HRC Fertility is one of the largest providers of Assisted Reproductive Care in the United States. Started in Southern California in 1988, the clinic has grown immensely, serving thousands of patients every year. In 2017, HRC took their success globally, joining forces with Jinxin Fertility and listing on the Hong Kong Exchange. Despite the booming expansion, HRC never forgot its roots: providing quality, personal care for its patients and giving physicians the opportunity to have full control of patient treatment.
On this episode of Inside Reproductive Health, Griffin spoke with Dr. Bradford Kolb, President of HRC Fertility. Dr. Kolb joined the practice in 2001 and worked through the IPO process with his partners, making HRC what it is today. Not only did we talk about the process of going public, but more importantly, we talked about how HRC was able to maintain their patient and physician culture in this rapid phase of growth. He shares the structure of the clinic and what they do to maintain a small practice feel for such a large organization. Plus, Dr. Kolb offers advice for young fellows and physicians entering the world of Reproductive Medicine and what they can do to be successful in the field from both a personal and professional standpoint.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES 1:02
Today on Inside Reproductive Health, I'm joined by Dr. Bradford Kolb. Dr. Kolb is an REI Specialist and President at HRC Fertility in Pasadena, California. He's been practicing REI for 25 years. Dr. Kolb specializes in the care of complex fertility problems and under his guidance has helped improve HRC’s donor pregnancy rate. Dr. Kolb is internationally known for his expertise in complex reproductive matters and is one of the largest providers of egg donation and surrogacy in the United States with patients traveling from around the globe to HRC Fertility in Pasadena to see him. Dr. Kolb, Brad, welcome to Inside Reproductive Health.
DR. BRADFORD KOLB 1:42
Well, Griffin, it's a real pleasure to be here and I'm excited for the next hour and just look forward to exploring this topic a little bit further with you.
JONES 1:51
I'm interested in having you on because I know HRC’s history is a little bit different from some of the larger groups and just for me, maybe it's because I'm on the East Coast, maybe it's because I haven't seen you at PCRS, but HRC is just a little bit less known of their history to me. And maybe that's just me because I'm on the East Coast, but I wanted to explore it with you because it's the development of one large practice group, but wasn't always that way. Am I summarizing that correctly?
KOLB 2:30
Yeah, I think to understand HRC, you need to understand the dynamics of the East and West Coast a little bit better. The East Coast has been always developed into large groups in different regional hubs. Most pods have one or two large practices that dominate that locale. The West Coast has never achieved that. If you look all the way from Seattle down to San Diego, there's always been a plethora of practices that have never dominated the marketplace. That's starting to change currently. But HRC was founded as just one of the small practices in Southern California by our two founding partners in 1988. And it's gone through a number of iterations over the course of time. So it started more like a traditional fertility practice in the sense that you had two founding partners and then you had employed physicians, and that changed in about 1999, so 11 years into it. It was restructured as a partnership. So there is a model for employed physicians to become partners and become equal partners in the process. And I think that's also one of the things that differentiates us from many practices is that we don't have a hierarchy of our physicians. We do have employed physicians that ultimately, hopefully, all those employed physicians will become equal partners in the practice. The other things that are very different about our practice is we allow the physicians to really run with their practices and develop it as they feel best they can serve their patients. We have some commonalities as far as sharing resources. But I think also one of the keys to our success is that when a patient comes and sees a physician at HRC, that patient is a patient of that particular doctor. So you don't see different doctors, a lot of practices you see the doctor-of-the-day doing ultrasounds, the doctor-of-the-day doing embryo transfers or retrievals. One of our key successes is that you see your doctor for essentially every visit, every procedure through the process. That we've been able to share resources and develop very strong laboratories and leverage that to utilize technology and hire wonderful staff to really serve our patients.
JONES 5:02
I want to come back to that operations model because I think that is something that might be unique to HRC or something that others might consider implementing. But I'm interested in understanding the growth of the practice group, too. And it might be useful to explore your own growth within that to best understand that. You mentioned that there are multiple physician partners, that there are employed physicians, that there were two founding physicians that have since retired. Now you find yourself as President, how did that come to be? Was this a large group or a growing group when you joined? Were you an associate at first? How did you come to be President of one of the largest groups in the country?
KOLB 5:43
So when I joined the practice in 2001, it was just on the starting to roll as far as picking up new partners, developing new regions, and becoming, eventually, a dominant player in the California marketplace. The changes in 1999--making it a partnership--was really the impetus that got that going. I came on as the first new physician since that change happened in 1999. And in 2001, I became an employed physician. And it really gives us the time to make sure that we're comfortable with each other. In other words, you want to dance a little bit before you get married. And so I was able to develop a thriving practice. So I became attracted to HRC. And it became a place where I became really happy and decided I wanted to spend the rest of my clinical career, as far as practicing medicine. So there is a process at that period of time where after two years, you went through an evaluation phase, and then there was a vote which elevated me to a partnership or equal partner. Once again, there's no junior partners--it’s employed physicians and partners. And at that time there was a buy-in. So there was a formulation to buy into the practice. That has been done away with for our new physicians coming in. That's as far as like any kind of buy-in. But in 2001, started as an employed physician, 2003 made partnership. And then over the course of the 10 years, the first 10 years at HRC, there's natural leaders that develop. Our initial model was to have a management board and not have a single managing partner or president. So most of those years--after about five or six years as a partner, I served as a Managing Partner. And then that management board was done away with in 2017 when we underwent our merger for Jinxin Fertility. At that point, I became the President of HRC Fertility. But we still have a very strong management board in place that helps guide HRC Fertility’s growth as well as our day-to-day operations.
JONES 8:09
So how does a new associate or an associate that wants to become partner, become partner If there isn't a buy-in in the traditional sense?
KOLB 8:20
That is a very good question. The patient or—I'm sorry, the employed physicians will practice for several years. It's not a defined period of time. Our goal is certainly to elevate employed physicians to partners. But that comes with responsibilities and we want to make sure that those that are elevated to the partnership role can handle those responsibilities. One is performing a certain volume of business that can sustain your practice. There's also--we're going to be looking at pregnancy rates, the clinical practice to make sure you're a good fit for HRC Fertility moving forward. Our vision is many of the large practices is to sustain the practice once the physicians that are here currently, move on into retirement or into other fields that are going to leave a void for HRC.
JONES 9:19
And do those folks that retire do they get to hold their equity? Do they have to sell back to the practice in order to open up space for new partners coming in?
KOLB 9:34
Well, we're now a publicly-traded company, so I own shares and Jinxin Fertility, which is our listing on the Hong Kong Exchange. And I'm not obligated to sell or forfeit those shares upon my exit of the practice, and new partners coming in are granted shares and other benefits as they come into partnership roles.
JONES 9:59
I don’t want to jump ahead, but you've definitely tempted me because I think the IPO is really unique. It's not terribly common in our field. We're more used to talking about private equity, a few private equity firms purchasing groups. We have had companies be public in the past, IntegraMed was public for a while and Sagard took them off of the market. But what was that journey like? How do you go from being a growing group to deciding this is the right move? How did those discussions even start back when they were a pipe dream?
KOLB 10:36
Well, how did it go or how, you know, I'll tell you, is difficult because we started this process on an inquiry of a patient of mine from China. And he kept insisting that he wanted to buy HRC Fertility. So eventually, I threw out just a number off the top of my head of what it would take and he said, “Okay.” We didn't ended up going with that individual, but then there was discussion--
JONES 11:05
Was that a “forget you” number? We’ll use the polite term for the gentle ears of our audience. But was that a forget you--like, for example, I have a forget you number that is a title sponsorship for the podcast because I actually don't want someone to buy the title sponsorship of Inside Reproductive Health. And that number will only keep going up if I feel like people are getting closer to it. But I guess, worst case scenario if someone really wanted it, I would find a way to live with it. Was that number that you first got, was that sort of a, you know, a get lost number?
KOLB 11:45
Actually, it wasn't because we've always entertained like, what is our exit strategy eventually? And we have partners that have massive practices. I mean, both myself and Dr. Wilcox at HRC, we each perform over 900 egg retrieval cycles a year each individually. So, you mean how can I transition that practice to a new physician and get some valuation for that on my retirement? It's impossible. So we've always looked at, okay, is there a possibility to transition the practice over to another entity or individuals? The other thing that we really wanted to look at is how do we expand and grow our practice? And we need financial resources to do that, but we need a lot of business expertise and guidance to do that as well. We’re very good at being physicians. We became very good at dominating our local marketplace in Southern California. So we had a much bigger vision for HRC. So when I threw out that number, it was based on strictly business principle. This is based on our EBITDA, this is the valuation of our practice or the amount of crop that we were bringing in the multiples that we were expecting based on sound business principles is what guided that. And it became an interesting discussion. But once we opened that box, there was a flood of activity. So we actually spent almost a year with that individual’s group. He assembled a group, but became an impossible ordeal for us. We were going to lose our practice, we're going to lose our control of the practice and just simply become an employee of HRC. And that was completely unacceptable to us as well. But we went through about a dozen groups, private equity groups, and different opportunities. We had groups out of Canada, the US, and China, and Hong Kong, that were interested in either acquiring a portion of HRC revenue streams or developing something much larger. And the group that we eventually settled on with Jinxin Fertility. So they came along after a year and a half of these discussions. We became very, I would say savvy is the best word I can think of off the top of my head about what we wanted, what it's going to take to accomplish this and they were on board for it. They shared the same vision about increasing our dominance in California and the West Coast, continuing with good medical care, allowing the physician to control the practice as far as the practice of medicine. And also they brought a vision about creating a global practice. So not only are we HRC Fertility, we have two partners in China, one in Chengdu and one in Shenzhen and they collectively do approximately 35,000 egg retrieval cycles a year. So it's created this unique opportunity to expand the clinical business but also start to look at how do we develop research and how do we develop a global practice that is not just a sum of its parts, but is unique and can develop unique avenues for patient care and improve patient care and opportunity, opportunities for physicians, nurses and staff alike.
JONES 15:18
And so was it together with your new partners? Were they already a publicly traded company and you became a part of that or together you listed on the Hong Kong Exchange?
KOLB 15:27
So, together we listed. So it took about a year for us to merge the practices and to apply for the listing in Hong Kong, which is quite a process. Fortunately, we had a lot of expertise from people like JP Morgan and Warburg Pincus that handled that for us. But that was a phenomenal educational experience for me, but they handled the listing and it successfully listed in June of 2019.
JONES 16:01
How did you decide which exchange to list on? Why not list in New York or--well, I guess you're not in the UK, so you wouldn’t list in London--but between China and the United States, you have a few different exchanges you could list on, why Hong Kong?
KOLB 16:19
Yeah, so we looked at the American Exchanges, we looked at the Shanghai Exchange as well as Hong Kong. And I think Hong Kong provided the best secure exchange, where everybody felt comfortable. Our fears of listing on the Shanghai Exchange would be that it would be very hard for the physicians or the owners at HRC Fertility to be able to bring or repatriate the money back to the US. It was just a lot of uncertainty that we were uncomfortable with. Honestly, the Hong Kong Exchange offered greater visibility for our company. We were the largest listing at that point in 2019, that generated a lot of resources and interest in our company. We would have been over dominated by so many large tech exchanges and other companies listing in the United States. And also, just from a business perspective, the multiple that we can achieve on the Hong Kong Exchange is going to be much greater than it would be in the US.
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JONES 19:25
So you're doing 8 or 900 IVF cycles a year yourself and you're listing a company on the Hong Kong Stock Exchange, merging with groups and other countries, learning how to entertain and decline offers from a dozen private equity firms. One of our biggest audience segments is fellows. It's one of the biggest listenerships that we have. And every week, I have a fellow reach out to me saying, Thanks, Griffin, we don't learn any of this in medical school. We don't learn anything about business. And that's generally true that physicians aren't learning about business in medical school or residency or fellowship. And here you are really looking like a Harvard MBA. And so how did you learn all of this during your tenure of practicing medicine?
KOLB 20:13
A lot of trial and error, but I've always had a little bit of an entrepreneurial spirit in me. And that goes back to my childhood, I used to scour the local golf courses for the stray balls, clean them up and sell them back to the golfers. And when I was 15, I managed to buy my first home--rental home. Not a very expensive one, but that got my entrepreneurial spirit going. Exactly like all the other fellows listening, I had no formal education in undergraduate, medical school, residency, or fellowship regarding business principles. It's a little bit flying by the wind underneath the wings, and going through trial and error. It’s being willing to challenge yourself, it's being willing to sell, get back on the horse and learn those principles moving forward. I've got some very bright partners as well. And together, we weeded through a lot of these different things as far as like negotiations, growth as a practice. So that's one of the key things. And I would encourage the fellows, if you have the opportunity--and there is an opportunity--take some business classes. If you're not planning on just being an employed physician--there's certainly nothing wrong with that--but if you have any kind of entrepreneurial spirit, take some business classes, see if you can get an MBA along the way. There's ways to do that. That can at least teach you some basic principles. You're not going to really be able to solidify these principles until you put your feet to the fire and you’ve got to be willing to accept failure, recognize that failure, look at what you did wrong and then continue to move forward. The other aspect of this is, I'm incredibly competitive. And in some ways that can be a bad thing, but I learned to channel it in very positive ways. Some of the physicians are very competitive. So as we're building our practices, it helps HRC. So we learn from each other, and we compete against each other a little bit as well. We don't want to be outdone or out shine by our partners. So we work very hard. So it's learning as far as patient care, developing a system that allows us to see these kinds of volume of patients. And most of our doctors don't see those kinds of volumes, we have probably about four that are seeing about 4-500 patients a year as far as OPU cycles. So we have lots of physicians doing 2-300 cases as well. So you’ve got to find what you're happy with, and what's gonna drive you and what's gonna make you feel good about your patient care. The other thing I really want to stress is difficulty in that volume of patients. You need to develop a system that's not going to compromise patient care or compromise your staff in any way. If you don't do that, it's going to implode on you in the long run. Fortunately, we've developed sustainable models as far as patient care, quality of care that looks after our staff and our patients and treats everybody very well in the process.
JONES 23:24
And I still want to explore more of that system. I'm curious because someone that buys a rental property at age 15, to me suggests pure blooded entrepreneur, but you didn't go that route in 2001. You started off as an employee, why did you make that decision? Why didn't you open your own practice in 2001?
KOLB 23:45
Well, actually, if you go back, I finished fellowship in 1997. I had--I was married, I had two young children, and I started looking at what it was going to take to open a practice. I didn't have the confidence at that point in my career, I kind of lost a little bit of that entrepreneurial spirit. And I was doing a lot of moonlighting to provide for my family. And one of those moonlighting jobs was at Kaiser Permanente. So I became a reproductive endocrinologist at Kaiser. In ‘97 was a very different world. There were very few opportunities out there for the graduating fellows. And I made a good go of it at Kaiser for about three and a half years, made partnership there, but it just wasn't the right place for me. I started to get that entrepreneurial spirit back. I started to rebel a little bit against some of the control processes that were around me as far as patient care and the things that I can do. Not saying anything bad about Kaiser, it's a wonderful place, I have fond memories of it. It just wasn't for me. So actually coming into HRC Fertility in 2001, was starting to stretch my wings a little bit. I worked with my wife, and for the fellows that are out there, make sure any decisions you have your spouse's buy into this process because they're coming along for the ride with you. Okay, I got my wife's permission to leave a secure financial situation and go at risk. As an employee at HRC, I did have a salary, but there was no security in that. I could have lost my position there. And much of my salary was based on performance. So I was able to really get that entrepreneurial spirit going to build the practice. And for the first few years at HRC, really all I focused on was patient care and building my client referral base.
JONES 25:40
And as you do this, and you start to have this entrepreneurial flair come back, are you the entrepreneur that tilts more towards the visionary side where you like thinking of the big picture and the culture and the patient relations dynamic, or are you higher on, I believer it is the D and C letters of the DISC profile where you're a control freak operator and you like implementing the systems managing the leadership team, holding people accountable. Where do you tend to fall on that entrepreneurial spectrum?
KOLB 26:14
Well, it depends on when you asked me that in my career, it's gonna change. And some of that, you know, the early parts of my career, were building my individual practice. And it transformed into maintaining that practice, that building HRC. I could tell you where I'm at now in life, and I feel like I'm in a very good position in life. I'm very comfortable with the practice that I built. I'm looking at transitioning my practice over to new physicians. Now let's be honest, at some point, it does become unsustainable to continue these volumes of patients. So we are looking very aggressively at good physicians to hire and slowly transition our practices over. That I'm very secure financially, mentally. And I'm looking at what do I do for the remainder of my career? I probably want to work for about 15 more years, but I'll probably start to wind down some of the clinical practice. I love seeing my patients. So I don't know if I'll ever give that up. But I'm starting to--I don’t want to say becoming more of a visionary--but I'm very much into data analytics and developing new models that allow practices to thrive, not just at HRC Fertility, I want patient care to thrive. So there's two focuses I have. One is how do you collect data in a very usable, reliable manner, which is not done currently. I don't know about other fields in medicine, but in Reproductive Medicine, it's not to any significant degree. But how do we start to look at this data? How do we start to individualize this data to help an individual physician improve their practice and treatment of their patients. We fly by our wings a lot as far as making patient decisions, treatment protocols. But there isn't a lot of data about that backs that up. So I'm very much interested in augmented intelligence to help augment the physician decision making process. But I'm also very interested in looking at how do we extend the breadth of reproductive medical care to the majority of people in society that can’t access it currently, and most people can't access it for financial reasons. This is a very costly service, both emotionally and financially. So how do we alleviate those barriers for patients moving forward? Those are my primary focuses for the last two years, if I start to look at some of these transitions
JONES 28:45
I want to talk about those ventures that will help us to have a little bit of context of just how you think of these solutions and how you build the systems based on the systems that you built for HRC. You mentioned that a few of the physicians are doing 500 cycles a year and yourself and at least one of your partners are doing 8-900 cycles a year to me that suggests really buttoned down systems, especially when the physician is seeing a patient for every step of their journey. What are a few of the key tenants that have allowed you to do that? Does every doctor have a dozen IVF coordinators?
KOLB 29:23
Well, we give the resources necessary for each physician. HRC is undergoing a transformation at a corporate level. So we're providing a lot of these key growth strategies for our junior physicians to allow them to thrive and focus on the practice of medicine. So our marketing department is really gearing up. I’m really happy to see the changes that are being made in our marketing, our branding and brand recognition. We also provide well-trained staff for our position. We do share a lot of staff in the IVF laboratory, the front office, so that's all taken care of for us. But as an individual physician, we've developed a model where each physician has their own personal team. We think it functions much better for the care of the patient, and also that interaction between the physician and the nurses. And I do want to say that I do look at everybody in this process as a partner, even though they're not formally a partner, but my nurses are incredibly important. The front office staff is incredibly important. Everybody that touches a patient or a process is really critical for our success. Each physician will have their own team and as their practice grows and it warrants, then that team will expand. I peaked out at about 20 nurses and assistants servicing my patients. It’s down a little bit because of COVID for a variety of reasons, but you need that kind of volume of staff in order to support that new cycle and really not drop the ball on your patients.
JONES 31:10
And did you always have this level of uniformity across the group in terms of systems and in cultures?
KOLB 31:23
No. I mean, this has been a practice under transformation. So in the early days, we fought a bit against each other. It was always very competitive. At one point, we segmented the practice into three regions: the Encino region, Pasadena region, and Orange County region.
JONES 31:43
And those are your three labs, right? That’s where your labs are?
KOLB 31:46
Exactly. Yeah. The reason for doing that was a couple things. We felt that it gave greater accountability for each region, to manage their staff and manage their resources. So we became very much more cost efficient in developing that model. Our model for years was basically eat what you kill. In the sense, the busier you are, the greater your pace is gonna be. But it can't come at the cost of driving up expenses, so you become unprofitable or a region becomes unprofitable. So if the region wants to go out and build a new center, you have our blessing, you have our full support to do that, but under that model, you have financial accountability that made us a very lean system as well. That's changed with the merger and the listing on the IPO. But it was time for that to change. So in 2017, fortunately, we came together much more cohesively, developing these models and growth strategies for HRC. But we still have a tremendous amount of financial accountability and accountability for our practices to Jinxin Fertility.
JONES 33:00
You said that you used to compete with each other and maybe that means butting heads, and I see it sometimes in two physician practices, much less than when you have multiple partners. How did you get everybody on the same boat because I could see after having a degree of autonomy, or of we're doing it this way in our region, it being difficult to bring that back under one direction.
KOLB 33:28
Well, it's a little bit like the proverbial herding cats. Ultimately, we knew what was good for HRC Fertility and our patients. And that principle never left us. That competitiveness and that eagerness to thrive also generated our success. Whereas a lot of models in reproductive practices, there isn't that level of accountability. Why should I spend 12 hours a day or seven days a week in the office? If I don’t see the rewards and benefits of that? So it did generate that kind of work ethic that we wanted to see in our partners. I know it's a changing world, so that's changing, too. We ultimately knew that what we did had to be successful for HRC as a practice, otherwise, it would become unsustainable. You would eventually--we didn't want to become like one of those rock groups where you reach the pinnacle of success and just have the world as your oyster, at your feet, and lose it all because of bickering and infighting. Fortunately, we never lost sight of what we've had to do, how to be best for HRC and HRC’s interest.
JONES 34:44
And now you're taking some of these systems or some of the solutions that you've thought about, you're starting to build ventures for other practice groups as well. What are those?
KOLB 34:57
Well, we're looking at opportunities. So I think, fundamentally, the low hanging fruit for us is expanding our operations. As I mentioned, we are hiring new physicians, we have four physicians that we're going to make offers to currently. So we want to increase our footprint within the regional marketplaces that we are in. We're also looking at the opportunity of merging in several practices in our region, essentially shutting down their laboratory, increasing the efficiencies of our laboratories, and the financial resources for everybody. Beyond that, it's a challenge as you start to expand outside of your region. I would like to expand up north--Northern California looks like a great place to expand to, especially as some of the predominant practices are starting to age out and I don't see many of them having a transition plan that's going to be potentially viable. I can be wrong. I haven't talked to some of those physicians. But that creates a lot of challenges, as I’m sure that some of the other practices on the East Coast has shared with you. How do you either take over open a practice outside your region and transition your practice philosophy, your corporate financial philosophy to that region? That is something where, hopefully, our partnership and access to business expertise will help us make some of those transitions in the future.
JONES 36:33
And are you beginning to delve into the software solutions or the EMR realm, or am I wrong about that?
KOLB 36:41
I am, but that's a separate venture outside of HRC Fertility. So I'm the Chief Medical Officer of Fertility Pro. And we're developing software solutions for fertility practices that we think are unique and very different than the software solutions that are out there and really encompass a much more greater realm of reproductive medicine and match the workflows of physicians, nurses, lab technicians, the financial aspects of the practice as well.
JONES 37:13
That sounds awful. Why would you want to take on that challenge? Why would--what is it that you see about the EMR landscape that you think yeah, this is a headache that I want to take on. I want all of the headaches that nursing managers and billing managers and physicians might have. What is it that you believe is the challenge to be solved by adding a new EMR to the marketplace?
KOLB 37:43
Well, first of all, it didn’t start as an EMR. I've been on three different EMR systems, none of which met any of my needs and for the most part of HRC’s. You're running multiple different systems in parallel, they don't talk to each other. They don't match physician workflows, it's almost impossible to get usable data out of these systems. So I started this venture, very simply as developing a small app that would allow me to do calendaring, or my nurses to do calendaring, instead of spending an hour to generate calendars to do it in five minutes’ time. So that was about seven years ago. And then, as we started looking at the different EMRs that were out there, we wanted the data from this app to flow in through an API into these EMR systems, and populate correctly into EMRs. And we realized the EMRs that are out there, they're not Agile, they have cloud-based issues. So I don't know if it was on a whim or just being naive. We decided, well, let's build an EMR system. And that was about five, six years ago. So the system that Fertility Pro is working on, solves a lot of these issues. And we'll have a full launch by the fourth quarter of 2020. So it's an exciting time to be in this realm. But it also allows me to start to transition my interest over to something that's going to touch a much greater level of patient care. Right now, I can treat maybe 800 patients in IVF or egg retrieval cycles a year. I'm interested in making a change for the industry, as well as for the patient care moving forward, beyond just domestically, but globally as well. Much of what fertility does, if you look at the processes in multiple different countries, about 80 to 90% of it's the same in all countries. So we're trying to develop systems that will allow practices to grow and expand in a very efficient way, systems that will allow the augmented intelligence and assisting patient care. And also we have some very unique features that we'll start working on next year to ease patient care to ensure that patients are following the physician instructions correctly, doing their medication injections correctly, much more accountability for the patient involvement in their care.
JONES 40:19
So how are you able to solve for this though? Can all of this be solved for? Because I'm not an operations consultant, I'll never be a full on operations consultant, but trying to be the marketing person, the marketing firm for this space. In the Venn diagram of finance, operations, and marketing, we try to fill in everything that's shaded in that overlap of finance and operations, so that we can consult and provide the best solutions. And it seems to me like there's so much variance in workflow from clinic to clinic and it's one of the challenges that networks have faced as they start to bring groups together. And every EMR has said that for the last, how long is--well, the other ones don't do, and then name the function in the feature, and partly solved for it, but how much is partly being able to solve for your own need? And then there's just a whole other slew of challenges once you meet the next person's workflow, which varies from the next person's and so on.
KOLB 41:23
Right. And that's very difficult--I would tell you anybody that says they've solved it or can solve it, it's either very naive, stupid or lying, because we're never going to solve it. Technology changes, workflows change, even as individual physicians, we were very whimsical and our individual workflows change quite a bit. You need to be based on systems that are agile, that allow for a great deal of flexibility with the individual workflows, but there's going to be some aspects to any electronic medical record system whether it be reproductive medicine, cardiology, dermatology, obstetrics and gynecology, there's certain aspects that are going to be have to be hard-programmed into the system that allow for not only, you know, some standardization of workflows, but also the data and analytics and ability to collect that data. It's extremely complex and hard. And we're learning through it by involving a lot of clinicians to help us develop these systems, these wire grams and workflows. And then as we develop it, they need to be tested and need to be beaten down, the flaws are detected and corrected for and it's going to be an ongoing process for eternity, as long as any of these systems and to be honest about it, for them to function effectively. We're not going to solve the problem that hopefully we provide solutions that ease the workflow and improve the efficiency of the practices for the patient's benefit.
JONES 43:03
I think that an open API will become requisite. And I hope that it happens more. I can tell you, it's why we've never attempted a CRM is because in order for it to really be the most effective, it would have to integrate with different EMRs and just not ready to tackle that right now. So I hope that that's one of the things that comes to fruition. Brad, how would you want to conclude with our audience either about the trajectory a younger physician might be might be contemplating for their own career, or what you'd like to see for the field? How would you want to conclude?
KOLB 43:42
That's a very open ended question.
JONES 43:45
It's basically my way of covering my butt. So that you get to say what you wanted to say if I didn't ask it already. And it usually ends up being, oh, shoot, that could be an entire ‘nother episode. And then it's my excuse to have you on for a sequel.
KOLB 44:02
I'd love that. Look, I'm just sharing HRC’s model. It's maybe not a model for many practices. Practices have to explore that for themselves within their marketplaces. We live in a marketplace, it's mostly cash or the coverage that does exist is covered by groups like Progyny or Carrot or others that manage those benefits. But we’re still at 80% cash-paying patients. It gives us a lot of flexibility. I don't know what it's like to practice medicine in covered states, like Massachusetts or Illinois. But these are the systems that work very well for us. We're always exploring change. We're always open to change. I think the things that were very tantamount to our success is giving the individual physicians a lot of flexibility to control the medical care that their patients receive. We’ll never have a system in place where you have to use certain types of protocols, you have to follow certain guidelines. As long as your patients are comfortable, they're receiving good care. We allow our physicians to practice and treat their own patients. And as far as like the young physicians, it's a very different market out there than when I first started. We see a lot of physicians not interested in the entrepreneurial aspects of it, they want a job. They want security. Those jobs are out there, we have positions for you, we love those that have very entrepreneurial spirits and want to take on some of the business development aspects of care. But I really encourage you to never take your eye off the ball. You went into medicine to serve others. And Reproductive Medicine is a wonderful field. You can do many different things. You can become a business expert, you can become a patient expert, but really never take your eye off the ball, which is always a duty to serve your patients and do what's best for them. But I would expand that. You’ve got to do what's best for your staff as well. Those people in your office, everybody in your office, is an equal to you. Everybody has an incredibly important role for the care of the patient, and to make sure everybody is taken care of--their safety and health and well being, especially during this COVID crisis. But that we should never lose track of. It's a changing world. Don't be afraid of change. Don't take your eye off the ball. And I guess the last thing I'll close on is for younger physicians, and I wish I had taken this advice a little bit more to heart, for those of you that have children or spouses, involve them. Never take your eye off your family, you’re a provider to your family, that your family, more than they need your money and your financial resources, your kids need you there to be part of their lives. And that's probably the thing.I wish I could change in my house and to be there a little bit more. When I was with my family was always very involved and engaged, but I wasn't there. Fortunately I reengaged my children in a very strong way. Take care of those around you at all levels. Be happy. Seek out the things that you want to do within medicine and life and be successful at it. And if you’re unhappy or you’re not finding success. There's always another opportunity out there for you. Those are my key pieces of advice for especially the younger physicians and follows.
JONES 47:44
Sounds like a decent life to me. Dr. Kolb, Brad, thank you so much for coming on Inside Reproductive Health.
KOLB 47:49
Griffin. It's been my pleasure. Hopefully we can do this again sometime in the future. Thank you for having me. I appreciate it.
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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 drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.