On this episode of Inside Reproductive Health, Griffin talks to Dr. Matt Retzloff, a Reproductive Endocrinologist from the independently-owned Fertility Center of San Antonio. Dr. Retzloff is board certified in both RE and OB/GYN and has special interest in fertility-related surgery, focusing on minimally invasive surgeries.
Dr. Retzloff is a firm believer that surgery for infertility-related issues are best managed within a fertility practice, allowing for continuity, confidence, and best outcomes for the patient. But looking at it through the lens of business, those benefits don’t always align with business operations and finances.
Together, we dig into the pros and cons of keeping fertility surgery in the purview of the REI.
Mentioned in this episode:
The Great Game of Business by Jack Stack
Learn more about Dr. Retzloff by visiting https://www.fertilitysa.com/.
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.
JONES 1:43
Dr. Retzloff, Matt, welcome to Inside Reproductive Health.
RETZLOFF 1:46
Thanks, Griffin. Great to be here.
JONES 1:48
We're going to talk about surgery today, which is a topic that is really important to you. I have a pious hope that we're also going to talk about what it means to have REI productivity and that ties into that. But why is surgery an important topic that you want to bring to the forefront?
RETZLOFF 2:07
Surgery in the realm of REI has always been a bit of a controversial area. And in what some of the controversy sort of revolve around are whether or not it is actually beneficial for the practice to offer surgery, for example, time management issues, reimbursement issues and how you tie that into the productivity of the clinic. And there now has evolved an entire other specialty, minimally invasive surgery, that where fellows who actually specialize just in surgery do many of the same surgeries that were sort of always the purview of the reproductive endocrinologist. So, you know, there are many reproductive endocrinologists who are sort of moving more towards just being in office, IVF physicians and seeing themselves merely as an IVF physician and others who really still maintain that surgical hole, that niche of surgery. And so I think that it remains very important to have that in your armamentarium within your practice. It doesn't have to be every one of the providers, but I do think there are advantages, both to the patient and to the practice, for an REI practice to continue to offer surgical procedures.
JONES 3:28
When did this start? Like, how long is this been a phenomenon? Would you say it escalated more along in your career?
RETZLOFF 3:36
Yeah, that's a great question. I think that, you know, I trained from 2000 to 2003 in Boston, at the Brigham Women's Hospital, and our fellowship was really quite diverse both on the surgical side as well as the IVF and the infertility side. And so I really got--I was exposed to breadth of surgery all the way up to and including laparoscopic tubal reversals, myomectomies, really just a high volume surgical practice. So really from a skill set wise, I felt like we really were sort of prepared to kind of do what I call the one stop shopping for the patients meaning they come to see you whether they had ever had any evaluation and you could sort of take them all the way through without having to refer them out. I think, to answer your question, over the next five to 10 years, as really residents and fellows began to see sort of a decline in surgical volume--and I say a decline because there became many alternatives to surgery and so as volume started to go down, training started to go down, and I think part of it was, it became a little bit easier, quite honestly and maybe even a little more comfortable to do, really focus in on just IVF. Whether or not the provider felt they could stay sort of up to speed with a lower volume of a particular type of a surgery or whether they just felt more comfortable increasing the IVF volume and having sort of a referral within the minimally invasive surgeons to sort of help them and that surgical volume. So, really, I think over the last 10 years, I've seen it evolve more and more to where REI practices in many of them are doing less surgery and more just office-based IVF.
JONES 5:22
The adjacent subspecialty that you described as minimally invasive surgery, is this a sub-subspecialty? Are these REIs doing minimally invasive surgery only or are minimally invasive surgeons doing surgeries across the board REI and OB/GYN surgeries are just among them?
RETZLOFF 5:42
So they are a ABOG-recognized subspecialty now, just as RE is, so they are sort of on the same subspecialty level as MFM, GYN-Oncology, the Uro-Gynecologist and now the minimally invasive surgeons. So they don't just serve in the realm or the purview of the REI-related surgeries. They do other hysterectomies, other types of procedures that sort of more fall onto the purview of the general OB/GYN as well. Just that Venn diagram sort of, for them, actually includes a lot of the surgeries for REI.
JONES 6:18
Do you like it? Do you love it? Are you totally against this? What's your opinion?
RETZLOFF 6:24
Well, you know, I think it's, I'm sort of biased. Obviously, I'm biased towards doing my own surgery. But what I mean by that, though, is you do have to be somewhat selective. There are cases which begin to sort of take a toll on the practice--I'll call it a toll--and what I mean by a toll is the time investment, whether it's the actual surgical case itself, which third party payers right now, the bigger cases just really, you're not reimbursed for your time. If you were to do a comparison for if I spend my time in the clinic versus I spend my time in the operating room, reimbursement is going to be much better for your time, hourly time, spent in the clinic. So there are some and I would use a repeat myomectomy, maybe an extensive endometriosis case, you know, I'm talking that two to four-hour case or sometimes even longer case where really those may fall under--and I still use, honestly, I have got a GYN-Oncologist here locally who are minimally invasive trained as well--and so I use them whether it's in an assistant role or even as a primary referral.
JONES 7:33
If REI centers, if IVF centers have their own ambulatory surgery centers, do the economic incentives change much?
RETZLOFF 7:41
I think if you were to go back 10 years, that was a big question. And honestly, a big interest of mine is to get certified as an ambulatory surgery center. If you could get your clinic and then there are still some that do that and there were advantages which unfortunately now aren't playing out like they used to. Reimbursement used to be much better, obviously, it came with its own set of overhead, you had to staff it independently. You had to keep all your certifications up, you had to meet all state requirements and guidelines. What has happened over the last few years as that reimbursement has gone down, it's become less and less of a sort of a go-to mechanism to sort of make that surgery make sense financially.
JONES 8:28
In general, it sounds like you're pro-surgery, but with some limitations. Some cases, especially the ones that are more time consuming, would be best left in the hands of referring surgeons, which surgeries still belong within the purview of REI? Which ones are better to refer out?
RETZLOFF 8:46
So I think there are very few hysteroscopies, I think, that really should be referred out. I think really now the debate on the hysteroscopy is what you feel comfortable with doing in your office, going into, sort of operative hysteroscopy versus what you need to take over to the ambulatory surgery center. And I do think that to make it sort of a viable component of your practice, ideally, you do as much as you can in your office. Third-party payers obviously appreciate that and reimburse you better because they're not paying the exorbitant fees. So the ambulatory surgery center, and quite honestly, really removing that from the surgeons' fees to sort of offset their expenses. So hysteroscopy, specifically, I think really still remains in the purview of the REI. Laparoscopy, I still think that anything sort of ovarian-related, whether it's a cystectomy, any sort of ovarian reconstruction, tubal surgery, and even laparoscopic myomectomies or accessive-type procedures which are ablative techniques for fibroids also still remain within the REI purview.
JONES 9:52
So how does this help or hurt the practice model if we're going the ideal case and keeping those procedures that you feel do belong in the REI purview? How does that help or hurt a business model?
RETZLOFF 10:10
Mechanisms I think which actually help the business model, number one, referral basis. So you're referring OB/GYNs so you become known as the surgeon for XYZ procedures. Once your name gets tagged to those procedures, they know we have this particular procedure, they're coming to you. It begins to sort of snowball, right, into the well, the infertility patients and really all your referrals begin to roll in and I always actually, for example, with my myomectomies with my referring physicians, I always offer them, I schedule it with them even offer them the primary reimbursement if they want, and I'll kind of go through the case with them. From a referral perspective, I think it can really work in your favor. You've got to have a niche and you've got to be the best at what you do. I mean, you can't have three or four people, you want to become the best at it. And so, obviously, you've got to remain competent in that particular skill up to speed, and in fact, be on the cutting edge of the technology as that, hysteroscopy as an example especially, changes and you've really got to be on top of that. Second off, the other area benefit is from the patients. You know, I see patients that really they'll come in to see you for the office, you refer them out for a procedure and if you don't track them any other way, you often lose those patients, they don't end up coming back to you. Because surgical referrals are different than a primary referral back to a general OB/GYN where you can kind of maintain that back and forth. When you get to the subspecialty levels, you refer them out for surgery, they may end up somewhere else and not end up coming back to you. And patients like the fact that they're seeing one physician, they're also their surgeon, they're also their treating physician.
JONES 11:49
You're making a business case for it. I can at least imagine a business case against. How do you suppose private equity entering the field impacts this dynamic?
RETZLOFF 12:02
Gosh, you know, I hadn't thought too much about the private equity component, although that's becoming, you know, a bigger factor obviously, over the last couple of years. You know, if private equity, what I see--what oftentimes will happen is, for example, they'll get a group of general OB/GYNs and a group of sub-specialties, almost sort of recreating a multi-specialty practice, just maybe not like physically located in the same office, but they sort of recreate it in a region, let's say in South Central Texas, or wherever you may happen to be. And that sort of a model may actually sort of have, Okay, these are our surgeons, they do the surgery. These are our IVF doctors, they do our IVF. And so then they can maybe more compartmentalize, and if you're referring within the same sort of network, per se, you don't really lose those patients. I'm, I guess, referring more to the traditional practice makeup where you have an independent practice, who when you refer out, that all goes out and you really don't see any sort of benefit or impact in a positive way to your practice versus I think those private equity firms that do that will still sort of catch that profit.
JONES 13:17
The business case against, and I'm totally speculating, so if somebody does this and they belong to a PE partly-owned group, feel free to contact me and we'll have you on the show--I have no idea how little or much surgery PE groups are doing. But I could see a business case against being, well, IVF is the bread and butter, I want my physicians doing 400 retrievals a year, 500 retrievals a year, everything else can we refer out. Is that not a business case? To me, it seems like the reason why this is on your radar in the first place.
RETZLOFF 13:58
Right. I do think that could be a counter-argument. If you could develop a prime system with multifaceted, multi-specialty groups where, again, you compartmentalize and compartmentalize where your REs are primed on IVF, and they come in and they do 12-15 retrievals in a day, and you can get the volume, a consistent volume, and maintain that surgery within sort of that network, to me, that is an alternative model that potentially could benefit surgeries being taken away from the RE and put into the into some other specialty.
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JONES
You're in an IO here, but you've also probably spoken with your peers, so you might have some idea, but often what I hear when I see someone with a group that they've got five, seven docs that are in a hot, growing market, they've got 15% growth year over year. I know they're getting calls every week from PE firms and I ask them, Why not?! Everybody else is taking the golden parachute. And there's still so many--for as amazed as we are, how many people have in the last five years, I'm still amazed by how many haven't?
RETZLOFF 17:29
Yeah.
JONES 17:29
And I asked people, why not? And--
RETZLOFF 17:32
Sure.
JONES 17:33
And they say it's because I don't want someone else telling me how to practice, how to run my office, how to practice clinically. Is this one of the concerns that they have? I don't hear them talk about surgery specifically, but how much is this something that others want to hold on to?
RETZLOFF 17:52
I think if you were to poll--and again, I'm just speculating here--REIs across the board there, it would be more of a minority of them that would sort of miss giving up some of that surgical component and many would be perfectly happy just focusing in on IVF. And I don't think that's an unreasonable kind of aim or goal for them. I don't think though that that's a big component when it comes to evaluating the private equity firm offers and sort of looks at the buyouts. I don't think surgery, at least in my experience, mine of one here, of course, and others may have other experiences that really you get dictated on the surgical side of the house. I haven't seen that become a big factor.
JONES 18:39
I just don't buy the argument that economic interest can't dictate anything that a clinician does operationally. I've heard lots of people say that. I've heard other people say that it's not the case. And this is not Inside PE, it's not pro-PE I get accused of being pro-PE. I think there are times where it can be good. But I just look at what we do. We're a sales and marketing firm. And so if you're looking at the Venn diagram of the three biggest functions of the business sales and marketing, operations, finance, it is a Venn diagram, those rings do overlap. And that's just sales and marketing. There are things in operations we can see. Like, if I owned equity in some of our clients, I might be making suggestions that aren't suggestions, if they--
RETZLOFF 19:32
Absolutely.
JONES 19:33
And I think the common response sometimes is, Well, it's the office, it's the business. But even that Venn diagram overlaps with those rings, as well and just-- What we see oftentimes, we start working with a group, and we can get them pretty busy pretty fast with new patients. And then often there's a bottleneck. And so at that point, it's like do you want to make this bottleneck go more? Do you want to have more? Well, that touches operations. And you know, there's some things where it's like, Hey, you know, I know that you're not using an ultrasound tech, you might consider it so that you're popping in. I'm a consultant. So I don't own any equity. I just offer these as suggestions. But if I'm a Wall Street guy, and I own 30% of this joint, or if I own a controlling stake in this joint, and it's my money that I've got to make back and that might not be a suggestion. I don't know how you see that.
RETZLOFF 20:35
Yeah, I mean, I do think that it can sometimes almost be confusing when someone would say, Well, are you concerned that you will have the way you practice dictated to you? And I completely agree with you, there's no doubt that you look at a private equity firm, Wall Street, they're gonna look at return on the money and if they're going to break my time into chunks of an hour and what do I get on the return of an hour. And if I can get twice my return by doing IVF, and half the return by doing surgery, or whatever else you may put in there, whatever variable, you're going to be doing the one that gets the biggest return. Now, that way you practice--and I think some people I've heard when I have the discussion get confused is, well, they're going to tell you how to do IVF. No, and I think most of them will be right up front and say, We're not going to tell you how to do it. But they will tell you, You need to do it. I mean, you can talk, whether it's volume, but really truly, what is the return on your investment? And what is the return on your time when it comes to a physician because what are we providing? We're providing a service, that service may be a procedure, whether it's IVF, or that procedure, maybe in the operating room, what's the return on that procedure? And I do think they would look at that. And hey, at the bottom line, what's it going to be? It's not going to be me and you here on the screen. It's going to be a spreadsheet in front of you showing XY and Z and it's gonna be a breakdown and it can be pretty impactful.
JONES 22:06
And maybe it's more carrot than stick. Maybe it's, you know, here's a bonus, etc. But I just don't see how operations doesn't interface with sales, top-line revenue, which also doesn't interface with the business operations and office operations do overlap with clinical. It's something that we've--
RETZLOFF 22:27
Absolutely!
JONES 22:28
We've had people in the group, they're very adamant that--or on the show, very adamant, we don't ask people to do it. Anyone's welcome to come on in and give their perspective. I'm just sharing my vantage point. When we start to get past that bottleneck.
RETZLOFF 22:43
Yeah.
JONES 22:44
And we get to a lot more consulting on but it's really it's their-- Do you, client, want to do this? And if they say yes, we help them, but if it were your money, it wouldn't be you know--
RETZLOFF 22:59
Well, I mean, you bring up a great point, I think that there is no intent from either you or me to say there's some sort of adversarial when you look at the private equity firms and what they do because quite honestly, it does become about business operations. And those questions, those assessments need to be done whether there's a private equity firm or not. I mean, that's part of running a practice is your business operations, and what's the return on your money? No one stays in business, no one stays in practice losing money. I mean, that's just the bottom line. And so I think those decisions honestly, have to be made. Yes, how do you structure that model? But in the end, ultimately, that has to, as you said, that Venn diagram has to have the business operations, have to include clinical services provided, and everything no matter who's involved.
JONES 23:51
I love capitalism. I love what markets do. I love what confrontation does. I'm just sharing my perspective, anybody's welcome on to do that. You're seeing though that it would probably just be a minority of REIs that really want to hold on to some of that surgery. You talked about--you made the business case for it. You also talked about the patient interest for it, being in the best interest of care. There's a third dynamic isn't there? Because I've been with you, and I want to say it ASRM Baltimore 2015, we're hearing people talk about surgery. I don't know if I was with you at that time, or I was texting you because you and I previously talked about it, but I remember one of the REIs stood up and said, "Yeah, one of the things that I missed so badly is doing surgery. I love doing surgery and I tell residents as they're deciding which subspecialty to go into that if you love surgery, REI is no longer for you." And so you've got the business, you've got the patient's interests, but there's also, there's a particular passion that some physicians have for it isn't there?
RETZLOFF 25:10
There's no doubt about it. I mean, I think you have those who enjoy surgery, there are others that sort of do what they need to do because they have to. And I think that comes across--that applies to sort of any sort of component of medicine, the practice of medicine, but especially surgery. And those that do surgery are typically very passionate about it. They love it, they get excited by it. And each case for them is actually a bonus personally for them. Kind of remove ourselves from the business model for just a moment. And REI, kind of, would offer that opportunity before, like I mentioned before that five or 10 years ago where it began to transition away from surgery and more towards office-based practice. But yeah, there's no doubt there are those that remain passionate about it, whether they can continue to survive and do the surgery or not, honestly depends on your unique circumstances and in the business model and how well you are at reimbursement. I think you've got to know as a physician, you got to know your coding, you've got to help your billing people out. It doesn't matter what you did, it really matters how you communicate that to your billing people upfront and how they communicate that to the third party insurance because you can spend four or five hours on a case but if you can't properly bill for that, you'll never your ship will think.
JONES 26:36
We could spend four or five hours on that!
RETZLOFF 26:38
No doubt.
JONES 26:38
It's like the IRS, isn't It?
RETZLOFF 26:43
It is! It is. The CPT codes. I've actually--my CME--I've spent a couple years, actually, still trying to focus and learn it and it's like learning the IRS code. Every time I think I get it, they change it up on me.
JONES 27:01
If I want to buy a gift for one of my employees, it's like that would you know there's a small limit, most of it isn't tax-deductible, or it's like we could use it at the next team retreat.
RETZLOFF 27:18
Right!
JONES 27:21
You know, I just sent a video to one of our clients who refers us and I had like a D list celebrity saying thank you. And I was like, well, if that's a gift that's not tax-deductible, but if it's marketing and advertising, which because its referral it is, it's the same thing.
RETZLOFF 27:37
Right.
JONES 27:38
It falls within either realm, but the coding really matters. And we talked about the business side of this, but is this a sub-strand of that where not just like the, you know, how lucrative or is it surgery but is some of the headaches of this billing or how much does that deter or not?
RETZLOFF 28:06
I mean, a part of it is the headache of that is just directly related to the complexities of the billing, knowing how to describe what you did, knowing how to add supplemental codes or however they may apply. The other is just collections and you know, that applies really anything we do. It's sort of--I'll do that periodically, I'll go back six months, and I'll send seven procedures and say, What did we get for these seven procedures? Because quite honestly, every day you're just kind of doing procedures, and you assume you're getting paid for what you're doing, but in reality, it's amazing to see A, the variability that each insurance company may pay for a particular procedure and B, how long those payments get delayed out. And so you almost have to have one person staying on top of the collections and then those that get declined if they needed a pre-authorization and all that. So it really requires a pretty savvy billing person to be able to sort of massage it through so that you're actually getting paid for what you did.
JONES 29:06
Got any slick tips for people or any key codes you remember off the top of your head?
RETZLOFF 29:12
I mean, a 22 modifier for example if you're doing lysis of adhesions and I will dictate extensive lysis of adhesions, I spent 30 minutes, 45 minutes lysing adhesion, so you need to within your operative report dictate the time you spent doing it. And I will dictate as a procedure, as a separate procedure, I'll list out extensive lysis of adhesions, that's one and staging endometriosis is telling which ovary if it's on both ovaries. Sometimes you'll get paid for bilaterality other times, they'll say, well, you did it for one side, if you did it on the other, it doesn't matter because they're all incorporated. You have to know and be as smart as your front office, unfortunately, at how to bill and how to describe what you did and translate that into a billable return.
JONES 30:04
Is that true? I kind of want to hear more about that thought--the physician needs to be as smart as that billing office?
RETZLOFF 30:12
Well, you know, unless you have--so for example, in our front office, I'm always offering because they have, either through ACOG or ASRM at the annual meetings, they'll often have courses. In fact, almost every meeting, they'll have a course on billing, and I will either attend or will pay to have our front office attend. And, you know, I think sometimes for the front office, it's understanding, as the clinician, the surgeon going in there, you can kind of understand, you speak the language. You take someone from the front office and the admin person and if they don't have the experience or speak the language, for example, you know, salpingectomy, lysis of adhesions, synechiae, these are some of the words will use to describe specific scar tissue, etc. If you don't know how to sort of understand the language, then you really don't know how to translate that to actually a billable code.
JONES 31:13
I've been reading The Great Game of Business by Jack Stack for anyone wants to look it up--I'll have Katelynn put it in the show notes--The Great Game of Business by Jack Stack and talking about how departments can learn, what the others are doing to help each other, to see the bigger picture. Shadowing is a big part of their strategy. Does that ever happen? Does the physician ever say, Hey, like, put on your scrubs--I guess non-COVID times--but I just put on the scrubs, put on the mask, stand right there. I'm gonna show you what's going on and what I'm doing with the billing team. Could that work?
RETZLOFF 31:51
Yeah, that's interesting. In our office in particular, I offer that up to really anyone in the laboratory and even anyone I've offered it to my MAs, I can't say I've ever offered it to the upfront admin because I guess I think they're less than in a clinical realm and I haven't even really thought about it. But I think that's actually a really good idea. Because I think it's amazing what you can learn by a visualizing, that visual opportunity, and be just the discussion that goes on in the operating room so that they can see when I dictate something, when I explain something, they know then what I'm talking about. That's a great idea. And honestly, no, I haven't done that. But I think that's really a good idea.
JONES 32:31
I'm huge into the inter-department shadowing, you know, I've got what 10-12 people on my team, we still do it, because it's just useful. We're a remote company. So it helps them because you just say "Okay, you guys are going to do this on Zoom together," but I will sometimes--you know, if I just want to learn a little bit more about AdWords, for example, or whatever new automation we're doing, I will go into the platform myself and then I'll have Barret, our Senior Digital Strategist, tell me what to do. So I'll say, Oh, this is what you are doing. And I happen to do the same with our Director of Client Success, with our Project Manager, our Creative Director--I'm having them do that with each other for this reason that we're talking about. And I do see that because when I go to visit clients, I try to shadow every department I can for the day, and I'll be talking to someone and I'll be talking to the next person and they don't know that the other person does X. So, especially, if we want to hold on to surgery, it sounds like we really need to be smart about how we're coding that that is, if not everything, it's a big part. It could be the difference-maker and so that could help. So what's the future for surgery in REI?
RETZLOFF 33:54
I think the future--I still am, I guess, the eternal optimist in that regard. I'd like to think it's going to remain a big part of the minimally invasive procedures, especially as you know, the advent of less invasive techniques are available. Unfortunately, some of those become more expensive, as we know any other technology becomes more expensive. So that kind of brings us back again full circle back to the billing and reimbursement but I think we are in a position to really be the leaders in fertility-related surgery. I mean, I think, you know, as we move forward from here, I would emphasize the need to really stay on top of the new procedures, changes in procedures, and I could give you several examples, whether it's hystroscopically or laparoscopically, you know, things that we do differently. You can't do it the way you trained 10, 15, 20 years ago, because you're out of date, and it's being done differently and probably done better somewhere else. So, you know, I think I tried to--some of the things I try to do is I'm a senior mentor with several different devices. So I actually go out and teach those devices. And that helps me as both a teacher and a learner quite honestly, to stay on top of pay, not just what's happened in my own practice, but what's actually happening, get my finger on the pulse outside because that tunnel vision can really start to set in after a while. So I think those are some general terms of where I think the future of surgery--you're gonna see, you know, more outpatient surgery, more move towards the office. So I think that's basically I think, the future for us.
JONES 35:36
Let's stay in that mentor seat for your concluding thoughts because if there's 150 fellows, I bet you a third of them listen to this show at some point or another and they often email me for career advice or asked to be connected to some of the people who've been guests. What would you have them consider about surgery as the field progresses and they advance their careers?
RETZLOFF 36:04
Well, I do think that if you enjoy the--you have to enjoy both infertility IVF and surgery--there's still a role for surgery within REI. I suspect again, in residency, you're going to get sort of some of the more slanted towards Well, then you probably need to go more towards a minimally invasive or maybe even a GYN-oncology, urogynecology subspecialty to kind of really focus on surgery. So I think as we move forward, for those that are in training, I really would encourage them to get as much experience as you can. And I mean, across the board, whether you know, it's hysteroscopy, operative hysteroscopy not just diagnostic, but what are the different modalities when a case gets canceled, take that surgical set and break it down. You need to know the mechanics of the device better than the scrub tech who may be trying to put it together for you. Learn from those who are strong in surgery. You know, if you have minimally invasive surgeons or you have an REI who does a lot of laparoscopy, whether it's robotic laparoscopy, or more traditional laparoscopy, again, surgery is all about volume. Volume translates to confidence. Volume translates into better outcomes.
JONES 37:22
Dr. Matt Retzloff, thanks so much for championing surgery, for your thoughts on this, and coming on Inside Reproductive Health.
RETZLOFF 37:29
Thank you, Griffin, for the opportunity. I've enjoyed it.
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