DISCLAIMER: Today’s Advertiser helped make the production and delivery of this episode possible, for free, to you! But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, and the guest’s appearance is not an endorsement of the Advertiser.
Your fertility center is growing.Do you expand your current office or build a new one?
Lindsey McBain, Executive Director of IVI America, has overseen numerous IVIRMA office setups, relocations, and expansions, playing a key role when they relocated their headquarters to a new city.
Tune in as Lindsey reveals:
The differences between starting, expanding, and moving your office [And the unique considerations of each]
The difference between building a new office and moving into an existing building [With and without a lab]
When to Buy vs. when to Lease
The non-negotiables that should go into a letter of intent for a new lease
Building a Standard Operating Procedure for launching new locations [So organizations can do it at scale]
How she selects vendors for each new site
Some Pro tips for what small offices can do to save money [And simplify logistics]
Lindsey McBain
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IVI America
RMA Network
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Twitter: @thermanetwork
Transcript
[00:00:00] Lindsey McBain:
Typically, when your lease comes up for renewal. We look at economic factors. We look at location factors, you know, we make an analysis of what's best. We look in the market to see if, you know, it makes sense to move. Moving is an investment, but sometimes it's the right investment.
[00:00:18] Sponsor:
This episode was brought to you by LEVY Health.
Seeing more patients for a first consultation may actually decrease IVF revenue by 30 to 40 percent. To see why, download the numbers for free at levy.health/conversion. That's levy.health/conversion. Today's advertiser helped make the production and delivery of this episode possible for free to you.
But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
[00:01:03] Griffin Jones:
Opening a new fertility clinic, easy. Moving a fertility clinic location, easier. Expanding a fertility location. That's the easiest of all said nobody ever. And I brought in someone who has done it a lot. Is Lindsey McBain a household name in the fertility field yet? She ought to be, she better be after this episode.
She's the executive director of IVIRMA America. She's moved, set up, expanded. A number of RMA offices. She was a linchpin when they moved their big headquarters from Morristown, New Jersey to Basking Ridge, where they are today. We talk about the differences between moving an office, starting a new one, expanding one, which is the hardest.
And what are the unique considerations of each the difference between building a new office versus moving into an existing building with a lab without she talks about. What goes into scouting a location for site needs evaluation, including variances in site plan approvals. Talk about when to buy versus when to lease.
Talk about building a standard operating procedure for launching new locations like this so that organizations can do it at scale. We talk about the non negotiables that should go into a letter of intent for a new lease. Talk about considerations for square footage. For those of you not looking to expand all over the globe, Lindsey gives a couple pro tips for what small offices can do to save money and hopefully not be logistically impossible.
She gives pro tips for looking at blueprints ahead of time and as the site is being built. She talks about who's on her team, what their roles are each responsible for, and her outsource team when she goes into a brand new state. That's to hire new architects, new project managers, how she does that, and how she selects vendors for each new site.
I enjoyed this episode. If you enjoy it, let Lindsey know, because she gave us a lot of value for starting new locations, moving locations, and expanding locations. On to the conversation with Lindsey McBain. Ms. McBain, Lindsey, welcome to the Inside Reproductive Health podcast. Hi, how are you? I'm doing great after some technical difficulties and switching to an old software.
We're recording this episode on Zoom, so I want you, the listener, to tell us, does it sound better, worse, or the same than the last several dozen episodes you've heard? Better, worse, or the same? I want your feedback, the listener, to let us know. Because what I really want to focus on is the conversation.
I've known Lindsey McBain for seven, eight years. Probably I'm thinking we both have said and said on the board for the association for reproductive managers of which Lindsey. was chair. She went through that whole officer cycle and Lindsey, you're not usually the loudest person in the room, but when you talk to people, listen, and I'm one of those people, and one of the topics that I have clung to that you've spoken on over the years is about.
Building new offices, building new labs, launching new offices, whether it's Terranova or not. And so I want to go through that concept with you today and maybe we'll end up breaking them into categories of like brand new office buildings, brand new labs versus when you might put an office in an existing hospital facility or something like that.
And I've done it across a number of states. So I want to ask about some of those nuances. But I'm interested in. The first time that you ever launched a new office, tell us about what that was like, because if my LinkedIn serves me correctly, you started your career in fertility with with RMA at that time, RMA of New Jersey at that time, at pretty much the very beginning of the Great Recession.
So pretty much the worst time to start a new job is September of 08. If my records are correct. So tell us about what was the first mission that you were put on? Because it's probably a very different landscape than, than what it looks like today.
[00:04:56] Lindsey McBain:
Yeah. So when I first started my first year at RMA, I did not do what I do now.
After about a year, year and a half there, I got involved into operations. And at that time, RMA was growing and we were in the best, we were in Morristown. That was our headquarters. That's where it all started for RMA. But we were outgrowing it. It was getting way too small. So they were looking, even before I got there, they were looking for a building.
They were looking to move their New Jersey headquarters somewhat in the same geographical area, but to move a new lab, new OR, and be on our own. In Morristown, we leased space from the hospital, Atlantic Health. We were across the street from them. But this was going to be our own building, everything. So I Um, Once I got in the field, I was started helping them go look at locations with Dr. Scott, Dr. Drews, and Dr. Berg. At the time, they were the three partners that were overseeing that. So we would go look at sites, we'd evaluate needs, we'd evaluate location, making sure that it was big enough that it allowed for some growth, and that it would be convenient. To our patients and fit within our footprint in New Jersey, my first construction, I will say, was not that it was a small satellite office for New Jersey was West Orange and Eatontown.
I did. And those were not labs. They were just office space locations for New Jersey, where those are the first two I did. I got involved in both of those. Probably I took them over from my predecessor. So those were my first two and then we started working on the Basking Ridge project, which like I said, I was involved from the search to negotiating the purchase to the construction with the partners.
[00:06:31] Griffin Jones:
So Basking Ridge is moving the headquarters from Morristown to Basking Ridge and that's about a year and a half into your tenure at RMA. So this is when it
[00:06:43] Lindsey McBain:
started, but it was. I mean, it took a couple of years to find a location to negotiate everything to start construction. I mean, nothing goes fast when you're doing real estate construction permits. There's a lot of red tape anyone who's done this,
[00:06:56] Griffin Jones:
I want to, I want to talk about that. I want to get to that of how it's, if you're thinking of a certain deadline, you should be tripling that in your mind. I want to talk about, Those expectations. So that's moving from Morristown to Basking Ridge. And that's process starts in ideation in 2010.
[00:07:14] Lindsey McBain:
I mean, like I said, they were looking before I even got involved. But yeah, I think 2010 is when it really took off. I'm trying to think. I got married in 2011, and I know we were in the thick of things, and I'm on my honeymoon because I was panicking being away.
[00:07:27] Griffin Jones:
Delightful. So. It's a nice, it's a nice little honeymoon gift, worrying about what is happening with the contractors and everything else.
But the West Orange and Eatontown, that happened before you chose the Basking Ridge location? So you were cutting your teeth a little bit. Yeah.
[00:07:44] Lindsey McBain:
Yeah, those, and those are satellite locations, which, with not having, you know. Oh, ours are labs or anything like that. And you're not buying a piece of the property.
It's a little bit different. It's a little bit easier when you buy property, you typically have to do well for us, at least we've had to go for variances or site plan approvals. It's a little more involved if you get town approvals, it's different than just normally when you go into a location for a satellite, sometimes you need a zoning permit, but the local town.
But typically that's something you can just handle with paperwork and fees at the local administration without having to appear before a board or getting a use attorney and putting a case forward.
[00:08:22] Griffin Jones:
It's like minor league versus major league, but I think it does merit some discussion that some of the lessons from those smaller offices.
How much of a process did you have at that point? Like a standard operating procedure. This is how we. open new offices when it, when you were working on West Orange and Eatontown, how mature or not was that at the time?
[00:08:44] Lindsey McBain:
So for me, it was brand new. We luckily had a GC that had done prior RMA builds with predecessors of mine.
So he had some basic guidance. The partners at that point were very involved as well. So they were still looking at plans and giving feedback as well. So it was very helpful to have their input and their expertise. So I worked with them closely. I worked with the GC and I just was learning everything.
Anyone that had been involved in prior. Offices at RMA. I was picking their brain. I was just learning anything I could to try to figure out what I was doing, how to do it the best way, how to do it better. And I was, I mean, I think I was just hands on with everything. I mean, I was doing anything and everything I could so I could learn every piece of it.
[00:09:29] Griffin Jones:
What do you recall a surprise or a harder lesson being from one of those first to the Eatontown? West Orange Satellite offices,
[00:09:37] Lindsey McBain:
I think just the coordination of the people and expectations. So you do work on this whole project and The people that are moving in usually aren't that involved the staff everyday staff and then to get them on board and showing up and All those pieces to fall in is harder than you think.
You're so focused on the construction that you kind of forget how to embrace the people into the move and make them feel invested and that they should be happy for. And that it's the right layout for them
[00:10:09] Griffin Jones:
With how do you make that decision to especially when you have a number of different options that People could go. It's not like you're in one city and then you're just opening one satellite office three hours away. It's like they're fairly close to each other.
There's at least, there's probably people that live in suburbs in between. How do you make the decision of who goes where?
[00:10:32] Lindsey McBain:
For staff, I mean, we look at the geographical area. If we're moving an existing office, we're typically staying within the same area so that staff will move. If we're opening a new office, we look for typically you have your doctor first.
So Eaton town was a new location for New Jersey at the time. West Orange was a move of one of our existing offices. So they were both a little bit different with Eaton town. We were really building with Dr. Molinaro was the doctor there. She was. Very, very involved, but it was building a team there and building an office rather where West Orange we were relocating a team to a new location.
So it's a little bit different given the staffs. They are moving them and reorienting them versus seeking out new staff or sometimes their staff that wants to relocate that's commuting and it makes sense to relocate them. And then you have experienced people. And they're moving with it. So there's different variables, but definitely for any of the builds, even the ones we have now, when you're going into a new area, the doc is key and they're always very involved and very crucial.
I mean, to anything, obviously.
[00:11:32] Griffin Jones:
How often do you find that you're hiring new staff for offices that are not so far away, let's say within 20 miles or so, are you hiring new staff specific to that area? Most of the time, or most of the time, are you bringing folks over?
[00:11:47] Lindsey McBain:
Sometimes. The nurses and docs will have them in the system already, or at least the lead nurse will try to have in the system.
But you're hiring new front desk, typically you're hiring, not always, but typically you're hiring new front desk, new clinical assistants, new phlebotomist, andrologist that are in that area. Again, sometimes you find someone who will move, but typically when you're opening a brand new location, like we recently opened in Jersey City, we did have to go to the local market and supplement the staff.
[00:12:15] Griffin Jones:
How much variance is there when you're, when you're. Opening, whether it's opening a new office like Eatontown or you're moving an office like West Orange. Do you find that, okay, this is typically the flow of this doctor is going to be here this many days. If he's going to do this many NPVs a week, then it's this many nurses, this many techs, this many, this many people for the front desk team.
Is that Do you typically have a formula that goes with each of those? Or is it so variant depending on the doctor?
[00:12:47] Lindsey McBain:
Well, it definitely is on the, it's more variant on the volume. I mean, our offices are typically five days a week. So we staff for patients to be there five days a week. Whether we're staffing for, we, we do morning monitoring a little bit different in New Jersey than a lot of even our other locations, because it's a block of time where you just come in where it's not scheduled.
So, five days a week that is open and then there's new patient visits and stuff after that. Each department has its own staffing model and based on the volume that we're telling them, they kind of go from there to assert the staffing. We definitely try in a new location. To allow ramp up time. I mean, you don't want people sitting around doing nothing, but you also don't want patients not getting the care they need.
So it's a balance of making sure, but it's all volume based and every department kind of has their own metric for how to stop it and how many visits or how many rooms or numbers that they can fit for the staff
[00:13:38] Griffin Jones:
Does that that tentative have. thing five days a week for who you're open. Is that like a minimum criteria for you all?
Is that one of your criteria for opening a new place that you just won't open a new place if, if you don't have a doc and a team to be there all five days of the week?
[00:13:55] Lindsey McBain:
Right now in New Jersey, all of our offices are five days a week. And then we have some that are seven days a week because of the geography of New Jersey, you know, you need to be able to offer a weekend hours.
In certain key locations, we don't have in every office, but because we go from Marlton all the way up to Englewood, we do offer multiple locations with weekend hours to serve our patient population and help decrease their weight on a weekend and their drive time. Uh, but generally all our offices are Monday through Friday, uh, minimum.
And then we have the seven days a week because we're three inches, five days a year. We're always going.
[00:14:31] Griffin Jones:
A lot of people that are listening to this are in markets much smaller than the greater New York Metro. And they're in markets that are a lot more sparsely populated. And so they do have satellite offices that might be open.
One day a week or two or three. And, but given that New Jersey is the most densely populated state in the union, it sounds like the juice wouldn't be worth the squeeze real all if you had to have open a couple of days of the week.
[00:15:04] Lindsey McBain:
No. And even when we open our EBRMA offices, the original offices are always about seven days as needed.
And then when they open satellites, we generally aim for five days, but you try to make sure you have the volume. But I can understand if a smaller market, a smaller one doc office, it's much harder to staff and make it worth it. I do know there are offices where they also share space with other providers to grow their footprint, which makes sense.
At one point, we had a post and overlook that we were only there. Three days a week, I believe it was. It was years ago. We're, we're no longer in that area. But to get in that footprint, we had a doc go three days a week with a medical assistant who also was able to do front desk and it had limited hours, but they were scheduled and it was there for that patient population.
So it can definitely make sense. I mean, the idea to be at the right location for your patients, I think.
[00:15:56] Griffin Jones:
Outgrow that location and overlook or was it this is a pain in the neck having a doc out here for three days and if we lose that medical assistant who can also double as the front desk, then we're in tough position because that person is going to be hard to replace with one.
And so what was it? Was it?
[00:16:15] Lindsey McBain:
Yeah, we grew our foot part in New Jersey, so it didn't make sense when we added offices. We were kind of covering that area with existing offices. When we grew our IVF, with IVF New Jersey came part of Army New Jersey, we kind of grew our footprint and we were in different locations, so it didn't make sense for us.
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[00:17:58] Griffin Jones:
I wonder if there's any kind of rule for, for folks that, that if you're not planning to grow to a certain volume that maybe you don't.
Try to open a satellite office there for part time unless it's one of these locations where that's the only way they're gonna They're gonna get fertility treatment And there are many rural parts of the country where those are the only places Where that that doc coming out there a couple days a week is the only way they can get treatment.
There are docs that Have their own planes that fly to some of these rural locations that they go out to yeah, and
[00:18:36] Lindsey McBain:
so if you can share a space, like I said, another MD like use it or a hospital space. I mean, that kind of lessens some of the burden on the cost and overhead. If you're able to do that and expand your footprint.
[00:18:48] Griffin Jones:
Did you ever share with? Another REI, because I have heard of groups doing that.
[00:18:53] Lindsey McBain:
We, we have not, I don't have experience in that area. I mean, overlooked. There were other providers there, but not other reis.
[00:19:01] Griffin Jones:
Were they all women's health? Like does it make sense to Yeah, it was all
[00:19:05] Lindsey McBain:
there. Or it was women's health and it wasn't just a reproductive health either.
It was. But it was all gear. It was a woman's health unit, but it wasn't just all reproductive health.
[00:19:15] Griffin Jones:
We got a lot bigger fish to fry than this place that used to be in an overlook. But I do think you've laid out a couple of good rules that can make life a little easier for people. One is the sharing space.
People might have thought about that. But I also think the having a medical assistant that can also double as the front desk person is very important in a situation like that, that can make life easier for people. Are there any other lessons that stuck out to you of when you had a place that was only open a couple of days of how you made it?
Not too logistically burdensome.
[00:19:50] Lindsey McBain:
I mean, I think RIT infrastructure really helps us. We were able to remote into our network and remote into our EMR. So I don't think patients felt it. We also made sure that the ultrasound that our, we're most familiar with and worked her best imaging was there. So we didn't want our patients that were there to not receive the same quality that they would anywhere else.
You know, so we made sure that the basis of. The foundation of what we needed to provide the excellent care was still there.
[00:20:18] Griffin Jones:
Oh, I think that's a pro tip. So you didn't buy the ultrasound machine there, did you? You chose the, the providers that were there had the ultrasound machine?
[00:20:26] Lindsey McBain:
No, we, we, we brought one.
We brought our own ultrasound, but it was, it was ours. We was, we leased our ultrasound. So it was a lease that we put there. And when we left, we took it with us. But like the exam table was there for us, the exam light, the stools, the waiting room chair, the desks, all that stuff was there.
[00:20:43] Griffin Jones:
Okay. Well then that pro tip is mine.
Then people are listening and they select a place that has an ultrasound machine that is like yours. So that that's one less thing. If you're going out to one of these places, we're only going maybe a couple of times a month or once a week. All right. Yeah.
[00:21:01] Lindsey McBain:
You've been fine. That, that's great.
[00:21:02] Griffin Jones:
But Lindsey's pro tip of leasing is probably more realistic in most cases.
All right. Bigger fish moving on to back to West Orange and Eaton Town, which were two offices. What are the, what are the considerations of, is it categorically easier to open a new office or to move a new office?
[00:21:23] Lindsey McBain:
I think it's, well, from construction wise, I think opening a new office is easier. Usually moving.
Is you're running two offices in tandem. You have to worry about the coordination of the move. You have to make sure that patients know where to go. There's always that time to get them acclimated to the new location. You don't want anyone to miss an appointment. So make sure that you're communicating well and getting the word out that you're moving.
And also it's a change for people. So change is always a little harder than. something new. I think the hardest is expanding a location, quite honestly. I think that's the trickiest because you're have a practice going that you don't want to compromise, but you need to grow it. So coordinating that construction around people working, patients coming in, I think that's the trickiest, to be honest.
[00:22:11] Griffin Jones:
Okay. So we have, we got three categories when it comes to location, you're moving, you're setting a new one up and you're expanding on the moving side. Pain in the neck that we always had to deal with was the changing of the local listings, which is just not as easy as it should be. Still, I, I started this, I started doing this stuff like 13 years ago and, and it's not any easier really.
[00:22:35] Lindsey McBain:
Now, even to update your Google location as much harder than I ever thought it would be my poor marketing team.
[00:22:40] Griffin Jones:
And it's, and it's critically important. It's one of the most important things. And, and you can send people to the wrong place. I've actually, we had a client where they. For whatever reason they Google was putting the pin in the wrong place of the new spot.
And so God bless her.
[00:22:56] Lindsey McBain:
Yeah Our marketing team is very good and very proactive But I know it's hard for them because it's very hard to make sure that You're communicating the right way, that patients are hearing it, that everything's updated. And then there's always someone that misses something or referring data as an old had in their office or old brochure that they give someone.
[00:23:18] Griffin Jones:
So when do you make the decision of if you're going to expand or if you're going to move? So let's, let's stick with the example of West Orange because that's where you had moved, so where?
The previous location was no longer sufficient and now it's time to go to a new place. What, what goes behind that decision making process?
[00:23:42] Lindsey McBain:
So typically when your lease comes up for renewal, we look at economic factors. We look at location factors. We make an analysis of what's best. We look in the market to see if it makes sense to move.
Moving is an investment. But sometimes it's the right investment. You have to look at your relationship with the landlord. You moved in 5, 10 years ago. Are they, is the building still in good condition? Is, if they're ahead of the bargain being upheld? Did the landscape outside the office, did roads change?
Is it not ideal? There's a lot of Pieces that happen when you're in a lease for five to 10 years that are outside of your realm of control. And there's other locations where that 10 year lease comes in and you're just like, Oh my God, I want to stay. This is the best location, like, let's renew, let's expand.
But it's definitely a conversation you have to have with the local staff and you have to be involved. And part of my role is also visiting these locations, going out, checking in, seeing how stuff's going, making sure. I have a team that runs day to day operations and is involved in all the day to day at these locations.
We're very aware of what's happening. Not just when we walk in to evaluate that we're involved the whole period so we have relationships with the buildings Maintenance the landscape we're out there. So it's important
[00:24:55] Griffin Jones:
And how do you decide when to expand because that's got to be a hard decision maybe perhaps even a harder decision because it seems to me like all of the Considerations you just listed are still at play when you're thinking about expanding and you're ultimately deciding are we?
Do we want to do those things here? Or, or, or start anew? So when does it make sense to expand an office location?
[00:25:19] Lindsey McBain:
So funny enough, we just, we, so 10 years ago when we moved West Orange, when I got involved in that project, remember it was started, I came in, we just expanded West Orange after being there 10 years in the newer location.
We're very happy where we are. We think it's a really great location. But we had thankfully grown with the doctors there have a very heavy referral base and they needed more space to adequately treat patients to make morning monitoring more efficient to add better space for our staff. And there was, the other thing with expanding is there has to be availability in building.
So we knew that there was adjacent space, which is vast, available, and we knew we liked the location. So we reached out and we started negotiating that deal. How long did that take? That one was a little, that was the trickier deal. It probably took me six months to get terms that we were happy with. I worked with Dr.
Drews, was very involved in that deal. And we worked together and negotiated with the building manager and got that deal secured. And then after that, construction started. What? I want, I want to talk. Some deals where you expand can be in two weeks. That was a trickier deal where they were going back and forth.
They had other people interested in the space.
[00:26:34] Griffin Jones:
Sure. And then was there a lab at that location in West Orange?
[00:26:38] Lindsey McBain:
There's an andrology lab, but not an embryology lab.
[00:26:40] Griffin Jones:
Okay. So then, it's not like, it's, it's not the hardest thing in the world to move a location like that. Like you said, it's hard, but you also said it's harder to expand.
So why expand there instead of going to a new place?
[00:26:55] Lindsey McBain:
Well, I mean, we like the location. We like the building. There is space available. It's significantly less, like, more economic sound to expand sometimes than it is to do a whole new location. You have to look at all the factors. If you're in a good location, and you're in a good building, and you think everything else makes sense, and there's that prospect to just add a little bit more.
Sometimes that's the better economic decision.
[00:27:19] Griffin Jones:
Tell us about what goes into the negotiation process. What do you have to make sure that you're on top of?
[00:27:26] Lindsey McBain:
I think one of the most important things for us is that we have very specific hours. So I want to make sure that there's no issues with the doors being open for my patients when we're open.
We like our doors to open either between 6 a. m. Most buildings do not, even medical, do not open that early, to be honest with you. So that's one of our key tenets. We also need to HVAC during that time period. We don't want people coming into a freezing cold building or a stifling hot building. We also need to be secure when they're coming in.
We don't want them going into a pitch black parking garage somewhere. So those are all kind of the basics. Basic stuff that, like, I think don't even, we can't even talk if we're not going to meet those basic pillars of access for our patients and safety for our staff. And then we need 24 7 access for MDs, but typically in our, like myself, that's really never an issue with any building.
If you're a tenant there, usually getting 24 7, that's not an issue for something critical. And then from there, we go into what makes sense economically, what they're, if we're going to do a tenant allowance, if it's a fit out, what they're contributing. To the cost versus and that's, I mean, that's economic decisions here, because it's really a T. You are paying that in your rent in some ways. So you have to weigh out all those factors and the timing and all that information for the lease allowing typically we negotiate some rent delay. Went to the lease to allow for construction, so.
[00:28:48] Griffin Jones:
Do you have all of this, like, in an SOP checklist now? Like, like, here's our standards for HVAC, here's our standards for what the parking needs to be, here's our situation for how the badge access needs to be, and what time patients need to be able to get in.
Like, do you, is this all in, like, kind of a checklist that you're just, voom, that you can send to any landlord?
[00:29:09] Lindsey McBain:
Yeah, now it is. Now, after many years and each year, I think we get a little more sophisticated and I've gotten better about documenting stuff. I'm really, and I try not to be one of those people that a lot of stuff stored in my head, which is not great for other team members.
So I've tried to get much better at documenting stuff for my team and Then everyone has to ask me a question, they can look it up and they'll have access to it. And it's much clearer also with working, not just the landlord. We're trying to very clearly our expectations with working with an architect or a general contractor, like this is what we expect.
We're laying it out. So we've gotten much better at documenting that stuff. I got it. And some of it, I'm just documenting. I'm getting from other genius people. Like I don't know everything, but. Gathered knowledge from people and I have a document so I know that this is what we need. So a lot of it is just taking all the information you learn and all the data of what the different departments and you know what we need to really function great and having it in one place.
That's not all knowledge that I developed or I know. I mean, that's key. I'm taking the wisdom from everyone else. I think that's important to realize. And I think that's one of the key things is that I spend a lot of time learning the different departments in different areas and learning from all the brilliant people I get to work with because that's really like where you learn.
[00:30:25] Griffin Jones:
You do deserve credit though for not letting it just go in your head though, because that does happen very often where someone does come, they benefit from the institutional knowledge that's kind of there in the ether, anecdotally talking to people, maybe they compile it for themselves, but they don't get it into an SOP for the organization.
And so that is, you deserve some credit for that because you want to be able to repeat and not have it. Be all you so that the next person doesn't have to think about it on their honeymoon. And so when you go on your, your anniversary, your 15th anniversary, you don't have to, you don't have to be thinking about all of this stuff.
People can access it from other places. And I've written, I've made a couple notes about your team because I want to ask about the team. I could jump all over the place. You've got so much. Gold in here. So let's stick with negotiation for just a second. Those are all really good places. Are there, is there any kind of phrasing that you learned to be aware of where there was some kind of phrasing that you, you, you were certain meant one sort of thing.
And then after you go through something like, Oh, that's not what we wanted or, or you, Oh, You promised us X and they gave you Y and is there any type of phrasing that that sticks out?
[00:31:41] Lindsey McBain:
Not so much. I mean, I, an LOI, I don't need an attorney for like, we know our terms. We know our letter of, LOI, letter of intent.
We know the terms we want to go in there. I mean, when then we get to a lease, we, we are smart enough to bring an attorney in to look at like the legal jargon that could step us up. And like, I tell the attorney, these are the things like I need to make sure are in my lease. Is there any hidden? I mean some of these leases are 200 pages long.
Is there something hidden in here that I didn't catch that I need to be aware of that's going to make it so my HVAC isn't on or they're going to close every third Thursday or something crazy like or their holiday schedule is X and my holiday schedule is Y. Can I pay to be open or are they shut, shuttering the doors?
So I think it goes back to knowing you're operating non negotiables and putting that in your letter of intent, which is the. Framework for your lease, and then relying on your legal experts to make sure that there's no legal barriers set up.
[00:32:34] Griffin Jones:
Is it always a lease? Do you ever buy?
[00:32:36] Lindsey McBain:
No, we own a couple locations.
We do. So, I mean, then it's different. It's a little bit easier. But typically most people, especially new people into the industry, usually are leasing their first locations, I would say. It makes more sense. But yeah, we do own some locations.
[00:32:51] Griffin Jones:
And, and I, I wonder what the breakout is. I wonder if it's like, I wonder if it's, if it's much less than a quarter that do that would be my guess is that it's a quarter of people that, that maybe it's less than that.
Maybe it's. Yeah. Well, we can add that to our arm team's surveys
too. Tell April, we've got one more survey for you. So when you all decide to buy, is it. What's the criteria behind that? Do you have to be the anchor tenant there? Is it like something that you did with your Basking Ridge location because you got a lot more people and then you can be the anchor tenant?
Talk to us about when it's time to buy versus when it's time to lease.
[00:33:36] Lindsey McBain:
So definitely for us being the size we were in New Jersey, we were well established. It was, it made sense to have the entire building. We were going to need the entire square foot building and they wanted to make it a purchase. That was always the intent.
We really weren't looking to lease anymore because of the growth they wanted and the flexibility to really design it themselves. So that's what we did there. I mean, we did the original construction and then I think it was. Five years later, we added 30, 000 square feet to our Boston Ridge location. I don't know if you've ever been there, but it's our original 60, 000, 65, 000, then we added about 30, 000 to it five years later.
[00:34:17] Griffin Jones:
So you're talking almost a hundred thousand square foot building.
[00:34:21] Lindsey McBain:
Almost. And that sounds a lot more because you have, you have to remember, you've got building areas, you've got elevator rooms, you've got loading docks. Like you, that's the one thing with buildings and you'll, even in leases, they have cam.
So there's different areas that you have to pay for, for like use, like your entryway. So there's a lot of lost space, even when you own a building that you have to be aware of when you lease, you pay for common areas. But when you buy, like, even though it sounds more, there's a lot of wasted, not wasted, but there's like lost space.
Like you need HVAC rooms, you need Duckworth, you need electrical rooms. Like it's not all clinic space ever.
[00:34:56] Griffin Jones:
The CAM, what is that? Common Amenities, Common Access something?
[00:35:00] Lindsey McBain:
Yeah, it's Common Areas Maintenance. I believe that's what it stands for, but it's. You know, typically you have those fees in your lease because you're paying to have elevators, entryway, core bathrooms, all that stuff.
So you still need all those amenities when you own a building as well. And that takes away from the footage that you have in there.
[00:35:17] Griffin Jones:
So it's, it's a big operation in, in Basking Ridge, but you are the only tenant there? Adding...
[00:35:23] Lindsey McBain:
Even with adding these other genetics is out of there. But yeah, all okay.
[00:35:28] Griffin Jones:
And so all right, then this is a good segue to go back to the when you were starting to move from Morristown to Basking Ridge, you had already done Eatontown and West Orange at that point, one was a new location.
One was a move. Now you're back at a another move. But at this time, it includes the clinic offices, but it also includes the corporate offices and a lab. And so did you leave a lab in a space there in Morristown? Or was it completely, we're completely getting out of here and moving into? Basking Ridge.
[00:36:07] Lindsey McBain:
We kept a satellite there.
We did not keep an embryology lab, but we kept a small andrology lab and we kept a, like a satellite office there. So we downsized our footprint in Morristown. in the same building? We've now moved, we've just actually moved Morristown in August, but we were there for another, we were there for many, many years afterwards.
We kept in the same location. We literally just downsized our current space. Our waiting room was the same. The main entrance was the same into our office in Morristown. We had space on the first floor and the third floor. So we gave up the entire third floor. We gave up part of the first floor. But we kept a location there and we also phased our move.
It wasn't, we all moved on a Friday and opened on a Monday. Departments moved in different waves to help control and allow time for setup and. Make it more efficient.
[00:36:52] Griffin Jones:
So at this time you're you're scouting the locations you're they had been looking around Prior to you even starting you start in 2008 you start getting more into it in 2010 of of starting the okay.
We're starting the moving process. What is What did the, the, the location scouting process look like?
[00:37:17] Lindsey McBain:
I mean, you're going to look at location, like, how easy is it to get to, I mean, any time you go to look at whether it's a satellite, a new build, how easy is it to get to a location, like, and I'm horrible with directions, if you ask my husband, so I think I'm a really good person because I can get lost, like, going down the street, so if I can get there, I always feel, like, better that other people can get there.
So you want it to like be pretty easy to get to off of main thoroughways. If there's multiple thoroughways there, there are like highways, it's more ideal because people from different areas can get there easier and then you like want to have plenty of parking. You want to feel safe. Like I said, you. We like it to look like a place you want to go.
You don't want to be like an industrial shipping warehouse going to your doctor's office. I think that the building says something about, and then there's code requirements. Again, parking. We want to have enough, but there's also parking code requirements. There's sometimes having a covered walkway as a requirement.
The loading dock where you can put a generator if you need it. Like there's all those.
That's one of the key questions.
[00:38:23] Griffin Jones:
We should put you as the person that goes to SRM conference cities before we have to go and you go through the airport and you point out all the frickin places where the rideshare signs don't connect to the other part of the rideshare sign. Oh my god. Cause I can't stand that anymore.
So you, you're doing a little bit of that recently. Yeah. It's going to happen. All of us, when we go to SRM this year and they'll happen again and again. And so you're doing this for the offices themselves, physically, how much.
[00:38:57] Lindsey McBain:
Do the first, like, sometimes someone will see a spot and be like, I was driving past this.
Can you look into it? Or I think this building is really great lens. Can you see if we can get in there? And I'll typically do like the first run through, like, and then I'll shortlist it and typically bring someone else for another opinion or present my findings back to like the board or the doc involved, depending on who.
The right framework is all typically, but I'll typically shortlist it. We'll have, I'll get 15 locations with a realtor that we'll find and we'll get it down to like three or four, and then we'll get other people involved and them to see it and or review that on a map, even if there's different variables, depending on the undertaking and where it is, but we'll definitely get other people's input.
[00:39:39] Griffin Jones:
Well, that's what I want to ask about. How much of it has changed with new technologies coming into play? Like in 2008, we were still printing out MapQuest in 2008. We didn't have to really consider, Oh, can a ride share? Oh yeah. I guess you would consider, can a taxi pull up here, but there are different considerations for ride share sometimes.
And so now that's into play. We didn't have. The virtual tours that we have of all kinds of real estate.
[00:40:07] Lindsey McBain:
Yeah, the virtual tours and even what when you're working with architects, they can map out and remove walls and you can walk through it is amazing. I mean, learning how to read a blueprint and really be comfortable and be able to guide yourself through that is very different now.
[00:40:23] Griffin Jones:
When did you do that? When did you learn how to read a blueprint?
[00:40:25] Lindsey McBain:
When I started doing clans, I had to. When I started, when I started this role back in 2009, I guess, then 10, that's when I just had to figure it out. I had never really looked at anything other than like a fire escape so much.
[00:40:39] Griffin Jones:
I bet there's a lot of people opening offices that still don't know how to read a blueprint.
How, how critical is it and why?
[00:40:48] Lindsey McBain:
I mean, I think to really like visualize the process, you really have to think about the path and you know, how everything lays out and how patients are going to walk around and how staff's going to access. So I think it's really important. I know it's hard. I work with colleagues that this is not what they do.
And I try to show them a blueprint of like, oh, it's so great because the nurses are here and the docs right here and the labs over. And they're like, wait, where is so I get it doesn't come. But if you're going to be in charge of it, I think it's really important that you can look at it and really see the different pathways and be able to follow it as a patient be able to follow as an employee on really Grass that it's going to work because it's much more expensive to figure that out when walls are up than it is when it's on paper.
I mean, even when you're building, they spray paint, they'll spray paint the floors. So that's I found to be a key time to go walk your site is when the floor plan is spray painted on the floor. So then. And walk around and feel it and help.
[00:41:43] Griffin Jones:
Well, that's useful to be able to do. So you could theoretically do it with the architect virtually beforehand, but then you can physically go there when they've got things spray painted and, and, oh, that's, that's, that's a good, a really good pro tip.
And so you, you mentioned that you're doing this with your team. Tell us about who's on that team.
[00:42:05] Lindsey McBain:
So we definitely, now that we're across the country, I definitely utilize project managers, which will be contract based because I. We don't have team members everywhere. And sometimes it doesn't make sense to have a long term team member.
Like I said, the docs are usually very involved. And then I have my core team of operations folks that are based out of New Jersey, but that do travel. I'm also finding the right architects and engineers to work with. They're important. Um, typically they'll be local and do site visits. But it's definitely setting the expectations up front for everyone and knowing what you expect and knowing the right times to check in and see stuff.
I still think that it's important that I make certain visits or someone on my team that knows make certain visits. I don't need to be there every day. If it's, if I'm building something in New Jersey and I can drive to Phoenix to be there a lot more often, then I can go to like Houston. But there were still key times when I had to get on the plane and I had to see it in person, even having wonderful team project managers and people involved.
Me and the physician were both in New Jersey at the time. So we had to go there sometimes and really walk in and see stuff in person. Like when it was on the floor, we need to see that layout and really feel it and make sure that stuff was right. And we made changes. So, but it's, it's specialized and it takes people a long time.
To really learn and get understanding of what goes into it. It's a lot and some people find it very dull and some people love it. I mean, there's a lot of different facets that I've talked about. There's negotiations, there's the ongoing maintenance, there's the construction. So I likely have team members who kind of thrive in different areas and we all work together.
And I also think that's really important. Oh, sorry, I don't mean to cut you off. I think it's really important, like I said, to work with all the other departments. and understand their needs and constantly check in with them and make sure that what I'm doing is still what represents what they need in the field.
I can't just go on what worked in 2010. It's really what's meeting the needs of the team and 2023 2024 that we're planning for. I have to constantly be in contact with them and checking them and they're the experts. I'm building something for them to be able to use and really do the magic. So I have to make sure that I'm checking in with them and seeing what they need and what they want and how They want to portray it.
[00:44:09] Griffin Jones:
So it's working with the docs and the lab team and the nurses and getting input from everybody and you're bringing in people from new areas as you move to those areas beyond your local team. Do you ever hire? Consultants, or are you beyond that, right? You're hiring project managers.
[00:44:24] Lindsey McBain:
No, for the project managers, they're consultants.
They're usually a contract, and they come in and help just for the projects.
[00:44:29] Griffin Jones:
Do you use, like, is there, like, a vendor of project managers? Like, a company that, that they have different project managers in different areas? Or do you just go hire a firm that's local to that area?
[00:44:41] Lindsey McBain:
So both, I mean, there are national firms that have offices locally.
I've worked with them. I've worked with people that are only based out of local areas, because even if a company is great, their L. A. person could be amazing, and their Washington, D. C. person could have never done healthcare, and not the right match for me. So we typically try to interview multiple vendors for anything we do, and get multiple quotes, and do interviews with people, virtual interviews.
I'm not flying out there to meet people just to do an interview. Thank God there's... These platforms where you can talk to people and see people virtually now, but it is important. You are.
[00:45:15] Griffin Jones:
And so that brings me to my next question, which is probably more of my ignorance about what it actually takes to build.
A new edification rather than smart question, but I'm thinking like we had clients all over the place and we would do, we hire cinematographers or photographers in their area. And then eventually got to a point where I say, I don't want to hire a cinematographer in Houston and San Diego and Seattle and Toronto and all of these other places.
We got this person and maybe a backup that had been killer. I would rather just pay for that person to fly across the country and do that job. And it works for that person because they're, you're lining up their work for them for a year pretty much, or at least getting them way busier. And it works for us because we have one throat to choke.
It's like they're, that's a very familiar person and we can be a lot more predictive of the quality for the client. Building a building is a lot harder than that. So why not? Send an architect that has worked really well for you in a couple places in New Jersey out to California.
[00:46:28] Lindsey McBain:
Are they licensed? They need to be licensed in the local jurisdiction.
They need to know all the local laws and regulations. And sometimes we have done that where we've had someone work with, that has a partner office in another location. Sometimes it's not possible. Sometimes there's not someone that we've worked with licensed in that area. And there's also a different cost sometimes if you have to have, if it's not the same office and you have to hire two offices and two architects.
That just financially doesn't make sense because you do need to be licensed in the area to be able to file. You need to know the local codes. And sometimes cities have codes and it's not just state just because you're in California. San Diego and LA may have different city codes that we have to adhere to.
So there's different things that go on and then general contractors aren't always national and they also have to be licensed and have staff and buying power and negotiating power in the area. So I would love to have one team. I just, hasn't always been possible or always makes sense. If in New Jersey, it's a little bit easier.
We can reuse professionals. But when we go national, it hasn't always been so easy.
[00:47:29] Griffin Jones:
Speaking of those regulations now that you've worked in a number of different states, what do you find, who's been the hardest state thus far?
[00:47:38] Lindsey McBain:
I think you learn your stuff with each time. I think... That more on more rural areas and it was a little bit easier than a city just because the unions and the different regulations and there's more building going on sometimes it's harder, but not always you get a town that's really difficult in the middle of nowhere where the inspectors and the takes forever or they have a lot of regulations.
So it really depends on the job and everything going on and also the quality of the documents you put forth and the team that did your work ahead of time is really important. And can we can be in the same city and I've done 2 projects and I'm 2 different realities because you had a really great GC or you had a really great architect who didn't need to make a lot of changes or another 1 who's missing the town and the town needed 30 changes.
[00:48:24] Griffin Jones:
Are there any regulations that stick out at you? It's like, well, I've done this 10 or 12 times. I've never seen that one before, like a municipal regulation or, or anything that sticks out of note.
[00:48:37] Lindsey McBain:
No, I think it's just interesting. Some cities, the architect files the permit. Sometimes you need a GC to file the permit.
I think that varies, which is interesting that each town, each city has its own little special quirks. I would say they all really give you a run for your money in some way. It's just working with them and knowing expectations and you're kind of at their mercy to some extent because they can stop you from construction and inspections and stuff.
[00:49:05] Griffin Jones:
So you want to make it nice and you want to follow the rules. So now that you're expanding to now, RMA is now RMA New Jersey, you've got EVRMA, you've got EVRMA America, EVRMA Global, what's on the docket for you? What's the next big lesson that Lindsey McBain is going to have to learn?
[00:49:24] Lindsey McBain:
To delegate. I think the more, the more we grow, the more I do have to trust other people to do stuff where I said, I've always been the mindset that I need to see stuff.
I need to make sure that it's okay. I need to trust these wonderful people that I work with that. And I know they can do it, but just trust them and really some of the control.
[00:49:42] Griffin Jones:
So what, what did each of them do? You talked about the project managers and the architects and what they do, and then what your in house team, the one that's with you physically in New Jersey, whether they travel or not, what?
What do we, each of their roles do?
[00:49:55] Lindsey McBain:
So I have another person that really just works on construction and projects with me across EV America. I have someone who works in New Jersey who really, she does some, she's amazing at moves. She's mostly just deals with New Jersey. She helps make sure all the day to day operations run.
Then we have, we also overseeing purchasing. So we buy all the equipment and furniture and everything for these new locations. So we added a purchasing specialist to our team this year because we were All doing it ourselves. There's a regulatory person who comes in and make sure it is the ASCs are meeting code and looks into the regulations for like you want to HST, she'll call the state and make sure that we are following all that as we set up and then we have an administrative team members that more work on credentialing and the paperwork behind the move.
I mean, my role isn't just this, I get involved in a lot of different facets, so my team's a little diversified, which is wonderful because they're all experts in their areas and they help me in the different areas that I need to be over instead of them all having to be experts in every area, they kind of help manage their.
Spheres of influence and they're all amazing and very, very lucky. And like I said, they all value you working with the other teams. I mean, I think that's very, like I keep saying, being constant contact with the lab. Is this the right equipment? Is this the right layout? Like we're constantly, we kind of put it out there.
Then we walk with them and we're like, okay, this is what we think. What did we screw up? Don't you like, what do we need to tweak? Okay, we just built this office. What did you hate about it? What would you have made different? And then there's certain things that we know we love and we keep trying to recreate that and put in different locations even if it might not be the ideal first thing.
[00:51:36] Griffin Jones:
What's fast and we added in and each time are you are you normally working with the same? Vendors now like we're gonna lease our ultrasound from the same folks. We're gonna buy our microscopes from the same people We're gonna buy PB from the same folks. Are you normally? Going to your current existing vendors, or do you find yourself going to new vendors when you go to new locations?
[00:52:02] Lindsey McBain:
Well, we try to use the same vendors across the network for economy of scale and purchasing sense that makes sense. You're, you have better buying power, but we're constantly looking at new vendors just because you were the best last year doesn't mean you're giving me the best this year. So we do constantly check and we quote stuff out.
Like I said, I'm big on getting multiple quotes for stuff just to make sure that we're still competitive. You, I think if you just rely on something, you're going to find that you are missing out. Even if you want to go back to your current vendor and be like, you are not competitive anymore because you have a great relationship.
That's a discussion you can have. And sometimes it doesn't make sense. I also won't hand over price lists to competitors. I don't, that's just not me. I'll tell you you're not competitive, but I'm not going to tell you what Mike down the street selling an ultrasound for. I'm going to tell you to sharpen your pencil.
So that's kind of the discussions that I'll have. But I do think you need to be out there and you have to be looking. You can't just say, you know what? McKesson looked good to me last year. So I'm just going to buy everything from him. Maybe Henry Schein or Fisher Lee. You have to shop around. You have to make sure it makes sense.
You have to. Make sure you're getting in the right GPOs. You have to make sure you're looking at economy of scales.
[00:53:05] Griffin Jones:
I think that bidding out process could be its own topic. I think there were 10 topics we talked about today. It could be their own topic, but this will be sufficient for the day. And I will be very happy, happy to have you back on Lindsey.
How would you like to conclude to our audience about what. Wisdom they should impart when considering expanding, starting anew, or moving a location.
[00:53:28] Lindsey McBain:
I think just to really look at what your team needs and talk to your team and make sure it makes sense for everyone. You look at the economic benefits, look at what your team needs, look what will be right for the patients.
And getting the big picture. And again, I've said I think multiple times about this podcast is that I always I've gotten to work with brilliant people. I've gotten to learn from brilliant people. And I take all that in and really value everyone's input. And I'm just making their ideas happen.
[00:53:53] Griffin Jones:
Lindsey McBain, thank you so much for coming on the Inside Reproductive Health podcast.
[00:53:57] Lindsey McBain:
Thank you for having me.
[00:53:59] Sponsor:
This episode was brought to you by LEVY Health. Seeing more patients for a first consultation may actually decrease IVF revenue by 30 to 40 percent. To see why, download the numbers for free at levy.health/conversion. That's levy.health/conversion.
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