Marjorie Dixon is the founder, CEO, and Medical Director of Anova Fertility and Reproductive Health in Toronto, Canada. After completing her training in the States and experiencing what the field was like in her home country of Canada, Dr. Dixon knew she wanted to start a new clinic that used the best technology, provided the best care, and increased access-to-care for the LGBTQI+ population, one that was close to her heart.
On this episode of Inside Reproductive Health, Griffin digs into why Dr. Dixon chose to start her clinic in Toronto and what she does to not only increase the availability of care to all populations, but what she does to make them feel welcome in her practice.
Learn more about Dr. Marjorie Dixon at anovafertility.com/dr-marjorie-dixon/ or find her on Twitter @DrMarjorieDixon.
To learn more about our Goal and Competitive Diagnostic, visit us 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 2:37
Dr. Dixon, Marjorie, welcome to Inside Reproductive Health.
DIXON 2:42
Thank you for having me.
JONES 2:43
You're based in Toronto--we've had a few Canadian REIs on the show before, possibly most, if not all, of them have also been from Toronto. You're the principal of a practice there called Anova. And I believe that was somewhere along the timeline of five years ago, if I'm in the right ballpark--one of the things I like to do on the show is to have founders talk about why they started their practice, that's a decision in and of itself, we have a lot of younger docs that listen. And can you talk to us a little bit about, even before the what of starting the practice, what led you to do it?
DIXON 3:26
So, I trained a little bit--though I'm Canadian--I trained a little bit in Canada and in the States. And when I came to the States, it was formal, ACOG-accredited training and the delivery of care and the what I felt like as much as the physicians’ accountability in the scientific knowledge and the technology that was involved in the care approach to care was, it felt like we were held to a higher standard. And then when I came back to Canada, to begin my practice, and now this, no want to say it out loud, because I'm gonna age myself, but it was 2004. And it just felt like I was stepping back in time or in paper charts. There was no use of antagonists at the time. And I remember that the way that I wanted to carry on practice, and I had done a really busy third party practice in the States because it was regulated by the FDA, and there was a clear approach and processes and procedures around it. And I felt like I was being handcuffed like I couldn't deliver the care that I was trained to do. And then also it was a thing of principle because in Canada, there was something called the assisted human reproduction act, and it was a bit complex and difficult to navigate and maybe a little nebulous, and physicians were leery to get involved in providing care to the LGBTQI+ of which I was a part. And out of a place of principle, I really felt like I wanted to make this difference and I wanted us to be the best and I wanted us to be held to a world-class standard and I didn't find a practice that I could practice in the provided that for patients. And so I don't know that I ever had the notion of Anova right off the ghetto like that off the hop. But it was to be the best and to provide care throughout the province and potentially Canada. But it was definitely from a place of, I want to provide everyone with access to care. And I don't want anyone to feel othered in their ability to access and build their family and grow their family--didn't want people to be seen as different.
JONES 5:21
You mentioned that you felt like you felt handcuffed in being able to provide the standard of care that you had been trained to deliver. Can you give some examples?
DIXON 5:32
Well, I just felt like there were standardized protocols, how I trained, we refer to the literature a lot and how we crafted protocols for patients, our approaches to patients as well. The LGBTQI+ community was seen though different as to be included. And it was a little daunting to me to come back to Canada where some of the older generation fertility providers were reluctant to allow me to practice and provide care to gay men. And they would say things to me like ‘Oh, well, I reserve the right to not deliver it.’ That's my guy voice, ‘I reserve the right to not deliver care if I don't feel comfortable to deliver care.’ And I'm like, well, that's discriminatory, actually. And everyone has a right to a family. And I want to be allowed to do this. And so I endeavor to create connections with legal teams, with lawyers who understood the act and what we could and could not do, and wanted to also create routes for patients to be able to get the care without feeling that they were othered or not welcome.
JONES 6:43
What do you speculate the reason, if you do speculate what the reasons are, or maybe you feel more strongly, but I could speculate one old school nurse being one of it to Canadian clinics tend to be even busier than us clinics in terms of new patients, at least partly because in most, if not every province, I believe that initial consult is paid for so it's not uncommon to see a clinic with several month waitlist. So I could see that being one thing said, Well, I'm so darn busy anyway, why worry about one more thing? The other is maybe legislation or fourth ancillary legislation, things like gestational carriers and donor egg. So of that whole hodgepodge, and perhaps others, what do you speculate the, or perhaps feel more strongly about the reasons for?
DIXON 7:31
I think it was just comfort and approach at the time and people really the physicians, in fairness that it was some of the acts and providing care to communities through gestational surrogacy and egg donation was quite punitive--it was covered in the Penal Code of Canada, right? So if you did any of the prohibited acts in the Assisted Human Reproduction Act, it was punishable by 10 years in prison or $500,000. Fine. So you know, I understand why the clinicians and clinics were there, initially, hesitant to get them involved, like there's a solution to every problem. And if you find the right legal team, and you have physicians who understand what you can and cannot do, and the provision of care, because you are providing care safely to gestational surrogates and egg donations--egg donors and intended parents and the unintended consequence of the nebulosity and the fearful environment that physicians lived in, was that the patients were given barriers to access care. And I don't think it was an intentional thing. It was an unintended consequence, but there were few physicians that were willing to stick their necks out and say, You know what, this is not right. We're trained to provide care to all and we have to find a way to create mechanisms for our patients to get safe care. And that was what I think was probably the biggest barrier for patients--it was fear. It was an environment that was uncertain. And you needed people to say, Okay, let's create a path that is conformed to the regulations, but that protects both the intended parents and the gestational surrogates and the voters.
JONES 9:12
From the regulatory standpoint, how much has it changed or not changed in the last decade?
DIXON 9:19
Okay, interesting things. Because I will one or two things one has been look for, for the LGBTQ community has come a long way in 10 years. I know that because I see some of my young staff, nurses people at all levels of the business, who are so open and who just see it as normal, which it is, however, I grew up in a very heteronormative place, right? So 20 years ago, when I started, it was seen as very different. I mean, even when I was having my family through donations, donation through donor sperm, actually, I grew my family through donor. And at the time, it was novel ish, starting to change in the late 90s, beginning of 2015 year-old IVF, baby. And then you need segue to now, where people are openly talking about their experiences of sexual identity orientation. It was so different back then that it was important for me to include it in the mission statement of ANOVA. That, you know, all are welcome that it's inclusive in the provision of care, regardless of your sexual orientation, or gender identity, socioeconomic status, geography, but ethnic background, like I wanted access to care for all because it was the right thing to do. And there were so many barriers, either visible or biases that existed. You said, Wait, and now, most clinics have some kind of program for the LGBTQI+ community. But I recognize that some of these places that are very open now were the same places that I wasn't allowed to do that stuff. Right. And much as you know, I may look young, yes, I'm older. And so the younger crowd were like, hasn't it always been this way? I'm like, actually, no, there has been a tremendous change. And still, though, there's work to be done. Because much as when you look around and we talk about AI, you're doing fertility awareness, the Canada us, we talk about one and you know, when life couples 15% of the population is infertile, but you know, the LGBTQI+ communities not infertile, they're an obligate needs of eggs, and sperm and gestational surrogate. And so, though, it's come a long way, there's still things that need to change, and we can grow and evolve and learn new things, even just how we present intake forms, and literature, and how we present ourselves on our websites. And how we speak which pronouns we use and asking patients in our clients how they prefer to be addressed. Like, all of these things, are very different from the standard heteronormative place that I came from, that I grew up in. And they make a significant difference to a patient's experience in the clinic. And, and we see patients internationally who come from jurisdictions where they're persecuted for sexual orientation. We see patients locally who have been even in local clinics and felt like they weren't accommodated or felt extremely othered in their experience, as they passed through from intake to care in the Fertility Center. And you know, though we're not perfect, we are very cognizant of it. And we are conscious of the need to improve in our interactions with our patients.
JONES 12:44
I smiled at your comment about some of the places now that have at least become serving the community. We're not the ones doing that 20 years ago, and I smile, because I'm not just talking about the principle of LGBTQI community, I'm talking about more of the principle of when you see society is going a different direction, you better know where it's going, and where you stand it where it will be 20 years from now. And I'm not saying that we can, we can predict everything. And I'm not saying that someone should go with, with society and everything. But I'm saying you should know where it goes. Because you're going to have to, you're going to have to either say, Okay, I'm going along, or I've got some other reason for it. And I see places all the time that are just playing catch up. That is Oh, oh, this is cool now or Oh, we're allowed to do this now. Yeah, we've always been down. Now. Yeah, no, yeah.
DIXON 13:42
Sometimes I you know, I guess as I get older, I feel more open to talk about it. But mainly because I recommend that I have a voice and another has a voice. And we have an ability to change the fertility landscape in Canada, for our inclusivity and for providing means of access to care and for the provision of the best care and technology and an amalgam of a universally covered environment and a private paid environment. So, you know, we recognize what we needed yesterday is not what we need today is not what we'll need tomorrow. we evolve and we change and we push ourselves complacency makes all of us crazy, that are driven by a crazy person, but complacency is not us. And society does evolve. And you have to have passion for what you do and passion for your patients because otherwise, how will you connect with all the people who aren't accessing care now? There are other people probably who aren't we?
JONES 14:37
Society is has evolved, how has the legislation kept up or not kept up in Ontario in Canada?
DIXON 14:46
Yes. So there the Health Canada has just changed regulations. The fact of may 4 2020, where you know it is now the process is much clearer. So Remember before I said 2003, this is human reproduction act very nebulous, people weren't sure how to navigate it or if they were safe to provide care in it. Now, there are clear guidelines actually modeled very closely to the FDA regulations in the US. So it is much more stringent in the approach and processes and checks and balances around the valuation and medical assessment of egg donors and gestational surrogates. And really, though onerous, the purpose of it is to protect patients from potential infectious disease transmission, because at the end of the day, we're physicians first, and we need to be sure that the care that we're providing is safe. And so having these additional checks and balances can give both the intended parents the peace of mind that the diligence has been done in the assessment of the donors and the gestational surrogates and sperm donors that they're involved with, as well as those who are providing gametes and uteruses to carry these gestations to know that the importance of what is their ongoing commitment, and then also how that medically we have to ensure that we are being diligent and clear and thorough in the approach, everybody's kept safe.
JONES 16:13
So you see this contrast in the status quo versus the vision of what you see for inclusion, that part of the genesis for Anova, then how does it start to come actually into action into fruition? Like, how did you see the need? Yeah, then how does it? How does it start to manifest itself?
DIXON 16:35
So interesting, you should ask that because we did start off by just having all of our patients into the general patient pool, and then we were managing our egg donors and gestational surrogates. Now, we have a dedicated team that does just this, because we recognized that in order to get our patients to care and to coordinate with the agencies and the lawyers and the social workers that are involved in the counseling and the physicians and managing the medical assessments, that it required some orchestration, so that we can implement the processes in a consistent way and get our patients to care in a consistent and efficient way. Because, you know, some of the rate limiting steps are the availability of gestation circuits, or the availability of a donors that match your ethnic background, or that you would care to select for growth of your family. So we wanted to create a process that wouldn't impede the moving forward in an efficient way, because this is a bit of a fancy party plan, right? Like, you have to make sure that you have a dedicated approach, that you have your checks and your balances, and that you do it in a way that's efficacious and as efficient as possible. And that is also an evolution. So now that we have this dedicated team, we meet twice weekly, we discuss our patients, we have obligate checkpoints out with patients. And it's been a passion project, you have to love doing stuff. It's a lot of work, right. And, for us, there's nothing more beautiful than seeing families come together that otherwise wouldn't be through the miracle of science.
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JONES
You have this data you have a dedicated team and process and how does that become fluid with the rest of the practice? So you are your tree Patients who are LGBTQI+, who in and of themselves are not a monolith. And then you have other segments of the population dealing with infertility. How does? How does it all become one ANOVA?
DIXON 20:14
I think the beauty of ANOVA is that we recognize that if you don't see yourself, then you won't want to be part of something, right. And so, I have been blessed with a fabulous team. And operators who recognize how to do the how to get people to care in a way that brings them through what we have is our general population. But that also has special attention to the details and needs of the community. So when we are presenting ourselves and we're talking about infertility, we make sure that we have gay couples represented transgender individuals represented in our literature, in our social media, on our website, and all our digital media on sometimes our print media, because people need to see themselves and feel included. And that's what I think the team has done really well. And also, they throw me everywhere to talk about how, what our approaches, and why it's so important for us to carefully consider everyone's experience from start to finish. So it's really having careful considerations from the referral minute, all the way through to the assessment to the provision of care to the going home pregnant, everyone is considered especially through operations, through our growth through nursing teams through our embryology team, everybody is aware of where someone fits into the puzzle of ANOVA. And there's a process and a specific path for that.
JONES 21:46
How did you build your initial team?
DIXON 21:48
With care. It started with recognizing that, again, I've said it before, what we needed yesterday was not what we needed today, it's not what we need for the future. It was also recognizing that it's more important to find the right person for the job than to try to make a job for the person, when you recognize what you need to leverage for growth. And so you know, having great HR team, having people who are experienced in the industry, having a lot of really loyal core team leads within the business has been really critical to the culture and to creating ambassadors for ANOVA, who are providing the care on the front lines, because you know, there's culture to all this right, what you will experience what patients experience going into one fertility clinic might not be what they experienced going to another, right. And so for us, it was very important to find people who would be part of the executive committee who would be ambassadors for the business, in both the amalgam of the vision, but also the business. And that's tricky. headhunters, HR, careful interviews, specking people for also, everyone wants to be the best.
JONES 23:14
Did you have a couple of Jerry Maguire, half baked people, the scenes in each of those movies? Who's coming with me, man? Did you have a couple of those from your network of Hey, this is what I'm trying to do. Who's coming with me? Have any of those folks,
DIXON 23:32
I guess, I don't know. We have figured out how to work really hard. But to love what we do, and to celebrate the wins and to use the losses because we don't win all the time, but to learn from what we don't do as well and to really, honestly, diligently and forthrightly strive to improve. And I have to say, there are some people who said like he had me at hello, right? In France again. But I'm like, people can tell if you're genuine. People can also tell if you're really dedicated. And if you're not just paying lip service, and actions really speak louder than words, though I have a lot of words and we had to Nova do speak a lot. I have some great communicators all over but and we are constantly innovating and working to improve our processes to improve our medicine, to continuing medical education for all of the staff that's involved onboarding training like all of these things that that we're doing to try to make ourselves the best place for anyone wanting to grow their family.
JONES 24:46
Your ‘you had me at hello’ point really sticks out to me because to the extent that someone can paint the vision, that's what allows people to take a bigger leap and follow you it's very hard to follow someone if the vision isn't clear, and if it's not compelling, and otherwise, you're just getting people who are looking for a job. And then maybe you can, you know, maybe you're leveraging something else, like personal reputation or or their possibility of professional development. But I think back to our first employees, some of whom are with us now, my creative manager, my project managers, like, why would they have done what they both left jobs, they had jobs, and they left them, right, they were happy with that they left and I was at least able to articulate some sort of vision, you've just articulated one that's very compelling, that's easy to recognize if that's important to you, it's easy to say yes, that's something that I want to be a part of. And I do think it's a challenge, especially for a lot of centers that have been around since, you know, let's call it the mid 90s. But I wrote a few articles a few years ago about that, I think, a lot of practices have inherited the model of the general practice from the mid 20th century. And that just often isn't enough for millennial employees for Gen Z employees who need something more, right?
DIXON 26:05
1,000,000%. And, and for us, I mean, like, honestly, people believe in the vision, I think that that's how we've got some really great people. And then there, I recognize how blessed we have been to have people who have left other jobs, and been willing to roll up sleeves and really get in there to get to where we need to get, I acknowledge the effort. Maybe sometimes I don't say it out loud enough. But I really feel tremendous gratitude to the great people that surround a nova, to make us look great. And for us to be able to provide the care that we provide in the way that we provide to our patients.
JONES 26:49
How good are you personally at celebrating wins with your team? Not how good is your team or your managers but you personally How good are you at celebrating?
DIXON 26:59
I think I'm a celebrated friend, I love the celebration, I do try to bring the fun and the recognition to the forefront, we have a newsletters and Friday days where we highlight something good or someone has said something positive or you know, through even our social media, right, so so you have to meet people where they live in their community where they are and now people communicate and access carrying information through the internet that that just made me my opponent, the internet, through the internet. And then also, you know, social media posts and websites and, and I have crews that take the little the positive things that we have, and we post them and we share them and we share them with one another and we celebrate each other in our wins. And then we have moments, a lot of moments of fun. And that is something that I think is critical. We created dashboards for showing people you know how many cycles we're doing, how many pregnancies we're having, those are the things that people can hang their hats on. That's real. Right? And that I think is so critical to keeping a busy clinic's morale up and you know, COVID hashtag crazy 2020 has provided yet another layer of oh my goodness, this is overwhelming and we're busy, we're trying to be safe. And we're, you know, wrapped ourselves in a body condom. And we're supposed to not be within this much distance that we can't touch and we can't like we're providing care as care providers through a computer. But a lot of the time, and that is even made that the celebrations of what we do well less, because we can't see touch feel each other that much. We do have some meetings. We have Google meets, we have we've had virtual, you know, not cocktail hour but we have virtual game time, those kinds of things, but it's just not the thing. We need seen we need to feel better. We need to be able to see touch, feel squeeze each other and you know, high fived one another we've done a good job that's it's a little hard right now
JONES 29:08
That concept of celebrating the wins is something that I've really had to learn and work out because my natural inclination is like you're only as good as your last at bat got to get it gotta move gotta keep on moving. And so I think it's really important for principals to take that like this is important to the team. They worked hard. We landed that account, we had a really successful campaign that ended up getting people pregnant, I need to communicate that and that's a lesson that I still need to work on. I think every business owner could write a book about the lessons they've learned in starting their business. What are some of the ones that stand out to you?
DIXON 29:47
Lessons that I've learned the idea or ideal of a providing for patients who otherwise may not be welcome or have Access to Care brings people along with you even through the toughest times. Because it's the right thing to do. People love to have a mission, people love to have a good reason to wake up every day. Right? Like I think about it five years ago, on the sixth floor of 25, Shepherd babies weren't growing in incubators as we sit live breeds do what we do. Now. 1000s of babies, right, and science is miraculous, like just really taking a step back and recognizing what it is that we do. That has been something that I just move, go all the time I'm hyperactive tangential people crazy. What has helped me is one recognizing what we do as fabulous and remembering to remind each other that we're doing really cool, crazy stuff every day, because that drives people. And then the other part is Focus, focus, focus, focus, because, you know, CEOs of tangential people, great ideas all over the place. But not every great idea needs to be chased, right. And the ability for focus on what you need for your patients, as medical director, and what you need for your business. As a CEO, the focus is the biggest discipline that I have learned.
JONES 31:28
I concur with that. That's why I chose one category was just working fertility. We don't even work with other OB/GYN because yeah, at least this way, if my business ADHD fires off in a couple different directions, at least I'm confined within one framework. You talked about the physical, the physical location in your office, how did you choose that? And for our listeners, you're in North York, 25 years ago, that was a suburb but now Toronto has grown so much it's been amalgamated into the city. It's within the city of Toronto now considered a borough but it's not it's not downtown. How did you choose that location, how'd you choose? Like how you built it out?
DIXON 32:09
The choice of location was strategic, partly was because there were no full service fertility centers in that region. So that was one. Number two, I really felt the need to serve my LGBTQI+ community. And I felt outraged. There were jurisdictions in the world were having babies was illegal for gay men. And I'm like, okay, so we got to be near an airport. So if they want to come to us for care, they can fly in. And so it's off the 401, which makes it 10 minutes from the airport. And then there is a significant segment of the population that doesn't love traveling downtown, like traveling downtown gets more and more difficult. And it's stressful enough to be on your fertility journey. And I just felt like it needed to be in a place where it was easy to get to that it was easy to park around. So that was convenient. And then the other thing was, scientifically, it was air quality studies, looked at a bunch of different buildings, brought in the best experts from actually around the world to vet the location before I selected, I think probably that's might be one of the first times I've ever said that. But yeah, so so much as I knew kind of the general area, it was important for convenience the airport be on a subway because we're on the subway system, it was important for parking for there to be under the building around the building, easy, easy to do and affordable. And it was important for it to be the right place to grow babies, because we know that not every IVF center is created equal. And some places the ability to grow embryos and make genetically normal blastocyst is less than in other groups. And we know that but some people don't. And so it was important for Look, when you're coming up and you're going to grow a business and you're going to make state that you're going to revolutionize your industry, you better be clear that you're going to create a contract path to success.
JONES 34:11
That point about the difficulty of commuting in a lot of larger cities I do think is a challenge. I do hope that a lot of this aspect of telemedicine is here to stay. I think of the last cfas that was in Toronto. I was driving back to Buffalo and it took me an hour to get from Bloor and Bathurst to the gardener and for those that have no idea what that means. It's about a mile or so. frickin hour and I do so I do see that as a big issue for access to care and considering locations and hopefully the future of telemedicine is being here to say, Marjorie, what do you see as being the future for serving the LGBTQI+ community? What are the things that we're seeing? Still moving in that direction that we still need to move further towards?
DIXON 35:03
Yeah, I think that having more visibility in what we provide, as are on our Instagram, Twitter, social media, websites, literature, even intake forms, in our clinics, images of gay lesbian couples, single men death. transgender individuals growing their families singly or in couples, like different ethnicities, we have to have representation, visual representation, even some of the digital media that we're doing, educationally because patients aren't necessarily now coming and sitting in front of you, for you to explain how things happen. So creating some of that representative of all of the populations is I think, where we will be headed, much less physicians explaining everything but having digital media created that can be used and reused and accessed to advance care that way. And I think it's so important for people to see themselves as normal in receiving care, as opposed to do you guys do this? Right. And I think that that's going to be the very specific change in recognizing how digital media and the power of digital media and being very mindful in the creation of it as much as who is the subject.
JONES 36:34
Most of our audience is your colleagues, it's fertility doctors and some practice owners and practice managers and other executives in the field, but it's mostly practice owners and mostly physicians, how would you want to conclude with to them about the needs of the LGBTQI+ community in our field, but also, maybe access to care large however you want to conclude?
DIXON 36:58
I so believe that the universe needs us to collaborate. And, and I have had a lot of experience doing this, even in providing stimulation protocols in Canada in the US for transgender individuals who are actually undergoing egg retrievals to provide gametes for their partners through reciprocal IVF. So people access me all the time, and I'm happy to share. And I think that instead of seeing each other necessarily as competition, to unify ourselves so that we can be great in the provision of care universally. That's what I see. I would love us to see being able to work together and amplify one another must be multipliers of one another for the better the community. Take ego out of the equation.
JONES 37:47
Dr. Marjorie Dixon, thank you for taking time to come on Inside Reproductive Health.
DIXON 37:51
It's been a pleasure. Thanks for having me.
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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.