151 3 REI Fellows Walk Into A Podcast…

What They Really Want Out of Their Future Permanent Position

This week on Inside Reproductive Health, Griffin Jones hashes out the goals, aspirations, and challenges of three prominent REI Fellows in their search for the right permanent placement.  Dr. Megan Sax, Dr. Victoria Jiang, and Dr. Zoran Pavlovic share their experiences on recruitment, what factors weigh in on their decisions on job selection, and how much they’re willing to put at stake for their professional (and personal) success. 

Tune in to hear:

• What they are looking for in a partnership and/or position.

• How factors such as location and politics have a huge impact on the appeal of job offers.

• Griffin press all three and question how much accountability they are willing to take on in exchange for the autonomy they crave.

• What you might say to a recruit to catch their interest.
  

Dr. Megan Sax Information:

Dr. Sax is a 2nd-year REI fellow at the University of Cincinnati. She has engaged in leadership roles as a women’s health advocate and medical educator. She previously served as the ACOG Junior Fellow Chair of Ohio and currently sits on the CREOG Council as the Junior Fellow liaison to ACOG. She has received recognition for exceptional teaching and humanism and intends to continue a career in medical education after her fellowship.

Twitter: @saxmeg8 

Dr. Zoran Pavlovic Information:

Dr. Zoran Pavlovic: Zoran Pavlovic is a second-year fellow at the University of South Florida Morsani College of Medicine and splits his fellowship training time between Shady Grove Fertility and Tampa General Hospital. His areas of interest include reproductive surgery, fertility preservation, third-party gestation, genetics, and IVF. Zoran loves meeting and conversing with great minds, innovators, and creators within the field of REI and is excited about the future of fertility care. He hopes to one day be an active contributor in the field of REI and a mentor to the next generation of physicians.

LinkedIn: https://www.linkedin.com/in/zoranpavlovic27/

Dr. Victoria Jiang Information:

Victoria S. Jiang, MD is an REI fellow at Massachusetts General Hospital. She is board eligible in Obstetrics and Gynecology and is currently completing her second year of fellowship in Reproductive Endocrinology and Infertility. She graduated from Emory University with a double major in Chemistry and Biology, with a focus in Organic Chemistry. She received her MD from Wake Forest School of Medicine in 2017 and completed her residency in OB/GYN at Emory University School of Medicine. She has received numerous awards for her teaching, research, and wellness efforts. Her interests include the integration of AI in medicine, genetic testing, and the ethical expansion of PGT, and PCOS.

Instagram handle: @vsjiangmd 

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Transcript

Dr. Victoria Jiang  00:04

For people who want to have a seat at the table and make those decisions, I think for me that's at least where I'm seeing myself now. I want to be able to sit at that table and have a little bit more of a say in how these practices are developed. Because I think the biggest frustrations that I see in kind of these big, you know, corporates, like scenarios is that loss of autonomy

Griffin Jones  00:28

already everybody's trying to learn, you're probably trying to hire them. Everybody wants to get an associate doc or someone out of fellowship, and they're in short supply. So I talked to three of them today, and they're already in conversations with potential employers there. They've just started their second year. They come from different parts of the country. I'm gonna let them introduce themselves in terms of where they've studied. It's Dr. Victoria Jiang, Dr. Zoran Pavlovic, and Dr. Megan Sax. And we talk about how important being active as a fellow is and how important being active as a recruiting physician is, in order to tap into this person. We talked about how important partnership is to them or not, as long as we talk about how important academics are to them, or not as much as political advocacy, the things that they're paying attention to, when they are interested in partnership, I pressed them about okay, what are you expect you to put forth? What are you expecting to be accountable for in order to have that level of autonomy, and that level of share of the product, the company in the practice? So this is not meant to be confused with data. These are anecdotes, but I'm introducing you to three sharp fellows who are active who are plugged in. And knowing people like this helps you get in touch with more folks like them and knowing what they're paying attention to can give you a recruiting advantage. So hope you take advantage of that. And I hope you enjoy this conversation with three Rei fellows about what they want out of the practice that they ended up joining and what they want out of their careers in terms of partnering with other companies in the facility. To talk doctors Sax, Pavlovic, Jiang welcome all of you to the inside reproductive health show. Meg Zoran Victoria, it's good to have you. Thanks for having me. Great. So I did I just mess up your last name even though you told me right before we started recording is it Pavlovic?

Dr. Zoran Pavlovic  02:47

No of Pavlovich. Close you know

Griffin Jones  02:51

that that's a tough that's starting to make a little bit of a name for yourself, which is interesting. Meg was just mentioned in a podcast that I recorded earlier today. I'm on the board for the Association of reproductive managers a subgroup with in ASRM and there was some sort of programming that we're talking about for younger Doctor fellows. And the three of you were mentioned because of the role that you had at ASRM. So. But no, I mean, Rei fellows are coveted. And I don't like to do man on the street interviews meaning like I don't like to have anecdotes be representative of population, I don't have a ton of data necessarily, but it is kind of useful to at least it's at least somewhat, if taken with a grain of salt to go through some of your experiences and maybe your aspirations and what you want to accomplish because people want to recruit you, not just the three of you, but the 100 and however many 120 or so 130 140 fellows that are out there, and and that all listen to this show religiously. So we're going to do that. So each of you just want to give a little bit of background of where you are, what year you are, what were your fellowship and let's just start with that.

Dr. Victoria Jiang  04:33

Sure I can. I can go ahead. My name is Victoria Jiang. I am originally from Atlanta, Georgia. I went to Emory undergrad and majored in chemistry and biology with a focus on organic bio organic chemistry. Then I went to Wake Forest for medical school and marine for residency and now I am a second year Fellow at Massachusetts General Hospital.

Dr. Megan Sax  04:58

Meg Sounds good and happy to be here. Thanks for having us again Griffin classic 2024 coming around the bend. My name is Meg sacks. I grew up in Michigan, huge Michigan Wolverine fan went there for undergrad and yet somehow married a Buckeye against all of my family's wishes. That's gross. It is gross. Let me tell you. I studied neuroscience and then went to rush Medical College in Chicago for med school and then match at University of Cincinnati for OB GYN residency where I stayed on as an REI fellow and I'm currently a second year. I'm very interested in patient advocacy, Uncle fertility and education. I work both via different initiatives that ACOG and Korea ag and I'm hoping to continue a career in medical education.

Dr. Victoria Jiang  05:51

Yeah, Meg is our advocacy queen.

Dr. Megan Sax  05:54

You gotta be when you live in Ohio. Gotta be oh, we're

Griffin Jones  05:57

gonna have to talk about some of that. Then what about us on?

Dr. Zoran Pavlovic  06:01

Yeah, happy to be here, Griffin. Thanks for having me on the show as well. My name is Zoran Pavlovich. I'm a second year fellow at the University of South Florida in Tampa, where I split my training between surgery at Tampa General and also Shady Grove fertility for the IVF part. I'm originally from Chicago, and I went to residency in Chicago. And then college was at Creighton in Omaha, Nebraska. So kind of been a little bit of everywhere. And I came back here to Florida because I also did my medical school here at UCF. So you see up to USF enjoying the weather, and it's it's, you know, 90 degrees and super hot right now, but I'm glad to be here. And our focuses are down. Oh, sorry. Go ahead.

Griffin Jones  06:41

You all just started second year.

Dr. Zoran Pavlovic  06:43

I'll just start a second year.

Griffin Jones  06:46

Have any of you looked at employment agreements yet? Have any of you been in conversations with people about you know, I should say later conversations with people about where you're going to end up after fellowship?

Dr. Victoria Jiang  07:02

Well, I will say, Oh, go ahead.

Dr. Zoran Pavlovic  07:04

You go ahead. We go first.

Dr. Victoria Jiang  07:06

Oh, well, I guess I will say, you know, I think one thing that's been really terrifying is that the employment kind of timeline has very much moved so early in our fellowship. So as you're trying to grasp, like, how do I be a human? How do I be a physician? How do I be an REI, you're suddenly faced with finding this would be my first job since I was literally a waitress in high school. And so there's definitely been a bunch of really great like, podcast people to be able to lean on. I actually came back from an interview yesterday. And so this was definitely the first very early foray into the employment kind of piece. But it's exciting that the idea of gainful employment that our future.

Griffin Jones  07:44

Yeah. Yeah, like, Do you know any medical students? Let's interview them, because it's starting early. And earlier. Sorry, I interrupted us.

Dr. Zoran Pavlovic  07:55

Oh, no probs can see I agree with Victoria. And that I think I started having my first conversations back in the SRA retreat in Park City, which was November of my first year, just a few months in still trying to figure out my research project and already talking about places for to visit them to interview to send emails and have zooms and that's it started way earlier. So as Victoria said, when you're a resident, you're just thinking about how to be a doctor. Now, as a fellow, you're already thinking about, Oh, what's my career gonna look like? What job do I want? What environment do I want to be in? And that's definitely different. And I think, something tough to tackle for everyone.

Griffin Jones  08:30

What about you, Meg? Are you having these conversations yet? Or?

Dr. Megan Sax  08:33

Yeah, it's just wild. We had heard last fall at Esrei that they're going to start come in and you know, prepare yourselves, get in mind what kind of practice you're interested in what location and other kind of aspects of that. And I think historically, it was really the ASRM conference that people had their first interviews. And now that timeline has really scooched up. So we're having places reach out to us as soon as at the end of the first year, just like Soren and Victoria had said, and I'll be honest, these two have been my gurus in terms of what I'm looking for, and practices and things like that, and even what questions to ask from these employers.

Griffin Jones  09:17

I don't think that was the case a couple years ago, I think it was like, you know, you get towards the end of your third year and you start talking about it or that was before every last place was looking for an REI. I'm not saying that every practice is hiring for an REI, but I don't think any of them are not not hiring at the very least they're like, Yeah, we would hire somebody if, if if it was the right fit at the least. And then of course, many are really actively searching. So at this point, until we see a major reversal in supply and demand, at least which isn't on the immediate horizon. I think that at this point, first year, like once you're in fellowship, you're going to be an RA I therefore you are fair game for recruitment. It's like we might as well just try to beat everybody. Because if it's like college football, right, like it used to be, yeah, you just sign the people after they had a stellar senior year, then then the big sec, schools are recruiting for the most competitive players, and they start signing up, and then their junior year, and then sophomore year, etc. So, same thing has happened here. So I want to I want to go into some of these questions that you have, which by the way, when I have podcast, guests, I asked them for three to five questions ahead. And I would say, at least a quarter of them, give me nothing ahead of time. And by producers, bugging them for quiet, you guys gave me 30 questions. So we're not gonna get to all of your 30 classes a day. But I love that that that continuing education mind frame that three of you are still in, you're very welcome, way more prepared than the vast majority of podcast guests ever do. So let's talk about what are some of the key elements in your job search. And I'd want to just start with, like, I want to do a little bit of I mean, you can go into detail if you want to, but I want to do a little bit of a lightning round. Let's start with location. And Victoria, let's start with you. Do you have a location or a number of locations that you would like to be in? Yeah,

Dr. Victoria Jiang  11:24

great question. I originally was trying to go back down to the southeast because that's where my family was. And that's where I'm interested. Interestingly enough, with the dogs were stocks in rolling that has really put a wrench kind of in that big planning picture. My husband's a dermatologist, so we're looking at big cities with reproductive rights.

Griffin Jones  11:41

So you're now more flexible than you were? Is that what you're?

Dr. Victoria Jiang  11:46

Yeah, definitely more flexible than we were, I think there are gonna be big limitations as far as certain geographical regions, as far as just density of population need for an REI in that case, and, you know, competition and whatever those pieces are. But yeah, big kind of big cities kind of all around the US are kind of looking very broadly, and kind of seeing where we land.

Griffin Jones  12:09

So how, like, is it still? Is it a shortlist of cities that are on there? Or are you in on a scale of, of one being we're going to this exact city 10 being where we're open to Fairbanks, Alaska, we're open to anywhere? Where are you?

Dr. Victoria Jiang  12:26

You know, I have Fairbanks, Alaska is great for freezing eggs. Constantly. I would say on a scale of one to 10 we have definitely our top five favorite picks. And I'm definitely looking in those kind of top five cities. So like looking at places that have opportunities like the space for potentially my husband's a dermatologist, so he wants to open up a hair practice. So if you guys need any hair advice, I got the man for you.

Griffin Jones  12:52

Those all like top 20 cities, are they all more or less coastal? Like Are we more or less talking about? Is Boston New York's or Chicago LA? Like? Is that what we're talking about?

Dr. Victoria Jiang  13:03

Yeah, so I think we're looking at, you know, big cities. And so we had looked at like, you know, Nashville, Tennessee, we were looking at Northern Virginia, we're looking at, you know, Denver, Colorado, parts of Montana, and like, kind of that Montana, Wyoming area. And so a slightly, you know, second, like, we're not like top 10 biggest cities, but maybe areas that have a need that we can fill that kind of give us a nice, kind of I think one thing that's actually really interesting that we've been thinking about more than like the, the go getter academic, like you have to go from place to place to place is really starting to value quality of life, and seeing where we can raise a family. And so kind of see where that kind of falls into that has been a really interesting transition of goals for me, which I think isn't the most natural thing for really anybody in medicine, because that's not what we're used to.

Griffin Jones  13:49

No, I want to see more of that. Let's ask the go getter, academic mag, where do you want to end up location for Yeah, well,

Dr. Megan Sax  13:55

I love what Victoria is saying about transition into this new mentality. You know, our whole career thus far has been get into the next program match into the specialty match into the sub specialty, with a little less freedom of selecting your location or ideal city. For me, I'm also kind of that Doctor, Doctor couple, my husband's Arad ONC. So we'd be centering more along the bigger cities where we have opportunities for both of us. We are definitely born and raised Midwesterners, but just like Victoria said, you definitely need to consider this political climate change. But I will say you can be surprised by the institution you join by the kind of coalition network you can form again, I I love a cog staying involved in advocacy, you form your network and you you fight and stick it to the man the best that you can, but you also need to look at the long term and your future. So I would say for us, I'm very interested at staying at a academic institution or a practice that works closely with residents and fellows which can restrict the field a little better where you're applying to but I'm very open minded in terms of cities across the Midwest cities where we have family We're also very interested in Denver with most of my my big brothers are all moving out that way. So kind of keeping that eye on family where you're going to have that network where there's some academic opportunities.

Griffin Jones  15:23

Would you also do the Wyoming thing like Victoria is thinking about and have that focus on the quality of life? Are you looking for a big city partly because your spouse is also a specialist and you have to Yeah, you have to needs to fill

Dr. Megan Sax  15:38

right Victoria is way cooler than than I am I'm not sure I would do as well in Wyoming if

Griffin Jones  15:44

you want to be in a major city you want to be a bit more city

Dr. Megan Sax  15:47

I think having lived in places to me Ann Arbor, you know, the Midwest is a city so I think something like Ann Arbor, Chicago, Cincinnati, Denver would be more like ours. You

Griffin Jones  15:58

want you want to stay generally in the Midwest, though. Yeah. Are you like what about New York? What about LA? What?

Dr. Megan Sax  16:05

Yeah, that's a great question. I think with the right practice, if you find a good fit, that I'd be open opened anywhere I need to need to kind of keep the whole family in mind though, for sure.

Griffin Jones  16:15

What about us on?

Dr. Zoran Pavlovic  16:17

Like, yes, I'm also in a doctor, Doctor relationships. There's all three of us here. Well, my wife my wife's maternal fetal medicine fellow, second year Fellow at University of Cincinnati. So you know, her making friends, which is nice. For my situation is actually a little different. And that's because she or her father's private practice is in the Boca Raton Delray area. And so she's going to go join him after fellowship. And so I have to follow her, you know, we're going to stay together. So I got a winter follow her and down to Florida. And we're going to be in the southeast. So I'm looking basically between Jupiter to Miami, that south eastern seaboard of Florida. And so my practice locations were much more specific. I wasn't looking at different cities or even regions, but much more specific. And I think that's kind of one of the reasons why I may have started my job search earlier by asking questions, networking, asking some 30 year fellows if they knew anybody, or had any connections, because I knew where I wanted to go. So I didn't want to wait till the end of second year, beginning of third year where maybe the spots where I needed to go have to go, we're already filled up and taken by somebody else. So that's why I started my job search earlier. But I also was looking for not straight academics, but not small one to two person private practice, something in the middle, kind of private academic model, which REI has a great field for. We have a big enough practice, you can still do clinical research, or mentor residents and fellows, but not have to be part of an academic center or be too small to do anything like that.

Griffin Jones  17:48

This is also where the marketplace for REIs can be beneficial for someone like us. So you like Boca is not the biggest market, but you're kind of looking between Miami and Jupiter. And this is a time where a lot of those Miami groups, they'll be like, oh, yeah, yeah, yeah, we need a bulk office. We're just kind of sure, like you. And so that may not have been the case a few years back. But for the fellows listening, I think that, you know, like, a lot of Detroit people do have an office like or, you know, like might have offices elsewhere in Michigan and or like, so you want to be in Toledo, Ohio, you don't actually want to be in Detroit. Well talk to the Detroit people, talk to the Chicago people, even talk to the Cleveland people, like you want to be in you want to be in Bar Harbor, Maine, like, maybe there's not a big enough area for that, but talk to the people in Boston. And so that's something that I don't think was as feasible a couple years ago. I think that you'll have options talking to some of those groups. So how about so it's a May you straight up want to be in, in academics? How hard are we on that?

Dr. Megan Sax  19:05

Oh, yeah, no, that's a great question. I think just like Zoran said, that Rei is a really unique field and that these private practices still work with residents, do a lot of research, do data analysis within their own clinic and database. And honestly, some of the best data that we have in the field comes from those large private practices because they do so much more, so many more IVF cycles and other HRT. And so, again, I'm pretty open minded. I think as long as there are those opportunities to work with learners and continue research

Griffin Jones  19:44

are either a view or are either view really wanting to be in academics for Victorians are on or Do either of you really not want to be in academics?

Dr. Victoria Jiang  19:55

I will say one thing that really drew me to the field I sound like I'm about to interview for fellowship. Uh, I will say one thing that I do think is really unique about Rei, that is really special. It's kind of playing on what Baggins Warren was kind of saying, is that a lot of practices are still participating and have really robust research infrastructures. And I think being an academic for me means a lot of different things. It's not just working with learners. But it's also like staying up to date having Journal Club, like being able to stay involved with the most recent evidence that is being published and staying up to practice with X y&z And so I think for me, we're joining a kind of middle sized practice where I can get mentorship and making sure that I get like, you know, library access and have like a continual journal club or team review, like those kinds of academic pieces, I think, carry over to a lot of different types of private, domestic and private jobs. And I think that with a lot of the local hospital affiliations, you can a lot of the time still work within a private practice structure, and still have residents and fellows that you can mentor and kind of work with, which I think is really special. I know that one of my uncles, like my in law, is an REI in Chattanooga. And his practice partner is, for example, one of the MCS faculty at a local hospital and is able to work with all of the fellows in that capacity. Shout out to Tennessee reproductive medicine. And I think that's what's really great is because you can have a lot of opportunity, but not have to fit that like cookie cutter academics, because a lot of the challenges that I've seen with the academic programs is, is they're all being bought out by a lot of private equity firms. And so even if you join what is under the academic affiliation of you know, one program or another, you may not actually be buying into that true academic structure. And so I think finding the right program for me, is more important than really like whatever the definition of academic or private or private MX really is.

Griffin Jones  21:44

I think that's why you have answered that same questions. I want to talk about that point, Victoria, I think it's worth every fellow considering. This is, this is an actual data, this is just what I think it could be that the chance, whatever, of practicing ownership, you end up signing up for the chances of it actually being that ownership in three years time is less than 50%. Maybe it's 50%. Or no, it's fine. It's probably somewhere around there. And that's actually something to consider as you sign earlier and earlier, right? Because if you sign in at the end of your third year, then you can have a little bit more of a conversation with the ownership of what kind of direction you plan to go in. If you sign early on in the first year, a whole lot can happen in two years. And I've, I've I've seen this a bunch of times as far as like, and I'm going to join this practice right now can't wait to join this independent brand owned by Sierra. I'm gonna be an academic Sierra going to the Cleveland Clinic man, and they're owned by the Maven click. So zone, what about you? How hard or not hard? Are you wanting to be in the academic sphere?

Dr. Zoran Pavlovic  23:06

Pretty hard on not wanting to be at a straight University, academic situation more. So I think for me, I found that to be a little more, I guess the freedom of the clinical practice that I wanted to do in the private academic setting. I'm not a big person for grant writing, which I think there's a lot of that in academics. And I think there's people that do that and do it really well. And I'm really happy that they're in our field. And I respect them and love them a lot. But for me personally, that would be very difficult. And when I look at the clinical research that I would rather do you see all these biggest groups around the country, the CRMs, RMA, shady groves, US fertility is all that they have these huge clinical databases where you can have up to 100,000 patients and your sample sizes. And you can be really great robust clinical data. And like Megan said, you can drive the conversation, you can change practice patterns, you can help create committee opinions based off of that. And so that's why for me, I felt like I could find an impact within research and still be involved in that academic capacity without being an academic setting. And I personally also have more of an entrepreneurial business sites and one of my minors in college was was business. And so I do want to go to a place where there's that opportunity for either equity or partnership or growth or some kind of opportunity where I can help create and build something together with the practice that I'm at. And that would be hard to do at other other facilities in an academic centers would be more so moving up a professorship and becoming tenured. Whereas in a private practice, it's it's a kind of a different situation that just more so appeals to me. Well, I can still remain Tane some of that academic rigor.

Griffin Jones  24:44

So I'm just hearing that more from people in general, they still want a bit of the involvement with either research or teaching and this is probably something that some private practices need to figure out a lot of this a lot of the larger ones are already involved with at academic centers, but many of the smaller ones are not. So they have to figure out some way of scratching that itch, whether it's, you know, whether it's teaching the residents or whether it's sponsoring some type of research or going in and research with someone else or allowing time for their Doc's to submit an abstract answer. I think that that's something that private practices that aren't that don't have an academic relationship probably need to consider, because what the three of you just said, seems to be a recurring pattern from what I'm hearing from fellas. But now let's talk about partnership, which you started to talk about. so on. So I'll go back to you, which is on a scale of one to 10. How much do you want to be a partner meaning someone that owns a piece of the practice that they're working at?

Dr. Zoran Pavlovic  25:53

That's a tough question. I think it's anywhere from eight out of 10 to 10, out of 10. And the partnership can mean different things that can be either owning a piece of the practice and of the laboratory, or being able to bind to equity of the overall practice. So all of those options to me are appealing and things that I asked questions about and looked into. But some of the practices that have been talking to you to offer these more structured partnership tracks, and that have defined milestones of how you get there. And what that means. That appeals to me a lot, because then I know what I can do to work to get there. What that means when I get there, what does it mean to be a voting member of the facility to be able to help to drive the practice to improve the laboratory outcomes, and work with my colleagues and where we can actually be kind of a almost like a family unit in in making our practice as best as possible. Rather than either being a number in an Excel spreadsheet, or just like one person in a huge conglomerate, or even just in a one to two to three person practice where you make a partnership and that, but how much clinical decision making can an impactful decision making can you make when you're not involved as much in research or academics or mentoring others. So for me, it's an important I think the three things I would say, that I look for when I'm talking to all these practices are the culture, they really want to be surrounded by great people and great mentors that I can actually get along with and vibe with and feel like they're my friends and family, not just someone at work with the ability for opportunity for advancement, which is either partnership or equity or some kind of situation like that. And the ability to pursue some of the endeavors and passions that I have within the field of Rei. So I personally would like to have a day a week to do reproductive surgery, fibroids, endometriosis, laparoscopy robotics, and to be at a practice that will allow me to do that and schedule that into my clinic time instead of just making me do IVF all the time is really important to me as well. So those are kind of three categories that I look at when I talk to practices,

Griffin Jones  27:53

the millennial that wants it all right, well, let's, let's just talk about that, that that passion, and we're in regard to the criteria for advancement as you were talking about. So because what I see happening is a lot of associate Doc's getting to a point where they've been, it's almost always at the two year mark, it's somewhere around there, maybe a little bit shy, sometimes it goes up to three years, but it's almost always around a two year mark, where they feel like they can buy into the practice that they should be allowed to. And the partners don't see it that way. They don't think they're in a position to buy. And it's very often because it wasn't spelled out black and white, this is the volume we expect from you. This is the revenue we expect you to bring in. And or maybe here's some of the other business responsibilities that we expect you to take on. So I think it's a problem because people are hearing I can have my cake, I can do my reproductive surgery this time. And I want this partnership track and what they're telling me and that they're telling me I can buy into the partnership track, but that means that I do have to do as much IVF as possible. So let's talk about what first seconds are on of what like when they're giving you when when you're talking about a clear partnership track, like I they showing this is these are the volumes that you like these are this is the number of procedures that you'd have or the number, the amount of revenue that you would have to bring in. And is that commensurate with what you can do while still having a day for your passions.

Dr. Zoran Pavlovic  29:30

Yeah, some practices are more specific than others. And I think that that's something that every fellow if I have a bit of advice to give is to get really specific and what those details mean. And also have the contract lawyer review that with you and go over all those details. And don't be afraid to ask those questions. Because for some practices, they say it's a four year track mark, you meet the milestone of being board certified or board eligible and then board certified and that your volume is at least this much per year, you're reaching this productivity bonus. And then you become eligible to be considered for that partnership track. And then you can buy in for that. And this is what the buy in typically is, or this is what it was these past couple of years for our partners. And so they tell you this defined ways to do it and that I think I really appreciate so you can actually have a goal you can build a game plan in your mind going forward, as opposed to be more vague, saying, well, after the three to five year mark, we'll see where you're at or or or if the partners agreed, then yes, you can become eligible to maybe buy into something those the vague language I think is something that we should always look at and try to define as best as possible. Because the ones that are more structured I think are better for fellows and allows you to really kind of plan your time there. What

Griffin Jones  30:45

better for the practice so there's nothing to be gained from mutual mystification. It's why I sometimes think I'm a dick, my sales process because it's so specific, I create so much content about the sales process itself, and then the delivery process? Because it's like, no, no, like if we if I don't have partners, agreeing on what we're doing here and what it takes to do that. I'm not letting you engage in anything. I'm not letting you just create what my company does in your mind, and then still hold me accountable to that same result. I don't think the mutual mystification benefits everyone, that's what results in in the in the discrepancy, you can always still have discrepancy no matter how specific URL but the more specific you are, the less likely you are to have to enforce something later on or have to dispute something later on. Back. What about you for partnership one at a time?

Dr. Megan Sax  31:44

Yeah, that's a good question. For me, it's really more about the fit, I would say. And I love how Zoran kind of prioritized his 123 I think, honestly, it's so important to be transparent when on those interviews with that and vice versa, kind of turn the tables to what are you expecting out of me or out of a new hire? What role do you guys really need to be filled? And am I going to be the best fit for that because you both want this to be a relationship you might be moving across the country for and to make sure that this is going to be a long term sort of, you know, beautiful relationship here. So I would say for me having an opportunity to become a partner would be in more of a private Demick setting would be important and to have that outlined and have those goals set up. But I would say overall, you know, I'm kind of open to various models here, I can see. My note is not a deal breaker for you. Right, I think the most important thing is, you know that longevity, I want the security of having a job that I love. And if that means every day I go to work thinking you know, I get energy from teaching, I get energy from doing research, having colleagues who want to write papers, which Zorah and I know is so sick of fun. But I think being able to have that energy is the most important thing and really loving where you work. Having a partner opportunity, I think is only only a good thing and in the way that I view entering this process.

Griffin Jones  33:20

Fair. So you're, you're you're lower on the spectrum, then John, John is not going to work for anybody where he can end up owning a piece of it. And you're open to others, you're you're you're interested in it, but you're also weighing in other factors. Victoria, where do you fall on that spectrum?

Dr. Victoria Jiang  33:37

You know, I've thought about this a lot. And I would say I'm probably closer to where Zoran is like the seven to nine, eight to 10 kind of range. As far as partnership partnership means something that isn't just like, you know, buying into the company, it's like for me partnership is really more of like, do I have the autonomy to be able to do the things that I want to do? Can I contribute meaningfully to the way that this clinic is operated in practice? And can I be able to have a say in the really important decisions that are being made? And I think at the end of the day, I mean, you touched upon it like practices are being bought out so quickly, like the landscape of a lot of different areas are really changing very rapidly. And to be in a situation where you're an associate provider in like a scenario where you know, your value, you bring a lot of value to the clinic say it's reproductive surgery, and you're otherwise referring out all those cases, I think being really kind of straightforward about that and asking for it's going to be important, but I also don't want you know, the rug pulled from under me saying that like oh, by the way, surprise, you're we're actually getting bought out by XYZ company in the next six months. We're transitioning all of our leadership and we're all suddenly like an employee model. And I think that's what's really challenging for me is that you'll build a life you'll build a home, and you'll live somewhere for three to five years and if you don't have a clear plan of where that next step is going to mean for you. I think that's going to be really challenging for career longevity because I think a lot of the burnout that we see He is that, you know, KPI metrics, like you have to meet these certain, like UVF conversion criteria, and you have to do X amount retrievals a year, and it very much feels like the industrial IVF machine. And, you know, I think we, as physicians, should see that we bring a lot of value and being able to negotiate that earlier on, if that means less compensation, to be able to do the surgery that you want to do. If that means carving out like a stake in your contract to say, you know, I'm really interested in artificial intelligence. So I want to be able to have the opportunity to develop that kind of technology freely, and you know, thoughtfully, being able to negotiate that at the beginning is kind of like being able to have like a good practice partner is it's kind of like the philosophical idea, but then also like that whole legal idea. And I really just want to work with a group of people that understand where my mission is, we have a combined vision that we want to bring forward. And we want to be able to expand our influence in a more meaningful way. And I think that can be negotiated in a very unique manner, and whatever kind of job that you're going to be looking at,

Griffin Jones  36:04

might be worth examining autonomy and flexibility. Because they're not totally the same thing. Some of the things that you mentioned seemed to me like it would be more advantageous as an associate employee, like if, if, if I don't want to be a production machine, I feel like okay, this is what I'm willing to, like, this is what I'm willing to work, this is the scope that I also want to be able to do those things. And in, sign me up for that salary. Whereas if it's like, if you're, if you want to be a partner, somewhere, you're gonna be a production machine for a little bit. It's like it's better if it's something worth buying into. There's a reason why that is.

Dr. Victoria Jiang  36:42

Yeah, no, totally. And I think that, you know, it's all about I think, what I learned in residency, the most valuable lesson that I learned in residency is if you have a problem, being able to propose a solution to the person that needs to solve your problem is a much easier way of getting something done than to just like, be like, Oh, I don't like this structure, but I don't have an alternative, right. And so like, for example, if you're like about to start a start working for a practice and say, they're worried about your productivity, you want to start doing reproductive surgery, you go say to them, you know, I, you know, really love doing reproductive surgery, I know that as my clinic volume revs up, that may not be something that I can do once a week, but in the interim, could you just refer all of your patients, as I'm filling my schedule, we can kind of get that money back for our clinic, we can reclaim some of those reimbursements from the surgery that we otherwise would be referring out. And then we could come back and say, you know, as my clinic starts filling up, you're gonna get referrals, you're gonna get friends, you're gonna get all these different, you're gonna be drumming up more business, that I think that they weren't necessarily having seeing as an avenue of revenue, and being able to sell that value that is very uniquely you, I think it's not just being a fellow that can do IVF. But it's also like, I can, you know, represent us at local, you know, marketing events, I can do all of these little pieces that kind of build into that practice that I think also builds rapport with your practice partners. And I think part of the whole practice partner piece is is that your partner is trust you and do your partners, think of you as somebody that they can lean on to make decisions. And I think I want to be able to build that trust with my partners.

Griffin Jones  38:12

Boom, that's bringing a solution that's coming proactively to make that selling your case for what you want to do. You also made another point that I think we should talk about, which is because I think it can go either way, it's something for people to consider and that has to do with future risk. Are you better? Are you in a better position to to mitigate that as a partner as an associate, meaning like all the people that are selling their practices? And it's like, Wait, this isn't? This isn't what I signed up for? I could see it going either way, if you're a partner, you potentially have more you potentially have a lot more to benefit from. If they're flipping that and and the partners are, are part of who gets to make that and they're not always that's one of the things that they can get screwed over on they did they get to make that decision, they get to vote on that decision to begin with. You could also be, you could also straight up get screwed ie Integra mat, like the people that were partners that those practices got screwed there. They had to find new payroll company money they had to the people that had paid ahead of time that year, they had to make that up. And if you're associate that's not really like that's not coming out of your overall bank, and God forbid if it doesn't work out overall, you just go get a different job somewhere else. So I could see I could see that. Like you mitigating risk. Are you taking more risk on? I think it could be either one? Well, I think

Dr. Victoria Jiang  39:46

it's like what do you think is like risk first benefit, right? Like I think the associate model like if you're able to say you have a side hustle, something that you're into, like say you have a really popular fertility podcast, and you really want to like figure out How to really lean more into that like that may be better for you to be an associate more like an associate partner in that capacity because you can work on side hustles, you can have things carved out, have a little bit more time in that capacity. But I'm a strong believer that without risk, there is no reward. And it may be that you take on a big risk, and it doesn't necessarily play out and what you want it to be. But the alternative is that you're going to be putting in just as hard of work on a day to day clinical level. And whether or not you're going to be able to be the person that's at the, you know, helm of the ship. I think that's the phrase, I think that's going to be per person, I think that's going to be what people deciding, you know, I've met people who are saying, this second phase of my life, I'm done with training, I want to focus on my family, I want to pass my boards, I want to buy a house and I want to like, you know, snuggle at home, I think that's fantastic. And just as important as any of these other aspects of your job. But you know, for people who want to have a seat at the table and make those decisions. I think for me, that's at least where I'm seeing myself now is I want to be able to sit at that table and have a little bit more of a say in how these practices are developed. Because I think the biggest frustrations that I see in these big, you know, corporates, like scenarios is that loss of autonomy, you know.

Dr. Zoran Pavlovic  41:21

That's a return. I've talked about this so many times via text message and phone calls. And we talked about how being at that table being able to participate in that decision making is so much more, it's better than not being there at all. And I think that can even carry over into advocacy, which may you can speak about if you're not at the table making those decisions, and other people will be making those decisions for you. And that's doesn't work out well in politics and advocacy in medicine. I don't think it works out well. And the business aspect, either. And if we're physicians, and this is our field, we should be participating in this situation, not everyone will want to which is totally okay, as victorious. There are some of us that do. And I think that that's we may be some of the people that want to hear in this conversation. And I think that's important because I would rather be there and at least try to put my two cents or help make a decision or put a vote in versus not having that decision taken. For me, I would almost regret that saying like, Oh, I didn't actually do my utmost or my best to try to change this outcome or influence it in any way. And that's why that kind of decision making capacity is important to me.

Dr. Victoria Jiang  42:28

He is in fact, a millennial who wants it all.

Griffin Jones  42:31

So that's this is what I'm trying to think about. Because it's like, okay, there has to be something in exchange for the decision making authority. I've had, I had, I had a real struggle with my employees at one point in the past year, which is because one of the things that I do promise them is autonomy, they get to make decisions for their seat. That doesn't mean they get to make every decision about everything. And, and so I also learned that I need to be specific about what that means, like, No, I own this company 100%. And I am ultimately accountable for everything I am accountable for if I have to make payroll every single time I have, I have mouths to feed, lots of them. And I have an accountability to our clients that nobody has that level of accountability in our organization. And the more accountability you have, the more the more autonomy you have. So it's like, okay, we want to make these decisions. So what are you taking on? What are you being accountable for, you know, in a partnership agreement that that gives you that seat at the table?

Dr. Zoran Pavlovic  43:47

Yeah, absolutely. I don't think you can want to be involved or be a partner or in a decision making position or seat without taking on some of the responsibility and accountability and look into those details of that practice and diving into your your functions, your operations, how that could be better, where things could change, dealing with issues at the with, with employees, or between patients or bad reviews, I think you have to you do have to take on some of that administrative work. And I'm not much not a big fan of administrative work, but I know I would have to have it, it's going to be part of my life. If those are the kinds of decisions, if that's the kind of position I want to be in one day, and you're right, you have to it's going to be some it's going to be additional responsibility. And so you decide for yourself, is that a responsibility that's worth it to you to have that partnership or decision making process or is it not? I think that can change throughout your life as well.

Griffin Jones  44:38

We're talking about lessons learned in owning a practice or owning a business in the fertility field and things that you may want to learn how to do or learn about before you go and start your own venture. Another thing is some of the systems that are used and help people that can give really good recommendations on the different EMRs they've shopped in that depth and scope. Both functions. But I would ask someone that you know, that uses engaged MD, if you're not already, if you don't use engage them D in your system, you're thinking, I want to open my own office within my own group or I want to open my own practice, I want to go join somebody else, and I want to be able to add something to it, engage them D is one of the surest bets that you can do. But you don't take my word for it. Ask someone that, you know, because more than half of your colleagues are using EngagedMD and more than half of your colleagues are extremely delighted with EngagedMD, because they've got real informed consent. They don't have stacks of papers that people have to sign and then account for and then keep an eye out for a file cabinet somewhere. They have true informed consent from patients that have a module at their convenience, so that the staff isn't overburdened with questions that they don't need to be getting that they can help the patient with the attention that needs to be devoted to that patient's case. Because the elementary the rudimentary is covered, and now it's just what that patient is stuck on or what's unique to their case that the care team can focus their care on. That's what personalized care is. And more than half of your colleagues have seen the benefit from engaged MD that way, so just reach out to any of them. Hey, guys, do you use EngagedMD in the people you want to fellowship with people that you see it ASRM? Hey, do you use EngagedMD? What do you think I hear Griff, talk about it. But he doesn't own a practice. What do you guys think, and see what they say. But if you want that free workflow assessment, you want to see what other practices are doing, you want those insights that EngagedMD has, and you want to see how your practice stacks against that ideal workflow, then you go to engage them the.com/griffin. And he mentioned that you heard them on the show, you mentioned that you heard them for me, and then you're gonna get that free workflow assessment. So ask somebody else, don't take my word for it, but go to engagedmd.com/griffin, or say you're on the show. So you heard from me, so you can get that free work assessment for you. That's one of the biggest system wins that you can have right off the bat. And you can verify that just by asking people you already know, I hope you enjoy the rest of this episode about things you need to know for the fertility business, you might start, I think there's there's a couple of different ways that you all can look at your careers, which is everybody talks about being an entrepreneur, like it's the greatest thing, it's not the greatest thing, there are advantages to it, one of the advantages is leveraging systems and capital so that you're not just trading time for money, and that so you potentially have the freedom to do a lot of other things. But it comes with a ton of risk, a ton of spotlight, a lot of obligation. And then another way of looking at your career is is you're a craftsman and and craftsmen can also have really great lives because they have a trade that is so in demand that they can call a lot of shots, then they don't have to have a whole system to they don't have to leverage a whole system. They can say this is what I charge like I'm this good at it. And make it seems a little bit more interested in I mean that you're still interested in the entrepreneurial route too. But but you're also open to this this craftsman, right? So what like, what is it that you also want to be able to do and advocacy is one of those things. So why is that important?

Dr. Megan Sax  48:44

Yeah, for me, it was really just being in medical school in Chicago, I did a lot of work with a program called the Midwest access project that did some elective termination training. We spent a lot of time at Planned Parenthood. And then coming to Ohio for residency was almost like a culture shock for women's health. But I will say in Cincinnati, it was really incredible place to do residency because it's, for those of you who don't know, the Ohio geography, it's on the river, and the other side is Kentucky. So it's really the first safe haven for most women seeking abortions from the south. So you got this incredible training at Planned Parenthood, which was five minutes from our hospital. And you just heard all of the stories saw incredible experiences and women going through just about everything to get there. And I can we have this Fetal Care Center and all these other you know, everything that you hear about in terms of fetal anomalies, medically indicated abortions. And so the dog's decision has just been tragic for the woman of Ohio. We overnight really went from 20 weeks, six days elective termination now down to six weeks. And like I said, this was the first is a place for a lot of the South to come to. And so I think not only do you have to Did it teach me coming here that you need to be familiar with the legislation in your state surrounding women's health, but you also have to be a fighter and you have to be vocal on behalf of your patients and share those stories with legislators, obviously, in a HIPAA compliant fashion. Because nobody else is going to speak the scientific truth if you don't. And so to me, you know, hearing Victoria mention this risk benefit and, and that I'm really thinking of it more from a perspective of, I want to be in a leadership position, I do want to make these decisions for my practice, whether I'm at an academic institution, but whether that's as a medical school clerkship director or fellowship program director, or division director, you know, to be in the room, where it happens, is definitely very important to me. But whether I take that risk financially to have that possible financial gain, I would say, you know, it's definitely very appealing and interesting, but I would be seeking, you know, consult from these two on that, as I typically do with with anything business oriented.

Dr. Victoria Jiang  51:15

I mean, for what it's worth, I think Meg is a great testament to the whole idea of finding that passion and learn, like feeling that spark for something and then chasing right after it like she has, we always say she's our advocacy queen, because she always has like, gonna sign this petition and like, we have this thing going on, like, oh, my gosh, we're trying to fly it in protests and do all these things. But I think that for me is like, that's the autonomy, right? It's like finding that passion, doing that passion, and then making something out of it. And I think that's the true spirit of entrepreneurship, right? It's like, finding something that you can have like a very specific niche and focus and being the best in that field and doing that. And I think if you bring those skills in that focus, then you can really like one of the biggest things I learned in fellowship is that you can't say yes to everything, and you shouldn't say yes to everything. And it's okay to not have your like eggs and every baskets, even though we like a lot of eggs hashtag. But it's like, you know, you can't say yes, everything, you can't do everything, you've got to focus what you're gonna do and market yourself from that perspective. And, you know, being partner for Meg, maybe being clerkship director or fellowship director, and that in and of itself would bring value and joy in that long, like career longevity. And I think for us, as at least for me, up to this point in training, it's been blinders on just clinical practice patients above everything, you know, you're in this hyper competitive academic environment is all about publishing papers. And then realizing and this last year doing research, there's so much more to the field that you can bring, that isn't necessarily the most traditional medical aspect, because the traditional medical aspect is becoming something so much more different than what it was 15 years ago, and being able to navigate that in stock to job search, but also like, life goal searching, I think, is been the most kind of interesting revelations, at least for me when thinking about that philosophical kind of partnership role, like what do you want out of your job? What do you want the freedom to be able to do?

Dr. Zoran Pavlovic  53:13

And other career I would say, the more the more philosophical, global aspect medicine, I think if you become complacent, right, medicine becomes run by someone or something else. And as physician burnout increases, I think a lot of that burnout comes from just us becoming complacent or being forced to be complacent. And so other people are making decisions for us. Other people are dictating our time, where we do anything from reimbursements to how much advocacy to do to what the laws are. And if we want to make medicine, you know, health care oriented, you know, physician and provider run system, we got to be a little bit less complacent at the least, that's what I feel like I want to be involved and that's what drives me. And I get the passion from that to be part of it. To help make it our own again, instead of just letting either businesses or politics or other other outside forces drive health care and medicine, if we can make any

Griffin Jones  54:09

change. Well, that can quickly become that can quickly become perverted, though candidate like corrupted that because like, it's like, then the business person really could just like the doctor can become the business person like and it's, it's, it's not immediately obvious where it's like, okay, that's the clinician, that's the business person over there. And, and especially when you can also as we see in marketing all the damn time, you can use ethics, you can even use or what's perceived as ethics to drive a marketing message. It reminds me of the Simpsons episode where Mr. Burns. He gets involved in recycling for some reason and like he's just using it to dry up the oceans or something and Lisa says, Eat you You're so evil and when you're trying not to be evil, you're even more evil. I saw this all over the place in business. Some of them the marketing messaging is, it is like just totally dishonored. It's perverse. And I don't think we're immune to that in the REI field. So I want to go down that rabbit hole, I want to ask you like, one other question, going back to the basket is Victoria talked about the basket, and maybe that will bring us back to this, of like, like this mission and message? Because I've asked you one question out of your 30 questions. And looking at this sheet, it's not just 30 questions, because each of them are like five quiz all like, all the things that we talked about were from one question, although we probably we did cover a lot that we covered what I wanted. But I want to ask you, well, there is another question that I'm glad you all put on here, which is do your do you see yourself in any role outside of medicine? So maybe that ties back to what we were talking about, like of keeping the mission Hall. And Meg was talking about advocacy. But that can really mean anything? Like what roles? It can mean anything? I mean, sitting on a board that has nothing to do with reproductive medicine? I could it could be not actually practicing medicine, but sitting on advisory forum for for a Silicon Valley company. What roles do you all see yourselves outside of medicine?

Dr. Victoria Jiang  56:30

Meg Sax for President 2036 Go.

Dr. Megan Sax  56:36

up right here. You got it.

Dr. Victoria Jiang  56:38

I'll be revised. I mean, all jokes aside, I guess for me, oh, gosh, I think that for me, I've always had this this is like totally. So like thinking totally outside of medicine, I've always wanted to learn how to bake like really fancy French pastries. So I feel like in the second life that I'll have, I'll probably go to like chef school and learn how to be like a patisserie, like person like pastry chef. And like the more realistic kind of like logical, field oriented way, I kind of imagined myself pivoting into more of a data science space, I think that one of the biggest untapped, you know, really untapped and truly understood like power of big datasets and clinical processing is going to be thoughtful developments of artificial intelligence and data processing, to be able to better diagnostics to be able to better die, like better, like genetic information processing. And I think it's going to be revolutionary towards the ability for us to have image processing. And so I imagined myself either doing my own kind of startup in that capacity, or potentially like joining a advisory board or serving in that capacity, kind of feeling how I can disrupt the field in a different way that is going to be bigger than me seeing patients myself, I think that is what I imagined my long term legacy to be and what I hope it to be because I think we have this one short life on the world, and I want to be able to make the biggest impact and get the most people pregnant as I can.

Dr. Zoran Pavlovic  58:06

Yeah, I agree with Victoria in the sense that there was a question on there that I think we pull it what do you think was the biggest things coming up in infertility and REO the next biggest innovation or what that and I think artificial intelligence and genetics are those two sectors that are really booming in our field, ai ai being closer to and like genetic engineering, all that being a little further away. But both of those are have such powerful capacities to make a lot of change in people's lives. But also, like you were saying, Griffin, there could be a double edged sword, you know, things different technologies may not be may be marketed as being great, but they may not actually be as great. Or we may be talking about when we get to the point of actually AI dictating care or genetics being able to be modified and embryo like what does that mean ethically? And I think there's these crazy ethical questions and business questions and medical questions that need answering. And I see myself as hopefully one day becoming knowledgeable enough and enough of an expert in my field, that someone would trust me to be part of a consulting group or a CMO of our company, or an advisory board or somebody people to sit down to help make these difficult decisions and have these difficult discussions. And I would like to train myself and gain my knowledge to get to that point one day, that would be really amazing, because I do feel like we have these epic situations and questions that we need to answer coming up. And if I can be a part of that and at least contribute in a positive way that I would look back at my life when I'm retired or just sitting on a beach somewhere in Bali, hopefully, like I did something, you know, beyond just like tutorial was saying, being in my clinic and taking care of patients, which is extremely important and the utmost importance of medicine, but that's how I would want to try to see if I can add to the field.

Griffin Jones  59:54

Yeah, I want to maybe just remark on that because it's amazing how It subspecialist physicians you're so you're so educated, you're so trained, you're so freakin smart. And, and, and truly are exceptional in many extra ordinary in many senses. And then in other senses, it's like, just as human as everybody else. And it's amazing. When I'm in a room of a very eyes, it's, it's a natural human tendency that likely comes from evolutionary biology that when you see someone getting more, you really want more, and because so much is coming into our field right now. It's, it's, it's very easy for me to say like, I want that, and I would just caution people a little bit yet you've worked really hard, where you're gonna be okay, no matter what you do, you're gonna, you're gonna be all right. Remember that the vast majority of human life up to this point throughout history, and even in great many parts of the world today is extreme poverty. And, and even by the standards of our country, you're going to be you're going to be doing well, no matter what. So I think it's just something to keep in in mind. As for all the the, for all the artists was for all of us, that it is our tendency to look at people and be like, they gave him what he's getting what for being on that board. He sold his practice for what? And it's like, you know, focus on some of the other things as well. And maybe you compare yourself to your ancestors, as opposed to the other colleague all of the time. I know, and just your competitive rate, especially REIs. So you're going to do it some of the time. But

Dr. Megan Sax  1:01:48

Matt, towards our patients for a second, too. Yeah. Yeah. I mean, you're so right. I think, unfortunately, that is kind of the human nature. But we feel that for our patients, too. And I know I've talked to these two about it. And one of the most frustrating things about our field is the accessibility and really lack thereof for such a huge proportion of the population. And I mentioned earlier onco fertility, huge passion of mine, as well as just fertility preservation for transgender population among other kind of medically induced infertility. Right. eugenic infertility. And so I mean, to kind of swing together the two questions of what's your passion outside of your clinical practice? And Zoran bringing in the where's this field going in the next decade or so I would say increasing access, I'm gonna make it back to advocacy for a second just say, you know, currently, we have 12 states that have fertility preservation laws, or in other words, mandating insurance coverage for that I intragenic. Infertility. And to me, this is this is not enough. And I can tell you, Ohio is not one of them. But, you know, we're seeing the state mandates increase now with 20 states, and we're seeing IVF coverage in 14 of those states. And I think that's going to go up. And I think in the next decade or two, maybe even sooner, we'll see a much larger patient population, I think that's part of the reason why they're coming for the REI fellows earlier in earlier is anticipating this huge increase, but I know the three of us will, will be fighting for our patients and increasing that accessibility and, and that's going to be hopefully part of something that I do outside of my clinical practice,

Dr. Victoria Jiang  1:03:35

I think that's really important to always like think of is that as you accumulate more resources, you also get to be the person who delegates the utilization of those resources. And I think what's what, you know, Meg was really thoughtful about kind of touching upon is even being able to practice right now, as a fellow in a mandated state, you know, even the state mandates aren't perfect, and there's a lot of insurance hoops, you have to jump through each case, you're you're spending a lot of time with patient, you know, authorizations and pieces like that. And so there's a lot of work to be done in the field that, you know, disrupting the field isn't just like, you know, the big bucks and making millions of dollars, it's like, allowing, it's like starting a genetics company and allowing people to have cheaper, more affordable carrier screening, so that they can actually know what carrier screening is, and being able to offer that at a price point that they can afford, instead of $1,000 a panel, it's increasing access to patients who otherwise would be afflicted with genetic diseases and offering genetic testing from that capacity and like being able to really utilize the resources information in the best, most thoughtful way. And I think that, you know, any physician that I have ever met always, you know, is thinking, what about my patient? How can I get the best care for this person? How can I get around these hurdles? And I think that that's something that uniquely positions, you know, physicians to be leaders and ethical development of the fields because we're always having that patient in mind and that may not necessarily be as easy to see, for, you know, politicians. I know, it's been a huge challenge with being able to bridge that gap of politicians being able to see like, what does it actually mean to have a six week abortion ban? And how is that going to actually impact the patients that you're seeing on a daily basis. And so I think having a bigger voice, and being able to be at that position is going to be hard work, you know, it's going to be seeing 1000s of patients and having good reporting good outcomes and doing the best for them. Because at the end of the day, that's what we do. We are craftsman, a craftsman with an idea for bigger.

Dr. Zoran Pavlovic  1:05:33

It's our job to kind of sift through all these things to these different technologies. You know, you go to ASRM every year and there's all these new booths or this brand new technology coming out. But how much of it is actually helping patients? How much is more marketing and a marketing gimmick? And what does it actually mean? And sometimes it's years of using that device or that idea before people are looking at the outcomes and say, this actually didn't help anybody. And so that's where we need physicians that are patient, mind and patient focus to be there at these advisory boards at these tables and to discuss these things to see what will actually be beneficial, what won't be beneficial, what is the research back what's evidence base, what might not be evidence based, but we don't have any other treatments for it. So maybe we should go down that avenue, and be able to make those decisions for patients so they get the best possible care and the best possible access is big in Victoria, we're staying.

Dr. Victoria Jiang  1:06:20

Clearly I've been doing these conferences wrong, I thought the best technologies were the ones that gave out the best sperm pens,

Griffin Jones  1:06:26

are getting the swag is something to be said for that. Well, one of the things I say frequently is that it's hard to provide, it's hard to to have a valuable business mean, it is hard to have something so valuable, that it is worth getting more money than then what you're what you're giving away, it's so hard to be able to do are you meaning actually, the opposite, I think I'm trying to say is that you have to give away so much value that it's it's worth more than the money being received for it. And in order to to actually like deliver something so high in value, all of the systems and people that need to be it's hard to do. And, and I take that obligation so seriously, as a business owner that when we're not doing our best, as a firm, we're just taking people's money, we're just I hear I say they all say they're going to add to the pie, but we just feel like, they're they're just taking away a piece of our pie. And when you fail a business, that's what you're doing, you're just taking away a piece of the pie. When you succeed a business you are adding to the pie. And it's so much harder to do than to say. But I want to conclude with let's just say each of you have interviewed at this point, each of you are talking to people, names, specifics. And I know you're not going to give those but give us some insights or just what are you paying attention to like as you're we've talked about the like what's important to you, but I'm talking about when you're interviewing with people, like what are the impressions that you're getting from interactions? What is it that you're paying attention to? Let's conclude with that? Dr. Sachs? We'll start with you.

Dr. Megan Sax  1:08:10

Sure, I think something that has really stood out to me and kind of gives you that that nice feeling like oh, wow, this could be a really good fit, is when they say we want to make sure that this is where you're going to be happy. You know, when you start to get into well, which clinics would it be? Or which you know, other kinds of details? Like Zoran would say, really that importance of the details. They'd say, you know, this is we want you to be happy. And that really stood out because I feel like as as a resident as a fellow, maybe it was more like No, no, I want you to want me What can I do? And it's really nice to kind of have this table flipped this time. And I think it feels a lot more comfortable than those kinds of stage we did. We were the first rate I think we were the first COVID interviews for fellowships. And we were so used to the zooms on zooms and those kind of, you know which answer which story am I am I tell him for this question, which just feels silly after a while. But these interviews, it's like, Who do I want to be my partner? This could be for 2030 years. So I think that's important. And I did also want to include that. I don't want any fellows out there feeling like Why haven't I heard anything yet? I think the three of us have, you know, gone to conferences,

Griffin Jones  1:09:28

I'd be thinking that I would think of that. You're gonna suck you suck if nobody's called. Nobody's college by the end of the second is something to be said for that make which is Be active. The more active you are, the more opportunities you have. And that isn't just there. It's not just for fellows to i, there's been a couple of people that I know are trying to hire fellows, and I've invited them on this show. And, and there's like they just don't It's like this, this fellows are listening to the show you're trying to I'm giving you free advertising to talk about whatever. I, the people that are really good at recruiting fellows, I'll just make up I don't want to say any doctor. So I'll just make one up Dr. Angeline. bolsos is so good at recruiting fella is because she's all over the place. And she's super generous. And, and there are other people like that. And it's tougher for some of the smaller people to do that. But the more active they can be, the more likely they are to be able to be connected with people like you. And and the same thing is true for you guys that opportunity begets opportunity. You are active at Mrs. Ai, you ended up on this show that's going to result in a couple of phone call or an email from somebody here there. Yeah, it was you met somebody from the armed group, which is going to lead to another opportunity. So no, I wouldn't be a little concerned. Like if you haven't gotten a call. Maybe I should start being a little bit more active.

Dr. Victoria Jiang  1:10:59

I will say I think a lot of people wait until ASRM of their second year. And I think that's a really great touchdown point for a lot of people because it's really easy to connect with people. So if any fellows out there I knew for me, like thinking of ASRM as like kind of a deadline or kind of like a touch base point of like putting out feelers and networking, I think was a good place to start. And I definitely think that we're really early in kind of looking at the field. But soon, you know, time flies, and you're going to be graduating sooner than we I mean, hopefully,

Griffin Jones  1:11:33

you're early and this is the least busy time of your lives for the at least the five years on either side of it. Right? Like you were busy as hell and residency and yeah, this is a brief window, you're gonna be busy as hell again. And so yeah, it's not like you're it's not like you're behind the eight ball if you are if you haven't talked to anybody by by second year, but but the more you put yourself out there, the more opportunities you get. There's one: What are you paying attention to?

Dr. Zoran Pavlovic  1:12:05

Yeah, pay attention again, but big for me is culture, how the different partners talk to you know, interact with one another, how they say the practice runs together, how they say the console. It's a big deal for me, when I talk to someone at the actual practice, and they say things like, Oh, I'm gonna have an issue, I just walked down the hall and my partner, I call this person or if I have a tough surgical case, this person is there to help and backing me up just just shows me that strong culture of collegiality and togetherness and collaboration, which collaboration is a big word for me, Megan will here has heard me say it a million times. And back when we met in the NIH, that's like all we did was collaborate on a bunch of things, and now Victorian and also doing some stuff. So that's that collaborative togetherness environment is big for me, because I think as a team of physicians, we can do so much more as a team of physicians and of course, other practice providers together, we can do so much more than an individual. And so it's important for me to be part of a great team. And so I pay attention to that team environment, how are they within one another? How did it happen? How does the practice run together? How cohesive are they to help each other out? And I get that from actually having personal conversations, not just from the interview? But I'll find people at the practice and email say, Hey, do you have time for a phone call half an hour here? Half an hour there and just speak to me one on one so that I can get them one on one? And really hear from them? What they think, what are their thoughts? What are some of the pros, what are some of the cons and that goes back to what you said Griffin about being active. If I had advice for residents, incoming fellows, new fellows or current fellows, now it's that don't be afraid to just kind of put yourself out there to network to have conversations with everybody around you even even if you're introverted, which may be harder to do that. Just put yourself out there, we have such a great field of so many people that want to help and there'll be excited if you're excited about the field and passionate. So walk up to that person after the presentation or go to the poster presentations or when some guy that you recognize from podcast walks up to you to pull up PCRs, you know, talk to that person. I think that was huge. When I met you for the first time, I was like, wait, I know your podcast. And that's our first conversation started, but just be active in those conversations, because that will continuously lead to more and more connections and doors and situations. And we can help each other that way. I mean, that's what makes them united. She asked me for some help with connections in Chicago people that I did research with, and I was just like, yes, let me text that person right now about you how awesome you are. And that's how it worked out. And so keep having those conversations and just be active. We're here to help.

Griffin Jones  1:14:33

Victoria, did I ask you what you're paying attention to or to interrupt you with calling people losers?

Dr. Victoria Jiang  1:14:39

Maybe a little bit of both. I will say the things that I'm looking out for definitely the same layer of collegiality. I definitely want to be practicing with people that I just love working with. But I think for me, it's going to be the little details of clinical care that I think are going to be the make or break it or you know, I want to be in like a medium sized practice. I don't want to be by myself. I want to have a little bit of mentorship. I don't want to be driving to 55 Different satellite clinics, you know. And I think what's really important for me is Journal Club and team review and being able to like lean on my practice partners to learn and get better. Because I think the great thing is, is that you're going to pull together people that have been trained in all different places in different times. And I think that you can learn a lot and make your practice like your own. And I think for me staying ahead on the literature on the new findings, the new technology is going to be something that's going to be more challenging as we get into the nitty gritty and I want to be in a like environment that pushes me forward and allows me for like professional development in whatever capacity that they may mean and being able to be around the right people to do that. And be able to have good mentors in that capacity I think is going to be what's the most important

Griffin Jones  1:15:52

if you go to Montana or Wyoming you're absolutely driving to six different satellite your your driving hours to go to the gym. Doctors Jiang Pavlovic, Sachs, Megan, zone, Victoria in reverse order. Thank you so much for coming on inside reproductive health. It's been a pleasure talking with you all. Yeah, thanks so much.

1:16:16

You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health