're just talking about that. I see more practices positioning themselves as female-only groups, which means that I think that there will be--I don't know if there'll be more male-only groups or just more largely male groups with maybe one female doctor, but I just see that happening more as well. Because if you have female-only groups and by default, depending on what percentages are, you might just end up with male-only groups, so I see could divide could get more split. But at the very least, I do see the positioning of female-only doctors being used more. I think that some of the folks right now that are doing mobile fertility testing are going to lead the way. I just think that convenience is everything. And to the extent that you can come to someone and not have them come to you, that's a major advantage. So I see more mobile care, more brought-to-patient care.

LINDER: Are you referring to like, Modern Fertility-type situations? Where you have at home tests? And then they come to the doctor, “Oh my gosh, Modern Fertility told me I had a low AMH. What do I do?” Are you referring to companies like that?

JONES: Yeah.

LINDER: Okay. Yeah, I agree with that. I’m very interested to see what will happen with that model as well.

JONES: I don't know who will win that race in terms of who the players are actually doing it. Or how it will be incorporated with different groups, but that delivery of care is absolutely going tobe the future of our field.

LINDER: I agree. I've I'm going to now living in San Francisco and it is so funny to live here, Griffin, because I'm from Chicago, and the markets--you know, Chicago's a major city. I mean the type of patient that comes in to a San Francisco clinic with the amount of coverage they have here, the amount of money that's available in this area, I mean these patients’ demand everything to be convenient. And I've never really seen that to this level before, so it's very interesting. And you know the companies like Modern Fertility and others are located usually in this area. So very interesting to see a slice of the future living here, is what it feels like. But I didn't interrupt what you're saying, so my apologies.

JONES: Those are my biggest predictions, but that one of just what patients demand is not going to be any more lenient in the next five years, I can promise you that. And it has not gotten any lenient in five years that I've been here! You just see the expectations are a certain way and I don't think that all of them should be met the way they are. I don't think that they’re fair, but the onus is on the clinic, on the provider, on the group to reset those expectations. Those expectations might not be your fault, but they are your problem. That's what people are coming with. So the high level of expectations in terms of speed, response time, and how people are spoken to. Making them feel like it wasn't just, “Oh, your test was negative. Goodbye.” I don’t know what adjective I’d use to describe that, but that's the expectation of the patients in five years.

LINDER: Is there any current--I guess this is kind of the same question, but with a little bit of a twist on it--is there any current void in the industry where you think like you want to shake people like come on guys? Like why haven't you figured this out yet? I know you and I have had many conversations prior to this podcast, but we talked about a while ago, the fact that infertility could not really book your own appointment online. You find that feature on websites very often, but that is just a form to fill out and then folks call you back. And we all know that doctor’s schedules are very tough in this industry. It's changing one thing often depends on the next, in terms of scheduling. So that would be my example. Like do you have any anything that you feel like is a void and you would like it to be filled? And I think, if you can think of one, who do you think will be the best position to fill that void?

JONES: I can't say what may be the best positioning, because I do talk with some people about this. Because this is a problem that I want to work on that I wouldn’t be able to do by myself. There’s different people that I think have a shot. I think if they try to do it without me, they're gonna tough it up. And I think it's gonna take a lot of us to really, really try to solve this problem as opposed to just, “Let's come up with a product and launch it.” Because there's just so many ways that that second scenario could go wrong. But if we can actually solve that, then we can make so many people's lives easier. And what you're talking about is essentially where the EMR and what would be a CRM, all come together and the tip of that iceberg is just patient scheduling. But ultimately, if we look at our patient journey we've got mapped out--we have in our company, we talk about it every week of all of these different little points in the swim lanes where somebody can become a patient or not. You talked about some of them in the beginning of the episode. But all of these different points are places that people can fall off and you'll sometimes hear people say, “Well, the people that schedule online, they have a higher cancellation rate.” And sometimes people say, “Well, I don't know that the cancellation rate is higher for people that schedule online, but it's definitely gotten higher with these millennials. Should we charge them? Should we cetera?” It's all because we don't have the system to nurture and move somebody from one point to the next. And the reason why I say I can't solve it myself is because it definitely--that solution extends into the EMR somewhere. It’s more than just a CRM, in my opinion, although it also serves as one. You would have a customer relationship management, patient relationship management our case, software that helps on our end. But on the patient side, it's just they have to be able to do things in real time. They have to be able to schedule in real time and move to the next step on their digital devices. And so I guess we could suffice it to say is like, yeah, it's new patient scheduling, its new appointment scheduling, but that really is just one application. The reason why we can boil it down into new appointment scheduling is because anyone under 35--and this is barely a blanket statement-- almost anyone under 35 hates using the phone to call and talk to a stranger. And that behavior is aging up. And for people that are under age, say 27, whatever you want to call it, won't do it. They would rather just email you back and forth and not ever schedule an appointment through your contact form. And so that real-time scheduling is definitely a problem that we have to solve. But I just think that the reason why we haven't is because it's tied into a lot of things.

LINDER: Yeah. Yeah, you’re right. I mean, that's a great point. That's just like the tip of the iceberg. It's really just making a more cultivated experience for the patient. Thinking more patient-centric rather than you know, this is my clinic and I have to do it this way because this is where I want my schedule. Is there any other industry voids in the industry? I know I kind of gave you that example, but is there anything else that you're able to share? Anything that, like, really frustrates you that you would love to see people kind of rethink? I know I have one!

JONES: From the marketing side?

LINDER: Yeah.

JONES: I think that ultimately, there just needs to be more indifferent seats delegated in the practice. Maybe if we're just talking about fundamental problems, like we talked about inheriting the model of the generalist practice from the 20th century. But the way of business is run is that there's a visionary at the top, there's an integrator that helps the visionary implement. And there's three core functions of a business: sales and marketing, finance and legal, and operations. In our case we might set up operations into lab and clinic. Even in the very largest of enterprises, those four functions are never split into more than seven. That's really a you got a person at the top, who was the visionary, who is responsible for thinking of future value. You have the integrator, who helps to implement. Then you have the people responsible for finance, legal, sales and marketing, and operations. And very often, especially in smaller practices, we have one person in charge of all of those, or they're in charge of maybe like four or five of those seats. And the reason why we keep getting into more trouble is because there isn't somebody who's responsible for looking at future value. Somebody has to consider the future value of the practice because there will always be more that comes back to the plate. We do not have more hours in a day. We do not have infinite resources. And the visionary needs to be able to say, “We're not doing this anymore. This is what's getting cut out. This is what's replacing this.” And doing it with such anticipation that it isn’t crisis mode. So, I do think that this issue needs to be solved and to be frank, I think we are seeing it solved by the acquisition that's happening in the field. I think that's no small part of why this is happening because otherwise, the doctors don't have an exit for this practice that they built for 20 years. There's not a new group of docs that wants to take over for the reasons that we talked about. And so what they can do is sell their equity to a larger group who does have that structure in place. So, I don't know if that's--I don't think that's the answer that you're looking for. The one that I'm obsessed with right now is just a digital contact, and then maybe adding chat bots and artificial intelligence to help people move around that that navigation. That's still my main answer, but this idea of how the practices need to be structured in order to compete and adapt. I think we are seeing that being solved by acquisition for good or for bad. And I don't think it has to be that way.

LINDER: What are some of your thoughts about all--I think the latest conversation at PCRS was a recent acquisition that happened and that seemed to be kind of like the talk of the industry. But what I've seen is that that can be great for some markets, but at the same time, that's actually allowing the small independent practices to have a great platform to stand on and say, “Hey, I am that small guy that's going to give you a personal touch. You're not going to feel like a number.” And some people are very attracted to that. So in some ways it's giving those people an opportunity to differentiate themselves. Do you have any thoughts about it? It sounded like you were saying that the acquisitions are a very good thing for the doctors, give them a chance to have a future set. So you have any thoughts on if that's a good thing for the industry?

JONES: Well, I don't think that they're good in a vacuum, I think they can be good for that reason. I think they could also be bad. I think it was my last blog, my last two blog articles, I write a lot more about that in detail of in what cases it would be bad and what cases it would be good. You're talking about the possible marketing advantage and just other types of attention from the industry, advantage that independent centers then and would have. And I think yes, but they really actually have to do it. And what I very often see is that smaller centers believe that they have that advantage, but they don't. And some of them do, some of them very much do, and that example that I gave you of that team that we really like working with, that’s them. But there are other people wear it reminds me of when I used to sell to restaurants when I sold radio ads, they would all say, “Oh, the chain restaurants. They don't have the service. They don't have the quality food.” And well, you stand outside and talk to the customers, they don't have a different opinion about that. They think that they're getting good service, and I gave that example of a large clinic that they really are awesome! And sometimes, some of the clinics that I see the least likely to adapt are the ones in small markets with very little to no competition because there is nothing lighting a fire up under them. And so I do think it can be, if it's real. If you really are--we are a boutique practice and we can demonstrate it, this is our culture, we know you by name, and you can actually demonstrate that. But if I come into your practice and you have a lousy culture of office personnel that don't like working with each other, they aren't great to the people. That doctors just come in and, “Ah, here do this!” And then you know the nurses don't like each other and one of them is a cancer because they didn't hire Monica Moore to tell them which one needs to be hired. If you have all of that going on, then you can't just say “We’re the boutique practice.” To be a boutique practice, you really have to be a boutique. And there are far more than say they are than there actually are. So short answer, yes, the opportunity is yes. The long answer is there are far more people that think that they have that advantage, but the patient is the one who decides. And they decide in front of everybody on social media and review sites.

LINDER: Seriously. I think that's a really good point that actually made me rethink a little bit about how I perceive a smaller practices. So that being said, this is the last question, Griffin, because I know you have many, many marketing problems to solve today. For those that are listening that know a little bit about you, or maybe want to even, like, doctors, nurses, office managers, that want to intentionally use you guys, or talk to you about your marketing services, why Fertility Bridge? Why Griffin Jones? Making them want to choose you versus all the different people out there offering marketing?

JONES: It’s because they want help with the larger problems that we talked about. If you just want somebody to do your Facebook posts, go get an intern. Or if you just want somebody to build the website, there's thousands of agencies that can do that. If you really want to adapt your practice in the ways that we're talking about in marketing being the forefront of what that positioning looks like, then we're the only ones that are taking the raps that we are. Right? We're the only ones that are only in reproductive health. I think there are some people that might have other clients in this field, but we're the only ones that this is just all we do. We talk about those swim lanes of how somebody goes from being a complete stranger to a successful patient. And then every time we fix one little issue, we’re onto the next one. Because it’s never ending. To your point of all these different things in the practice of how somebody needs to have their needs met in order to go all the way through and be a successful patient, it's just constantly ongoing. We're the ones taking the rap. And for us, we have broken out the system in the ways that--we talked about the goal in the first place, we talked about the strategy. We didn’t really talk too much about strategy. We talked about goal, the next part after that is strategy, the next thing after you had your strategy would be to have a project that is the most effective in reaching that goal from the strategy, and then moving on the continuous improvement method. That is the system that works. If you set your goal, you create a strategy for it, you do the thing from the strategy proves you can get results, and then you keep going and iterate. You do it in that order. It's successful. And we don't bundle that together. At any point, somebody could move on to the next phase by themselves or with someone else if they didn't think it was a good fit or they just got what they wanted from us. And so I just don't think there's any reason not to do the Goal Diagnostic. We set it up in such a way where it's a few hours of someone's time, it's a small investment. We tell people on the website what we're going to ask of you and what's involved. And it is really important to sit down with your leadership team--I think every single clinic should do that and it's helpful to have a third party do that. So we make it pretty easy, we just say let's do this one thing, if it's not a good fit for the next phase, that's fine. But a few hours, a few hundred dollars or whatever the investment ends up being, because it will be more expensive in the future. But just making it just so easy to have that one thing, I just don't think there's any reason that someone in the fertility field wouldn't not do it.

LINDER: Would you say the Goal Diagnostic is like a patient initial consult? Like you just come in, talk about your goals, get kind of diagnosed, and then what everyone chooses to do after that is up to them? Whether the patient chooses to do IUI, IVF at their center or elsewhere, but it is up to the patient? Would you say that is a fair comparison?

JONES: So what I tell people is you need AMH testing, FSH testing, if we’re talking about a heterosexual couple, semen analysis for the male. Then you have an initial consult. And so someone can ask you like what is it going to cost for me to have a baby? Or what's it going to entail? How long is it going to take? You don't know any of those answers until you have the first round of tests and meetings. Someone might need a gestational carrier if they want to have several different children and they need donor gametes, and somebody else just might need an IUI, right? You cannot--so it doesn't matter if you do need five gestational carriers, donor gametes, and if you can't afford it, if you don't know the answer--the first thing you need is what are the answers and we are we going? So we do that, get those answers first, it doesn't matter what you might need in the future. You need those first couple answers to figure out what the next step is. It goes in that order: goal, strategy, most effective project, continuous improvement.

LINDER: Ok, Griffin, I always love chatting and picking your brain and maybe one day we'll do a part two with me, with someone else, who knows!

JONES: I will be very happy to have that! I'm glad it was you that was interviewing me because you’ve been in so many corners of the field and you really know what I'm talking about. And so you can just like ask better questions, but also help me bring the thoughts out as some having them. So Stephanie Linder, thank you for being so kind to come on and interview me.

LINDER: I love it. Anything else you want to share with people or any last thoughts?

JONES: Maybe this is just my time to tell everybody how grateful I am. I'm so--so many people have actually become close friends. I look and I’ve got like half of the field in my cell phone and I text probably, you know, a quarter to half of those people pretty regularly. And I--and a few have become really good long-term friends. And I just want to be useful! Owning a business is kind of like just this ultimate way of gauging your usefulness because the market shows you how much it’s valued in terms of dollars and cents, but I really need to feel useful and I'm able to do that when people let me work on their problems, let my team come in and collaborate with us, that want us to help them. And so for everybody that's given us those at-bats, I’m exceptionally grateful.

LINDER: That's awesome. I think that's a great way to end an amazing podcast. Thanks, Griffin! Everyone go up and say hi to Griffin the next conference. I'm sure you'll be wearing some kind of colored pants, right? So they'll find you easily?

JONES: You know where to find me! Thanks, Steph.

LINDER: Alright, 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.

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, my guest on Inside Reproductive Health is Dr. Michael Levy. Dr. Levy is currently the IVF Director and President of Shady Grove Fertility. He attended medical school at University of Cape Town in South Africa and completed OB/GYN residency and REI fellowship at George Washington University. He has worked to make fertility treatments more affordable for his patients by creating programs such as the shared risk financial program, the fresh shared donor egg program. Dr, Levy also founded the IVF program at Shady Grove Fertility. He co-founded donor egg bank and he's on the scientific and clinical advisory team of California Cryobank. Dr. Levy, Michael, welcome to Inside Reproductive Health.

DR. MICHAEL LEVY: Thank you. I’m pleased to be doing this.

JONES: I'm interested in this conversation mainly because I want to go into the brain of someone who helped found the largest fertility group in America. Maybe I’ll back up and give a little bit of context, because I think what we assume that everybody knows about Shady Grove. There are a lot of people in this country, and other parts of the world, that are listening that are just practicing medicine in their little practice that listen to this show, and they actually probably don't know a lot about you because they don't often check out, necessarily, the other things that are happening with other people in the field--they're doing their thing. You're a group that started in Maryland, in the DC area, you now have close to a thousand employees. Is that right?

LEVY: Correct, yeah.

JONES: And how many REIs are you at now?

LEVY: I’ve started losing count, but I think 58.

JONES: 58, which is just an extraordinary number, considering that a group that had nine or ten would be--most folks would consider a big group and I'm very interested in how that starts. So you're one of many to have found this practice. A lot of people will start their own practice and have 10 people work with them, and that's a good life, and a good career for them. You got a 58 physician group with almost a thousand employees, around 950 when we spoke to Marianne Kreiner earlier in the show. Did you set out to do that?

LEVY: Absolutely not. So my goal for me, career-wise was to--well, first of all, I had a mandate from my wife that I was staying in DR. So I wasn't able to look further afield and there were no jobs available in DC. I wanted to join Frank Chango--and ultimately he became one of the partners in our practice. But my goal when I set out this practice was, if we had three or four physicians and then 3 or 400 cycles, I would have signed on the dotted line right there. So there was no grand roadmap or ambition created at a..

JONES: Well, it wasn't an accident either, because if it were an accident, everybody would have done it. How did it happen?

LEVY: So every quarter I speak to a new hire orientation, and these days that's about 25 or 30 people, which was bigger than our entire staff in 1991 when we started the IVF program. And I'll say the same thing to you that I say to them. We never had grand designs to to be as large as we are. We focus on one core issue and that led to a virtuous cycle, which I think allowed the practice to expand. Before--and you’ll know what that is, but before I articulate it properly--Patty Stull, that you probably know who is the Director of Marketing--not the correct title, by the way, she has a better title than that--but she started at the very beginning with me and about seven or eight years into the practice, when we were about 10 positions and growing rapidly, she was cornered at ASRM by a couple of physicians who said, “Okay Patty, you’ve been at Shady Grove for eight years, what's the secret sauce?” and she said, “You know, the absolute central tenant of the practice is ‘Always do the best thing for the patient.’”And immediately their eyes glazed over they said, “Stop BS-ing us, we want to know the secret sauce.” She said, “No, really!” She says, “Always do the best thing for the patient.” And I think we absolutely adhere to that, and that's allowed us to have patients feel very good and comfortable and refer their friends. For physicians to know that’s the way in which our patients are going to get treated, and what I mean by that is, not only do I need to have very good success rates, we have to be incredibly transparent with patients, we have to have financial programs that are affordable and that in turn, attracts physicians who want to work in that environment, patients and staff who want to work in that environment. We have very low staff turn over. In 28 years, we've had one physicians leave the group and that was because she got divorced and wanted to work part-time and live in Northern California. No other physicians ever left the practice and that, I think, speaks volumes to the environment. And we have a true partnership. We are 100% physician-owned and we have 28 equity partners. And the model is: everyone becomes a true equity partner. Everyone has skin in the game and feels engaged from day one.

JONES: I don't even know how to break this out with 28 equity partners. Maybe I'll come back to that because I'm really interested in how you manage the direction with 28 equity partners. But let's talk a little bit about doing the right thing for the patient. And I can see the physicians’ eyes glazing over as Patty gives them that answer and they’re like, “Alright, tell us, tell us!” What they're looking for one or two tactics, right? They’re looking for something that's a specific process that they used, or some very specific thing as opposed to seeing it as an attitude. And I wonder if that just speaks to--well, there are hundreds of tactics, right? There could be thousands! There are hundreds of different--or dozens of processes. See, there's hundreds of key players. There's however many techniques, but they're all grounded in that one virtue of doing the right thing by the patient. I think we need to explore it a little bit more because, to me, it just seems so subjective. And we were talking about this with--I think I was talking about this on another podcast interview where it's very often like the local restaurant owner that says, “Yeah, we've got the best service in town, but sometimes, they just don't. Sometimes it's a local restaurant that perceives that they've got the best service, and the place across the street does. So as you're growing, that means you've got to measure things. So now you have people in place like Marianne and Patty and some of whom started from the beginning. But, when you're measuring in the beginning, as Michael Levy, someone that starting off with a handful of docs, and now you're at 9 doctors, and you go invest, how are you measuring? How are you keeping the pulse of how you’re serving the patients?

LEVY: On a formal basis, we survey the patients on a regular basis and we get constant feedback. And we’re never satisfied, which is good in your work life, not good in your personal life. So, you know, we’re constantly pushing each other and ourselves and you know any negative feedback freaks us out. So, we look carefully at what the cause was and welcome that. I think most importantly we’ve attracted staff and retained staff who get that. And we were never good at letting anyone go, which was an early problem with Marianne and a more professional HR team. Occasionally, someone doesn't fit in, and we will let them go. But, I think that everyone is a role model for everyone else. So from the front desk, or the new patient call center here, which was a modification we made about seven or eight years ago. Typical doctors offices, yeah, you got someone in the front is checking you in, checking you out, answering the phone, and make a new patient appointment. So when the patient calls up our practice, we now have a call center in our office, very well-trained individuals who know a lot about infertility. We give them a completely different experience with that first phone call. And we look at the whole patient journey and make sure that it's going well. There's some large practices that don't give monitoring appointments--it's like, first come, first serve--you can wait an hour or two for your appointment and we are upset if the patient’s not in and out of the office in 20 minutes for their monitoring visit. We will bend over backwards because everyone knows--we had a patient last week who, with the floods in the Washington area, came in two hours late for her appointment and we had already shut monitoring down. And a relatively new front desk person was talking, saying, “Well, there's no one there, we can't do your monitoring.” And she came to be expecting I was going to say, “Yeah. Yeah, she's out of luck, she's two hours late!” And she's very frustrated, but, you know, and said that she was two hours late, but she showed me a video of the basement flooding. We turned the machines back on, and we got staff, and they did her monitoring visit. And there was no question that that's what we would do. And I'm sure many, many practices would do that, but we are also modeling that for the staff, so that person at the front desk knows that next time, this should be no question that we can accommodate a difficult situation for a patient. So, I think you create a warm--and when people come and visit our practice, almost across the board what I hear is, “What do you put in the water? You know, everyone seems happy! Everyone seems in to it!” We remind our staff that we so lucky to work in this field--unbelievably motivated patients! We transform lives when it works and we have to help them through the difficult journey when it doesn't work. And we need every one of those people to feel the support that we give them. And we do really well about patient satisfaction surveys, but not unbelievably well. And I'm much more anxious about it now, given our size and our geographic diversity than I was with our staff meeting was 15 people in the entire practice.

JONES: I love that you just said that. You’re coming from a practice group that is doing very well just in terms of what the practice is doing. And when you talk about the patient satisfaction survey, “Well, we’re doing well, but we're not doing that great in terms of what I would want us to be doing,” and I think that is pretty telling. I often hear people think, “Oh, we've got the best patient satisfaction,” whether they're looking at any surveys or not. And I often think about a lot of different groups. I just think not hungry enough for me--you're not enough paranoid enough for me that somebody else could be serving the patients better. And I try to run my businesses the same way. With every single thing, “We could be doing that better. This is pretty good. We had a lot of success with this, but I'd still like to be doing this much or have the client this happy instead of this happy.” And I think that's the really important attitude. I also think the example that gave about a woman comes in, she's two hours late, she shows you the video on her phone of her basement flooding, you make the call to turn the machines back on and get her in. That particular example--I think is some version of that, is one that I hear small practices tell a lot about the advantages of a small practice. That large groups don't or can't do. And here you are bringing about that particular example for you. How do you though--is it you, Michael Levy, that can make that call? I mean can an associate doc make a call like that? How do you--when it's your practice, and it is eight people on your staff, it's pretty easy to say, “Okay. This is my bottom line, my top line, I can make a call if I'm going to help somebody out.” Once you’ve got 58 doctors and 950 employees, it's a lot harder to make these judgment calls. So you can make it in your practice, but can other folks and how do you maintain that? If you can?

LEVY: So that's an important point. One of the things that I say to all the new physicians and all the new staff is we want fresh eyes to see situations, and make it better, and empower people. So, I’d be really disappointed if a staff person that had been with us for one week didn’t make that same call. I'm pretty easygoing and I never want to make anyone feel bad about anything, but I would sit someone down, and expect any physician in the practice to sit someone down, and say, you know, accommodate the patient, that's the culture. We had a physician join us, who is a senior partner now, and he’d been in practice elsewhere, and in his first couple of weeks, he had an embryo transfer and there was some communication issue between him and the embryologist, and he was frustrated with it. And he walked into the lab and he started yelling at the embryologist, and everyone, like, looked around and crack that! Like where the hell do you think you are?! You know, that is but what happens at SGF. If there's an issue, you come and discuss it, we’ll explore it, we’ll make sure it doesn't happen again. But that type of hierarchy, that type of bad behavior, just doesn't exist. And what was great for me was, it's organic to the practice of this point. So it's not that we're not a very hierarchical organization at all and everyone who has been here awhile gets a culture and buys into it and reinforces it. So it's not just, I could make that call, or half a dozen physicians who’ve been here for 20 years could make that call, we empower people. The physicians know more about the business realities of this practice within a week of joining us than many physicians do having worked somewhere for ten years. And they've got the you know, seen the partner who is keeping everything close to their chest. So transparency and empowerment are the core of our model.

JONES: That's part of the culture and you say it's organic, but as you start to grow, partly by acquisition--and you talked about that 58 physicians, we had one leave and that time one left for personal reasons--I imagine that doesn't mean doctors of practices that you've acquired, but as you start to acquire practices in other areas, how do you make sure that it fits with that organic culture? Because you've grown it through beginning. You're in the offices in the DC area, you and the founding members now. And once you start to get to other states, you're further away from that base. And you might be hired, you might be buying practices of people that have no problem dog cussing their embryologist in front of the rest of the staff. How do you part ways with them, if that's the case, or get them on board? How do you decide what's the route there?

LEVY: So I think it first goes along with who you partner with. So many of the physicians who have joined us, we've hired, we just know they're good fit and they have the right combination of clinical skills, personal commitment, entrepreneurial instincts, and we want them on the bus. And when we’re looking at a practice to acquire, that is probably the most important issue: will these doctors fit in with the culture? It could be a great business opportunity on paper, but if, on a personal level, you've got a very egotistical physician who is never going to let go, it's a bad start for them and for us. Because you know--but at the same time we don't straitjacket and the personality of our Tampa office, and our Richmond office, and in Philadelphia, will be different to Rockville, but they have enough commonality. So one of the other critical issues we have is we meet on a regular basis. So, three out of four Monday nights, we have physician meetings. We have a clinical meeting, we have the general club, we have the business meeting, everything is discussed. And as I said, it's important, that transparency. So that helps build the culture. And one of the things--we had a very difficult situation a week ago we had to deal with, and the senior partner in Richmond and the senior partner in Atlanta both spoke up in such a moving way to say, “We get the culture, we get how this needs to be handled, and we're fully on board.” And that may not have been the case, and I think it's a combination of we had the right people who we merged with and acquired, and they got the culture and recognize that the greater good is served by all of us reinforcing it. We're not competing with each other, you know, our compensation formulas are very well-balanced and fair, largely rewarding productivity, not seniority, not equity. In fact, the opposite is the case. You have to sell your equity at 65. We did not want to have a top-heavy situation where you've got, you know, a 70 year old physician working part-time and trying to take the lion’s share of the income. You’re phasing out at 65.

JONES: Now, of all the 28 equity-holding physicians, do they all come to those meetings and they all go to the business meeting, via video conference or whatever means?

LEVY: So not only that, but all 58 physicians come to the business meetings.

JONES: Every Monday? Excuse me, every business Monday?

LEVY: So now we’re probably down to two out of four Mondays a month we have a meeting, because it does become unwieldy with 58. So now we have an elected board and no one has tenure on the board. So anyone can get voted off every two years. So we have seven physicians on the board that meets every Monday with our executive team. We have a shareholder group with everyone with equity, which is 28 physicians, and that's a quarterly meeting. And then a business meeting, I think we have one or two a quarter. All physicians, associated physicians, know our revenue, know our profit, know our expenses in detail from day one. We've always held that transparency as a key to the culture/ And it's interesting because new physicians who’ve never been another practice take it for granted. They like it, but they don't know any different. And then physicians who’ve been in other practices are really enthusiastic about having that level of inside and transparency.

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JONES: We had Louis Weckstein--Dr. Lou Weckstein from RSC-Bay Area on the show as well and he talked about how his partners and the physicians at his group meet and they meet each Monday and one Monday a month. They talk about business with 58 physicians, that's a lot harder. So I see the importance of having a group. But, I can't stress the importance of reserving time for all of the partner docs to talk about business. Not just, “Oh, let's pick a time here and we will get to it,” but then so-and-so's on vacation, something happens to so-and-so, and then someone else is covering their patients. And those meetings that are supposed to happen every two weeks, happen every six weeks or every two and a half months and so on. And the time of reserving the attention and focus for everybody to meet and talk about the practices of business, I don't think can be understated. And to me it often seems that the smaller the group, sometimes very often, the less likely that is to happen. One of the things that we do as a company when we start working with someone, is we need to make sure that they have the time, focus, and attention to be a part of whatever engagement that we go through with them, which is why we start off at a very small, little level. People sort of can't get into that little level, they want to do want to jump forward and say “Well, can’t you just put together some service package for us?” And I say, “I'm not going to put together anything that is destined for failure.” And if there isn't the ability of the leadership to say, “Okay, this is important.” Then there isn't the ability of the subordinates underneath them to say, “This is what we need to be working on because we know it's important because leadership is meeting with us on it frequently.” How do you decide who gets on that board? You said it's not tenured. So people can sometimes--people leave. You said at 65, people start to phase out. Is the board sort of a volunteer? We work with some bigger practices that they have at the marketing committee with some of the partners, and you might have a finance committee, and other types of committees, but how do you decide who sits on the board?

LEVY: So it's a mix of our shareholders. So we have an election every two years.

JONES: Which are the 28 physicians.

LEVY: That’s right.

JONES: Now, it's different because your a group that is entirely physician-owned. One of the concerns that a lot of people have is about the consolidation that's happening in our field from groups that are backed by private equity firms. And it would certainly be easier to become the largest fertility group in the country if one had private equity, that things can move really fast, or venture capital for that matter, you haven't yet. So I'm assuming that means that there's some concern, but that's an assumption. Do you share the concerns about what's happening with consolidation? And if so, what are they?

LEVY: So I think that there are many facets to that. I was going to disagree with you that it would happen, you can become the largest group more quickly, if you have private equity. I'd say the opposite is true, because I think you get distracted by quarterly performance, and you have pressures that don't allow you to be as strategic--especially if they are on a short-term exit plan and they try to micromanage without the clinical insight and experienced leader. You know, they may be very well-trained business people, but it's not widgets. And I think that, to a certain degree, private equity is discounted the importance of individual physicians and how much of an impact that has on the practice that they are appropriately motivated. You know, we probably get to calls a week from private equity groups wanting to get into the space and we resisted that. At a certain point, we’re going to have capital needs that we're going to have to address, but we've managed to finance it internally with that and the bank funding. And it is tempting, to be honest, but I think that our structure is such that it precludes all the physicians wanting to exit and get a nice multiple for private equity. Because if you;re 35 years old that a new partner, you’re not as excited about private equity as if you're 60 years old. I happen to be 60 years old, but I like--my primary responsibility is to the practice and to the 35 year old doctors in our group. And I’d be a voter which is good. So I think looking long-term is important for future growth and private equity doesn't look as long-term. We recognize that there are probably four or five networks in the country, most of which are private equity-backed at this point, and they are good competitors. But when I started in practice 28 years ago, a really lovely colleague in the area said to me, “I'm sorry you weren't able to join us because there was no space, but it's a big space with lots of patients, and we’ll all do well.” And that was true then and it's true now. I think the market is underserved. I think we're too expensive. I think that there are patients who don't have access to care who should be accessing care, and we find ways to accommodate them the whole pipe grows and we'll all do well.

JONES: This could be an entirely different topic, but maybe it's worth bringing up--because I really agree that the market is underserved. I talk a lot on the show about the interior of the country, especially because I think we're seeing even more disparity. A lot of younger REIs are moving to the DCs, Bostons, New York, Los Angeles, San Francisco, and very often, the only doctors moving to the smaller markets are those that are from there. They grew up there and they just want to be by their family. Those practices are having a much harder time recruiting folks. And I think that ultimately limits the number of people that they can serve in those areas as well. And this might be a little of a side topic, but did you talk about we're too expensive. I had Rob Kiltz on the show to talk about that particular topic, and I could probably have more guests just to talk about that. Why are we so expensive when so much of what we do is cash pay? The criticism of healthcare and why healthcare’s costs increase while most consumer technology costs goes down, is that it's because you have the government, or insurance whose not really insurance because so much of their liability is mitigated by the government, or someone else inflating the cost--in our field, the majority of it is self-pay at least for IVF. And so why are we still so expensive?

LEVY: You're touching on the topic that I'm very passionate about. I have always looked at ways to ensure better access to care. And if you look at our field, the rate of inflation and IVF is much, much lower than in other fields of medicine. One of the facts I'm most proud of is when started the Shared Risk Program in 1992, our package was $19,000, which included up to six cycles fully-funded to have a baby. We just modified our Shared Risk Program into three tiers and for patients under the age of 35, we reduce the price from $21,000 to $19,000. So 28 years later. it’s the same cost. That's the opposite of what's happened in medicine. And, by the way, as you obviously figure out immediately, we do much better because our success rate is double. As technology improved as it does in other areas, you should become more cost effective. I think the fact that there's such a huge barriers to entry allows practices to charge more, which is problematic. Your costs do go up in general, so our margins are lower now than they were 10 years ago, our pricing has not kept pace. I'm also very frustrated at the cost of medication. I think this is a problem across the board in medicine, that the cost of gonadotropins have more than doubled in the last 20 years. And, certainly, the cost of an IVF cycle has not come close to that. So whereas early on, it was about 20 percent of the cost of an IVF cycle, now could be 50% of the cost of an IVF cycle. Especially when the prices are--I’m going to bash for a little bit here with this opportunity--but especially when you look at Europe, where the cost of gonadotropin is a fraction of what our patients pay here. That's very problematic. So we’ve got a whole health care system that’s messed up. I do believe-- and I'm not I guess it's ironic given my career--but I'm not that much of a capitalist at heart, but I do believe in transparency and price competition. And I think the fact that it's a self-pay market, has kept prices down. If you look at the cost of the knee replacement 28 years ago versus IVF, and you look at it now, it's exponentially higher with the rate of inflation, with the knee replacement. Because patients are looking closely. I could go on and on about this topic and I'd love to talk to you about it again. I became very interested in it. In our practice, our health insurance is our biggest expense after occupancy. And we're now exploring becoming self-insured, because we want to control costs better. And I think medicine has failed dismally at controlling costs. And I do think, if you look at the rate of inflation in infertility, it's much, much lower than medicine as a whole.

JONES: I think we definitely could have you back on about that, but it does explain why you got into some of these other ventures. And I want to talk about how one gets in them, because I think a lot of--especially principals of fertility groups--have the opportunity to maybe be a co-founder of a new software, a new EMR, a new, maybe an opportunity to get involved in physician-owned pharmacies, or a number of different side ventures, sit on an advisory board for some large tech start-up or existing pharma company. One of the things you started with, this passion you talk about, why you started the shared risk financial program. Then you also helped co-found Donor Egg Bank and I think you're involved with my friends at EngagedMD. How do you make those decisions? You've got your main focus, which is presumably the practice group, and then there are different ventures and there could be a thousand that feel meets technology and meets all of these new opportunities. How do you decide which ones are a good fit? What advice would you give for principals that are thinking about maybe getting involved in some sort of venture that is ancillary to their practice?

LEVY: I think we always do better in an area that we know well. For me to say, I think I’m going to invent some kind of IT opportunity unrelated to fertility would be completely crazy and that would be almost certain to fail. But, I think if we have entrepreneurial instincts and we see areas within our field that open up new opportunities--I think egg bank exemplifies that--and we pursue it with a vigorous focus, it will be successful. So, when the new technology for egg freezing was developed about 10 years ago, I think that it opened up a big opportunity with egg donation. When typically one egg donor was matched with one recipient and it was extremely expensive, so egg banking allowed went to decrease the cost by less than half of what it used to be. And we were early adopters of it and started the egg bank in partnership with a number of other groups.

JONES: Maybe a good place to conclude is with the model that you talk about. Because you made a really great point, which is when you're 35, a private equity offer isn’t so exciting. When you're 60, the private equity offer is a lot more exciting, because the buy-out is essentially one’s golden parachute for retirement. And I have made this argument on the show very often that I think no small part of the reason and why a lot of retiring physicians, or doctors that are within five years of retirement, are taking this exit because they don't have another exit! Because they don't have a doctor that wants to take over their practice, or if they do, there's trapped equity that the incoming doctor can’t afford what the practices were, and even if they can, the expectations aren't set well. We talked about that with Holly Hutchinson on the show of why associate doctors would leave after two or three years before ever becoming a partner and why that happens fairly--pretty quickly. So, I think maybe the 5-7 doctor groups, because they're still a decent number of those and they haven't sold equity yet, but they're probably around that age where they're really thinking about it. Does the Shady Grove model work for someone that size where you're getting people in, they’re meant to be on partnership track, and then the older doctor meant to phase out. Or is it too late if the doctors are at a certain age or a certain career?

LEVY: Yeah, so we we refer to our constitution as critical components of our practice and that's all embedded in our constitution and I don't think it's too late for any practice. I think that you’re absolutely correct that if an earning avenue for exit in significant way is private equity, and you don't have younger physicians who are going to purchase your equity in the practice, you're in trouble. So we have a very clearly defined internal multiple and exit. We’ve had three physicians or more probably this point. So when I started the IVF program, I joined Arthur Segoskin and Bob Stillman, who had been our fellowship director at GW, joined us five years later. Both Art and Bob have now sold their equity in the practice and that was very orderly. The younger physicians hold the equity. It's a win-win. They got a good valuation and the younger physicians got a good deal to be able to acquire that equity. So I think ensuring that that is in place at the earliest stage is a good idea.

JONES: Can doctors do that like an owner-financed home? I buy the home from the older couple who's going into the nursing home, we don't get the banks involved, we draft the contract and maybe I put down a down payment. I owe them directly, as though I am paying them the mortgage, not the bank. Can it happen that way? Or do younger physicians typically have to get loans in order to be able to buy that?

LEVY: So the way we structure that when physicians buy into the practice is we--the practice guarantees a bank loan for them. So it's a significant amount, but the return on that--and they earn that equity they want--and the return of the profit pool that is returned, according to equity more than pays it off for them right away. So we ensure that they will do better from there as an equity partner. Everyone can get about the same amount of equity in the practice, but someone has less productivity would not be able to afford to buy the next little amount of equity that they could, because it would be too expensive. But I think it could be financed internally by the practice. I don't think that you have to involve a bank to do it effectively. But I really do think that it's--when we interview, it's interesting, I think the incorrect stereotype applied to millennial physicians, or graduating fellowship, is they want to check in and out, they want to get a nice salary, they aren’t interested in the business side, and they aren’t that focused on the long-term partnership track. I think many of those probably exist and those are the ones we’ll attract. Most of the physicians that come to us from word-of-mouth, know that they are going to have the opportunity to become true partners. It is important to them. They have to be productive and fit in with the culture in order to achieve that opportunity. But I think we have--in an era in which there are fewer of them graduating then there are positions, so the most fellows get multiple offers--we have almost our pick of the fellowship graduates who are not getting into research, the one getting in clinical practice, because of that model.

JONES: I think that, that point of, there are still so many entrepreneurial REIs coming out of fellowship, so many of the--some of the millennial REIs that I know, some of whom are still in fellowship, are among the most entrepreneurial that I know with their involvement and looking at Silicon Valley, they're following funds on Wall Street. They are really dialed in and I think from a recruiting standpoint, why it sometimes appears that way is because these millennial physicians are going toShady Grove, often times are not going to another place because you have a structure for them. A lot of times, there isn't a structure in place and the ambiguity that sufficed 25 years ago, doesn't suffice anymore. They need to go to a place that has a human resources department, that's active on social media, that isn't using paper charts, that is forward-thinking, because--I make the analogy very often that it's like buying the old house, but the work needed on the house is so much more than just then buy-in. And especially if there's going to be someone in place that’s quieting you on the changes that you need to make before they retire--if they ever retire. And I think that you all have that structure in place, it seems. So I'll give you the final thought! What would you want to conclude on? I did I like that you countered my point that it would be easier to use private equity to build the largest practice group in the country. You countered because you've actually done it, so it happens true. He said that you didn't set out to do that, but for someone who wants to grow or sustain their practice, or your general view of the field, how would you want to end?

LEVY: You know what one area that you have a question that we didn't touch on which I'll finish with is, I think one of the other really key decisions we made early on is that physicians need to fully engaged, but they should not be the business leader of the practice. So we have a really superb executive team led by Mark Segal, our CEO. I think Mark had the vision and mission to grow as big as we did. And we went along with him in support of that. So, we have the right balance between not trying to micromanage. I do see physicians fall into the trap of, “We know a lot about a little, so we assume we can learn a lot about everything,” and you know, that's risky. So we have, as you said, great HR, great marketing, administration, accounting, and we don't micromanage that group at all. The board meets every week with that team, so we know what's going on. And we’re involved in important decisions, but finding that right balance is critical for the right foundation for the practice. I spent 80% of my time practicing typical medicine. I still enjoy it the most, which is why I keep doing what I'm doing. I certainly want to be involved as do all our physicians. And lastly, I love the fact that you say that you're familiar with a lot of entrepreneurial young fellows and reproductive endocrinologists and send them our way! But I wouldn't want that to be their primary driver. The right physician in our practice is going to do what's right for the patient every time. My favorite patients are those with sexual dysfunction where I send them home with a ten-cent, 5cc syringe and tell them to inseminate themselves at home and they don't need us for anything and we make--because we’re doing right by them. It’s the most cost-effective treatment. And if everyone knows that that's what we're going to do, the practice is stronger for it, because they're going to send their friends, they’re spouse will know that's what's required, and they get to act like that in every situation. And of course, I love the patient with the complicated situation and they need to use all the bells and whistles of technique. Bells and whistles of the top technology get a good result, but we've got to tailor to the patient. So do right by the patient, but be entrepreneurial and a successful father.

JONES: Dr. Michael Levy. thank you very much for coming on Inside Reproductive Health.

LEVY: You’re very welcome and I enjoyed it!

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.