Technology is changing how we look at fertility and family planning. On this episode of Inside Reproductive Health, Dr. Janet Bruno-Gaston (Director of Fertility Preservation at Center of Reproductive Medicine, soon to become Shady Grove Fertility Houston) joined Griffin Jones to talk about how the latest technology in fertility preservation affects decisions of families today.
Listen to the full episode to hear:
The current state of artificial intelligence for fertility doctors.
How technology in fertility preservation is changing couples' family planning decision process and what that means for you.
Easy ways to increase referrals from physicians in your area.
Griffin’s rant about the metaverse and how it could change the landscape of how you treat patients.
Dr. Janet Bruno-Gaston:
Website: https://infertilitytexas.com/meet-the-team/
Linkedin: https://www.linkedin.com/in/janet-bruno-gaston-1bb6a014b/
Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.
Transcript
[00:00:00] Griffin Jones: This is just crazy old Griff, throwing out a fastball for everybody.
I was talking with a friend at the Association Reproductive Managers meeting last week and. She has a child in early teens and I said do you think so so's. generation will, do you think more than 50% of them will have children? She said no. And I said, I totally agree again, speculation.
[00:01:02] Griffin Jones: The future of fertility preservation, artificial intelligence, practice areas, the metaverse. These are some of the things that I talk about with Dr. Bruno-Gaston in my episode today. But before we get to that, a little shout out for Dr. Susan Davies from Chicago, sometimes I get really lovely messages from you all, and they don't always have to be out business. So sometimes. You can send me a personal note because you thought of me from hearing the podcast. And I love that. So shout out to Dr. Susan Davies for making my day one time and all the people at her practice, including but not limit to Aanal and Shannon and hope everyone there as well.
Okay. In today's episode with Dr. Janet Bruno-Gaston from the center of reproductive medicine, or by the time you are hearing this Shady Grove Houston. She is someone that has dedicated a practice area to fertility preservation. She did her medical school at Morehouse. She did residency at USC, did her fellowship while getting master clinical investigation at Baylor.
And she's presented at many conferences and written on number of topics, including non-invasive markers of gammetes and embryo viability, PCOS, a number of different things. But what we're talking about today is her practice area in fertility preservation. What the future of it is the technologies that will disrupt or increase it.
And what it's like for younger doctors to go on that kind of career track. So I hope you enjoy today's Inside Reproductive Health with Dr. Janet Bruno Gaston.
Dr. Bruno Gaston Janet, welcome to Inside Reproductive Health.
[00:02:44] Dr. Janet Bruno-Gaston: Thank you so much. I'm super excited to be here this afternoon.
[00:02:48] Griffin Jones: I'm excited to have you and to talk about fertility preservation. I'm interested in a few different areas. One, because I think it's gonna be the it is one of the fastest growing segments of our field.
I still think that that is going to increase. Maybe some people thought it was gonna grow a lot faster than it did. Maybe some people think it's done growing I still think it is going to be one of the, the fastest growing areas, but I wanna start with just, how did you decide it? This was a particular area of interest for your practice, because there are a lot of young docs listening or there's people at docs at groups that maybe they were a two doctor group now, but now they're at a 7, 10, 12 doctor group and there's areas for different people to carve out their little niche. And so how did you decide that this was something that you wanted to pursue?
[00:03:41] Dr. Janet Bruno-Gaston: Yeah, I think for me I'm a little biased by my training experience. I trained at Baylor college of medicine and got an opportunity to work with Dr. Woodard at MD Anderson. So we have a strong exposure, to fertility during our training. And for me it was a niche that didn't allow me to abandon kind of the basic reproductive physiology and the breadth of reproductive pathology that you would see practicing general REI, but added the complexity of cancer diagnosis and working around that.
So it was challenging. It was a very interesting patient population. They're extremely vulnerable and it's a very humbling position to be able to step in, in the midst of everything they're going through and talk about building a family and what future family planning looks like for them. So I really enjoyed that exposure.
During fellowship and went into private practice. And in my group ,there was no one really championing that cause. So it became a very smooth transition for me to help recruit patients, improve access to care and really Kate for more educational awareness about options for fertility preservation, because as you alluded to this field is continuing to grow.
The options are becoming unlimited and it is not only for medically in patients, but as obviously elective as well.
[00:05:14] Griffin Jones: So your interest was peaked by the medically indicated by oncofertility. And then at around this time was, was social egg freezing as they were calling it or elective fertility preservation.
Was that starting to blow up in the public sphere or was it already kind of being talked about on social media? How did your interest from the medically called foresight meet with that.
[00:05:39] Dr. Janet Bruno-Gaston: So I think I was just at the cus where we were starting to see fertility preservation and specifically oocyte cryo preservation being talked about in public platform.
So you'd see it on a good morning America, or a talk show in the afternoon. It was something that people started talking about. And I think with the shift in society of how people are building their career and thinking about family planning. It was just very intuitive that this, this was something that needed to follow that shift.
And while as an infertility specialist, I am not promoting an intentional delay in family planning, but what I am strong and passionate about is providing patients options. And each patient has a different family planning goal. They have a different outlook on where their life is going.
And so providing them options is really important for them to help navigate that process.
[00:06:40] Griffin Jones: So you're physically in Houston to Houston area, right? I am. And I remember in 2015, 2014, 2016, when egg freezing really started to. I wouldn't even say it really took off, but really started to get buzz in New York, LA San Fran was like, okay, it's here now in just a handful of years, it's gonna be in Atlanta, Dallas, Houston.
And then after that probably your Cleveland's Buffalo, Detroit, I could say that I'm from one of those areas. And so did that happen in that way? Did you see a big increase and then start to flatten off. Did you see a continuing maybe not a hockey stick, but an upward into the right curve?
What has growth been like or not been like since you've, you've been practicing in this area?
[00:07:28] Dr. Janet Bruno-Gaston: Yeah, I think that's interesting. I can't say if it's been growth from a geographical standpoint, but certainly what I am seeing is different iterations of fertility preservation. Right now I'll say there is a huge push or advocacy mission to extend fertility preservation to the trans community.
And even having discussions about that and what that looks like as people are performing gender reassignment, surgeries hormonal therapy. And I think as a REI we have to now embed ourself in that conversation because a lot of that is happening with Pediatricians or primary care physicians, depending on where they are in life when they decide to make that transition.
But I think an important part of that conversation and something that was missing from that dialogue is whether or not they want. Children or how they want to build a family. Because for a long time, I think the assumption was a part of making that transition was letting that goal go. And certainly fertility preservation does not require that.
And it provides very unique options for that particular patient population to consider family planning.
[00:08:40] Griffin Jones: So that's one demographic that is increasing in utilization of fertility preservation. I wonder if you're seeing it this way, where we think of fertility preservation is for those that want to extend their family building window and they it's like an extension of their plans.
And I wonder if as the generation's grown a more useful way of thinking about it is maybe not even an extension of plans, but an option for people to change their mind. Right. Like, I really wonder if the, if the birth rate just continues to decline and doesn't stop. So I think part of what we're seeing in REI right now, part of the reason why everyone is so busy is because the median age of childbirth has gone up.
Right. And so I wonder if, that's just, okay, it's gone up until it's gotten to the point where the trend just continues, that people don't want to have children, but fertility preservation is an opportunity to say well, but if you change your mind, do you think people are starting to think, do you think about it that way or do you think it's very much the extension of a plan?
[00:09:57] Dr. Janet Bruno-Gaston: I see both and I'm smiling because as you were describing that maybe I might change my mind. I mean, I've been across the room, had a patient say that to me. Hey, I don't even know if I want kids. This is something my job is covering and I hadn't thought about it before. And maybe I will in the future.
So that's why I'm here today. So certainly patients are starting to look at and think about their reproductive years and say, Hey, what do I want to accomplish here? And if family planning is not a part of that immediate goal. Certainly fertility preservation can be an option to say, Hey, I may be interested in this later on.
So yes, I do agree that there is a subset of patients that strictly want to not close the door on that option of building a family in the future.
[00:10:55] Griffin Jones: I wonder if it just like becomes what we do as a field. Like I really believe this is total speculation. I have no data to support. This is just crazy old Griff, throwing out a fastball for everybody.
I was talking with a friend at the association reproductive managers meeting last week and. She has a child in early teens and I said do you think so generation will, do you think more than 50% of them will have children? She said no. And I said, I totally agree again, speculation.
And I was like, well, what percentage do you think? And we're like, ah, I don't know, 25% again. No, no to data whatsoever, but it's seems to me that this is the direction that we're going in. And so we're what we offer part of. Of what you all offer as the clinicians in this field is the opportunity for someone to not lock that in.
[00:11:50] Dr. Janet Bruno-Gaston: Mm-hmm mm-hmm
Yeah. I mean, I completely agree. And while we don't have data to look at that long term regrets, things like that, those studies are just kind of gathering information because as you said REI in general is in its infancy still when you compare it to other disciplines of medicine and certainly fertility preservation is so we're still gathering data on what that looks like in terms of utilization regret in terms of what, or they did not, or did not did, or did not use fertility preservation.
I don't know if I think there will be a huge paradigm shift in terms of the decision to build families certainly finances and, and just the structure of our society have changed the way people look at the amount of children they want in their household. And when they decide to start their family but I do agree that having fertility preservation does change the sense of urgency particularly for women obviously in that they can and consider other things in life and when they start considering other things in life differently, I, I think.
There will be a shift in value system. I don't know how long that will take and if we're just seeing that evolve. But yeah, those are my thoughts.
[00:13:12] Griffin Jones: Well, I just think for all the people listening that have like preteens and teenagers, it's like, I doubt the ability. I doubt the ability of that cohort to be able to raise children.
It'd be nice to be wrong, but I really, but I they're gonna have the metaverse. I say that somewhat in tongue and cheek, but, but honestly, Janet, you say that kind of joking, I'm dead serious about the metaverse and we look at in this, I think the metaverse is at now. I'm really gonna go off on it too.
She's gonna be like, why did I go on this guy's podcast? I came to talk about fertility preservation and I got him down a rabbit hole of the metaverse. I think it's as possible of a paradigm shifter as genetic testing and CRISPR for childbirth that it could. So if the value prop behind CRISPR and genetic testing is.
Look at all of these awful diseases and traits that could be avoided. Well, doesn't the metaverse have that to offer at least once it gets to a point where it feels as viscerally real as the world that you and I are in today. And at that point it's like, well well in the metaverse I don't have to be short.
I don't have to be chubby or scrawny. I can be ripped. I could be six, five. I can change my eye, color, hair, color, skin color, whenever I want.
[00:14:30] Dr. Janet Bruno-Gaston: Yeah.
[00:14:30] Griffin Jones: And I don't even need to maintain this physical form. I can go to another one. I could have children in the metaverse and so.
[00:14:38] Dr. Janet Bruno-Gaston: It's scary.
[00:14:39] Griffin Jones: I don't have a question there. I don't, I just. You can respond to my.
[00:14:43] Dr. Janet Bruno-Gaston: You can go, you know, AI is infiltrating every, every aspect of our society. We're not gonna be able to evade that. It's interesting to see it in medicine and that's changing our field as well.
But I mean, you're right. I don't even think we can fathom right now, what that's gonna look like. For, for the younger generation growing up, it's just gonna be so foreign. But I imagine as the technology improves, like you said, and they can address all senses so that you truly feel like are existing in this virtual world then yeah.
[00:15:22] Griffin Jones: Well, let's get back on solid ground and you gave me a good segue. You set me up well, which is that artificial intelligence is changing every aspect of everything much, certainly our field. How about fertility preservation in particular? How has AI changed it in the last three or four years or are most of the changes still to come?
And if they are mostly still to come, what do you see on the horizon?
[00:15:47] Dr. Janet Bruno-Gaston: I think most of the changes are still to come. I don't know if it's specific to fertility preservation, but I will say that there's a, a lot utility. And research going into the use of AI in the lab. And that's because a lot of what we do, a lot of what the embryologists do to their credit is monitoring and picking up and looking for non-invasive markers of embryo viability.
And I think AI just as it has done in radiology and pathology has been shown to be more active, obviously we need to program it. So the system only works based on what you put in, but I think over time a lot of what happens in the lab will be taken care of by AI. And it may lead to better surveillance of embryos.
It may lead to new markers of embryo viability, new ways for us to assess viability to your point about a specific example in fertility preservation, one of the things that's difficult in counseling patients is. What is a good number and yes, we have studies looking at the outcomes from women who do oocyte cryo preservation, but at the time of a cryo, we really know very little about the health of the egg outside of morphology and maturity level.
Well, there are a lot of studies looking at metabolic competence. Right. So what is happening from a developmental standpoint to suggest that this egg is healthier than the other, and they're using microscopy and fluorescence imaging, and all of that can be streamlined with AI to kind of help better counsel patients on what this means at the time of cryo preservation and preparation for future family planning.
So I do see a lot of work there.
[00:17:37] Griffin Jones: Is it mostly to come because the technology's not there yet, or the business model isn't there yet? Or is it because clinics and labs are slammed and they might not be as adopting the newest possible technology as quickly as possible because they're so busy.
Which of those is it?
[00:18:00] Dr. Janet Bruno-Gaston: I think a little bit of both. I do think the technology is there it's being used in other fields. I think we have been slow to adapt a little behind in that sense and, and part of it and to their credit embryo ologists, they are very particular, there's a very type a personality and there's ownership in, in what they do.
And obviously as a clinician in debt, because I can only do so much what happens in the lab impacts my patient's outcomes profoundly. And so I think that would be a bit of a culture shift for them taking away what they have been doing primarily for, since the inception of this field.
So I think that may be a little bit. Uncomfortable for them and perhaps for us too. So I think the technology is there. There's not enough data to support it yet. But it's coming.
[00:18:52] Griffin Jones: It's coming well, embryologists are so busy right now that even if they're, even if they became the case manager of more cases, but their own, or at least that part of their workload is reduced.
I don't see them going out of work in the next 10 or 20 years. I think we're we're, I believe David Sable when he says we're only doing. 200 to 250,000 cycles of the 2 million that we should be doing in the United States. And for years it really seemed like the clinic was the bottleneck.
And it was like, okay, well, we can't a lot of, at least maybe since 20 17, 20 18, a lot of clinics were busy, but they could still do more cycles in the lab, if they could convert more patients to treatment. Now it's probably three quarters of labs are slammed too. And so I don't see that going out of, out of work and I wonder what what I wanna talk more about the oh, LA and artificial intelligence are adopting it from your vantage point, because probably a couple times a month, Janet, I get.
Hit up from startups in the IVF space that are in AI mm-hmm and some of them have way too much homework to do. It's like, go prove your concept first and then gimme a, but some of them it's like, this is legit. And they're having as hard of a time as anyone getting their product to market.
And seems to me like this could solve a big problem. So can you talk a little bit more about I don't know if you can think of any examples or Or just maybe why we haven't included AI in fertility preservation as much as perhaps it should be.
[00:20:28] Dr. Janet Bruno-Gaston: I think there's still a, a bit of fear of not about how this will replace me. But just some fear about trusting that what we do and the stakes that we take with patients as much as possible, we strive for perfection. And so committing a patient to a, that you're not comfortable to. It's a very difficult transition for both clinicians, theologists and researchers, and we should be critical and we should be hesitant to adopt things. Because our field, all of the iterations of that with developmental and how that impacts offering in generations, like we have to be steadfast and holding to a certain standard because we are the gatekeepers that ultimately this technology could impact an entire generation. So I think a bit of it is fear. A bit of is anxiety with change and not feeling comfortable yet. And I think the data is still lack.
I think, I think there's still room for us to have more robust. Data to support that science, but the technology is certainly there. The technology is certainly there and it's being used in other fields. And I think it will just take time before we feel. Comfortable with that. I mean, even onsite cryo preservation was experimental until 20 12, 20 13.
We've had the technology of, of how to do that and it's evolved and improved, but it still took some time. It still took some time for us to be comfortable with that.
[00:22:02] Griffin Jones: So you were, you were talking about Using AI for embryos a little bit earlier. Is there bigger opportunity for oocytes? And I know someone who's doing that, I don't know that I can, or that I will, I won't say their name right now, but if people are interested, they can email me privately.
But one what , the value they purport to bring proposed to bring is that there isn't a way of being able to grade oocytes other than just theologist, examining EEG, but that there's an opportunity for artificial intelligence simply by compounding all of the possible learning that it can do.
Is that an area that you've seen or, or is most of the AI that you've seen been geared toward the embryo?
[00:22:46] Dr. Janet Bruno-Gaston: Most has been geared towards the embryo. But I brought up just the fluorescence imaging because I did a lot of research with PCOS and looking at mitochondria and mitochondrial health and how that translates into embryo health.
And one of the things we came across in partnering with the core microscopy at Baylor is just that they have a lot of fluorescent imaging techniques to look at without getting too scientific, but redox potentials and just markers of metabolic competence. And that could be potentially something that is another marker of oocyte viability and does, and can be used at the time of cryo preservation to more objectively counsel patients about what they have at the time of freezing. And that's something that can be trained through AI, once you start to figure out algorithms and track outcomes so.
[00:23:46] Griffin Jones: When do you feel like we became ready for prime time or do some people still have a way to go?
Does it depend on the lab? Does it depend on the clinic becoming ready for prime time for fertility preservation in the field? Because I'm not a clinician sometimes that makes me ask dumb questions, but sometimes, it gives me a perspective of looking at this from someone who is not educated about it, which is the majority of patients, their first.
Go around and one concern had been that, well, we, we know how well these eggs freeze, but we don't know how well they thaw and so when do you feel like we became ready for prime time for fertility preservation to market it, to offer it to the majority of patients who could benefit it from it?
Or does it still depend on the lab? Are there still people who aren't ready for prime time?
[00:24:37] I just got back from the Association of Reproductive Managers Meeting in Atlanta. And you know what everyone was talking about? Every embryologist, every nurse, every manager, every practice owner that was there was talking about burnout. That's what everybody's talking about everywhere, by the way. And every aspect of the workforce. Everyone's talking about burnout and we can keep trying to replace people who also seem to be burnt out. The people that we're bringing in are burnt out from something else. So that's one solution. We can also do things to make the log lighter because when you take 10 people, on a log and you take four of them off those six people are burnt out.
So if you can't put four more people back on the log, or you can't put six more people back on the log, you have to make that load lighter. And one way of doing that is using Engaged MD. And I'm at a point now where I feel like it could be a real disservice to your staff, to not be using Engaged MD at the point where so many of your staffs are overworked.
So many of your labs are slammed, but also your managers, your nurses, your billing team. That anything that we can do to take things off of any of their plates, especially we're not just taking something off their plate in the moment, but we're also using that to make their interactions and lives with patients easier and better beyond those tasks, we should be using it. And that's what Engaged MD does.
Your nurses and your care staff should not be doing things like telling the same thing to the same patients over and over again, when the patient has too much information to absorb, but time anyway, when they could be talking to really educated patients, meaning that you've educated them by using Engaged MD's platform ahead of time having a, a smaller window where they're repeating things and not having to do things like track down consents because Engaged MD does all of that for you.
Burnout is it's the worst that I've seen since I've been in the field. If you can replace all of your people and, and overstaff, 'em great. Most of us can't. And so when we have to use technological solutions. And for those of you that are listening, Engaged MD is already in more than half of practices out there.
And if you are not there, you're now on the wrong side of the bell and it could be at the expense of your staff. And so I hope that you'll use the opportunity to go to engagedmd.com/irh. They'll give you 25% off your implementation fee. If you use my name or you use Inside Reproductive Health mentioned that you heard it on the podcast, but don't do it for me.
Do it for your staff, engaged md.com/irh. Now back to my conversation with Dr. Janet Bruno.
So when do you feel like we became ready for prime time for fertility preservation to market it, to offer it to the majority of patients who could benefit it from it?
Or does it still depend on the lab? Are there still people who aren't ready for prime time?
[00:27:51] Dr. Janet Bruno-Gaston: I don't think so. I think most people are very comfortable fertility preservation, I think once ASRM removed the experimental label. And we had all of the studies looking at long-term outcomes, most people were very comfortable.
Now I will say that there's certainly an increase in to see, because you have a lot more celebrities talking about fertility preservation. It has infiltrated social media. And so it has a bigger platform primarily through the work of the patients. They have been advertising this more for us than we have.
If I wanna be honest about that and through that need, I think is what has drawn our attention to say, Hey, this is something that they value. This is something that's important to them. And so, because it's important to them, it has to become important to me.
[00:28:39] Griffin Jones: I was gonna ask about the, the advertising part coming from the people are seeing celebrities talk about it and, and.
And following them on social media of their journeys. Is this an area that is still under referred from other provi even before let's even before we get to the elective side, even on just the ENCO side, is this still under referred from other providers?
[00:29:03] Dr. Janet Bruno-Gaston: I'm so glad you said that I embarrassingly so, embarrassingly so, it is difficult to create a network that geographically spans a large region outside of a metropolitan hub, like Houston or big cities that you mentioned. So that really creates a disparity for patients on what they're able to be offered. If they're offered in what they're able to receive it in a timely manner.
And to me, that's just uncomfortable. Because this is a standard part of REI that, , any group should be able to perform for patients. And the fact that there are these disparities that exist one city outside of here is, is just very disheartening. But to your point, this is not even entering into the elective space.
This is speaking in just medically indicated. I can't tell you how many patients I see after chemotherapy and they say to me, well, No one told me, they said that I should kind of check it out after, or they mentioned it briefly, but in the midst of everything that was happening, that was difficult.
So I really tried to prevent myself as a resource. I reserve spots so that if patients need to be seen immediately, they can come in. I've assembled a team that we kind of get things started in a very streamlined way. I partner with local pharmacies to be able to get medications delivered within 48 to 72 hours, if we need to do random starts.
So those are things that I put in place, so that if I can make this process easier for them, both their provider and the patient, then they will be more receptive to referring to me and allowing their patients to go through a treatment before they come back.
[00:30:56] Griffin Jones: It seems to me again, this is coming from a non-clinician, but it seems to me almost negligent to not refer to an REI as if, especially if someone was about to go through chemo. And I probably wouldn't have believed that happened at any kind of scale, but I was in my home city. I was talking to an oncologist at a social event, had nothing to do with work, told her about what I do for a living.
She had no idea of the REI's in our town. She had never referred out and she said, oh, maybe, yeah, I should start doing that. It's like, yeah, maybe you should.
Why don't you go ahead and do that. So is it because, I mean, do they think that they just have, so, I mean, they do, they cancer of course is life and death in many instances.
And so maybe I'm asking you to speculate, but I'm asking you to speculate why do you think that It's not as broadly toted of a message.
[00:31:55] Dr. Janet Bruno-Gaston: Yeah. I mean in their defense, there is a lot going on. There is a lot going on even emotionally for the patient and the provider. And so in the midst of this long discussion that they have to talk about, they then have to remember also bring up fertility preservation.
And so I think in the long list of things that are a priority for them to get through with the patient, fertility preservation may be somewhere on the bottom or doesn't exist. I also think that there is an assumption as providers we have our own bias as much as we try to ,exclude them that one, this process is expensive.
It's timely. You may not be able to afford it. So what is the purpose of going through all these hoops just to say, well, I'm not gonna do it anyway. And so I've had patients come back and say, well, providers said, Hey it's expensive. It's out of pocket. You're probably not gonna wanna do it.
And when you present the option like that that really isn't counseling the patient in a very neutral way. And so I think a lot of what I try to do is even if it's just a quick fact sheet that I'm like, Hey, you can pick this up and take in your office so that they can save their visit to do their counseling.
And the patient can then read about this and contact the clinic as they need to is a compromise between us both. I'm just really too trying to make their job easy without taking up much time from the primary counseling that they wanna do.
[00:33:26] Griffin Jones: Is it the same with elective fertility, press for OB GYNs. Do you suppose that they're not doing, and maybe this is an assumption, but from what I'm gathering, they're not doing a whole lot of family building counseling. They're treating people who need to be treated. They're referring to REI's once they, once they encounter infertility or once they encounter something like endo or, or P C O S.
But just from a oh, you're 32 and this is what you want next in life. I don't know that's happening. What education needs to be bridged for the fertility preservation side for referring providers?
[00:34:04] Dr. Janet Bruno-Gaston: So to your point with generalists, I actually do think they do quite a bit of family planning and family planning in our world is always expansion, growth, wanting kids, but family planning in their world also includes contraception.
So they do have very clear conversations with patients about what are their family planning go OS and what I will say for the elective for fertility preservation. I would say the patient leads that referral. So most times when I get patients coming in for elective, fertility preservation, it's truly something that they advocated for themselves.
They said, Hey, I heard about this. I wanna know this can I see someone? And that's how they come 'em to me. Or if they come on their own accord directly to REI. They come in, well read about, about the process and, and kind of have an idea of what it looks like. So it's interesting. There there's a little more initiative there because they have a very clear goal versus from the uncle fertility perspective, this may not have been something you were even ready to think about.
And now I have to pose this question to you. So the that's my thought there. And then in terms of just how do we improve referrals from, from, from providers across disciplines? I think like you said education making them aware that this is accessible, this can be done in a timely manner.
We're welcome to collaborate, to help coordinate care with patients so that we don't create treatment delays and that compromise their cancer diagnosis or their treatment outcomes. So a lot of what I do is just education and lending myself as a resource. And like I said, creating as simple as a.
A patient fact sheet with your card and your clinic's information is an easy way to walk into an oncology office. Maybe it's Heon or , surge on. And you just come in and you're like, Hey, I'm an REI in the area, I have a strong interest in fertility preservation. If you come across patient patients feel free to refer them.
This is a patient fact sheet. They can read this in the waiting room while they're waiting to see you. And if they have any follow up questions, they can contact me directly. That makes their job easy. I haven't taken up counseling time from what they need to, to get across to the patient so for them that works.
[00:36:32] Griffin Jones: So we talked about referral patterns. We talked about referral tactics. We talked about some Terminator, two stuff. We talked about your interest in fertility preservation as a practice area. I wanna go more into practice areas in general, because there are younger docs listening and thinking of, of what that will be.
So how do you delineate those duties among a group of so I think we can say now that you're, you're part of the center of Reproductive Medicine in Houston, which was a, a six, seven doc group.
[00:37:03] Dr. Janet Bruno-Gaston: It was prior to me joining, there was four. I replaced one physician and one retired. So there's four of us now, but we're kind of like acquiring more.
So we're getting there.
[00:37:14] Griffin Jones: You got some more docs coming and I even know one of them. And then you also have a big announcement as joining one of our bigger groups, the Shady Grove group and so when one's doing that, and in your case, we're talking about fertility preservation, but for other people it's gonna be recurring pregnancy loss.
It might be, and might be endometriosis. It might. How does that work within a practice? Or how could it work? Because I imagine the way it works varies differently from practice to practice at some places, it's probably just a title at other places, it really is a practice area. And so what does it mean to actually have that practice area?
[00:37:51] Dr. Janet Bruno-Gaston: Yeah. So I definitely agree that can manifest differently depending on the business model and practice you join for me, I knew that I wanted fertility preservation to be a part of my practice. And so I made that very clear on my interview. So for the fellows and recent grads, if there are something that you want to continue to pursue, perhaps it was in line with your research, your thesis from fellowship.
Be clear about that on your interview, because oftentimes the practice is excited about that because that becomes an area that they can then advertise and market and tap into that they probably are doing a few fertility preservation cycles here and there, but if you're, you're passionate enough about it, and you're thinking about becoming a center for that I think that's actually a selling point on, on an interview for you.
And so I talked very candidly about my interests on my interview and set some for myself and I'm happy. To be able to be achieving those goals and creating partnerships that improve access and more importantly coverage for fertility preservation. And from a business side, those partnerships are important because that becomes another pipeline for you to get referrals for patients.
So that has been helpful for me. And that has been my approach in, in kind of carving a niche for myself and getting to know clinicians in the area that you work. I mean, medicine is always a small community, but it can be joining local societies going to meetings just so that they have a face with the name.
And that could be the way that you start getting referrals from an office persistently. So I say definitely network make sure that you partner that you're partnering in line with your career goals and, and be consistent with that.
[00:39:50] Griffin Jones: So I see the selling point for you, Dr. Bruno guest honored you, the physician, you, the fellow whoever's listening as a different differentiator and a way to build your practice pretty quickly.
What about though, making sure that you are not sold by the clinic, by the practice owner, by whoever fellows are scarce right now, Janet, there's 44 of 'em. They're always scarce, but maybe only maybe only 20% of people would've hired 10 years ago. I don't know. But now it's like anybody is trying to get a doc right now. And so oh yeah, you wanna have a fertility preservation pregnant? Of course. Sure. We'll name it the Janet Bruno guest on fertility preservation consult room. You have any deceased grandparents? We'll name the garden for them. So like, most people, I believe in our field, I do believe the vast majority of people in our field are ethical. Really good people. There's probably a couple that aren't, but it, but they're they're I do believe they're the exception. Most people are here with great hearts very often though even the people with great hearts. Sometimes they just want to, they just wanna get the deal done. Not cuz they're bad people, but they're just like, oh yeah, Jan
sure. Yeah. That's what you wanna do because they don't really have a clear picture of it. In their mind and they're willing to put whatever placeholder there without firmly checking it against the, what, the picture that the candidate has in their mind so.
[00:41:14] Dr. Janet Bruno-Gaston: Yes.
[00:41:15] Griffin Jones: So I'm cautioning people right now. This is advice that I may or may not be qualified to give, but for the people listening if they have a practice area in mind and what that entails that they should be getting that clear picture from the hiring group mm-hmm and, and making sure they're in accordance and, and probably making sure that it's in writing simply because again, not because most people are unethical, but because writing just helps to really firm up X expectations.
Yeah. And so what did that have to look like for you or, and what does it have to look like for someone that's really serious about a practice area?
[00:41:49] Dr. Janet Bruno-Gaston: No I definitely agree with you. You wanna know that they're gonna be able to support that, that they respect that and they understand that that's something that is a part of your career goal.
For me, I kind of laid out a plan. I said, this is what I want to achieve by year one, I had a goal of working with some specific organizations. The mission is a nonprofit that provides grants to fund fertility preservation cycles. They do require a contract with the clinic. And so I told them very candidly, Hey, this is an organization that I would profit with partner with, how do you feel about that?
Have you done that in the past? They very receptive to that. And I kind of, because I worked one of my mentors, Dr. Woodard at MB Anderson, I had a sense logistically of how she had things set up. And so meeting with my nurse, I said, Hey, , what's my nurse's experience. ? Who would she be open to, I mean, I met everyone during the interview process you can take as many visits as you want.
That's something like, I didn't know either. I had a lot of people that said, Hey, I went back to the practice and like kind of just shadowed a day to work with them, to get a feel for the culture. So when your interview and considering practices. Yes, reviewing the contract and, and having a lawyer look over that is important, but there's also just a sense of culture that you want to assess.
And that's hard to get that from just reading black and white. And so a lot of times, I just came back up there and was like, Hey, I'm gonna kind of shadow today. I wanna see, the feel, the flow of clinic and those things. And I was asking the nurse would you be open to that?
What are your thoughts about that? Just getting a sense of how hard was this gonna be for me to build? Yeah.
[00:43:31] Griffin Jones: You could see how is she fighting? Yeah, because they'll say whatever, but the nurse, if the nurse is like, yeah, yeah. Then I'm doing that. You can get a little bit of an indicator.
That's a good idea. It's really good idea.
[00:43:41] Dr. Janet Bruno-Gaston: We talk to them, the people, the support staff around you like everyone from the front desk to the ma, because you really get a sense of perspective from everyone's everyone's job. So that to me, made a difference. I'm someone that has a strong instinct. And that means more to me than a lot of things.
[00:44:01] Griffin Jones: I'll let you have the final thought, whether you want it to be on fertility preservation on building a practice area within a practice there aren't dystopian futures would, how would you like to. On the better coating remarks on the metaphor.
Yeah.
[00:44:17] Dr. Janet Bruno-Gaston: No, I mean, thank you for having me on, I mean, this is a great afternoon for me to, to talk about fertility preservation.
It is something I am extremely passionate about, and as you can see it. The fact that we are not getting appropriate access to care, the healthcare disparities that exist across so many different communities. It is important for us as Reis to really champion that cause and make sure that we are constantly trying to advocate for those patients and provide betters opportunities for future family planning.
Because that is really important both for medically indicated patients. And for those who decide to choose fertility preservation, electively there are great organizations out there who are invested in, in helping practices, improve access. So for those of youngs musicians or anyone who decides, Hey, this may be an interest of, of, of mine.
Please check out the chicks mission, Baby Quest Foundation. These are great nonprofits that are strictly looking for clinics to partner with, and they are on the ground. They are lobbying for legislation to improve access and coverage to care. And they're just looking for REI clinics to partner with so that they can and have patients come through so.
[00:45:40] Griffin Jones: We'll link to those organizations in the show notes, Dr. Janet Bruno Gaston. Thank you so much for coming on Inside Reproductive Health.
[00:45:48] Dr. Janet Bruno-Gaston: Thank you.
Thank you.