Let’s save you and your patients some money!
From the materials you buy to the software you invest in, it can be difficult trying to find where to safely and effectively reduce, replace, or eliminate to save money and maximize your practice’s bottom-line.
We talk with Dr. Mark Amols, founder of New Direction Fertility Centers, and he walks us through his low-cost affordable IVF model. He reveals where and how he invests, or doesn’t, to keep his practice thriving.
Dr Amols breaks down his four categories when purchasing materials and services:
Which line items can be completely eliminated
Materials that can be reduced or replaced with cheaper alternatives
Finding cost-effective versions of necessary commodities
How to know the expensive must-haves to pony up full price
Dr. Amols opens up his playbook and gives specific cost examples from his own practice, so listen in and see where you can cut your bottom-line.
Dr. Mark Amols’ LinkedIn
New Direction Fertility
Transcript
Dr. Mark Amols 00:00
There's nothing special we're doing. I mean, this is typical supply and demand type of economics and in when it comes to the vendors, I think one of the most important things that I do as a business person is I don't look at it as me trying to get the lowest price. I don't try and get the best deal. I kind of look to the vendor, I say, how can we work with each other?
Griffin Jones 00:28
Let's save you some money. Let's go through your income statements, fertility doctors, let's go through your costs and see how we can save you money by eliminating, replacing, reducing, negotiating. But before we do that, I have to fess up to some technical difficulties that messed up this interview a little bit. It was my part I know that breaks your heart, you're not going to get to hear all of my witty insights the same as you would if the recording for the audio went properly. But Dr. Amols who was our guest, Dr. Mark Amols from New Direction Fertility in Arizona, gave us so many good insights. I was late to the interview to begin with, but no good excuse just my carelessness, I didn't want to have to bring him back on for his time for the audio issues that were on my end, but my audio stopped recording about a quarter of the way into the conversation. So I re recorded my questions, I tried to do my best to match them up with how the conversation went. And the answers that Dr. Amols gave, if any of the answers seem off, blame it on me. But the insights in this episode are terrific. I asked Dr. Amols to walk us through his low cost affordable IVF model that he's had a lot of success with in the Phoenix area, I have him go through those things that he spends less money on things that he doesn't spend less money on in his system for approaching that I definitely wanted to have him back on for another conversation about top of license, not just the REI, but everyone in the fertility practice, going through the accountability chart and what that would look like. But today, we focus mostly on materials and services. And we break those into four categories. The first is those materials and services that you just don't need, you can eliminate those costs altogether. The second, which ones can you reduce or replace with cheaper alternatives? Because you're reducing them in some way? The third is those commodities that you need them. But there's a wide range of prices and not a wide range of quality. So how do you get the cheapest? And then the fourth, maybe there is a wide range on prices, maybe there isn't, but there is a wide range on quality. And you really have to pony up sometimes. So we break into those four categories. We also talk about things like software and professional services. And Dr. Amols is very generous. In this episode, he gives specific examples, he gives specific costs, he opens up some of his playbook very transparently. And he shares that with you. So if you talk to Dr. Amols, please tell him thank you because I want him to come back on and share more. But I also want everyone to come on and share a little bit more. And it always pushes the envelope when somebody's willing to just share a little bit more makes that episode that much more popular, more valuable. And then people want to mimic that and they tend to share more valuable information and give more value to the audience when they come on. So enjoy this conversation with Dr. Mark Amols, Dr. Amols. Mark, welcome back to Inside Reproductive Health.
Dr. Mark Amols 03:28
Thank you, I greatly appreciate it.
Griffin Jones 03:31
I thought to invite you back on because I was in a meeting not too long ago, with an older physician who was expressing distress in their voice, I could hear how troubled this person was that they wanted to reduce costs at their IVF center because they wanted more people in their area to be able to afford treatment. And they legitimately did not know how to do that they're already being squeezed on the margins, I could see their numbers. It's not like they're raking in a whole bunch that you know, it's just coming out of a inflated top line for them. And there's been a handful of people that have been able to do a lower cost affordable IVF model in the country, only a handful. And you're one of them. You've been on the show to talk about that for and that's still one of the most popular episodes. And I remember at that time we did it live and it was during the COVID shutdown and we had more people than we had capacity for in the Zoom Room we had we had to you know upgrade our our account. And so I wanted to have you back on and I wanted to go through with you how you select your partners, meaning your strategic partners, your vendors, because a lot of people would like to be able to lower costs and they just feel like they're getting squeezed everywhere. So how do you think about this challenge?
Dr. Mark Amols 05:06
Yeah, you know, it's interesting when you told me about the topic, I was kind of confused when he said, How do I choose my vendors, but it actually does all come together? I think the question isn't so much how we do it. But why other people can do it, there's nothing special for doing I mean, this is typical supply and demand type of economics. And in when it comes to vendors, I think one of the most important things that I do as a business person is I don't look at it as me trying to get the lowest price, I don't try to get the best deal. I kind of look to the vendor, I say, how can we work with each other. And so for example, like I understand the vendor has shipping costs. So if I want them to send me something every month, I realized that's gonna cost them more money. So I'll work with them say, hey, whatever, I just take like two large shipments a year, I'll take a huge volume, you give me a lower cost. Now you're not paying shipping all the time. And I'm, you're guaranteed dismount every time I'm again. And so that helps kind of like, you know, look at it as a relationship in that standpoint. But the other thing is, is I understand the point of volume. So when you're talking about low costs, I mean, it to go like Target and stuff, you have to have more volume, if you don't do more volume, you're going to lose. And the way that traditional IVF is set up is really this kind of, you know, we're gonna get 1020 patients in per month to do IVF. And so they rely on making a lot of the sale, and they don't have the volume. And so when you do have the volume, or at least if you're going to have that volume, you can go to these vendors and say, Hey, here's my volume, here's my projected volume, you can see how much growing each year. And I tell them I say listen, if you make a deal with me, and help me, I will stay with you. You know, even your prices go up a little bit, I'll stay with you. And so down to the vendor pick, like we were saying, so getting back down to how do I pick my vendors, you know, it depends on your product. So there are some products that are made by multiple vendors. There are some products that are not right. So if you think of, let's say, fairing, or you go up at the end of the men's out there, that's like the electric company, you really don't have a choice, right, you only have a choice between Gameloft and follistim. But when it comes to manufacture, you really don't have a choice. So for those type of companies, there's really not much you can do that the relationship is really just them being nice to you and your stuff to keep buying their product, but with Folsom and go limp off, so you can work with them to try to get better pricing for your patients. When it comes to things like product for the lab, you're a little bit limited, because there are quality differences. Luckily, it's been very standardized in their industry now. So you know, most we're using the same products now. But with those vendors, it comes down to, I think building some type of loyalty with them. So you know, you work with a company every single time they know you're going to come in and buy, you know, six ultrasound machines, you know, 620 incubators the same time, they're going to, you know, keep giving you better prices through the years because they know you're gonna stay with them. And again, building that relationship with them, you know, always sending stuff that way. And then the other vendors are going to be your vendors that have multiple vendors that do the same thing. So when you talk about things like speculums, or you talk about things like drapes, you can get drapes from multiple companies, there's stuff I buy off the Amazon, because it's cheaper for me to get them off the Amazon than it is through my suppliers like Henry Schein, they have tegaderm, which goes on the skin after you put an IV in. Bye bye for them. It's like 100 bucks for 100 of them or 80 bucks. I got off amazon for $15 the exact same things. So when it comes back to choosing the vendors, going back to that question of how do we make it work? So one of the things is, is I tried to find those strategic partners. And and I talked to them like they're a business, I don't talk to them, like I'm trying to buy their product. I taught them to say Listen, how can we both help each other? What do you need me to buy? How much have you need me to do? Because like there's things I want a lower price, I'll go to come I said I need this at a lower price. And they said, we can't go any lower, it's okay. But if you buy more of this, then they'll offset I can lower that price. And so again, it still ends up the same, right? We're still looking at the same thing, which is overhead, which is your expense versus what you make. And that's really all it is. It's just the differences. It's harder to do. So I'm not trying to say that about most doctors, most doctors don't want to do business. I mean, why would you still want to become a doctor, you want to go out and just make money. And so for most people, they see money in their bank account, they're happy, they're like, it's going up, I'm happy I see the numbers going up. But that doesn't mean they're efficient. That doesn't mean that they've actually at the point that they're getting the most amount money they make. I can almost guarantee you that if they went and got a person like you know, Scott Robertson, you know, from practice up, they got him to go through their practice, I guarantee they'll make more money just by him going through and finding out where they're wasting tons of money. And so in those situations where you have those practices that already have this high overhead they're trying to do this low cost model, but they're not efficient. And that's really that the main thing is you have to be efficient, and there's more to it, we'll go over that in a little bit more detail. But that's really the biggest thing is when you're looking at vendors, you're trying to make sure that, you know, you pick vendors that you can build that relationship with. So you can get lower prices and be able to offer things you know, better cost. So things like speculums. I mean, I, my spec homes costs, I think some like 10 cents. Whereas like, when I was at another clinic, it was a buck 50 per speculum, and it wasn't needed. And so again, there's things you can do to get better pricing, that doesn't matter. No one's gonna have a bad idea of cycle because respectable isn't great. But they aren't going to bear the IVF cycle, if they're incubators bad.
Griffin Jones 10:47
So I do want to go through those different categories of what's more interchangeable versus what you think is less interchangeable, and I want to break up those different categories. First, I want to think about how do you approach looking at this systematically? Or do you like do you do you just start to negotiate and look for different options? When you're ordering something? Do you go through your p&l at different points of the year and, and go line by line and say, How can I start with this and go all the way down the spreadsheet? How do you approach it?
Dr. Mark Amols 11:21
Yeah, every three months, I go through and I look at everything that we order. And I find out if it's one of those categories of where we can't change, right, there's no option. It is something that we can change, but we can have very little room because it might be something like an incubator, I'm like, I can't go for the crappy incubator, or is it something that's easily changeable, like a drape or something like that. And then what I do is I always go through and look for the best price. And so for example, like propofol is one of the drugs we use for anesthesia, I found a way for us to get propofol at 20%, the cost we originally paid. And again, it doesn't sound like a big deal. Because most clinics, if you're only doing 10, 20 cycles a month, you're not going to notice a couple of dollars here and there, when you started doing 100 Something a month. Now all of a sudden, that becomes several $100 Every month in that one product. And so those little differences make, you know, make a big difference. And so yeah, I go through every every three months, I look at things, I'm always looking for ways to reduce costs. Here's example. So one way we reduce our costs for bloods by 50%. So we made more margins was I know this, we were buying 10 milliliter tubes to fill the bloods up. And then one day, I was wondering, they make smaller tubes that cost less. And we went and found that they make like four milliliter or five milliliter tubes. And so we went and got five milliliter. And then later we found even made a smaller tube when we run like six tests in our clinic, so we realized we could use less blood, it costs half the amount and we reduced our costs overhead for those supplies by 50%. So just things like that, looking for things, looking at what do you need? And what are you getting, and you may not need what you're getting,
Griffin Jones 13:04
I would love to have you back on for another topic to talk about top of license throughout the accountability chart. So you and I can go through the accountability chart of fertility center together, because we often think of top of license as just the REI. But the whole purpose of getting someone to practice at the top of their license is to get the next person to practice at the top of theirs down to the person that is checking someone in and bring someone to their room.
Dr. Mark Amols 13:32
So it means a culture, right. So as a culture as a clinic, we all believe in the same thing, which is making this affordable. So everybody knows that the better our overhead is the lower we can keep costs for patients. And so my lab, you know, will always look for the best price and other times they'll come to me and say this is all we can do. And I say okay, let me look at it, I might look into a little bit more. I have to be very nerdy. I love numbers. Like a dat in there. So I love that stuff. So I enjoy doing it. But yeah, I have other people who will do a lot of that for me. And then when they can't, they'll come to me and but I'm I'm always thinking of ways that we can reduce costs, just because our field I do believe has a lot of fluff and a lot of overhead. It's not needed. You know, we made some big changes just recently on just even staffing away I thought the box of we have staffing our clinic different where you know, medical assistants are very difficult now to find. And you know, I kind of looked into the legality of like, do we really need medical assistants for every little thing and so we found out that we could even just put greeters out there who can help us just you know, put patients in rooms and then again, that brought cost down so it's just it's not resting on your laurels and just saying hey, this is what we're gonna do. It's always gonna be this way we're always changing and adjusting. Same thing with vendors, you know, always looking at different things. Now, there's the point where again, once you have that relationship, you know, if you're constantly just changing for the lowest price, well then no one's ever gonna work with you. So I mean, there's a little bit of flexibility you have to have right so if someone's give me a great price now and then two years later that go up a little bit. And they're a little bit more than next one, I'll still stand with them. Because at that point, I know I've built that relationship. And again, that's an I'll talk to them and just say, hey, it was a little harder than we need. Is there anything we could do to get that down? Can we can we purchase more at one time? Can we do this stuff like that, but things like there was little things like shipping all those different things working with your vendor, you can get better pricing by just working with them and ordering more and committing them more. So
Griffin Jones 15:25
For the sake of this topic, let's break it into four categories, those costs which you can cut, eliminate entirely those which you can reduce significantly, either by replacing them with something else or reducing them by a lot. Third, that which is a commodity, you need them. But you can find a wide range of prices for not a wide range of quality and that fourth category, those things that really matter, there might be a wide range of prices. But there might not be and there certainly is a wide range of quality. And it's too significant.
Dr. Mark Amols 16:01
Exactly.
Griffin Jones 16:02
What are those costs that fall into the first category that you can eliminate entirely.
Dr. Mark Amols 16:06
One of the things I when I was in other clinics, you know, obviously did this with one person training and then prior business I was with, is there was a lot of stuff we did to make, like a few dollars, but wasted a lot of our time, I think the thing that's most important understand is there's only so much time in the day, right? As a physician, I only have so much time, I'm probably when you think about when it comes to resources, the most scarce resource in the clinic. And so what happens is, is that there was a lot of stuff I was doing as a physician that made absolutely no sense. So we used to do what are called IVF consults, where we would sit there and go over the whole process with the patient of the IVF, we used even do a surgical visit the day before then make an extra dollar or two through the insurance. The problem is that same hour and a half being used for retrievals could do three retrievals. Or I could do two consults. And so one of the things that can be thrown away is really using people who can do things in their category. So for example, there are things no one else can do that I can do right as a fertility doctor. And so those are under my license, any nurse can do those things I was doing before those other clinics. And I can guarantee you there are claims out there today, where the physician is still doing a ton of stuff. And there's no reason to do that. It's a waste of money, it's a waste of your time, you'll never build do this low cost money, because you're looking at going, I gotta spend all these different employments eight payments, before I get to this point. Now you don't you have a team that that can do this stuff. And so part of what's important is, is you want to utilize people to the max they can be what's the most are allowed to do as a nurse. And then but you also don't want to waste their time doing things that you don't need to right because you're paying them too much. So when you look at overhead, so when you talk about what can you get rid of, it's for not getting rid of it, but adjusting it to out of the wrong hands instead of the doctor bringing it to the nurse, bring it to maybe you have a specialist, that's all they do is bring in someone, let's say off the street, you pay him 16 bucks, Darren, you're like, you teach them everything about IVF, you say this now is our IVF consultant, and they're just going to tell them about IVF. And you know what, they're gonna be pretty damn good at that job. You don't have to pay someone $80,000 a year as a nurse to do this every day when someone else can do it. And they'll do just as good because that's what they're specialized that that's kind of the way I look at things when you're looking at these models. I think one thing that's really interesting, though, about our clinic versus some of the others is that I think it's really important, though, to stay a high quality clinic, you know, not seeing other claims are bad, and I won't name the clinic. But there are a lot of people who do what I do, and have very poor pregnancy rates. And there are clinics like me who have very good pregnancy rates. And I think that's really important in this big thing. So when you're doing all these things, you're making these adjustments, you don't lose being a good clinic. You know, it's not about just getting low cost and having bad service, you have to stuff that service. So all these things I'm saying when they take them out. It's not that they're there's none important, like I said, so one of the fluffs I always talk about is like, most people don't want to sit there for an hour and hear about the idea of like, you know, the prepper rather read it on paper or give it to him in a text or something like that. So just stuff like that is how I've taken those things out product wise, is more just choice. Some physicians like use an iodine, you don't really need iodine. There are other changes you can do, but those are very small.
Griffin Jones 19:24
How about the second category that which you can reduce quite a bit or swap it out for a much less expensive alternative?
Dr. Mark Amols 19:31
Yeah, I mean, a lot of the things it sounds crazy, but like going from four by fours to two by twos for certain things, you know, we just did it away. We we always did it one way needles. You know when I'll give you example, one thing that a lot of clinics use, is they use other fine needles. Butterfly needles are really expensive. I mean, the best price you're gonna get for them. It's maybe a buck, but usually they're like a buck 52 bucks. You go to a regular needle mean the pennies and so Oh, you know, you think about your doing 1000 or 2000 needle sticks, you know, every few months as 1000s of dollars versus a couple $100. So that's something where, you know, we still had those if needed, but any phlebotomist knows what they're doing does not need to use a butterfly. But yeah, clinics use up you can get skinny needles that are still butterflies. So another example, too, was not only going from the five milliliter tubes was a big difference. But we actually found out that there are other brands of the tubes. And so a lot of people when they use like tire top tubes, most expensive from you know, Beckman, but you can actually get these ones caught we call McDonald tubes, or they look like a McDonald's franchise, too. And those are when I say lower costs, like 1/10 of the cost of the other tubes. And so again, something as simple as that can save a ton of money.
Griffin Jones 20:56
And how about that third category? Those things that you definitely need, but they're commodities, you can find them from enough for a number of different vendors for a wide range of prices? How do you find the best price for those?
Dr. Mark Amols 21:08
I think one is, obviously you have to have a company where you can keep looking at you have to look at see if they have multiple companies that sell that product. Now, here's an example of drapes, the pads the patient's sit on. So we were buying a certain size, but they were kind of too big. And I found if I just get a size, it was like two inches smaller, we see it like half the amount. This is like little things like that, and always ask them the question of do we need that, we obviously need the purpose of protecting the patient so that you know, but not sitting on a drape. But if it's falling over the sides, well you can wear when there's two inches smaller. And now you see a cat and mouse like little things like that that we look at. One was a male stands we used to use Mayo stands all times when you do surgery thing called Mayo stand up, put up a sterile drape over and then that way it protects anything on which you obviously want to have is sterile. But then one day I was I was wondering why why are we putting a male stand that we put a sterile thing on top of already when we open up the instrument. So instead, what we did is we took our instruments by a slightly bigger kind of like the truth that we cleaned it with, put it on there, we opened it up, and now that becomes kind of our sterile drape. And we saw at the same benefit, as if we were being the man stamp, but we're paying a fraction of the cost. And again, we're not losing a sterility, everything's still the same is that we just use the drape that it came with that we have everything cleaned in sterile area. I think of other things where we've we've made some changes to sorry, is that there's a lot of things I mean, but you know, those are kind of some of the big examples of you know, things where we would just look at everything. Here's another one, I just thought one was a probe covers. So when you buy pro covers, if you buy them in bulk, you get a huge difference in costs. If you just buy like the 100 pack every time you pay a premium, but you can buy like 1000s of them in bulk, and they're clean. And then that way you just put those in into your rooms and then use those. So again, another place you can save a lot of money. I think the big question for speculums is you have to ask what what your volume is. So if you're only doing let's say, five a day, you're probably going to save more money than using something like a reusable one and just you know, clean them but that takes money cleaning those it takes a person cleaning them in a busy clinic like mine, that could never happen. You have to use disposable. And like if you use the common disposable, you'll pay a lot of money. So here's one I'll give away. This is a good one people really like so if you buy Welch Allen lighted speculums they're very expensive. The light that goes in them are very expensive. Everyone loses those all the time drives me nuts when my nurses there were some because they're like 300 bucks for those lights. The speculums themselves cost about once you about $5 Each speculum. So Henry Schein makes another version of it. But the problem is, it's a wired version. So the problem is you have to put a wire into it which is which is horrible. You want to have it you know portable. So there's a company that actually makes a little light that fits into the Henry Schein when I figured it out. And so we were able to buy all the lower cost Henry Schein lightest speculums and use a disposable light. So the best part about it is, is that if a man loses a light, it was just 10 bucks on that light. And the second thing is we reduced the cost by half of our speculums. Just another thing I found by researching things though, it's not always just the supplies you use, but also the time committed to it. So for example, like a Sano histogram, way most clinics I've seen do it, they by saline models, they pull the ceiling up into a 10 cc syringe. And then they go and they do their solo histogram pushing with the st lame. When we used to do it that way. We had to do solid histograms about every 15 minutes. And then I found prefilled syringes, and I thought well if they're more expensive, we're gonna pay more, but then we'll have to To time into it and said, How fast can I do it? We're using everything prefilled we end up doing them every eight minutes. And so again, one of the things you also look at is not just the cost of them, but you're also looking at, does it make it more efficient. So we switched over now completely to prefilled ceilings. And back to that thing where I said about the 10 CC's. So we were just buying 10 CC's for everyone. And then I went spoke to the nurses, I said, Well, how much do you use, they go, Oh, we only use about three or five. So then I went looked up and found out they make three or five milliliter ones, or those lower costs, and they were so at that point, okay, oh, by the lower cost ones. And the same thing with like propofol, people, when I got the better price, one of the things I found out was sometimes when they're given propofol, they open up a whole nother bottle for just a tiny bit. I thought, well, one of the really tiny bottles so that way, we don't waste so much medicine. And they did. So we bought those. And so then and this is all just these need a little bit more use smaller bar, which cost less. And so it's not always just about getting a different product, but finding out are these these little areas that you're not using so much, you know, and stuff like that is really how you do it, even on the pay what you do each ESGs for, there's several bottles, and you'll find that there's one bottle, it's about a third the cost. So so back to that fourth category. Yeah, you know, again, I think it depends on how you look at your clinic. And that's why I made that point. They were the biggest difference or clinic, we have, we have to have high quality, I feel like what good is do they have a lower cost, and you're just gonna have bad rates. And so the things that I feel like you can't come away from are some of the main products, you know, good incubators, you know, you really have to be up to date on their incubators, I think there is some adjustments you can make between them. But you know, I feel like, Sure, you can get a cheap pair cell incubator, but it's not gonna be the same quality as a benchtop incubator. Same thing with things like gases, you know, I would love to be able to use cheap gas. But you know, you're not able to if we're using mix gases, we, you know, we have to have it certified, that we did find another company again, for cost again. So we always are working on that. And we're even looking at now mixing our own gas to save money. But but the point is, you can't, you really can't do much, you know, now there is like, like I said, when it comes to medicines of it, you can't change that. There's nothing you can do the company. But when it comes to things like incubators, you know, we look at a lot of things, we buy a lot of them so we're able to get good deals. But there's really not a lot of like I said adjustment. I mean, other than when you want to be one of the top, you have to use some of the top stuff.
Griffin Jones 27:29
What about other costs, particularly related to your tech stack things like your EMR, your payroll, software, other software, your billing and scheduling software?
Dr. Mark Amols 27:38
So EMRs I feel they all suck. I don't think there's a good one. If anyone says they have a good one, I want to know about it. But I don't believe there are any good ones. So when I looked at I said, well, listen, there's no good ones, I'm just gonna go with something that gives me the fastest speed. So we went with a system called Dr. Chrono. And what's unique about it is is you can do the whole thing on the iPad. And it's very fast. It's not made for fertility, we're actually trying to make a component for for fertility. But so we went with that, but it's free, doesn't cost me anything. So my EMR costs nothing, they do my billing for me as well. And take the same fraction amount and take it from any other biller. So we just use a company, sometimes there's some things that are cheaper to do when you outsource until your volume gets high enough. So obviously, like a big company, like Pinnacle or CCRM, right, forgive them when they charge and stuff. But for smaller places, it's actually cheaper to just find the company that will do it, than hiring someone to do it. So we do all that outside.
Griffin Jones 28:36
How do you approach paying for professional services? Things like business consulting, marketing, consulting, accounting, financial consulting, legal expertise? How do you pay for professional services or think about costs, like, associated for those?
Dr. Mark Amols 28:53
So because I like the business side, I do a lot of it myself. Honestly, I only have so much time in the day, I do have a CPA. So my CPA does all my bookkeeping does that. We do have a legal firm that we work with all the time if needed. Luckily, we don't have to use them a lot, except for all the expansion we're doing right now. And through the other cities, when it comes to financial stuff like that. I do a lot of that myself. We don't do much for marketing. Luckily, we're very fortunate that we don't have to, but I do do my own marketing when it comes to things like Facebook, my podcast.
Griffin Jones 29:25
My recommendation for professional services is to separate them into sporadic engagements whenever possible. So sometimes you need professional services for execution, some marketing services, some things that you might need for legal help in terms of drafting documents that are pretty easy to do here and there. Just the drafting part of it. I'm talking about things that you might need accounting services like bookkeeping, those ongoing things. Try to minimize those costs as inexpensive as you can and then be willing to pay for professional services as at a high hourly rate. That's something thing that I do now I charge at a higher hourly rate. And I could do packages and things, but that allows people to engage us at a rate that works for us because they're paying high by the hour, but also works for them because they don't have to lock it in every month. So go ahead, pay for expensive business consultants, expensive legal consultants, but try to separate that from the ongoing costs of monthly implementation when possible.
Dr. Mark Amols 30:25
Recurring costs are one thing that can kill a company. And so you know, you're hitting right on your right things like consultations, you don't need recurring forever, but it's worth getting the best when you do it. And usually, that does cost more. And you know, now that we're doing all this expansion, we use lawyers more. And so we've been looked at potentially going to have an in house lawyer, but again, recurring costs get expensive. And so I agree with you 100%. on them,
Griffin Jones 30:50
You're still independently owned, I sometimes see independently owned fertility practices having more leverage because of consolidation. Because there are fewer people to buy services, there is more emphasis on those buyers that remain. And so even if you're not the size of the networks, as an independently owned, Fertility Center, do you have more leverage, because everyone else is consolidated? And people have to make deals with those that remain? Or am I fantasizing too much about this?
Dr. Mark Amols 31:23
You know, I think, again, comes back to that slide the man or thing, right, so if you have a clinic that's not using a lot, I mean, I don't know how they're gonna be able to really get best prices and things like that. I think clinics that do more, you give example I see and why and you see why it's humongous, or I'm in the summer, like 4000 retrievals a year, they're able to get the best pricing just as big as like a pinnacle or CCRM. You know, and so I think I would tell someone, if they're trying to do what I'm doing, is I think the most important part is explaining, show them your growth, right? If you can show growth every year and say less number grow in play in expanding, then you become kind of your own group, you know, Purchasing Group, and you say, Listen, every client I opened up, I'm gonna still order from you. And that helps it one of the things that you I think you and I spoke about one time is why not all the little guys teamed together and make one group you know, and then that way, we'll be our own Purchasing Group. I think it's a little bit fantasizing, I think, as a company, if I was a company, and symbol was so low, and they were doing a lot, I wouldn't give them lower prices, you know, because that's the only reason you're given the lower prices at the bigger companies is because of the volume they're doing. And it just wouldn't make financial sense to give it to someone who is using very
Griffin Jones 32:33
Giving us really specific examples. You've also given us a framework for practice owners to go through their own books and see how they can lower costs, how they can increase profit for themselves and ideally pass on a lot of those savings to patients. How would you like to conclude?
Dr. Mark Amols 32:52
If anyone's ever interested in learning about this, I mean, I don't try to hide at this you know, I'd love for everyone to make fertility more affordable. And I think there's always going to be those niche, you know, offices that offers you know, that one on one the whole time process with with a doctor and those are going to do great, but if anyone's ever interested, I'm more than happy to talk to you if they want some of the ideas. I have the reduced money costs, you know, on their overhead, more than happy to talk to you about but hopefully I was able to help some people.
Griffin Jones 33:20
Dr. Mark Amols, owner of New Direction Fertility in Arizona. Thank you very much for coming on Inside Reproductive Health and I look forward to having you back on for another topic very soon.
Dr. Mark Amols 33:31
I look forward to it.
Sponsor 33:33
You've been listening to the inside reproductive health podcast with Griffin Jones. If you are 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.