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Could your impact as an REI be magnified by where you live and practice?
3rd-year REI Fellow Dr. Zachary Walker shares his strategies for creating an impactful career, outlining where and how he intends to contribute to the fertility community.
With Dr. Walker we discuss:
Promoting diversity among patients, providers, and outcomes (And research needed in those areas)
Income versus cost of living for REIs (Big cities vs. small)
Establishing REI Fellowships in states without existing programs
Talking about access to broader IVF care versus providing it
Dr. Zachary Walker
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Transcript
[00:00:00] Dr. Zachary Walker: I think the more we can start to push this agenda to current fellows that going to, I would say, these rural areas, not technically rural, but to service a population is definitely needed to improve access to care. And I think with my background of going from Indiana to Birmingham, Alabama to Boston, I've seen all different types of populations, cultures, and it's not very shocking to me to be able to practice in a place that may not be.
The most conducive or liberal to reproductive health, but feel comfortable being able to provide that care that's needed.
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Announcer: 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.
[00:01:37] Griffin Jones: Exponential impact. As a graduating REI fellow, as a young fertility doc, as any fertility doc, you're going to have an impact. Could that impact be magnified if by no other factor than where you live in practice? I explore that concept in my conversation today with Dr. Zachary Walker. He's a third year REI fellow, and he's not moving from Indiana to Boston.
He's going the other way. Zach talks about what he wants to accomplish in practice to promote diversity among patients, providers, and outcomes, to do research in those areas, and to help to launch an REI fellowship in a state where one currently doesn't exist. Consider that for a second. It's one thing to say that we need more REI fellowship.
It's another thing to say, I'm going to move to this area and try to start one in this specific location with this specific institution. We talk about that. What's the difference between saying we want broader access to care versus actually providing broader access to care? We talk about the proportionality in income to cost of living for REIs in big cities and REIs in small cities.
And we talk about a relationship between the clinic and the lab, which might either be really complicated or might be a totally new and beneficial way. For Reis to diversify their business interests. This conversation was a lot of fun. If you're recruiting Reis or if you're an REI looking for the next chapter, I think you're really gonna enjoy this conversation with Dr. Zachary Walker. Dr. Walker. Zach, welcome to the Inside Reproductive Health Podcast.
[00:03:00] Dr. Zachary Walker: Thank you. Thank you for having me, Griffin. This is amazing. I'm happy to be here.
[00:03:04] Griffin Jones: Finally, I get to talk about a topic that I've probed at different times with graduating fellows, with younger docs, with some of the execs, where I'm really curious about how we expand access to care geographically.
I'm from a small city. I live in upstate New York. There's lots of Buffalo, New York, and lots of Akron, Ohio's and lots of Indianapolis, Indiana's and it seems to me like 80 percent of the graduating REIs go to 10 or 20 cities. And maybe it's not that uneven of a distribution, but it just seems like there's a lot of people going to the Bay.
There's a lot of people going to New York and Boston and L. A. and It seems like that the smaller markets are not getting their fair share. And so when we talk about access to care, we talk about a financial level. Can people pay for it at a technological level, the demographics that we're serving, all valid pillars of access to care.
The geographic one, I think is really important because until we all live in the metaverse, you got to see people in your area. And I was when I ran into you last and you told me that you were going to. Practice in the Indianapolis area after fellowship. I thought maybe this is the guy to talk about this topic with.
So let's just maybe you're a third year fellow right now. And so you're going to practice in the Indianapolis area next year that we're recording right now in January of 24.
[00:04:33] Dr. Zachary Walker: I started in August of this year.
[00:04:36] Griffin Jones: So Tell us about how this came to be.
[00:04:41] Dr. Zachary Walker: Yeah. So it was somewhat of a, I would say like a roundabout journey.
Initially, my thoughts were to, as you kind of alluded to, most people stay in kind of bigger cities during fellowship. So my plan was to stay academics and I was going to stay at Brigham and Women's Hospital in Boston, Massachusetts, where I am now in fellowship. And then things started to happen with my family, both me and my partner's family are both older, so they're getting thicker.
So we. And we also wanted to build our family, so it seemed that staying in the Boston area may not be the most conducive to our future as far as family building and being able to be there for our family because both of our families are very far away from Boston. I interviewed at different places, so I interviewed back and At my residency at University of Alabama in Birmingham.
I also interviewed at Indiana University, which is the academic institution in Indiana, and then also the private practices in Indiana as well. And then before I moved from Boston, I also interviewed at the private practice in Boston CCRM. Initially, my plans were to stay in the academic kind of realm, so I interviewed at Indiana University School of Medicine, and their school there does, they don't have a IVF lab, so they are partnered, at the time when I was interviewing it, with two different private practices to send their residents to get the experience with IVF.
And as a referral base, it's one of them being a Midwest Fertility Specialist, which I've signed with. And then another one being Indiana Fertility Institute, which is really close to the Midwest Fertility Specialist Practice. So I interviewed at both, and they both had their kind of pros and cons, but ultimately, I think we'll get to this in a little bit, but the Midwest Fertility Specialist Practice just felt more like home and really felt comfortable moving into that realm after fellowship.
So that's where I've decided to move forward after fellowship and continue learning and growing in that space.
[00:06:39] Griffin Jones: There's a lot of people that live in Boston and places like Boston where places like Indianapolis are nowhere in their narrative. How readily did you accept this and just say, okay, my partner's from here and so I'm, I'm down.
Or how much of it was like like a pill you had to swallow? Tell us about that.
[00:06:59] Dr. Zachary Walker: It was a very easy pill to swallow. I mean, I did medical school in Indiana, so I was familiar with the terrain. And if you ask any of my friends from medical school, they are very shocked that I'm coming back to Indiana because it was a very cold environment and I didn't see myself being there for a very long time, but then I met my now partner and I started to fall in love with the area more and most of my mentors from medical school are still there.
So when I interviewed, it was. It's like coming back home a little bit. So the foresight of me being back in Indiana has become more clear. And I feel like, as you alluded to before, the need is still there as far as REI in terms of how many providers are in the area. Basically the Midwest Fertility Practice and the Indiana Fertility Institute are the biggest two groups.
They are serving this IVF need. So patients are coming from all over the state to get their IVF in that area. Yeah. I think the more we can start to push this agenda to current fellows that going to, I would say, these rural areas, not technically rural, but to service a population is definitely needed to improve access to care.
And I think with my background of going from Indiana to Birmingham, Alabama to Boston, I've seen all different types of populations, cultures, and it's not very shocking to me to be able to practice in a place that may not be. The most conducive or liberal to reproductive health, but feel comfortable being able to provide that care that's needed.
[00:08:27] Griffin Jones: So when you say cold, do you mean culturally or you mean like it's chilly, like climate wise, it's a cold place to be. So you had this experience from medical school. Did you meet your partner in medical school in Indiana?
[00:08:40] Dr. Zachary Walker: Yeah, so me and my husband, I met when I was a medical student in Indiana.
He works, he was working as a, in a restaurant as a bartender and we met and then things just kind of took off from there and he's been on this whole residency training journey with me since then, moving with me to Alabama, then to Boston. So yeah.
[00:09:01] Griffin Jones: Had you met in Boston or somewhere else and you hadn't ever had that experience of living in Alabama, of living in Indiana, but particularly Indiana because that's where you're going back to, would you have considered it as
readily?
[00:09:15] Dr. Zachary Walker: I think I would. I, The appeal of being in a big city, I mean, it's nice because of just the fact you have things to do and Kind of a accessible place, but definitely I grew up in a somewhat of a small town. I grew up in Hampton, Newport, East Virginia, which isn't like a big city. It's filled with military families and pretty much a lot of people know one another's close knit community.
So the attractiveness of moving to a big city, wasn't really top of my priority list. Mainly I just wanted to be at a place that would allow me to continue to grow and allow me to feel comfortable. to practice and to live and build a family, and that was the most important thing. So regardless of where we met, I think I would have still considered moving to smaller cities or outside of the, like the major network.
[00:10:03] Griffin Jones: Appreciate the distinction that you're drawing between smaller cities and rural because a place like Indianapolis is rural to someone from LA, but in the grand scheme of things, like I lived In the heart of South America in the country, two and a half hours from the city. And I had to hitchhike to the road to get to the main road, to hitchhike again, to get to the closest small town, right?
Like there's rural and then there's just small cities, which is. Which is like what an Indianapolis or a Buffalo is or a whole lot of places that are Tucson, Arizona that are really nice to live. And I think it's an important distinction to make because, unfortunately, the patient population that it does live in the rural areas is still driving to those small cities to, to the provider in many cases.
There are some people that are out in North Dakota and they're going to really, rural areas. But for the most part, when we talk about these small cities, we're talking about places that, sorry, you're going to have to take a connecting flight to ass around when it's in New Orleans.
I know that sucks. Like I want to take a direct flight too, but you know, you, you lose out on your direct flights. You lose out on. That your three star Michelin restaurants you, but for the most part in you, you talked about this in the beginning where your interest is in building a family and having a family, like you're a busy provider.
You're gonna be a busy husband and dad like. How many three star Michelin restaurants are you going to in a month anyway? Like, you'll go there when you go to New York, like, I will go to the nice restaurants when I'm in Toronto, in L. A. And then in the meantime, I'll just be a dad, work out, and work my tail off, and then not have time for anything else anyway.
So Correct. Do you think about this, though? Do you think about what amenities you're giving up, and what amenities you're
[00:12:01] Dr. Zachary Walker: Yeah, I mean, we've been in Boston for the past three years, and me and my husband we go out, but it's not like a often thing, like every weekend, we're not going to like see a show or going to explore the city.
We are very much homebodies. And that's just me personally. So I can't speak with everybody that lives in a bigger city. But giving up those, I guess, amenities isn't a big deal. Because like you said, there's You're, there are always going to be times where you're going to go on vacation or you're going to go out and make time to do those things that you really want to do and they're not something that I do on a regular basis.
I mean, I think some of it might be a little bit overrated for me, but the small city to big city life is probably going to be very much the same in terms of what I access and did on a regular basis.
[00:12:49] Griffin Jones: And, there are some people that I know, I've talked to some REIs that they practice in Midtown Manhattan, and they live in Midtown Manhattan, and that walk through Midtown is part of their day, it's like part of their essence, I get it, there are some people who having access to those amenities is really part of their life, I think for 80 percent of the folks Who often clinging to that.
It's like, how often do you really use it? And when you're a top one percenter, as most of the people listening are, or at least the top five, top 10% or earner, it's like, you can do that whenever you want, like especially have, did you look at like the delta in between, you know what? R. E.
I. s are making in some of these coastal cities and what they're making in some of the smaller cities. And then also the delta in cost of living, like they're not, how equal are they?
[00:13:43] Dr. Zachary Walker: Like, yeah, it's, I, so I've looked at some of my other colleagues who have in my year who are have signed and moved to different cities.
Some of them are. Moving to like smaller cities, like, I think some people were considering moving to places in Tennessee and, or places like smaller cities in Texas. And definitely the cost of living is the part that is the kind of gets you as far as like the sign on bonus that they may offer you or how they do their bonus structure and living in Boston, like coming from Birmingham, Alabama, where me and my partner had a house, our mortgage was.
Like, like in the 500, they're moving to an apartment in Boston, spending, spending over like 3, 000 for an apartment. It's crazy, insane, but definitely you get that inflation in your salary that makes it seem like, Oh, I'm making a lot more money. The most that is coming out of your paycheck every month that you would have had to use to spend if you were in a lower cost kind of city.
So I think the contracts or the salaries that are being offered are pretty comparable. Throughout the states in terms of what it already makes coming out of fellowship, but as far as like the bonus structure, the sign on bonus may be a little bit higher for, like, bigger cities because they know. That if you're coming there and like moving stipends and signing on for an apartment or wherever you're going to live, needing like first, last, and for that lease.
So it's a little bit different from that standpoint, but I think overall the base salary is very similar throughout.
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[00:16:51] Griffin Jones: My impression was that it wasn't proportional, though. Do you think it is proportional? Like, so that the cost of living is so much lower in this, in the smaller cities and the salary isn't that much lower relative to that gap. But you think your read is that it is more proportional?
[00:17:10] Dr. Zachary Walker: I think it's more proportional from what I've seen most recently among my year. I mean, maybe it has changed recently, but most of the salaries. are very similar, like from Texas, Indiana to Pennsylvania and some places in Boston. I think the salaries are, and this may also be with like private versus academic because academic has their kind of salary base here from everybody who's signing for an academic position versus if you were in private practice.
I think the gaps between what people are being offered is between 50, 000 to 100, 000 different.
[00:17:45] Griffin Jones: And, which to me I guess it depends on, I would, maybe I'm assuming erroneously, but it seems like you could get a house in suburban Indianapolis for six or seven hundred, what would be two and a, two and a half million in suburban Boston.
Correct. So maybe some parts are proportional in some parts are less. So do you think about ways of being able to win the trade off in different areas? Like one of the reasons why I started remote work long before COVID was because I'm from upstate New York. I wanted to stay in a small city in upstate New York.
I wanted my money coming from the. to be more comparable to the larger markets. And I wanted to win the tradeoff. I wanted to have that lower cost of living, no traffic, nice quality of life, but also have that career opportunity that comes from being in a much larger area. And I think that may have been more difficult for docs to do even 10 years ago, but now with the opportunity to, as networks by practices, and then you could buy Equity into that network and you can sit on a seat for that network or you could be a medical advisor board for any of these new Fertility tech companies that are emerging like you can do that from anywhere You can do it from san francisco or you can do it from boise, idaho. Do you think about those opportunities?
[00:19:05] Dr. Zachary Walker: Yeah, a little bit. I mean, I would say starting fellowship at Boston and having that network, I've been able to connect with a lot of interesting people and have a lot of interesting opportunities presented to me as far as like, being an author for up to date sitting on the ASRM committees and then doing some things outside of that realm as far as mentorship.
And then also I'm talking to researchers in the Boston area as far as collaborating research for new technologies that are coming out as far as like sperm research and analysis, which is my kind of niche and male factor infertility and being involved in that, either like remotely or actually doing hands on stuff.
So I do think that. wherever you are, you can get involved, especially when you're going to these conferences like ASRM and meeting all these different companies that are selling new products and helping them with research or innovation. And you don't have to be in a big city to do that. But I think the biggest issue is that what is your prerogative after fellowship in terms of, are you getting off as I say in terms of academic research and just Focusing on quality of life, private practice, taking care of your patients, and not really focus on research as much anymore and just wanting to be a normal working civilian in a sense.
Or if you're still ingrained in it and want to do research, then you might want to pick an academic job where you can focus on that and not have the constant drive or push to bring in patients for like IVF cycles and have that revenue coming through and you can focus on other things and expand that.
So I think the, as you mentioned, the opportunities are endless. If you're interested in them, they're out there. You have to seek them out and it may be a little bit tougher if you're in a smaller city or not in a collaborating with the big academic institution. But if you have that interest, it pretty much only takes an email or a talk at a conference to get involved.
[00:21:04] Griffin Jones: Now that you are moving towards this next part of your career, what is it that you want to accomplish when you're practicing?
[00:21:12] Dr. Zachary Walker: A couple things, I would say. The biggest one is mentorship. So my biggest thing is that I want to make sure that we continue to expand the amount of fellowship slots that we have available to, one, expand the supply for the demand that's needed in IVF or REI.
In America right now. And I think ASRM is currently tackling that by discussing, expanding the amount of slots at each institution and growing that so that we have that kind of Chain or flow coming through every year and then there are more institutions getting RAI practices. One of my goals while I'm at Indiana is to hopefully be able to foster or create a RAI fellowship with the Indiana University School of Medicine and partner with them to be able to create a fellowship because they have pretty much every other fellowship but the RAI one.
The second thing I want to do is make sure that. We continue to promote diversity within the field of RAI. I'm involved with the Health Disparities SIG in ASRM, and then I'm also on the Education Committee at ASRM. And one of the focuses are diversity in the field as far as patient care and also advocacy and who's taking care of these patients.
I think I was on a meeting with a couple of the diverse RAI physicians. And we're just thinking back to how many people are of color or underrepresented physicians are out there in RAI. And I think it's probably less than 20, and how many patients are underrepresented. Trying to find us or looking for us in the field and most of us are probably in bigger cities So we need to expand a little bit more to smaller cities or other places so that they can still find us or be Represented in a sense and feel comfortable coming to their provider, but you're actually willing to do it
[00:23:04] Griffin Jones: I want to stop on that point for a second Zack because we work in a field where that tends to you know Go one way just in terms of general I guess Dis ideological disposition or political disposition and people say the right things.
But then whenever ASRMs in Baltimore, people are like, Oh, Baltimore is like, it's like, really, what's wrong with Baltimore?
[00:23:27] Dr. Zachary Walker: Yeah, I agree.
[00:23:29] Griffin Jones: What's wrong with, what's wrong with Buffalo? What's wrong with Cleveland? What's wrong with Detroit? Oh, okay. So I get it. I get it. Like I grew up in these types of places and you got to have a certain, you got to be able to say like, I'm good with living with.
With less of amenities and or just different ones and having a trade off in amenities but it's like you can't say that we really want equity We really want equality and then do something that Yeah, that doesn't go with that. Yeah, that is part of moving away from the mean, but you're actually doing it though And so like do you does that play into your head?
Like do you think of like are you the type of person that's like f everybody else? I'm actually gonna do it or is it just like no This is where my husband's from and I think it's a good thing to do like do Does any of that chip on the shoulder play in your decision making? Even a little.
[00:24:28] Dr. Zachary Walker: I I don't know if I, I would like turn myself as a trailblazer and like, say like, oh yeah, f everybody else, I'm just gonna do what I wanna do.
I mean, there are some days I do feel like that when I'm working and I just want to like, like be my own boss. But I think everybody, every fellow feels that way, . But no, I think we do need those leaders who say, Hey, we know that it's a need and I feel comfortable. Doing that or providing that and not feel like I'm going to be going out of my way, because everybody has different backgrounds, experiences, family concerns, family needs that don't allow them to be able to take those steps, and I'm not trying to say that we all need to move in this direction, but I do think we need to make it feel Less, what's the best word?
More comfortable for fellows to do that and not feel like they're being judged about not going to like a bigger practice or joining a bigger company because they're not getting a bigger salary or being able to be a partner at here or there. And I think it's, I mean, the future of REI may be moving in that direction where everybody's joining these big practices and they're expanding and that's the way that.
It's just going to be after fellowship that you just join one of these groups, but I think that we need to have fellows feel more comfortable that you don't have to follow this trend. You can pave your own path and do what you feel is best for you. And for me, going back to Indiana and being able to serve this population, create opportunities for other fellows, create opportunities for the residents that are there and for REI and train them.
That's perfect for me. That's always been a goal for me. So it just seems like a, probably like a perfect fit.
[00:26:01] Griffin Jones: I also think that establishing a fellowship is a very meaningful, measurable to, to point to and say, I either did it or I didn't do it. And right now there are states, there's plenty of states that don't even have a fellowship.
There's no fellowship in the state of Arizona. University of Arizona doesn't have one, Arizona state doesn't have one. Does the state of Indiana have a fellowship right now?
[00:26:25] Dr. Zachary Walker: Not an REI. So yeah, it's a, they have like definitely the private practices, but no fellowship. And Indiana university, it's a really great residency program.
So it's, they've had one in the past, but just over the years it got lost. And I think it needs a little bit, some time to come back.
[00:26:45] Griffin Jones: That would be an exponential benefit, Zach, if you can pull that off, because you're not only bringing one REI to that state yourself, you would be, you'd be bringing at least three in a given year, right?
Plus the faculty, so maybe four, and then maybe every one, four years, one of those stays in the area. And so you could have an exponential impact. How do you think you might get that done?
[00:27:11] Dr. Zachary Walker: So I think right now, my goal is to try to see what the tone is between my practice, Midwest Fertility Specialists and Indiana University in terms of like partnership or their ways to do that.
As you hear of other hybrid REI fellowships like RMA New Jersey or RMA New York that are with a big institution like Thomas Jefferson or Mount Sinai and they're able to have a fellowship through their kind of private practice but it's affiliated with an academic institution. I don't know exactly how that conversation starts or the kind of the build begins.
But I know Dr. Peipert, who is the chair of Indiana University's OBGYN program and had conversations with him when I was interviewing for to stay at IU. So I'm hoping that through my time there, being able to teach the residents and being able to Take care of patients that we can start to talk about how we can structure a fellowship program and I've reached out to some mentors who are doing it recently.
And I know there's a lot of paperwork that comes with it. A lot of logistics. So I don't think will be easy in terms of getting it started. But I believe when spoke with my current, my future partners at Midwest Fertility Specialists who are interested in doing that. And then also the residency program director at Indiana University, Dr.
Scott, would also be interested in trying to get a fellowship started. So I think the interest is there. We just need to hit the ground running and try to get it started.
[00:28:46] Griffin Jones: I want to go back to the topic of where, of how you sussed out these interests when you were looking at different programs and applying to different programs, but I did cut you off a bit when you were talking and I would just want to make sure there weren't any other core objectives that you mentioned that you want at hoping to add a fellowship, wanting to improve mentorship and also promote diversity and any other core objectives that you're thinking about for how you want to practice.
[00:29:14] Dr. Zachary Walker: Thank you. Oh, so I like the last thing for me is I still like to do research and I'm hoping to continue that even in kind of being in this private Demick center. So I'm currently mentoring one of the Indiana University residents. I'm hoping the best for her when she applies that she matches, but, trying to increase the research that they have available in terms of RAI at Indiana, and then also within my practice, whether it be like IVF techniques or kind of racial disparities care, whatever kind of niche I can grow into, and the fact that when I interviewed at this place and told them my interest, they were also willing to help me with research and were going to give me the space to do that, and I didn't feel that I was going to be the pigeonhole into just churning out IVF patients was a big thing for me to know that I wasn't going to have to give something up readily when I signed this contract and they were willing to work with me in whatever facet or space in the REI world to make sure I felt comfortable joining the practice.
And I think that's a big thing. And I didn't feel like I got that everywhere I interviewed. So when fellows are going out to speak with all these different businesses and companies, and they're telling them this is what your job is going to be, it doesn't, that doesn't need to be the end all be all, you should kind of seek out what jobs are going to work with you to make sure you're not uncomfortable signing this contract, you want to make sure you're getting into a job that's going to continue to expand your mind, expand your thoughts about the world of REI, and provide you satisfaction.
Yeah.
[00:30:48] Griffin Jones: How much of the interview process was informed by having these objectives ahead of time and how much of the interview process formed your prioritization of the objectives?
[00:31:02] Dr. Zachary Walker: I was looking back. That's a good question. I will say looking back. It was probably 50 50 So one of the things I do want to kind of Highlight or bring attention to is that as a R.
E. I. Fellow in our first year you go to A. S. R. M. You have once they know you're a new fellow or you're starting off, you'll get all these pulls or emails of what? Where do you want to go after you finish? What jobs are you looking for? Are you interested in this? We have these opportunities and it's overwhelming and you don't even know what you're doing as a first year.
Really? You're just trying to you. figure out what it is to be an RAI, but yet you have all these job opportunities coming to you left and right. And there's a some somewhat pressure to make sure you're not missing out on an opportunity because that's how we're trained as like residents or medical students.
We're very like type A personalities who don't want to miss out on something. So you. Get all these invites and you may jump into interviewing places early before you even know what you really want. And so I fell into that trap a little bit and interviewed probably at the beginning of my second year.
And I, they were asked questions of what do you really want to do when you come out of fellowship? How do you see your schedule? What do you think is the most interesting to you? And I really didn't know 100%. So it didn't start until late, my late second year, beginning of my third year, to where I really knew, okay, this is how I see myself in the future of REI.
And this is what I want to give back and had more meaningful conversations during my interviews about what I wanted and what they can offer and how we could find common ground to do that. We should feel comfortable working kind of signing contracts. It's at a place that, that is going to foster your ideas of what you want to do as an REI coming out of fellowship and also what they would need out of you.
So it takes some time to develop those, that knowledge. It did for me. I don't know for everybody else, but until my third year, I really didn't know a hundred percent what I wanted to do. So I think the more time people take to really Reflect about their thoughts of their future practice and see what is out there before jumping into interviewing would be my best piece of advice for any future fellows looking for jobs to not feel stressed about interviewing and missing out on certain opportunities and take time for yourself because the need is there.
There will be jobs available, but don't feel rushed to sign something so soon before you really know what you really want.
[00:33:33] Griffin Jones: Sometimes general advice for determining who you want to be in this world involves outlining what you don't want to be. Was there any of that? Did you consider ahead of time what you wanted to stay away from?
[00:33:48] Dr. Zachary Walker: Yeah, and part of this did change a little bit because of all the stuff with my family that was going on, but initially I never thought of myself working in like a Private practice that didn't have research available because that was such a big part of why I was interested in RAI, why I wanted to be RAI fellow was because of the interest, the research was very interesting to me.
So I always thought of myself going into the academic Kind of space to continue that. And when I was interviewing and talking to different places, this private Demex model of this hybrid model was very enticing to be able to say like, Hey, I would still be able to make a meaningful salary. And also do IVF, but still have the ability to mentor, do research, and train the upcoming RAIs for the future was like a perfect fit for me.
And then this opportunity at Midwest Fertility Specialists and collaborating with IU seems like an even better deal. So having that space, kind of headspace of what I really wanted to hold on to. Was important and knowing that I didn't I wasn't going to sign a plate to a place that was going to make me give that up
[00:34:58] Griffin Jones: How did you suss that out because in interviews people generally especially when they're trying to recruit you know, they're not the they being clinics and networks are not the Beneficiaries of the supply demand imbalance typically they are typically trying to everybody's trying to get their hands on an REI for the most part.
And so people very often be like, Oh yeah, you can do that Zach. Sure. And then it's like, when it actually comes time to do it, people find out they weren't specific enough in their negotiation and then they tend to fall back to maybe later, or no, that's not what we meant or not now or whatever it might be.
And so how did you suss that out of who could provide you with what you wanted the most?
[00:35:42] Dr. Zachary Walker: So I, Part of it was talking to other fellows ahead of me who've signed contracts with those companies or who knew someone who's working with them about what their day to day was like and if what I was being told was true or not.
And I think that went a very long way to have someone on the inside know. What is their day to day? Are they actually able to do research? Are they actually doing surgeries as much as they thought they were doing surgeries or how much of their day is literally? No, you need to sit down and see new patients and bring in as much IVF volume as possible.
So I'm very grateful for the people I know and like my network in the REI field from my co fellows to prior graduates and keeping those friendships close. Another part of it is My practice that I'm joining isn't part of one of the big conglomerates. Not yet, hopefully not anytime soon, but it's not part of the, like one of the big five or whatever.
And I think that is what allowed me to know that they were, I would have more wiggle room to do things because this practice has been in play for over 20 years and they have seen the shifts of all the different RAIs in the state and can. provide me with background on what's possible, what's not possible.
And they felt very comfortable in my goals and my dream for this, for the practice of what I wanted to do. And I believe them. So I think those two things really played in hand to make me feel more comfortable signing the contract and moving forward with them.
[00:37:13] Griffin Jones: So if they're not part of one of the networks yet, as you say, but how many docs are there?
Four or five right now is five. Yeah, I'll be number five. You'll be number five. So that's a group that one of the networks wants to buy. And I've seen this before is that I have recommended I've helped connect some fellows with their future jobs. And then it's an independent practice.
And by the time they start, it isn't. And have you thought about what it will be like being in a city right now where there's like two, maybe three programs if you go further out versus, if you are in a larger city, if you're in the Bay Area, if it doesn't work out, it This place, you can go to one of 12 other places and in the meantime, you might have, if it doesn't work out at a particular place in a smaller city, you got your kids in school, you bought your house and say, gosh, do we have to like uproot and go somewhere?
Totally. I'll say, how do you think about those terms? Or do you just try to push it out of your head?
[00:38:21] Dr. Zachary Walker: A little bit of the latter for sure. Just like, everything should work. But yeah, in residency, we had these kind of career talks about how often do people stay at their first job? And it's not that high.
Usually most people will leave within the First three years of their first job because of not liking it or things that were promised were not there. And, that definitely may happen to me, but definitely trying to be as optimistic as possible is my head space. But if it, yeah, if it doesn't work.
I will most likely have to move because of the contract of what's the term I'm looking for? Non compete. Yeah, non compete, yeah. So that may require me to move or not be able to practice for at least a year before I can sign again, which would be definitely very difficult. Like the biggest network of potential jobs would be in Chicago, which definitely has a plethora of REIs.
But. I'm kind of remaining optimistic, moving forward with that and hoping everything works out. I mean, I love the people that I have met for my future job and they all seem very great. They all are very supportive of me, so I'm just hoping it all works out very well.
[00:39:27] Griffin Jones: It's also part of when you want to do something meaningful, there's a certain amount of risk involved.
I want to go provide access to care somewhere. It's a hard thing to do, which is what makes it meaningful. Hard things have risk attached to them. Hopefully that's it's win for everybody. And I, if you think about, do you want to like buy into the practice? Do you want to, do you want to own equity with whoever you're working for?
Or do you like not having to, have those business obligations? Where do you stand?
[00:39:59] Dr. Zachary Walker: So I do have a goal of being a partner with the practice I'm with, so that is one of, one of the interesting things that drew me to the practice a little bit more, was that they do have a partnership tract, which I think some of the bigger companies may not offer that anymore for incoming providers, or it's not the same as what other people got in the past.
[00:40:20] Griffin Jones: Because there's not as many of them. Like, there's just, yeah, there's not as many of those types of, I mean, there's different types and they might be good too, but. That old, like, I buy in early, I get some equity, and then I'm part of, I put my sweat equity in so that I'm the beneficiary of a larger share of financial equity later, because I'm not buying it at a discount, I'm not discounting my future profits now, so that It is kind of, I wouldn't say unique, but definitely less common opportunity than it used to be.
But so sorry for my commentary.
[00:40:51] Dr. Zachary Walker: No. Yeah. That, I mean, that's right. So the practice that I'm working with now just they are, the lab is separate from the clinic. So the clinic has just been bought out by a group called Axia. And even though the branding is different, the Axia women's group is partnered with Midwest fertility specialists.
They are recently kind of renewed contracts and that's when I kind of came in and I'm under this contract with the new group.
[00:41:18] Griffin Jones: So they are, they are part of a bigger group, but you're just saying they're not part of one of the major fertility networks. They're not like
[00:41:24] Dr. Zachary Walker: CC. Yeah. Like CCRM, RMA.
Yeah, but yeah, they are part of a group. Yeah, so the, and prior to me being there, they were part of another small group, I forget the name of it, so this turnover to Axia was happening in the past year. The lab, on the other hand, is a part of the Ovation Network of Embryology Labs and IVF Labs, so the ability to kind of buy into both of these practices is possible for me doing the partnership track.
And I mean, it would make sense for me to join right now from a financial standpoint if I can to work to be a part of that for future wealth. But that wasn't always the goal. The goal was mainly for the kind of academic research mentorship ability to create something new for the REI, like REI fellowship at Indiana, which is my primary goal.
So the whole kind of financial things that come with it are definitely a bonus, but they weren't going to make or break.
I
[00:42:30] Griffin Jones: can't wait to interview you in five years again and do a follow up of this conversation because I wonder if that is what kind of path that will be having the two different opportunities with the two different companies, one owning the lab, one owning the clinic, because often it, we've seen the ovation model before, and often the clinic will stay, you Independent then, and the Ovation owns the lab, then USF acquired Ovation.
And so many of those clinics that were independent, many of them still are those that then decided, Oh, I want to sell the clinic later on, I think would sell to us fertility. Same parent company still, I think of infertility institute originally had sold their lab to Vivera, which then was acquired by Prelude.
And then it became part of the inception and network. And then, but then later on, it was Prelude that, or either, one of their brands, Aspire, that bought, I don't know exactly that bought HFI. So still, again, still mapping up to the same parent company right now, Lab Clinic for you, two different parent companies.
I wonder if that will be complete chaos and you'll hate it or you. Or what I'm hoping, what I'm hoping for you, Zach, is that you are on the, that you have tapped into something like the record labels or the content producers who are on different streaming services, like South Park, is still on this streaming service, but then for these specials, they'll be over on Paramount plus and they can do it and they're benefiting from the different labels and some artists.
Can I'll make this content over here. But when I do my crossovers or I'm with as a solo artist, I'm over here when I'm with the band, I'm over on there. And when we do a crossover, there's a benefit and they're a little bit more diversified as well. So I'm hoping that's the case for you and that you, we'll see.
You definitely pioneered something.
[00:44:21] Dr. Zachary Walker: We will see. Definitely. I'll check back with me in five years. Might have a little bit more gray hair.
[00:44:28] Griffin Jones: How do you want to conclude, Zach, about either about expanding access to care either by geography or any other measure or any of the subtopics that we covered today?
How would you like to conclude?
[00:44:38] Dr. Zachary Walker: Yeah, I think I just have kind of Three main points. One for any future fellows like listening to this podcast, you're in the midst of looking for jobs or thinking about starting the interview process. I would say take time to reflect and don't feel rushed to sign contracts or push to do that.
And definitely make sure you're having meaningful conversations when you're interviewing so that you feel comfortable signing the contract and can move forward with that process. The second thing is for future fellows as well. This is your time to see if you want to get off the kind of academic train and go private practice or continue on and finding like a hybrid model or moving towards just working like a private model and making patient care memorable and taking care of your family and moving in that aspect.
So this is a pivotal moment that we've never had before in terms of this isn't a match process. This isn't a put an algorithm. This is literally. your opportunity to pave the way for the rest of your future. So definitely take advantage of that. And then definitely the last thing is we do need to expand our access to care and making fellows feel comfortable moving to smaller cities or other areas to be able to provide that care.
So hopefully this interview will make other fellows who are interested in that endeavor feel more comfortable. And doing so and seeking out opportunities for themselves to be able to grow in their space. And yeah, thank you so much, Griffin, for having me on this show. This is amazing.
[00:46:12] Griffin Jones: That's my pious hope.
Your wish at the end there, Zach. That's my pious hope. I haven't really been able to do it, so I'm hoping that giving you a tiny megaphone is able to do it more. Dr. Zachary Walker, thank you for repping small cities. It's been a pleasure to have you on the show.
[00:46:26] Dr. Zachary Walker: Thank you so much.
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