Stephen’s Info:
LinkedIn: www.linkedin.com/in/stephen-hutchison-61583697
Website: https://ivftucson.com/
Christine’s Info:
Website: https://ivftucson.com/
Transcript
Griffin Jones 00:45
You make money when you buy, not when you sell. Of course, that's not true in every sense. But you're going to hear me say that a lot in this episode, because we talk about the concept of arbitrage and it's a really important concept for you younger doctors, especially to understand what does it look like when millennials run a fertility practice an independent fertility practice? Not just the docs, but the embryologist the business managers are millennials. Is that happening? It is happening and we talk about that in this episode. How do younger Rei guys find the best value in an REI practice? How do they find the REI practice equivalent to the underpriced house in the up and coming neighborhood that is underpriced for some market inefficiency, but not because it needs so much work. And because the neighborhood is underpriced because it's on the rise, not because it's in a really bad neighborhood. That's the concept of arbitrage. How do Rei guys find those deals for practices? Talk about that, if you're going to PCRs you're going to see a whole team of people wearing one kind of shirt that are from an independent fertility practice putting on an event for you. How are they able to do that? What's What are they all about? We talk about that in this episode, we talk about the changes that millennials are making in fertility practice, things like embryo storage, and cryo inventory. And finally we talk about a culture where you can bring your baby your child to the fertility practice. Have you seen that in many places, it's happening here and I hope you enjoy this conversation with Christine DeLuca and Steven Hutchison. Mrs. DeLuca. Christine, Mr. Hutchison Steven, welcome to Inside reproductive health.
02:38
Thank you. Thank you for having us. Yeah,
02:41
thanks for having us, Griffin.
Griffin Jones 02:43
You know, I told you that I was going to make this episode about millennials running a fertility practice and that I was not going to let it be any kind of baby boomer bashing session. So I'm wearing khaki pants right now. It with New Balance sneakers. And if you're not watching this on video, then you can believe that and that I'm wearing a striped polo shirt. And I make sure that this is entirely a proactive session. But I'm thrilled that both of you on because I think it's such a cool, unique story. And before we start done pack the whole story, will you please each just give us a one minute background of how you got to be in your role in the fertility center that you're at now?
Stephen Hutchison 03:33
Yeah, I can I can go first. So you know, I learned early on kind of in life that I didn't want to be a physician. So my dad will talk about is an REI. My mom's an OB GYN. I learned that's not really the life that I want to lead. And I really liked science. I really like research. And so I pursued my Master's at the University of Arizona in physiology. So I was studying kind of metabolism and aging and circadian biology. And out of the blue one day, Holly, my aunt, the practice founder with my dad, text me and she said, Hey, have you ever considered embryology you're Andrology before? And I told her I hadn't I had never even considered that as a career path at all. So my plan was to continue my PhD at the University. But she said Hey, before you do that, come and check out the lab, see what it's like. And I did and I fell in love with it immediately. So after that I meshed really well with our other embryologist Ava. She has 20 years of experience. And so since then, she's been mentoring me. I've learned a lot and so we've just kind of been humming along since then.
Christine DeLuca 04:40
Yeah, and then I kind of started this whole thing I've been working at Reproductive Health Center since God I think I was eight. I mean, started washing speculums doing all the dirty work all the fun stuff too. And you know, work there all throughout. High school and college, and then went off into the world tried to make my own whole scene decided to work in finance for quite a while. wasn't exactly my favorite thing. But I did learn a lot. I mean, it's a very interesting way to kind of start, you know, working for major, major corporations. And what I realized from, you know, the pandemic, everything shut down was living in Brooklyn, it's like, being stuck in a one bedroom apartment with your husband as your honeymoon. I mean, we got married the week before, it was not exactly my idea of a good time, I think we had, I think it was like 50 days in our one bedroom apartment, rarely leaving except for going to the grocery store. So we promptly moved back to Arizona. And then I mean, I just see such a benefit of the work that we do in our clinic. I love all of our patients. It's interesting now being my own market, my own demographic. And it's just so heartwarming and awesome to work with my family and kind of fill the shoes my mom, but mostly handled handling the practice management side.
Griffin Jones 06:10
It's such a cool family story. And I want to talk more about the advantages of a small market potentially. But Stephen, when Holly Hutchison called you or texted you and said, Have you thought about embryology or in geology? How long ago was that?
Stephen Hutchison 06:28
That was in around kind of the end of 2020. I think,
Griffin Jones 06:34
how far into your studies, were you? Or did you have a different lab job at that time?
Stephen Hutchison 06:40
Yeah. So I had, I was just about to defend my masters actually. So I was working in a lab separate completely in basic research. And so you know, I had all the tools needed really to function in an embryology lab and an IVF. Lab. But I just never, never really considered it in terms of cell culture and things like that. So that's kind of she knew that I that I had the basics down. So that's kind of why she reached out. I mean, as you know, finding and training embryologist is unbelievably difficult now, almost as difficult is as finding our UI. So I think she just took a shot. And it really worked out nicely for us.
Griffin Jones 07:18
Yeah, well, that's one way to do it. Just text, someone that you know, going for an advanced biology degree and see if you can't sway their path a little bit. I want to give a little bit of background on the center. And you both can tell me if I'm getting this right. So we have brothers and sisters got Hutchison and Holly Hutchison Phoenix born and raised, is that right? Then, both I believe, studied some of the sciences in undergrad, Scott went on to medical school, became an OB GYN subspecialized in Rei. And Holly went the genetics route. Is that right? She became a scientist, how close to accuracy?
Christine DeLuca 08:00
That's accurate. 100 accurate.
Griffin Jones 08:03
And then at some point they decided to buy in Rei practice together started I should say start together and be 5050 business partners in Tucson, Arizona.
Stephen Hutchison 08:17
Yep. Spot on.
Griffin Jones 08:19
Then how have we gotten to the we did give a little bit of the how you each got into the roles that you're in. But the inception of this practice was 20 years ago. What What was yours?
Christine DeLuca 08:37
I think it's been 27 years. Yeah.
Griffin Jones 08:41
So 96 Yeah. So longer than some of the the junior embryologist have been alive longer than some of the youngest people that might be listening to this show hadn't been alive. And and they did that for at least two and a half decades before you each came on in your cohort. And you talked a little bit about how you arrived. What has the passing of the torch been like or? I mean, the torch isn't passed. Maybe that's not the metaphor. What has the continuation, the generational continuation been like? For each of you? How did it start? And what's gone into it?
Christine DeLuca 09:32
Yeah, I think at least in my son's it's kind of Yeah, you're right. It's not necessarily a passing of the torch. It's been kind of like a business partner that is still your family. So I I already intrinsically like know what their morals are. And we have the same one. So we never really our view or have any problems with how we want things to run or how we want things to continue. We never really have to have a conversation. It's just like the meeting in the hall our masks actually working or not. And should we like actually be wearing them? Or things like that. But um, yeah, I mean, I think my mom is just like ready to move on. She's been doing this for forever. She has other passions and hobbies. But I mean, I know that I always have a safety net with her right, she will always be one of the owners, she will always be contracted, we're always going to need her help. It just will not look like what it has in the past, right? I mean, she will just kind of be like a satellite. But it is so important, I think, to have that safety net, it's given me like, if she was just out the door in three months, I would be, I'd be really scared. So I'm really glad that I have that. You know, just the support. If in case I run into anything, but I mean, she's trying to let me fly on my own, but it's not as easy as one would think.
Griffin Jones 11:02
It's kind of like so for everybody listening at home, I'm going to keep the characters straight. Because if you're reading the Game of Thrones, you're you're you're getting all these characters. So Holly sister, business side is the mother of Christine, who is now part of the business side. And Scott, Rei, is the father of Stephen now embryologist side. So Stephen, what has the transition or the continuation been for you?
Stephen Hutchison 11:32
It hasn't been all that jarring, to be honest. And this is why I don't think there's much of a distinction between Millennials or boomers. Because we all want the same thing. I do see the general trend overall of these younger fellows, these younger Doc's, especially embryologist as well, there's more of a drive towards evidence based medicine than there was in the past. And so both are our evidence standards are higher, and then on top of that, kind of our ethical standards are much, much higher than they were before. So those two things are kind of progressing along nicely. And I think and that is not to say that boomers in the past didn't care about those things. I just think, in general, now they're, they're weighed much more heavily. So I know that in our clinic, personally, I mean, this is exactly what they want. So you know, that being said, I have the lack of the breadth of experience. Like I said, 2020, so three years now less than that of experience. And so, you know, I looked through the literature, and I read things, and then I think, Well, I think I figured out IVF I think I know now how I can optimize pregnancy rates and just blow it out of the water. And then I'll march into Holly's office or my dad's office and tell them all about my hypotheses. And you know, they very calmly dismantle whatever hypotheses I have. And it's because, you know, they have all of this experience that I don't have. And so they've been thinking about these exact same problems. And so it's really nice to be able to, to one to grow on my own and to develop and to see the problems that they're seeing, and then have them provide feedback. And really, it's kind of like the same, you know, if you want to go fast, go alone, if you want to go far go together. And that's kind of the way I see it. By using that the former generation, you can actually move a lot farther than you do it alone. So
Griffin Jones 13:18
Christine, you haven't had to have any conversations about how you want things to go. You talked about that. You know who these people are implicitly and so you have the trust there. But that's different from future direction.
Christine DeLuca 13:35
I mean, yeah, that's true. I definitely. I think as far as like attitudes are concerned on their parts. And like, I think working really hard is very important, right? But I think the mentality of you must be the first person in the office. And the last person to leave doesn't necessarily sit well with me, because I always feel like I'm working anyway, whether I'm working or not, right? I think like as millennial generation, like is concerned, I feel like everybody kind of wants to be on their own and be their own boss. And so at least for me, in the side of how the workplace functions, I want my employees to be happy, I don't want to have to babysit them. I want them to be able to take time off to go to the doctor or go on vacation, right? As long as they're doing their job, and they're not leaving it to anybody else. That's more of the direction that I want. Because I think that gives people more of a reason to show up every day because they love their job and they get to have some sense of like, this is my thing. I'm taking ownership of this and if I can improve things I will and I don't know necessarily that that was always the case in in their clinic. It was kind of like everyone, whoever's here and just grinding grinding. That was I think, just like a higher I don't know how to describe it like, it looked better. But now I don't really care what anything looks like, as long as the job is being performed and people are doing what we're doing and revenue is continuing, and patient care hasn't changed, right? So that's kind of more along the lines of where I'm kind of shifting to where it was not always that way. And we're also way bigger. I mean, I think we now have 22 people on payroll, whereas before, I mean, like, maybe not even four years ago, it was like, seven or eight. So, I mean, with ARS shutting down and everything, we've just, we have so many people that we need to take care of. And we're trying to bring on more people. So I kind of want that mentality of whoever's there does, it doesn't really mean anything, if you're just sitting on your phone and watching like, tick tock, right. It's like the quality of what you're doing.
Griffin Jones 15:56
What have you all thought about in terms of either quality measurements that you want to install to be cognizant of those things or other changes that you want to make? Because even if you loved everything in the past, if we buy a new house, we have new plans for it, even if we we love what the family house has been for the last several decades, there's still well, now I want to put a garden in the back, I want to change, I want to update the kitchen in this way. What are some of the changes that you all our thinking are on the horizon in the if not the coming decades in the coming years?
Stephen Hutchison 16:36
I think from from a lab perspective, the number one thing with that is transparency. So already, you know, across the field itself, I mean, transparency in the IVF lab is almost zero. And that's you know, we're getting to a point where we actually have much more communication with patients, and they can see exactly what's going on. And then second from that, I think would just be a shift in primary outcomes. So I think, historically, there's a focus on pregnancy rates. So simply just you know, how many transfers we do, and how many pregnancies result from that. So we have this per embryo transfer rate. And that's a great, that's a great measurement. But it doesn't tell you the full story. So I think really, what we should we should be thinking about is that intended to treat the number of people that are actually coming into our clinic, and then are actually leaving with a baby in their hands. And so I think, think thinking about it in that and framing it around that we improve the quality of our care. And so there's many different add ons and IVF. And we can kind of talk about that. But it's really thinking about how we can serve our patients best rather than just improve our kind of like those cursory numbers to make us look best on, you know, SARS, or something like that. And again, let's
Griffin Jones 17:45
talk about a couple of those things, what are some of those things that you are going to be necessary to to serve the patient's best?
Stephen Hutchison 17:52
I think moving forward, it'll be a combination of vitrification and then use or not use of PGT. So you know, I know it's becoming the industry standard now to do PGT, across the board. And, and right now, the literature is mixed. Whether there's clinical benefit or not, this is something we've had heated debates about in the office. You know, I think it's moving in a direction where we're, the testing of embryos will be very clinically useful. But you know, in 2016, I don't think that was the case. So things are constantly shifting, and we have to adapt to the new technology. And unfortunately, research lags behind those things. And so we have to be on top of it all the time. So that's one example. I mean, the other I think, with respect to inventory and patient transparency, we're adopting the tomorrow platform next month. So this is one of the first digital platforms for, for cryo inventory management. And so in this way, patients will actually be be able to see in real time what their inventory looks like. And before it was just it's your your embryos are sitting in a dewar. And we promise they're there and I and hopefully, they are in 20 years. So it's kind of like this, they're taking it on faith, but now they can really see what's really there. And so that's, to me, really exciting.
Griffin Jones 19:12
The topic of the debate of PGT is one that I'm going to devote to another episode with a clinician that really wants to speak on that topic. And maybe I can consult you for some notes before I interview this person, Steve and Christine, what needs to happen on the business side?
Christine DeLuca 19:28
I mean, gosh, so many things. So I think one of the interesting when I first came back, one of my first assignments was our embryo storage billing, which I swear is like, prehistoric from the Dark Ages. I mean, we were like losing 1000s upon 1000s upon 1000s of dollars on just this one thing alone. So now we're actually moving to embryo options with Cooper and they have a 90s 7% rate of embryo storage being paid either monthly or annually. You're welcome,
Griffin Jones 20:06
Andy. You're welcome. That's a free one.
Christine DeLuca 20:10
Yeah, I should get paid too much. Just kidding. No, but I'm, I'm really excited for that. Because it really is something that it's really hard to keep up with people change their info all the time. I mean, trying to track down patients after they've had a baby is like, impossible, like they're happy, they've had a baby. Now they see how wonderful the baby is to they don't want to make hard decisions about what to do necessarily with their embryos, and then they just stop paying. So then you contact them in three years and tell them that they have a balanced like $3,000. And they're like, there's no way we're paying that. So, you know, having them pay monthly is going to be extremely beneficial for us, like if I don't have that headache, so really gonna take a lot off of my plate.
Griffin Jones 20:58
One of the reasons why I'm so interested in interviewing both of you is because I think there's a limitation, perhaps perceived, perhaps very real, that many young RBIs perceive when they're thinking, do I start something off on my own? Do I buy into a small group do I take over for a solo practitioner, that they may face a limitation of who is going to be my support. So if you're an REI coming out of fellowship, you're probably a couple 100 grand in debt from medical school, and many of them went to a fancy undergrad, so they've got some of that debt, you haven't really made money, especially if you're supporting a spouse and have children in residency and fellowship. And then they have the opportunity to maybe have a high salary at a network clinic, or they have clear partnership track with some groups. Many of them are scared to start something on their own, partly because of the debt. But then in addition to the debts like okay, let's pretend for a second that I can afford it that I am not saddled by this debt. I'm interested in potentially buying a solo practitioner group or joining with one. But then when even if I learn a ton from them in the next two years ago, I'm stuck with the Office Debbie's I'm stuck with whoever they have been working with for the last 30 years who are going to fight me tooth and nail and every change that I want to implement. And, and then what I'm going to have to, to look around for for someone so what has it been like for you all to know that you're on the you're on the flip side of that, like you are the you're it's like that's already happened? The the the younger support side has already come in for the changing of the guard. So what is it like for that to be flipped like that?
Stephen Hutchison 23:14
Yeah, it's it's not a great position to be in, right. I mean, what you didn't mention also is that, you know, when fellows are coming out, they also don't have experience in the field. So it's on top of everything they relied heavily, I guess you alluded to, but I mean, they really rely heavily on who they're working with the docs are working with, to learn the ropes, really, I mean, they don't have 1000s of retrievals. of experience. And that's something that that really you need. So, you know, on top of the rely on the doctor, if there's a single practice, doctor, for example, will be have, they come in, and then they better mesh really well with the doctor on staff. And if that's not the case, you know, it's not going to be a good fit. And so this, this is a huge gamble in that in that sense. But from our perspective, I mean, we're, we're the last privately owned clinics. And that gives us a tremendous amount of autonomy. Compared to other clinics, really, I mean, it's fundamentally different in the way that we are beholden to really no one. So the expectation with someone coming in is that they are business partners and that they do contribute and change the practice. So there we are not expecting someone if they do come in whoever it is a nurse and embryologist a doctor. The expectation is that they do contribute and they do provide ideas. We don't want to bulldoze them, and we don't want to have them just kind of, you know, toe the line the party line and do exactly what we want. I mean, doctors coming out of fellowship now are really intelligent, they have a lot to add to the conversation. So I think listening to them, adding their perspective is actually how we're going to move forward in the field in general. I mean, I think there's a long, long way to go.
Christine DeLuca 24:55
I think that's actually quite the contrary like if any doc came in a we already have all the systems in place, think of literally show up, do two weeks of training. And then they off to the races, right, just seeing patients, learning from Dr. Hutchison once he's kind of moved closing out of the door, great. Like, I mean, they don't necessarily have to deal with anything other than, yes, we want their input. But we also want them to understand what we've been doing for the last or what our family has been doing for the last 26 years, which just be good to your patients take really good care of them. And I don't see how that is, you know, like a bad thing. I think we definitely want to innovate for sure. But at the same time, I feel like this would be for a doctor a really cushy, easy thing to walk into. Not only that, too sounds actually pretty cool now, and it's relatively cheap. So you can have like a really beautiful home here that's affordable. I mean, I would love to live in Brooklyn or LA for the rest of my life. But at the end of the day, what do I really have to show for it, right. And I know that a lot of the RBIs. And a lot of the fellows want to go to those major cities, but realistically, I mean, you'd be at the top of the town, you'd be like the big head honcho here, like that's pretty important.
Griffin Jones 26:16
I will not let this episode end without talking about small cities and Tucson. In particular, I want to talk for a second about the concept of arbitrage what I see here, arbitrage usually refers to buying and selling. But it essentially refers to when there's an inefficiency in the marketplace, for whatever reason, for something that can be sold elsewhere, or something that can be valued higher in different circumstances. And I see something like that here that I just don't think exists in many cases, because if you're a buyer, what you're looking if you're a soup, a super nuts buyer, a meat and potatoes buyer, you're looking at an income statement, you're looking at a couple of other things like how old is my provider? How close are they to retirement, you're not really looking at staff. In many cases, you might be looking at a couple key positions like embryologist, but you're not generally looking at the staff. And so your situation a situation like yours would not be valued higher from a just a meat and potatoes buyer standpoint. So you're not having that kind of like being driven up. And then but on the other hand, it's that's the opportunity for somebody to be able to come in and in a situation where they're just not going to be able to get that in most places. If you take over for a solo practitioner, in many cases, you are going to be inheriting the Office app as you are are going to be able to you are going to have to replace that in this case you don't. And whatever the investment that you make in is leverage because right now you all are seeing more new patients than you know what to do with it, or am I getting something wrong?
Stephen Hutchison 28:14
No, I think you hit the nail on the head. I mean, really the volume. Look, if you think about it, and millennials in general is the we're the largest generation in US history. And on top of that our priorities have shifted. So we're having children later and later in life. There are physiological consequences to that. So you have all these people are getting older, and they are building families later in life. And so the demand in general for for fertility treatment is far outpacing the number of providers for those services. And so for us, there's not a the volume is not the problem. It's really finding the people. Right, and so, Tucson, I know, as you know, I had a meeting yesterday with Cooper surgical and, and one of the reps kind of mentioned, oh, hey, I know you're in this remote location. And my must be hard. And I never really thought about that, you know, the Tucson this isn't remote. But from their perspective and from the in the IVF world, we are remote. And so despite that, though, there's so much volume that so untapped. We don't even begin to to fill the need that's here. So I think, you know, finding people who actually want to help the community, despite not having this have the, you know, the big bucks aren't here. I don't think I mean, in New York, there's so much volume that I think shareholders and everyone else can can make, you know, those those promises for that $500,000 sign on bonus, more sign on salary, and that's something that I just don't see happening here or cities kind of similar for the time being,
Griffin Jones 29:48
but I see the big bucks. I mean, maybe I see the so if I'm looking at this, I'm looking at maybe some of these newer networks or groups that we're putting Just by networks that have brand new private equity partners, and they're offering really big salaries up front, but the equity side has, you've got the retiring Doc's and you have the you have a private equity firm that whose limited partners need to be paid in about three to seven years. And some of them are so concentrated, that there isn't equity left for the younger Doc's to eventually buy in. Because the private equities limited partners need too much of a return on investment relative to the scale versus a place where okay, I can buy into this place I can event I can buy these people out and become 100% owner or at least part of majority owner, and then I can bring on other partners in a growing market. That's where I see more opportunity. Down the line, I see a lot bigger bucks because if you can, if you can buy an underpriced asset. Remember you make money when you buy not when you sell, you buy an underpriced asset, then you're the one bringing the efficiencies, not a private equity firm that is saying that they're going to be bringing efficiencies and maybe they can maybe they're not, you're buying it underpriced, you're bringing the efficiencies, you have the leverage by then being able to recruit other younger Doc's and younger embryologist. And now that equity is better leveraged by those folks buying in, and you have a greater share of the multiple in the future or simply the profitability that is generating if you choose never to sell it, I see a lot more opportunity. I think, in many cases, getting big bucks now is Pennywise pound foolish, what is it going to look like for your asset in half a decade to two decades?
Stephen Hutchison 32:02
Yeah, no, I couldn't agree more. I mean, that is really the long and short of it. Right? It's what you know, it's the your it's your input. Now it's just thinking about the long game rather than the short game. So yeah, exactly right. Right now you can I mean, you're what you're going to be offered right out of fellowship is not the same here as it would be elsewhere. But the long term is looking much more bright. I mean, but the problem you mentioned before is that these these rocks are coming out with an enormous amount of debt. And so do they have the ability to kind of saddle that for the time being for those for those years to for that, to really realize that long term payoff? I think that's kind of the struggle, and maybe I'm speaking for these Doc's. But that's kind of the way I see it, and I see their, you know, the downside for them?
Christine DeLuca 32:48
Yeah, but I also see it's a quality of life, right? So kind of like the same thing that I was talking about, as far as like, you walk in, you're your own boss, obviously, the doc, so whatever. But at the same time when you're working for those, like huge firms where yeah, we may be paying you a lot of money up front, at the end of the day, how many hours are you working? How many IVF? retrievals? Are you pumping out in a month? Like, How ridiculous is it? Do you want that work life balance while still having the ability to make really good money? Do Are you gonna have time on the weekends to go to your kids soccer games? Like, yes, these are all the things that we can provide. And it's not necessarily about making money, like we would never push someone into doing an IVF cycle. If they didn't, you know, they only have one follicle, it just doesn't make sense. We get to like the luxury of making decisions and not pushing numbers ever. It's always what's right by our patients, because at the end of the day, like it's not that we're concerned about any of that. But like, our whole business strategy is based off of word of mouth. Like, a lot of my friends have been through the process. I've already been through the process. So I mean, literally, it's it's easy. It's it's small community. I mean, it's big, but it's small in a sense that, you know, people talk and I don't know, it's nice to be a part of something where you never have to question like, Oh, am I doing the wrong thing by a patient? Or am I doing this for a payout? Or am I pushing somebody through something that like, I don't necessarily agree with but hey, I'm gonna make my bonus this year, like, that doesn't exist and are like, one doctor practice like, it's pretty cool that way?
Griffin Jones 34:33
Well, because I don't think there's a lot of clinics in your situation. There are some, but it often falls on one side of the spectrum where it's a single doc group that has very little marketing machine that has outdated processes. And there is financial pressure there too. If somebody wanted to take over because As they need a lot of reinvestment, and they, they need more people in order to, to be able to support their existence. And on the flip side, you don't have that same financial pressure where it's like, we, you know, we need to reinvent a lot of things. And we need a much wider patient pipeline, but you have investors, and the reason why they're paying you a lot of money is because they expect that investment to be returned. There's not a lot of people where you're at where it's like, we've got plenty of volume, we have updated systems that we are not only are we updating right now, but we have the support folks that are invested in being here for a long time, too. And don't have that, that investor pressure. There's So Christina, I don't think it's I don't think it's that common where you're at? Oh,
Stephen Hutchison 36:02
yeah, no, I agree. Completely uncommon, it's to not have pressure for profitability is really uncommon. I mean, we take on patients that we know won't be profitable going into it. And then we have the luxury of doing that, you know, that not every patient is going to look, we're again, we're dealing with physiology, and it's not always perfect, and it's and it's not always easy. And some Patients will demand a lot more time. And this is something that we actually can do for them.
Christine DeLuca 36:30
We work with like a lot of low income patients as well, where we discount heavily their IVF cycles, because we know that they can't afford it. Like that's something that we get to do and a lot of people can, and that happens often.
Griffin Jones 36:45
I'm a bit biased towards you all, because we've worked together for a long time I've eaten in your homes, I've known families for years, and done a lot of business together. And so I'm biased towards you. But I do really want people to consider that. It is worth looking for the diamond in the rough. I know there's not a lot of them. But you're also not the only ones. There are a few in different parts of the country, where if you can get the system where there it's it's a relatively lower buy in where there is a lot of upside in the marketplace, where there's proven growth in the practice. And there aren't existing financial obligations either through debt or investor obligations. It it's not an easy deal to find. It's like looking for the house in the up and coming neighborhood. That also really has to be the up and coming neighborhood and it has to be a house that is underpriced. But isn't so much of a fixer upper. Those aren't easy to find either. But in both cases, it's absolutely worth it. And you make money when you buy not when you sell and I mean that figuratively as much as I. I mean, literally. So you all now are going to PCRs which I think is going to be cool, but you actually sponsored something at PCRs Tell me about that.
Christine DeLuca 38:15
Yeah, so we are we're doing a happy hour for all of the new fellows. I can't exactly remember where it is. But apparently it's gonna be pretty lit. I think it's Jimmy Buffett themes. So everybody get your party hats on.
Griffin Jones 38:30
So so much. So much for getting rid of the baby boomer theme. Yeah. Oh, no, we millennial like Jimmy Buffett. Right? I
Christine DeLuca 38:39
mean, yeah, we just kind of we had to let them fly with it. Because a it's gonna be hilarious. But be like, Man, who can't loosen up to a little Jimmy Buffett, like, party with your parents kinda, but like, also get to know the younger generation. Yeah. And I mean,
Griffin Jones 38:58
tell me about how you decided to do this, because I think it's so cool. And we've been talking a lot to the younger Doc's in this episode. But I want other practice owners to be thinking about this too, because very often, who do you see as the sponsors, either it's one of the pharma companies, maybe it's one of the genetics companies, or it's one of the large networks, they're the ones paying for sponsorships. They're the ones wining and dining, they're the ones making themselves seeing you all aren't that yet, you decided, hey, we're gonna swim in this pond. So how did you make the decision to do that? Why? Why was it important enough to make the investment?
Christine DeLuca 39:40
I mean, it's not just a Steven and I need to meet all of the folks in the community, right? Like we need to kind of make a name for ourselves in general. But it's good to see where everyone is what they're doing, get to know them, see what they're either other practice managers what they're doing that's working versus Just while I'm doing and kind of comparing notes for Steven, it's probably meeting new Docs. Again, for me, it's also going to be meeting docs and follows and all of that stuff. I mean, like, some of the best days are when we have our residents come in from Ghana. And we just get to, you know, basically should, I don't know if I can say, on the podcast, you can bleep it. But
Griffin Jones 40:22
that, but but well know that you said it.
Christine DeLuca 40:25
Okay. Well, the point is, is that, you know, we're all again, it's, we're the same age, basically. So you know, not far off. And we're all kind of trying to figure out where we are in this world. I mean, not necessarily, as it works with practice managers, as well. But mostly like with the younger fellows and the docs, like it's just good to kind of see what's important to them, and what is making them want to be a part of reproductive medicine. So it's just nice to spend the time to get to know our own community.
Griffin Jones 40:59
I want to talk about Tucson in smaller cities, because I've said it a lot on the show. But the there's two things, one is quality of life, and the first is access to care. And I really don't think we can be serious about an access to care commitment, when everybody wants to live in one of 15 cities, how can we really say that we're serious about expanding access to care if all of us want to live in New York in the bay? And there are people in large swaths of the country where they're not seeing an REI. And so can you talk to us a little bit about Tucson, which on one side as a city has been growing, has more young people going in on that sort of patient demographic side? But on the other side, you have less providers than you did a few years ago? So Can Can you talk about that?
Stephen Hutchison 41:57
Yeah, I mean, that's exactly the case. It's a growing city. So it's, it's, I don't know the demographics. Now it's well over a million, right. So that and then the university is only growing, it's always been a big university. I mean, I've been there, Christine, Holly, my dad, everyone is from U of A. So that means that there's a lot of young people and they're all coming out of that system, and they're all living in Tucson. There are now two RBIs. And for embryologists in Tucson, so you're servicing over a million people, which is there's not nearly enough again, it's it's the the volume is there, it's just trying to figure out how we can possibly service all these people. But you know, living in the city itself, it's not about a city. You know, it's it's something that is actually bustling, there's like a huge downtown. There's the university, like I said, it's an active University, and they're active with us as well. So I mean, we actually get to engage in research if we want to. So we have fellows coming in, we have our ability, we're connected with the actual, the departments at the University for research, which is really unusual for a lot of specially private clinics.
Christine DeLuca 43:10
Yeah, I'm so sorry. I feel like such a brat for not writing down his name and remembering but what was who's the doc that was from Tennessee, and he moved back home. And he was talking about like, you know, yes, as a younger doc, and you move back to like a smaller city, and you start taking care of patients, yes, you have to work. But at the same time, you get to do surgeries, if you so choose, and you get to run studies, but you're just heavily leaning on other people to help assist you. Like so you can still have your cake and eat it too. It doesn't mean that you don't get to do all the things that you want to do. You just have to put your patients first. And then after that delegate to research assistants delegate to, you know, the masters students, tell them what you want, tell them like be that point of contact for them, where they help run the study. And then you you know, kind of oversee it and still be a part of it. Some accents.
Griffin Jones 44:09
I think you're talking about Dr. Neil Chappell from Baton Rouge, Louisiana who, okay, who was talking about that. But so if you're thinking of it from one of two ways, either quality of life or from mission, I think for those folks that really are mission driven, and some of you are far fewer than say they are, but some of you are the true blues. When you're thinking of your vocation, as it were your mission, and for many of you that is access to care if it really is a mission to access to care. We have a problem in our field, like when SRM is in Baltimore, and we the that we the Bucha Wazee who are very well educated and know better and know how to behave with polite values go, Baltimore, you that type of response, that type of sentiment is fairly common. And I think if we're serious about access to care, we need to challenge what that is because there are a lot of Baltimore's in the world. And I actually don't think that Tucson is one of them. So sorry, I think that if you're truly mission driven, that there probably are even more places in need than Tucson. I don't think that Tucson falls there. But you could at least say, okay, maybe I'm not the most mission driven person. But I do know that there is a lack of providers relative to the population and anywhere that is, should drive people if one of their their motivators is mission, I don't think that that necessarily will be the the exclusive motivator for most people. And that's when you have to talk about quality of life. So Christine, you moved from Brooklyn to Tucson? What's different about it?
Christine DeLuca 46:14
Well, obviously, I have a car. I could get to places really easily. No, but it's I mean, there's hiking, they're like really fun downtown. Like when I went to school here, there was no like, like, mini little train system that went through all of campus and down through the university, and like down to Fourth Avenue, which is like, one of the bigger bar areas and then into downtown, all the way past the freeway to like this new cool box yard concept. I mean, it's just like, there's so much to do hear now, a lot of restaurants. I mean, we're a UNESCO heritage site for Mexican food. It's kind of put us on the map. I mean, even my brother, he just so he's trying to get his kid into preschool. And he him and his wife, like, fell madly, like had a couple crush on these two other parents who are similarly went in for the interview for their like two and a half year old to get them into preschool. And they're from Brooklyn, and they want to get together. It's like, we actually are there are a lot of people moving from these major cities to Tucson, because it's, I don't know, I guess kind of like a new Austin, Texas in a small sense. I wouldn't necessarily say it's completely that way. But I mean, I own a home. Now, I don't live in a one bedroom apartment. But I paid vastly too much for my groceries. I mean, not lately, but they're pretty inexpensive compared to major cities. And I love it here. I have a really cool community and meet people on the daily have more social engagements than I know what to do it. And my family's here. So I mean, once you're kind of a part of the Tucson family, you're here for life.
Griffin Jones 48:03
Well, you know what people don't didn't say 15 years ago about any place. They didn't say this is the new Austin. You didn't say this was the new Denver. They said Austin is the new Chicago, Denver is the New Boston, the new Philly, whatever it was at that time, but the time for for a few markets is right now. And to me, all of the indicators suggests that Tucson is one of the I don't like to be speculative, because there's so many things that can change. But if all of the indicators are pointing in one place, is it in a state that is high growth and is likely to be for a long time? Yes. Is it a place that has warm weather? Yes. Is it lower cost than the places nearby it that will make it more attractive to people from those areas? Yes. Is it on the border with Mexico as NAFTA becomes increasingly more important in a regionalized, less globalized economy, a check, check, check. And those windows don't last for very long. Like it was oh, Denver's an awesome place to live. I can't believe we can be so close to the markets and get a house for this cheap and it's as expensive as New York in in a couple years time period. And we're seeing that in in a couple of markets, Boise, Reno Tucson. There's only a few of them, and the window doesn't last that long. So I I encourage people to look into a couple of those markets if, if you're inclined to do so. But what about Christine if you're not from that place, because in many cases, people go to either one of the big markets or they go to where either their spouse or themselves are from. So what what's available to someone if they and their spouse are from a totally different part of the country?
Christine DeLuca 50:06
I mean, that's great. Especially, I mean, especially if you're joining our team, because if you're joining our team, you're already family. So you're going to be saddled with a lot of social engagements, a lot of new friends, a lot of new things. But even if you're not Tucson is extremely welcoming. All you have to do is like, I don't know, find a intramural soccer game, and people will welcome you easily into this town like it is not. I mean, Tucson is very wholesome. And we're really down to earth. I mean, unless you're just like, not a very good person in general. I mean, we'll still be nice to you. But realistically, like, that's never the case. People are who they are. And normally, they just want friends, to someone's gonna welcome you like, in a heartbeat. We're just not that way. No one's better than anybody. Everybody's like, you know, we don't put on airs, and we want
Griffin Jones 51:00
to do whatever you want high taxes and snow.
Christine DeLuca 51:09
Nice. I don't know what the taxes are, like on Mount Lemmon, but sometimes gets to know,
Griffin Jones 51:14
sorry, guys, I have to stay in upstate New York, I do want to talk a little bit about how you have been changing some of the culture or adding to the culture and the brand simultaneously. So it's one thing to have an outdated infrastructure, if a young doctor is looking at taking over a practice, they also have to look is Is this an outdated brand? Is it something that as the kind bodies and the other consumer global brands do very well in are more prolific? Is it something that can stand up against that? And so you made some changes to your brand? Tell us a little bit about that process?
Christine DeLuca 52:00
I mean, yeah, I think we've updated multiple things, not just like, the way that our office looks, but presenting information to patients immediately when they walk in with like, our TVs, changed our brand to kind of be all we want you to feel comfortable, right? So when you walk into our waiting room, you should feel like you are in your living room or in a friend's living room. Right? It should be warm and should be inviting and comfy. Yes, I mean, we do have the 26 years of experience behind us. But again, we've got this new generation coming through. And we really do. I mean, it's it's kind of the same as far as we take care of people. And I spend more hours on the phone with my patients than I don't know, any other kind body you could ever imagine. And again, it's like word of mouth and making sure that you're also taking care of being recognized on the internet. I mean, we realized we didn't have as much touch on a lot of patients surveys or Google reviews. So kind of how to rope that in. I Steven, can you think of anything?
Griffin Jones 53:09
But am I am I allowed to talk about something together? Right? Yeah, this credit goes to Donna Schrader, who is the creative director on this project. But we did something called homing from work campaign for telling the RHC story. Steven, can you explain what that story is? And And can you explain what's behind the campaign? Yeah, so
Stephen Hutchison 53:37
the, you know, this is a family oriented business, I mean, through and through, we're all family. So, you know, the whole point was to the video itself is, you know, I was, I just happened to actually watch this last night with my wife. And I was thrilled, I was tickled because I was the star of the show. But really, you know, it's, the whole thing is, my I have a nine month old son now at the time, he was six months old. And, you know, we he's in the office all the time, he's in every day. And so, you know, he goes through every he goes from the front desk, all the way to the back of the lab. So here we embrace family. So we build families, we embrace families. And on top of that, like Christine was saying, we're here for personalized medicine. And that's what the campaign is about, as well. I mean, we're, this isn't a mill. This isn't an IVF mill. Everyone is personalized. And Christine alluded to before, we're not going to do IVF if lifestyle factors can be included as well. So wellness has something to be considered always a prior to any kind of intervention. So I think all those things combined is really what we're going for.
Griffin Jones 54:45
Is this a privilege extended to Hutchison babies only if there's a Rei with two young children are they welcome and they are more
Stephen Hutchison 54:53
than welcome. In fact, we have other babies all the time in the office.
54:58
We have nurses Tada, her baby in here are one of our front desk managers. She's got her grandson in there. Poor Ben never touches the floor when he comes to the office like literally we all just, it's, it's exactly what the video looks like, literally. We all like Ben's here, oh my god, Ben, and then we all run over and we're like, super giddy then. So
Stephen Hutchison 55:23
and to add him to the Game of Thrones here, Ben is my son.
Griffin Jones 55:29
I wonder how many practice groups can say that can say that children of our staff and our providers aren't as welcome here they are here. I think it's probably a pretty short list. And we will remember to link that video in the show notes and link it in in a couple other places so that people can see that because now people are like, I want to see what they're talking about. So we'll make sure that wherever that lives for you all, we will link that in the show notes. Hopefully this episode right now, I've got this episode scheduled to come out before PCRs, which will be great because there's going to be younger Doc's listening to this show that are also going to be coming to PCRs, they're going to be a little bit shy to introduce themselves. Now. Now those of you listening, can use this as an excuse. And if you're still shy, let me know. And I'll I will soften it up with Stephen and Christine. And for those of you that are more extroverted, you'll need no introduction whatsoever, because of how welcoming you both are, I'm going to let you conclude of how you want to see the continuation of the fertility practice as the next generation begins to take over the home.
Christine DeLuca 56:52
Yeah, I mean, ideally, like it's the same thing that you were talking about with patient care and serving a community, we would love to have a doctor that would come in and take over for Dr. Hutchison, but still have that safety net, to be able to provide service and really good quality service. But also, I mean, as just being the younger generation, I want us to continue to have the same moral compass that we always have and never sell out. And always do. It's not just for our morals, but what's best for our patients, and continue to, like just serve our community.
Stephen Hutchison 57:31
Yeah, I mean, we're not here to reinvent the wheel. So bringing more people on, really, we have an excellent track record. So if we can just continue that and then build on top of it, we already know that the field is going to change dramatically. It won't look in 10 years like it does today, just like it didn't look anything like it does now 10 years ago. So we will need to adapt as that comes along. But right now the current pace that we're at, we're right on track for that. It's just the matter of finding the right people who have the same vision you do.
Christine DeLuca 58:01
Yeah, wouldn't hurt to wouldn't hurt to be the only place in town that was you know, kind of took over completely the market and we have the lion's share, but there's a full on reason for it because we're the best. And because we care.
Griffin Jones 58:18
Arbitrage listeners windows aren't open for very long and there aren't that many of them. Pay attention for the arbitrage you make money when you buy, not when you sell. True figuratively as it is literally, Steven and Christine, thank you both so much for coming on inside reproductive health.
58:37
Thank you very much. We really appreciate it.
58:40
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 thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health