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.
The job market is red hot! There are more jobs open than people to fill them, true for the broader economy and just as true for the fertility field.
Dr. Eric Widra, Senior Partner at Shady Grove, talks through his experience with recruiting and training personnel, and how to project future needs.
Dr. Widra discusses:
The need for Human Resources (And the risks they mitigate or eliminate)
When to listen to what HR says you need (But also when to push back)
Redundancy and cross training personnel (The appropriate levels to have)
Adopting technology to automate and augment tasks (While eliminating others)
Individual job training (And when company culture training becomes important)
The “Godsend” technology solution that’s made the workload and workflow of his financial counselors a lot more efficient.
Dr. Eric Widra
Shady Grove Fertility
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US Fertility
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Transcript
[00:00:00] Dr. Eric Widra: We've often asked the question, should this be, should we outsource this or should we own it? And, outsourcing can be very effective, especially for medium and smaller practices because you just pay for what you need. And so you're not bringing on, long term overhead in terms of the staff and you're still getting, the, expertise that you need.
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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.
[00:01:19] Griffin Jones: Hot. The job market is still red hot. There are more jobs open than there are people to fill them. True for the broader economy, you know it at a cellular level if you operate a fertility center. My guest is Dr. Eric Widra. Eric is a senior partner at Shady Grove. I should have asked him for the latest headcount in both doctors and employees for both Shady Grove and US Fertility. Shoulda, coulda, woulda. Suffice it to say, they've hired a lot of people. We talk about how to train, recruit personnel, and project future personnel needs. That means adopting technology to eliminate certain tasks, automate others, and augment others. And it also means good old fashioned HR. I take us a little bit more down the second bucket in this conversation.
Partly because Dr. Widra said something to the effect of, I never knew how badly I needed HR until I had it. That resonated with my own experience. Eric talks about the gaps in recruitment that HR eliminates. He talks about the risks that they eliminate or at least mitigate. It gives general benchmarks for shady growth, staffing ratios, nurse to physician, average IVF cycles, numbers for each.
We talk about redundancy and cross training. What's the appropriate level to have? When do you listen to what HR tells you need? When might you have to push back? We talk about individual job training versus at what organization size do you need a company? culture training. Think of the Disney example.
We talk about the downward pressure for reimbursement in healthcare, what that means for projecting the needs of advanced practice providers. Dr. Widra believes they should be the first line of evaluation for fertility patients, and he explains why. And finally, he shares a technological solution that is almost a godsend that has made the workload and workflow of the financial counselors a lot more efficient.
Enjoy this conversation about training, recruiting, and projecting personnel needs with Dr. Eric Widra. Dr. Widra, Eric, welcome to the Inside Reproductive Health podcast.
[00:03:10] Dr. Eric Widra: Thanks. It's a pleasure to be here, Griffin.
[00:03:12] Griffin Jones: I was interested in having you on as a speaker because I saw two of your talks at PCRS. One was about negotiating a contract, and I had originally thought about approaching you for that topic for this episode.
But you also did one about projecting staff levels, about meetings, staff, and filling positions. And I Want to go that route first because I think people are still struggling with it. It seemed like this came on as it's always been a challenge, right? But, then, but, then 2020, end of 2020, it really became a challenge.
2021 was really hard for people. 2022 was really hard for people. You sit at Shady Grove, which is a large organization across multiple. Dates was, which is a part of a larger organization in us. Fertility is in even more states and even more companies in your estimation is, the, challenge in retaining and filling seats as hard as it was in the peak of 2022, is it starting to calm down a bit or not?
[00:04:23] Dr. Eric Widra: It depends on what category you're talking about. and I, the fact that we are, large and diverse organization in my mind doesn't limit the challenges, to just those types of places. I think everywhere, everyone I talk to is still struggling quite a bit with attracting, retaining talent in the right seats.
One of the things that I think we've seen ease a bit. post pandemic, if we're allowed to call it post pandemic yet, is that a little less transition and turnover. And some of the clinical staff, specifically nurses and medical assistants, things like that is still a challenge. There's a huge fight to get nurses because of what hospitals are, paying them.
But people seem a little bit more willing to Come to work and sit in their chair and not be looking at the next thing as much as they were. On the, physician and embryology side. Yeah, this market is hot. And I think that there are, there are real challenges for us to not just address this on the staffing side, but address it on the technology side.
Like what can we do to be more efficient and. Utilize the staff that we have without killing them.
[00:05:41] Griffin Jones: So I want to talk about the technology solutions because that's where I've found the conversations going. Each time we talk about the personnel issue, because it seems like it's the only way to solve the personnel issue that you have to reduce workload.
You have to make things more efficient, that different people can do more things because more. They have the assistance of technology or you're eliminating workflow because it can be automated. It is technology. The only solution is there an HR or management solution to this? And if so, how much is at play versus how much of this is, we just have to figure out a way to eliminate more things and give people more automated help.
[00:06:35] Dr. Eric Widra: Well, I think it's both. And, for anyone who's listening here, who isn't part of a gazillion doctor practice, I make the comment all the time. I didn't know I needed an HR department until I had one. And while, practices of varying sizes may not have that in house, there is a whole group.
Body of work and body of knowledge around HR. That's developed over the years that helps to identify and measure the needs you have and how you fill those needs. And, as an intro to the answer to your question, I think that, yeah, I think there are management. Tools that can be used to rationalize, the people you need and retain them and attract them.
But I think healthcare in general, and because so much of infertility is still in smaller practices, I think we underutilize technology more than many other areas of commerce. the, I've signed up for product services and healthcare online where I've interacted with a bot and my needs were met.
In terms of, scheduling something or onboarding a, a patient to the practice. And in some ways it was more organized. Like we didn't go down tangents. It's Hey, do you need this or do you need that? Are you this or are you that? I just use that as a, as an example. And
I think if you look at every level of the experience of a patient coming through a fertility center and our Struggling to meet their needs. There are opportunities for technology, but it's not the only answer. bringing a patient in, that's one example. Sharing medical records and filling out the forms and the paperwork.
I think that's still a disaster in healthcare in the U. S. and I think it's right for people to come up with solutions to that. And people are working on this. It's just, how does it filter in, how do you use technology for education? I think that's a huge piece of this because so much education falls on the nursing teams and they've got to do their workflow, right?
Which is make sure the doctor reviews the results, make sure you communicate those results to the patients and that it's done with high fidelity and that they follow and they get scheduled. there's all these workflow steps that the more we can automate, the better we are. And I think it's coming, but it comes in.
And first it's a very long answer to your question
[00:09:12] Griffin Jones: i want to go into some of these technological births that might be useful you said something that i don't think is a throwaway statement i agreed with it wholeheartedly from my own experience that you didn't know how important it was to have an hr team until you had one tell us more about that what do you mean specifically by that.
[00:09:37] Dr. Eric Widra: presumably we're all growing a little bit, whether that's, very rapidly or slowly and that growth comes with real challenges in, your people and your human resources and the ability of a doctor or two doctors or five doctors and a office manager or supervisor to manage that over time leaves a lot of gaps.
It leaves gaps in. Evaluating the credentials of the people who are applying because you're just you're saying, Hey, this is what I think I need, and you might be right. You might be wrong. Doctors are notorious for having an opinion about everything, whether it's correct or not. And in many cases, it's I think I need this.
in health care, there are measurements that people take about What types of credentials perform in what environment the best and that an infertility medicine is not Immune to that we can figure this stuff out the other thing that HR does is it is it takes away risk and we live in an environment where In good ways and in bad ways, we're very sensitized to how we talk to each other and having an intermediary there when that conversation might not be perceived on either end is appropriate, is huge.
And so I think that there are layers. I think layer 1 is the HR professionals can help you identify. By having a broader view who you need for what role they can help you recruit that more effectively, and then they can minimize. Risk and conflict later by making sure the rules are clear, right? So I don't care how many staff you have, if they think they're supposed to be doing X, you think they're supposed to be doing Y.
Somebody's got to reconcile that and having a good set of rules up front and job descriptions and things like that sound. Very pedestrian, but they make a big difference.
[00:11:43] Griffin Jones: Some of the people listening will work for organizations much larger than yours. Some will work for teams even smaller than mine, but many of the people listening are somewhere in between.
And so for. Many of them, they might be listening and say, that's easy for you to say, Woodrow. You work for the largest fertility clinic group in the country and now one of the, largest networks. and so there you have this HR infrastructure. I would have thought that way. I, a little more than a year ago until I realized, wait a minute, we live in a.
part time remote world and I can hire a part time remote HR person and then I can hire more part time HR people and it has, it's been dramatically life changing for me and someday I'm going to write a book about delegating to outcome and the importance that redundancy and the HR support. play in that.
But people might look at me and say, that's easy for you to say, Jones, you're not in a physical office. You're, you have a remote company. You don't have the regulatory burden of being a healthcare business. What would you say to someone that, that feels that they might not be able to build the type of HR infrastructure that you and I have?
[00:13:07] Dr. Eric Widra: I think you're exactly on the right track there. And I don't think it just applies to H. R. By the way, I think it applies to many aspects of what we do. And in fact, even as large in an organization as we are over the years, we've often asked the question. Should this be it? Should we? Should we outsource this or should we own it?
And, outsourcing can be very effective, especially for medium and smaller practices because you just pay for what you need. And so you're not bringing on, long term overhead in terms of the staff, and you're still getting, the, expertise that you need. And the reality is we live in such a competitive economy that while there's definitely going to be some, mediocre and even poor, Performers in that over time, you're going to find good people who want to do this and are motivated to do And that was redundant, but anyway, you're going to find good, And I think this is true for marketing. It's true for billing. It's true for credentialing for insurance. And as well, it is, however, a very difficult landscape to navigate because everybody's going to tell you. they're best at this and that's where I'm contradicting myself a little bit, but that's the rub, right?
All this stuff is out there, figuring out who's really good at it and who's going to help you. It can be a challenge, but it can be done. And we've done it through our growth in all those areas at different times.
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[00:15:31] Griffin Jones: one way that I snipped through some of the people saying that they were the best is one of the things that I do now for every single seed is I really think about what that seed is to be responsible for, not just a job description, but what are the outcomes that I'm going to measure them against.
You can't quantify every last outcome, but to the extent that you can try to enumerate them, try to quantify them, try to make them as specific as possible for each outcome. I also identify here's what I think that I have for you to achieve the outcome. This software, this system, this process, this team member, et cetera, and here's what I don't have for you.
To achieve this outcome that you might need. I don't have this software. I don't have this process yet. I don't yet have these team members. And so I, for every single seat, I try to delineate what those are. And then if you do have the opportunity to do some outsourcing, there's, you can. Hire or contract people simultaneously and give them the same or similar assignments and you'll find out who's better at your outcome.
And so that's what I did. I just started with multiple HR folks and then ended up with one that was a good fit that took me to a certain level And then help me get to the next level that I needed for HR help. Is that realistic with fertility clinics when they need some when they have so many bodies in house and they have so many FTEs that are in a physical location?
Is it realistic for them to be able to try out part timers or independent contractors in that way?
[00:17:15] Dr. Eric Widra: I think there's several things, insights in what you said that are worth touching on. And I feel like we're putting a little bit of a puzzle together here as we talk it through. I think one thing that we do poorly in healthcare is identify what the outcome from that person you want is.
Yeah, embryology is a little bit easier, but come on. The rest of healthcare doesn't have embryos, right? They have, nurses and MAs who need to Do certain tasks. And I think we fail sometimes by pigeonholing them into, skill sets rather than outcomes. And so when I think about onboarding nursing, one of the things I want to understand is, am I hiring somebody?
And I, for anybody who's listening as a patient on this, please forgive the operational nature of this. But, for any nurse that I hire, I want to know how many cycles she can handle, right? Effectively. So yes, she needs the soft skills and the nursing skills to engage with the patients and build those relationships, but she also needs the hard skills.
And if she's not at an appropriate level in terms of that throughput. you've got to make some hard choices. And so I think again, I'm answering the question a little bit differently, but I think both things are true that you should be getting HR that understands that. And I don't know whether it's reasonable to try more than one or not, but I, the, the, but I think that if we're careful about how we invest in this and ask good questions, we're going to make progress.
It doesn't mean you're not going to have errors or wrong fits or things like that. that's life in business. But I think if we're careful about it, just as you said, you're going to, you're going to kick some tires and you're going to figure out what the right fit is. Was that responsive to your question?
[00:19:08] Griffin Jones: Partly. It doesn't totally answer the question. if just by virtue, can you have remote? One of the reasons why I'm able to do this is because I'm an entirely remote company. Have been long before COVID. I've been remote. Since 2012, started building my company in 2015, finally zoom and the voiceover internet protocol videos infrastructure became viable in 2017.
And so we've always been remote. And so that. That I think allows me to play to this advantage where you can start people, you can start many of them as 1099s even when you move them to W2s. And is that, is, are you, is, that not realistic for brick and mortar fertility clinics that have to have bodies in house, even if some of their support staff might be able to be remote?
[00:19:59] Dr. Eric Widra: It depends on the seat, right? yeah, you're not going to draw blood remotely or do ultrasounds remotely, but we have a lot of remote nursing. We have mixed feelings about how effective it is and how to, manage it, but we have tons of remote nursing. I think that a lot of the back office stuff can be remote.
And again, for practices that don't have the size or infrastructure that we have, outsourcing that can be incredibly effective. Your billing, your insurance credentialing, your authorizations. one of the things that I think we're going to need to adapt to is, how do we do those functions?
Because those functions are going to become more important as there's more access to care and more insurance coverage. the rest of healthcare has mostly figured this stuff out and we feel like we have to reinvent it. But, there are software programs out there that automatically do benefits.
They're not perfect, but you don't need three people doing that. You need somebody who manages the software and, we're just starting to wake up to that because we've been in such a unique environment for so long.
[00:21:05] Griffin Jones: Okay. So it is possible to have the HR support be remote. Oh yeah. That part.
[00:21:10] Dr. Eric Widra: I, yeah, I think that those types of, I think HR is probably one of the easier ones to be honest because your measurements are easier.
It's I have this many open seats. Are you filling them? And I was, And to your point, are the outcomes from those filled seats what you need them to be? Billing is always nerve wracking because you don't know if you're optimizing it.
[00:21:31] Griffin Jones: On the outcomes of those seats, you mentioned one example that you want your nurses to be able to do a certain volume of cycles.
Do you put that number in the job description?
[00:21:46] Dr. Eric Widra: The way we describe it is we have benchmarks for, nursing output in terms of cycles, and we don't necessarily expect a new nurse, especially if she's not coming from fertility, it's almost always she in our specialty, to necessarily meet those benchmarks right away.
So no, we don't put them in the, contract, but it is part of their evaluation. Top of the pyramid nurse. And I actually Griffin don't know the number off the top of my head. So I'm embarrassed to say, but that's because I get to let somebody else do it. this is the benchmark for, a 90th percentile nurse.
This is the benchmark for a 50th percentile nurse. And if you're starting at the 30th percentile, we want to see moving in that direction.
[00:22:33] Griffin Jones: So that's, I, don't put the numbers in the employment agreement typically, like it's not contingent on, like I'm not that sophisticated yet. Maybe someday there will be some sort of a performance for each of your, I'll do it for you.
Yeah, exactly. Yeah. But for the time being, I do have a separate document. It's not a legally binding document, but it is, useful for expectations that I have. Everyone. Look at and it's a, you're responsible for this many podcast editing, this many podcast episodes per month, you're responsible for this much billing under an account, et cetera.
and then when I can, I do try to put that in the job description and I'll, put. Up to in the, up to a certain amount so that I just want to set the table with anyone that I'm having an interview with that they know this is what I'm expecting of you. I want to set that expectation early and often not have them come in and be like, Oh, this is more than I thought.
And Even when there's a range I'll put the up to. And I find that really useful to start with in the job description while they're still applying. Do you see any reason why fertility centers shouldn't do that? Why they shouldn't put numbers in the job description? Absolutely
[00:23:50] Dr. Eric Widra: not. And in fact, you just identified a hugely important function of HR, whether that's in house or outsource, which is evaluation and performance.
Reviews, we used to joke all the time that, if, nurse a wasn't performing, she'd go to Dr. X and complain and Dr. X would say, she's great, and you just got to get rid of that. And that's true. Whether you're two doctors or 200.
[00:24:21] Griffin Jones: And so your talk was about also projecting for needs that I'm, hoping that because you were speaking at PCRS, yours is a little bit more sophisticated than mine is.
What I tend to do is I'll start at a part time level. Usually if it's a new, if it's something new that we're working on or a new area or a less mature part of the business, I'll start just part time and I'll usually Just get somebody at 5 to 15 hours. I'll make my outcomes more sophisticated as, that becomes developed and I'll start normally more junior on the accountability chart than senior and that's how I figure out what I, what, I need and, and.
how much it will cost me. And it's not the most scientific, but it does give me a bit of a measurement. how do you project staff levels? How do you know when it's time to hire a new person versus this doc just says he needs a new nurse when is it, this doc is doing more with less nurses.
[00:25:28] Dr. Eric Widra: And and I think the three areas that we're, we've focused on is, docs, when you need a doc, and I think there's some really interesting things to think about there as our system evolves, embryology nurses, some ways on the wind, you need somebody. Embryology is probably the easiest because what they, the, they, the measurements that they make are very.
it's not squishy. It's you do this many egg retrievals, you do this many PGT cases, you do this many ICSI cases. And over time you start to see, you develop a matrix, if you will, of how many people you need to do those things that does, however, need to be pressure tested with the rest of the world.
And I think that our professional societies actually do a good job on the embryology side of saying, Hey, we think this is a reasonable workload for an embryologist at this level or this level. And practices can take those data and then You know, massage them based on how, what their workflow is like and what their function is like and the capacity of their people.
and because it's the, risks are so high and the outcomes are so obvious, right? You get a baby or you don't. I think it really behooves us to, to be strict about those numbers. And, only adjust them or adapt them if we have really good reason to do And one of the things I see a lot in some of our smaller practices or newer practices are we sometimes make the mistake, it's a mistake.
We sometimes start with more people than we need. Based on those metrics, either because they were there already or we wanted to make sure it was as smooth as possible and then they struggle as with growth and managing that is really important, but I think if we're responsive to the data and the numbers embryology is probably the easiest way to easiest thing to do and nursing.
I think we've talked about a bit. It's Yeah, some docs do more with less and, at some point there's just going to be that human element that you can't measure perfectly because we're not going to turn the docs and, or the nurses for that matter, into robots.
[00:27:52] Griffin Jones: Do you set a sort of standard as a company of this is how many, this is how many nurses one physician should have or is it, more by volume?
Oh yeah, and we have stuff that we, yeah.
[00:28:05] Dr. Eric Widra: So it's, both actually. and a lot of our docs are coming out of fellowship. And so they're not bringing a patient base with them and we have, yeah, we have a standard approach to that, which will be okay. new doc is joining me and I'm just making this up, joining my office.
And so we'll hire another nurse and half of her old do Eric and half her new doc and his new dog grows. She can. do that or, cross cover other things, but yeah, we have a, again, it's not a formula I can recite for you and Griffin, but we, yeah, we have formula about that. and basically we start with the mean, and then we decide if somebody is, performing to the left or right of the mean.
So an average SGF doc, probably does, just, Plus or minus 200 egg retrievals a year. And they need two nurses to do that. But it's a pretty, it's not a very tight curve. it's pretty diffuse.
[00:29:09] Griffin Jones: You mentioned embryology being one of the easier positions to look at the numbers to see where there's need.
Nursing might be in the middle of the road. What about support? What about support staff? What about medical assistants, phlebotomists, down to front desk? How do you, possibly project what you're going to need in those types of roles?
[00:29:31] Dr. Eric Widra: I gotta tell you, that's HR's job. It's a struggle because there's high turnover in those positions, but, it's not that hard to measure.
You see this many people, between seven and 10 o'clock and, to get them through, you need this many people drawing their blood and doing their ultrasounds. it's not rocket science.
[00:29:49] Griffin Jones: it might be HR's job to determine the levels that are needed, but there is a business call that's made on the appropriate level of redundancy.
I had David Burford, who's the CEO of Care Fertility on, and I talked about this bec And I thought it was fitting because he's in the UK, where they use the word redundancy to describe layoffs. If you were made redundant, that means you were laid off, and I think Ah, the English in their language,
[00:30:16] Dr. Eric Widra: I love it.
[00:30:17] Griffin Jones: yeah, there's, some poetry in there, and I, think it's a bit revealing because That is why you would do layoffs in a company as if you had multiple people doing similar things to become more efficient. You'd reduce your head count and you'd eliminate redundancy. I have found a necessary level of.
redundancy to, to, reduce burnouts, because if you have a, a certain number of people that are responsible for the total workload of the company, and then that number gets smaller, it becomes harder for the people that are there. And then you start to have more attrition because it's harder and you can't feel fast enough.
So that's one of the reasons why I think redundancy is important. Reason I think is that it's just it's easier to cover for people. It's easier for to plug people in when it's easier to cross train on. Then ultimately, if you have a big enough organization and especially if you have a wider layer at the bottom of the pyramid of junior people, you're, you have a feeder system for, senior people.
And if you, if your middle layer is a bit wider than you, then you've got another layer there. And but that's a business.
[00:31:35] Dr. Eric Widra: People get sick and take vacation and have babies and all this stuff is just part of managing your business and you need that. Yeah.
[00:31:42] Griffin Jones: And it's easy for me to make that decision because I'm a, I own 100 percent of the business.
I'm the only managing member. You're in a much larger organization where you have to consider different people's shares and you have fiduciary responsibility to the company and to each other. How do you make that decision at that level of what is the appropriate level of redundancy?
[00:32:06] Dr. Eric Widra: To be honest, Griffin, I spend almost no time on that, as even in my leadership roles, we really do, we ask HR, what do we need to get this done?
Now, sometimes we'll see some
[00:32:18] Griffin Jones: And you just do it, whatever HR says?
[00:32:20] Dr. Eric Widra: Ah, within reason, yeah, but you don't I approach it like I do anything else. The hypothesis is HR is correct, and then we see the data, right? And if the data support the hypothesis, we're good to go. We have absolutely had times. That HR is seem to been just like on a hiring bench and you're like, guys, what are these people doing?
it looks like a lot of people standing around. yes, you need manage, you need input from the physicians and the managers and the office supervisors, but I, yeah,
[00:32:48] Griffin Jones: I, I think you articulated it pretty well.
[00:32:51] Dr. Eric Widra: Yeah, you. You are very well. Actually, you start out with what you think makes sense and if it's working and you add or subtract as needed.
I think that in health care, there's a real risk of being too lean in terms of the risk of errors per patient satisfaction. And so I think you're always going to see us error a little bit on the side of having some redundancy. But, we're very active managers at S. G. F. In fact, sometimes as physicians.
In fact, sometimes I think we're in too much in the weeds, but we push HR pretty hard to tell us why they're doing what they're doing and to prove to us that it needs to be done based on some metrics.
[00:33:33] Griffin Jones: The default is that HR is correct and then you look at the data. What's an, and so most of the time you're going with the recommendations.
What's a specific example where you did push back against HR?
[00:33:45] Dr. Eric Widra: Yeah. and it gets interesting and complicated, right? Because you and I might think that this job over here would be great for a part time person, but it may be really hard to fill that job with a part time person. In fact, the people who are applying for it as part time may be terrible.
And so you have to make compromises to say, maybe that person does something from 7 to 11, something different from, noon on. But sometimes you, need to really pressure test that we, what's interesting about the way our workflow in a day goes in the clinic is between seven and 11, we're seeing an enormous number of patients who are coming in for their IVF and IUI and other ultrasound and blood work.
And you need to be staffed for that. And these women want to come in and get out the door and get back to their jobs or their, lives. And. You need a lot of bodies to make that happen, but then one of those people do the rest of the day. And so that's been a great example. And one of the tensions we've had over and over again with HR through the years is, you I don't want to be paying somebody to be drinking coffee often, that's not.
That's not good business. And so I think that's one example. and, the reality is the solution to that ebbs and flows with the job market.
[00:35:08] Griffin Jones: Have you developed a process for cross training to solve for that? Absolutely. Yeah. Tell us about that.
[00:35:15] Dr. Eric Widra: Yeah, but not every, again, the, simply the volume demands are different.
So yeah, we will take, we'll take an MA who's in monitoring the call in the morning and cross train them to do the instrument prep for the OR the next day. but that presumes that the people who would normally do that are busy all day. So it's, a challenge. I don't have an easy answer for you on that one.
[00:35:40] Griffin Jones: as you're bringing on more folks and the companies get bigger, has there been a change, have you seen a change in, Shady Groves training of the Shady Grove way? So I'm not talking just about this is how you do this particular. role, but rather think of Disney. It doesn't matter if you're, a new VP of business development for a theme park, or if you're someone that washes the grounds of the magic kingdom, everyone goes through a certain level of.
Disney training. This is how we do it here. This is, we point with two fingers. Don't I, don't ever let me catch you pointing with one finger. That's so funny. I didn't know that one. Oh yeah. I still do it to this day, Eric. I point with two fingers whenever I'm pointing somebody in this direction. And so everyone learns a certain bit of Disney culture.
And I'm starting to do that with my company as well. Starting to, here's the inside reproductive health way. This is the fertility bridge way to, to have that cohesion. In addition to here's the training for your particular role. How much level of shady grove training is there? Has it increased? Is it remain the same?
[00:37:00] Dr. Eric Widra: It's big and it's a huge part of what we do. And for better or for worse, it still relies on kind of the ancient apprenticeship model, right? That, you're going to work with this nurse and she's going to teach you how to do this. You're going to work with this MA and this is, you're going to see how, the workflow happens and the way we talk to people and the way we escort them into the room and the things that we say.
And. Now we do, we have what we call it for nursing. We have what we call cohorts. So we've got a whole bunch of nurses that are starting between, month, between the 1st maybe that's 10 nurses. I'm just making that up, but they will all sit together in the same training and that training will be.
electronic and in person. And so we try to acculturate them that way. But then they're going to go and work with a more experienced nurse and, start to really see how to implement those concepts, as they grow their, practice, if you will, of, people that they take care of. we're really expanded our use of advanced practice providers.
And I think that's something worth talking about a little bit before we wrap today. And, we have a, whole protocol for onboarding. Advanced practice providers, and it still is very much here are the leaders of this and they've been here forever and they're going to show you how we do stuff. I can show you how to start an IV or doing all well, we'll teach ultrasound a little bit, but how do we approach problems?
How do we take care of patients? How do we triage? How do we fit in as that intermediary between the patient and the physician? So yeah, there's a lot of that.
[00:38:36] Griffin Jones: But you're still getting away with doing it at the individual level where each individual mentor is doing that for their team as opposed to like having a cohesive Shady Grove University.
Here's the modules of here's how we do everything so that everyone and not just job training and not just handbook stuff, but like a cultural training.
[00:38:58] Dr. Eric Widra: It's both. So yeah, like the nursing cohort and that stuff. And we do have, tons of manuals and online stuff that we used to actually call shitty good university, but I think we changed it because everybody called every, company at university after that.
We didn't invent it. Come on. it is, it's a combination, but, I think part of what we're trying to talk about today is, that's what works for us because of our size and complexity, but I think there's that it's critical in any corporation to have a culture that you can teach and transmit to your people.
[00:39:33] Griffin Jones: Yeah, I think I've found out how I thought we were such a small organization we had 20 people on team right now, and it's it's still really important and it would have been important when I had six, and, and I don't think I don't know, maybe two or three is too small, but for the vast majority of the people listening, I don't think it, they can be in too small of organizations in order to start building that cultural training and because they'll, find it very useful as something to point to later.
Yeah, I, agree with you that we should hit on APPs before we wrap. Is there an appropriate staffing ratio to? To, to APPs, how would one even figure that out in a formula because of the different variants of what they do? Is there, and especially as we move to utilizing more APPs, how, do you figure out when you need an APP versus when you need a nurse versus when you need a doc?
[00:40:32] Dr. Eric Widra: Yeah. And call me back in a year and I might have a better answer, but my, my, one of my projects for this year is to address the following pressures. We, have, to our credit, expanded access to care. It's got a long way to go, especially in vulnerable populations, but we're getting there. What that means is the reimbursement for the services is going to have downward pressure.
That's just the way the world works. It's not anything unique to us and the rest of healthcare has lived through this and probably much more. Disruptive ways than we're likely to, in addition, not just because of the price pressure, but just because of the volume pressure, you're going to need to, see more patients per unit time.
And because of the price pressure, you're going to need to do it more efficiently. And I think that the challenge for us is to find a way to get to that perfect or perfect is never going to happen to that correct ratio where you're still providing appropriate levels of service. But triaging that level of service based on what the patient is coming in for.
And so I think, and this is already being done in plenty of places. Bad thing about being this big is it takes time to institute change. But there's lots of places that are like, you use APPs, what do you do with them? I'm like, Whoa. Yeah. So I think. I think that the role of the APP in fertility medicine is definitely going to expand in some places.
They do all kinds of things now, but I think they're going to, they're going to triage new patients. They're going to see new patients and order testing before they get to see a doctor. I think they're going to continue to do more and more hands on stuff, ultrasounds, in office procedures. I've heard people talk about training APPs to do egg retrievals and embryo transfers.
That's a podcast unto itself. I think that's not going to be a very big piece of the puzzle, but the other pieces are going to be critical to maintaining the economics of what we do and the quality of the service we provide to our patients.
[00:42:42] Griffin Jones: The APP topic is a topic in and of itself, but while we're still on it, you mentioned their role is going to expand.
What are some of the, what is maybe one thing that you feel many APPs are not doing now, or at least they're not doing in a great many places that they could and should be doing, and it's probably the first area in which their role will expand.
[00:43:04] Dr. Eric Widra: I think that they should be the first line of evaluation for a lot of infertility patients, especially in underserved areas.
the fact that you live somewhere rural and have infertility shouldn't be such a massive burden because so much of what we do is not hands on. hopefully this joke will come across. Okay. I don't do physical exams on my patients. There's just no role for it. Yeah. They get an ultrasound eventually.
Sometimes the first visit, usually not. So I can, if I have an APPU seeing someone in, West Virginia, I'm in DC. And, they're in an underserved area, but the APP is happy to, they can order the stuff. The testing that we do is preliminary, is, straightforward. Anybody can do it. And then, and then I can have a virtual consult with that patient where I can be efficient and also provide a high level of care.
One of my associates, Edward Harton said something interesting to me the other day, we were talking about these challenges. He's the less I know about a patient, the more time I have to spend with it. And while our goal as physicians is not to minimize the time we spend with patients, that's not correct, we do want it to be efficient.
if you called a cancer doctor and said, I think I have cancer. Can I see you? They say, no. until you have a diagnosis and the pathology from the laboratory and all this test done and your imaging done, I'm not going to see you. Because it's not a good use of either of our time.
And so I think that as we move, as we expand access to care, I think you're going to see a little bit more of that. And I'm sure your colleague in the UK had some insights into this. in the UK, you don't see a doctor necessarily, especially in the private sector until you're pretty far down the pipeline.
[00:44:53] Griffin Jones: We're going to bring you back on in a year to talk about how you figured out those ratios, but you've at least given us a preview of what people need to project for as they start to expand their use of APPs. I'm jumping around a little bit, but we I had a thought pop out about training is have you learned any lessons about what absolutely needs to be in included in training?
So what we try to do is lay the process first. We use a project management system, and that's where most of our processes are documented. And then we'll use a software. We're called loom to do video documentation of it. And there's other softwares called train you all. And, other competitors to loom and train you all.
Have you found a bedrock of, about what absolutely needs to be included in every training or how it needs to be structured as, a framework, regardless of what specific role it is.
[00:45:51] Dr. Eric Widra: It's a great question. And as you mentioned those things, I'm reminded how far we still have to go in terms of using these types of tools for that.
I think that's, that even though I'm proud of the way we train people, it sounds very primitive compared to what you're doing. And I think that's an opportunity for us to get better. But what I do think is the most important in healthcare, especially for what we do, is this acculturation.
That I don't think many of our skill sets are, so narrow that we need to like overtrain for those, the soft part of nursing is the same, whether you're, in a pediatric clinic or an IVF clinic, drawing blood and doing ultrasounds is the technique, the techniques, very little in the patient population, but their technical skills, but getting across the division and the mission and the culture.
Yeah. It's got, to be the most important thing in my mind because that influences not how you draw the blood, but how you interact with the patient and how you value that person's journey and the issues that they bring, that's the key. And I think that one of the things we've been successful at, despite the fact that we're, we were a business and we have to measure things and buy things and give services for revenue, is that we've been able to demonstrate.
That the patient comes first and I think if we can teach that and we can Live that because saying it and doing it are completely different things, right? you can be famous hospital X who says we're the best at this and you can get treated like dirt in the ER and it's all just talk. But if we can live that and show it and keep the people who are able to do that and redundant out the rest, that's the, that, to me is the secret sauce of staffing.
[00:47:46] Griffin Jones: We started the conversation talking about technology and HR as means of in, in being able to recruit more, being able to fill seats, being able to have longer retention. I took us down the HR route more deliberately. I still want to glean, a, second of a technological lesson if I can, is what's an example of in the, since.
Recruiting has gotten as crazy as it has in the last two years of a technology that you've implemented that has either made certain staff more efficient or just taken things off of their work entirely that has been a godsend to you.
[00:48:29] Dr. Eric Widra: it's happening now. It's not quite at God's end level yet, but I can see it emerging.
So several years ago, we work with a vendor who does our consenting process and it's extremely thorough. It's video based. The patients have to answer questions along the way at the end to demonstrate they actually watched it. So both from a patient education standpoint, a consent standpoint, and a legal standpoint, it's awesome.
And, and, Mike Levy to his credit is like, why are we doing this for our financial counselors? Because we still have a lot of patients who are self pay and we have a whole menu of financial programs depending on the types of treatments they need and that can take a long time to explain.
Especially when you're talking to somebody with the anxiety they have about. Not just, am I going to get pregnant, but can I afford it? So we've made those modules, with our vendor for the financial counseling. And, it's, it was amazing, the resistance to it as there was when we did the consent thing, because people are like, are you taking away my job?
I'm like, no, we're making your job actually easier.
[00:49:41] Griffin Jones: Because of what Dr. Harriton said, because the less you know, the longer it's going to take. That's also true for the patient. The less they know, the longer it's going to take. Yeah, and for the
[00:49:51] Dr. Eric Widra: financial counselor. Yeah, a hundred percent. And so I see that as a great use of an adaptation of technology that, was staring us in the face.
[00:50:01] Griffin Jones: There you go, EngagedMD. That's your new slogan for your website. Almost at GodSend level, you can It's a free one from Eric Widra and I. you have the final thought, Eric, whether it's something from your talk at PCRS that I didn't ask you about. If it's just something else about how to train, recruit personnel, projecting personnel needs in the future.
How would you like to conclude?
[00:50:26] Dr. Eric Widra: Thanks. I, it's great. I, the, horse that I've been riding lately is we have to adapt to the world is changing around. This is changing faster than we think. And we, need to be open to that. Physicians, especially hate change. What we need to do is get ahead of the things that are going to affect the way we deliver care.
And that means being open minded about the role of different providers. One of my, I stole this line from somebody, it's very businessy, but we want everybody working at the top of their license or their credential. I think that, but that makes a lot of sense, me explaining how the menstrual cycle works.
Probably not at the top of my license explaining how IVF and PGT works. Yeah, that's my job and being open to technologies that can streamline things for us. And that's a two edged sword because some technologies are better at it than others. But once again, your comments before left me like, Oh wow, there's still stuff out there we don't even look at.
So I hope that was a cogent closing comment. It
[00:51:30] Griffin Jones: was, and as much as there's more to look at, I'm still looking at more of it, too. I say that I'll write a New York Times bestseller once I'm a black belt at all of this. And I'm a yellow belt right now. I'm a yellow belt right now, orange belt at best. But someday you'll see it in the airport, and I'll send you a free copy, Eric, because I'm thankful to you for coming on the Inside Reproductive Health podcast.
Thanks for coming on.
[00:51:56] Dr. Eric Widra: Thanks for having me, Griffin. Have a great weekend.
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