Dr. Eric Forman currently serves as the Medical and Lab Director at Columbia University in New York City. After his fellowship and early years as an REI in a private practice, Dr. Forman took an opportunity to join one of the most well-known academic REI divisions in the country.
On this episode of Inside Reproductive Health, Griffin and Dr. Forman take a look at both the private practice and the academic REI division models, dissecting the pros and cons of each. From restrictions on care to cumbersome processes, Dr. Forman corrects some preconceived notions and offers his advice to new fellows searching for the right career path for them.
Learn more about Dr. Eric Forman by visiting https://www.columbiaobgyn.org/profile/eric-j-forman-md or find him on Twitter @EricFormanMD.
Mentioned in this episode:
59 - Michael Alper
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 2:20
Dr. Forman, Eric, welcome to Inside Reproductive Health.
FORMAN 2:25
Thanks for having me. I really enjoy your shows and your work and I'm happy to participate.
JONES 2:31
I wanted to have you on the show because for being a very soft spoken guy, you're also a very popular guy. And I've always just found you interesting because you appear in a number of different places, I think you're part of one of the advisory boards or maybe the Scientific Committee for MRSI. Is that right?
FORMAN 2:50
Yeah, I'm on the Executive Board for MRSI, which is a great meeting that's also done a great job of transitioning in this era of COVID to have a virtual meeting last year, and we're having several virtual meetings throughout the year. So it's a good venue for people who are listening that haven't participated previously.
JONES 3:10
That's where we met in person. And I've seen you on a few different committees, a few different subgroups and you have an interesting career where you worked in private practice, you built a name for yourself, now you're at Columbia in Manhattan. And so I wanted to start with--and that's what we're going to explore during the show is the difference in potential career paths for people in both of those avenues, how they're changed what, what's on the landscape for them, but how did you make your first decision coming out of fellowship? Why did you choose private practice to start?
FORMAN 3:45
Well, I think part of it goes back to even my training and part of why, you know me, and I've met so many people, as you say, they think that I was fortunate to have an amazing training experience with Richard Scott, who's my mentor and a real leader in this field. And I had an opportunity to go to meetings like MRSI from my first year of fellowship, and there was really no limit to meetings and presenting research and I took as many opportunities as I could to meet people and hear about what they were doing. Even from the time I was interviewing for fellowship, even when I kind of had an idea of where I thought I was going to go, I loved the interviews and just learning about different places and different people and even the other fellow applicants, I'm still, you know, friendly and collaborate with many of them like more than 10 years later now. So I landed in fellowship at Reproductive Medicine Associates of New Jersey, through, at that time, UMDNJ Robert Wood Johnson medical school, which became Rutgers Robert Wood Johnson Medical School, now they're affiliated with Thomas Jefferson, but, but the vast majority of the fellowship was that at RMA and I chose that service because it really was a unique paradigm at that point that focused a lot on the embryology lab, and giving fellows real clinical hands-on experience that could potentially set one up to become even a high complexity clinical laboratory director, which came later. So I was really excited about this new fellowship, this new way of training reproductive endocrinologists, because I knew that in vitro fertilization was a huge part of what we do clinically, even though a lot of the fellowship time is spent learning other important things and doing research projects that may be less, sometimes, directly but sometimes not so directly related to IVF. Still, the vast majority of reproductive endocrinologists spend a lot of our time with activity related to IVF, related to the lab, and really being intimately involved with what goes on there, I thought was critical. So I had a great experience. And then I had an opportunity to stay on. And I didn't really even--I mean, I have maybe in retrospect, I should have--I didn't really apply or interview anywhere else. It was--everything was great and I didn't have to move and I knew everyone I knew the nurses and knew the embryologist they knew, you know, I threw my fellowship rotated everywhere. So, it was really easy to transition into an attending because that's one of the biggest transitions. I think, for reproductive endocrinologists, we have all these, you know, transition, graduating college and medical school, residency, fellowship, and then as an attending, now you have to take all of that and, you know, kind of, you're never on your own completely, but seeing your own patients and, and integrating what you've learned through all those years to take the best care of your patient, but also now with a new group of people who maybe do things differently. So it was a pretty seamless transition, because I knew how the system worked and that was great and I used that time to stay involved with the lab and I was able to become an HCLD lab director. So that really, I think, summarizes how I ended up staying in private practice and made him think about it so much as private practice, more this was a very busy clinical practice that's very academically-oriented and did research and fit with my goals, really.
JONES 7:21
Yeah, the division isn't always so stark, there's often a Venn diagram. We've had Michael Alper on the show to talk about Boston IVF relationship with Harvard and Brigham and Women's and so you are in fellowship in conjunction with a private practice, what you talked about, one advantage being that you had a seamless transition when you chose to stay with that group. But what are some advantages and disadvantages, if there are, of having that type of relationship where there's--because sometimes there's just the university in the health system, sometimes there's exclusively private practice--what is the benefit of a relationship, like where you started or disadvantage, if there is one?
FORMAN 8:10
One of the advantages of a private group is that you can be more autonomous with decisions, like even things as simple as where you buy supplies, or where you buy furniture even. When you're part of a bigger institution, often there's preferred vendors that you have to go through. Although that's not always set in stone, again, you can make a case for why something is important and benefits the division. And, again, we've been successful at changing things here and doing things that we think benefit our division, but it's a kind of a different path, maybe.
JONES 8:51
So you've been at Columbia for a few years now and you are in a more senior role. If someone from the University of the administration comes to you and says, ‘Well, Eric, we've got the opportunity to merge in our program with a private group.’ How do you advise them on that?
FORMAN 9:14
That's a good question. I mean I think it would be I'd want to know, like, what is the advantage? What are we gaining from such a merger? Is there something that we are not able to do right now that we would be able to do that--there has to be some benefit to us, to our division, to our staff and our patients, and the department or the medical center for them to do it. So, you know, if it maybe expanded our reach beyond, you know, where our current footprint is, and we could take some of our approaches and spread that beyond, I mean, that might be a reason, but I think as you said before, some of these lines, they're sort of hazy. And I don't necessarily--I'm not sure that there are so many things that a private practice can do per se that, that we can't do. You know, and I think we've tried to sort of merge the best of both worlds that--I think a common perception is maybe more than private practice focuses more on the patient experience and outcomes and quality, whereas academics focuses more on research and education, and things like that. And I don't think that dichotomy is necessarily so clear, like I said, I had great research and training at a more private hybrid kind of practice. And I think we've done some things and continue to try to make the patient experience as good as it possibly can be. And, you know, from day one that I came here, never had the attitude that an academic practice--so that means that we don't have to provide as great or better service to patients as any private practice. I mean, I think that perception is out there that it's like a big, a big hospital, a big Medical Center, and you can never get through to someone, or you don't know who your doctor is, or they're doing research. But it doesn't have to be that way. I think we can provide the best care that patients expect and be competitive, you know, from a clinical standpoint with any practice. Similarly, I think private practices if they have the right focus can educate, and they do and train fellows and residents and medical students and do amazing research. So I think, I don't think it has, you know, I don't think that's clearly defined. So my advice would probably be again, why do we need to do this? Is there something that we're gaining?
JONES 11:58
It sounds like you would need to be convinced of the benefit. It doesn't sound like you readily see the benefit?
FORMAN 12:04
I think, yeah, I think that's fair to say. I mean, I think we're, you know, we definitely have always room to improve. But, I think we're trying to do that from within and looking at ourselves, looking at our practice, continually evolving and improving. And I would need to hear you know, why some outside entity is necessary or is going to make that better.
JONES 12:29
So you felt that--just speaking in broad strokes who talking about that it's often the case where private practices have more autonomy and academic institutions have less in making this decision where you're at right now, you don't feel that way. From day one, you feel that you've been able to implement changes or at least implement, at least give your input? And you said, it doesn't have to be that way. How have you been able to--what changes have you been able to bring to bear or improvements because I think people often do think of academic practice as being a lot more rigid. And I can tell you from experience that I've had enough experience that validates that, but I don't think it has to be an axiomatic truth and do you might be able to shine a light as an exception. What have some of those been?
FORMAN 13:26
Well, I think I mean, part of why I chose to move I was doing well, like you said, and I was, I think, taking excellent care of a lot of patients and had a very good center and involved in research and go into meetings and leading, you know, or helping to organize meetings. So I was happy where I was, but this was a great opportunity, like you said, to have more of a leadership role, which I think, you know, a lot of--I thought was important, but also to, to improve and shape things. And it's not just me, single handedly at all, there's a whole team of us who have really made a lot of changes. Zev Williams, who's a division director and recruited me, Colin Thomas, I know, you know, as our COO, administrator, and our whole team has had this vision of we have to improve, we have to improve our center, we have to improve the patient experience, and not stop and keep improving. So I knew coming in that, that there was going through, they were receptive to change, I mean, so that may be different than some other situations where someone takes a new position and, you know, things are running smoothly and going a certain way and maybe more difficult to make broad changes. But from the beginning, we knew that we had to change our physical space, and we built out a new clinical space, a new IVF lab. We had--we changed the culture. Just how we organize our teams with more clearly defined teams that patients know who their doctor is, who their nurse is, who their financial coordinator is. We try to be available. Patients want to hear and have access to their doctor. So, you know, being even willing to give out email addresses and communicate directly with patients, I think our patients, you know, and nowadays, are not so accepting of hearing like that they have to wait a few weeks to talk to their doctor if they have a question, they want more direct access. So, we changed, again, a lot of these things, then, from the clinical standpoint, we, as a group, reviewed our protocol, the way we do things, medically, the way we treat patients, our lab protocols and tried to merge and come up with best practices that we all agreed on, some of which things I had seen at a successful place, some of which was already established and doing well here, some that had been in their experience. But I think in order for that to work, we needed buy-in from our doctors, from our nurses, from our management, from the university, that that change was needed, and that we could make changes, and then we can evaluate how that was doing and make more changes. And so that's kind of the, you know, in big brushstroke, like you said, it's like the model that we've taken. And that's been in the beginning, it was pretty daunting because it's a lot easier to work at a place where things function pretty smoothly, and you know how things work. Like I said, I knew everyone to come into a place where I almost didn't know anyone, and then have to really reorganize, but if you can get that buy-in, you know, and everyone on board, and everyone has input, it really can work really well. And that's been a very rewarding experience and definitely would, I would do it over again, if I had to go back in time.
JONES 17:13
Talk about how to get the buy-in. And I'm not necessarily suggesting this example. But I'm just giving you one example of someone that I knew that worked in academic REI practice that was very successful on social media, believed it to be a very useful tool in building rapport with their patients, and not just recruiting patients, but educating them, building rapport with them, and it was very useful. And the university said, ‘You can't have any social media content that's affiliated with your work here in any way, even if it's on your personal channel.’ And I think of just one example like that. But let's say if you wanted to invest in patient experience training, or you wanted to create new resources for patients, or many clinics don't even have their own website, they're just buried on a backlink of a backlink of the university site and they can't even get a Google My Business listing. Talk about--how would you advise someone on getting buy-in for those changes that they want to see? And those are just a couple examples, but the examples that you gave are also valid.
FORMAN 18:25
Yeah, I mean, so that buy-in seems to like more high level. And I think, you know, I mentioned before our leadership team like Colin and Zev, I think, have done a really good job at advocating for what we need. I think that, you know, fertility and reproductive medicine, fertility clinics, you know, were trying to practice in a field that's very competitive, especially in New York City. There's a lot of options. And so, you know, that's a choice, do they want to have a really well-rounded department with a great reproductive endocrinology division, that the heart of that is IVF and an IVF lab? And if they do, like, don't compare us necessarily to other departments, or divisions that maybe function in a different way, but we have to look at like, what is our competition doing? And what kind of websites do they have? What kind of patient services do they have? Do they have a presence on social media? So I think that getting that kind of buy in, this is what we need to do to thrive in this space. And just, again, to some extent, you have to make a strong case and be persistent and hope that you have receptive leadership, which we did, because they were committed to improving this division and we saw that. That's why I came here. And I think that my level, I'm the Medical Director, and I'm the Lab Director. My focus is more on getting the staff, you know, the doctors, the nurses, the embryologists to buy into what we wanted to do. And, you know, that I think comes from experience and integrity and like leading by example, I like to think of it. And also honestly, like a little bit of luck, too. I don't want to credit luck, but there's some anecdotes, I remember, just like when I first came here where they didn't, you know, maybe they did things a certain way. And I knew we could do things a different way because I've seen it and done so much in my previous experience and went out on a limb, rather than, again on the one hand, you could go with the flow and say, you know, I'm here now, and this is the way they do it, or you could say, you know, I know that that's the way it's been done, and it can work that way. But we can also do things a different way. And then actually do that and get a good result and then use that as an example to kind of get people to buy in. I mean, so first, I think you have to convince--people have to believe in you, that you're competent, and you know what you're doing. And that goes from, like procedures, and, you know, other doctors being like that, you know what you're talking about, you know what you're doing. And so like, I mean, I couldn't have come in here, I don't think like straight out of fellowship, even though I had a great training and experience, I don't think I would have been confident enough to go in to meetings with other doctors who had more experience than me in terms of years, and get them to buy into changing our protocols, changing our way of doing things, or getting the lab to--the embryologist to buy into changing some of the things that they were doing. But after four years, which isn't that long, but four busy years managing lots of cycles, doing lots of procedures, working closely with the lab, that gave me, I think, more confidence that I could come in and say like, let's do it this way. And, and even if it didn't work, because again, maybe I got lucky that a lot of things I did, you know, worked out well and we got some good outcomes and I think that helped. But even if it didn't, I think I would have had the confidence to stick with it. And the next time it would have worked. But you know, I wouldn't have given up so easily.
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JONES 24:48
You mentioned our mutual friend Colin Thomas, who's the Administrator and Dr. Williams, who's the Division Chief. And of course when anyone goes anywhere, well presumably they're doing some sort of feeling it out to see what it would be like to work with those people, but was their ability because you talked about their ability to work with the leadership and the administration of the university? Was that specific tenant, my administrator and my division chief's ability to work with the university was that on your radar at all when you were interviewing them.
FORMAN 25:23
A little bit. I mean, again, I think I just--I wanted--I definitely wanted to go to a place that one, was open to change and wants it to get better. And, you know, from our chair there, Dr. Mary D’Alton, who's a very well known and well-respected chair in Maternal Fetal Medicine, and she was very supportive and still is of our mission to continually improve and provide the best fertility treatment, care, and experience for our patients. So I mean, it was definitely, you know, a fact that I wanted to be able to work with the other leader, manager, management team, and feel like we had the support that we needed.
JONES 26:09
There's a lot of REI fellows that listen to this podcast. So I want to try to give them some actionable career advice. And I'm going to ask you your’s. One piece that I thought of was that if this is a concern that people have, and I know that it is sometimes a concern of how rigid will this system be? Will I be allowed to bring my input? I think it's a good question for the division chief for whom someone is interviewing to say, ‘Tell me about a time where you had to persuade the administration of something, and that you had to implement something that previously had not been implemented?’ I think that's a good--that's one good question for people to be able to ask to kind of get an idea of one, how much your division chief wants to implement some change with, two, how it might or may not be possible, depending on how deeply they sigh when they respond. But for you having been in both types of practice groups, what personalities or maybe not personalities, but perhaps what type of profiles do you feel do better within each?
FORMAN 27:15
Before I get to that, I mean, I want to also mention, just like--if it’s okay if we get sidetracked for a second--you know, how these lines are kind of blurred. Also, I think private practices that can be rigid and are large and in some ways bureaucratic, too.
JONES 27:34
Even the ones that aren't--even the ones that aren't large, and aren't necessarily bureaucratic, can be every bit as rigid.
FORMAN 27:40
There are places where, you know, there are things that they do, and you might think we could do things differently, but that's the way it is and it could be very difficult to change. And that could be private practice, or academic, I think that more just reflects the culture of the organization and the leadership of that organization. So I think those are important things to think about when you're applying, as you said, for a job. And, again, I mean, maybe I'm idealistic, but I mean, I think you can do well. I mean, I think you have to be obviously hardworking and passionate and care about your patients and good at what you do. And if you do all those things, you can be successful in either place. And I think I was doing well where I was and I think I would have continued to do well and grow and expand my abilities. And I think here, similarly. So I don't think there's any place where you can do well by, you know, not working hard. It's hard work and it's a busy career, but it's very rewarding. Our patients are very demanding, but they're going through a very stressful experience, but it's been very rewarding to help guide them through it, in minimizing the stress and burden that they have. So, again, I think anyone who has the right attitude can do well, that either place, but--
JONES 29:09
Do you interview physicians when they're applying for a position at Columbia?
FORMAN
Yes.
JONES
What do you notice? What are some of the things that come to the top of your head of what makes a candidate stand out versus one that you think, eh, maybe not that one?
FORMAN 29:27
I mean, I think as you mentioned earlier, like make a name for yourself. And I think one of the things that I really like about our division is that we all have a certain focus or niche you could say, like Dr. Williams really focuses on recurrent pregnancy loss and complicated cases. Paula Brady has focus on our oncofertility; Fethiye Karipcin is focusing on more prevention of genetic diseases, single PGT; Rogerio Lobo is a well-known expert on PCOS and menopause; Briana Rudick manages our third party team and we have a few other doctors as well. But I mean, I think having a passion in an area that you're really interested in, I think is really helpful to maybe differentiate yourself in a very crowded field or market. So that's something that stands out. I think someone who can get along with other people is really important, because the, you know, our clinics are centered now are complicated places with multiple components with your own team and other teams and labs and being able to interact and get along with everyone. We’re a growing center, we now have 10 doctors, and, you know, we want to have, like I said, each doctor can have their own identity and their own interest, but also not have like 10 separate clinics functioning autonomously, because that could kind of be chaotic. So someone that can get along, come to consensus and say, This is the way we do things, but also is intellectually curious and innovative in thinking, because we are going to reassess everything we do. And if there is a better way to do it, we'll change it. But we'll all incorporate that into the way we do things. So those are some of the things that I think about, and someone who's gotten really passionate about this field. And, you know, like I said, even if we do research, even if we're in an academic place, we spend a lot of time talking to patients, answering their questions, counseling them, so someone who is good with patients, and really understand like that you have to be available--not 24/7--but we have to communicate well and have systems in place where patients can have questions that they want their doctor to answer, that you’re available to do that.
JONES 32:37
In some cases, many people make the argument for private practice that they get to determine that not so much against academic medicine, but against networks, for example, that I don't want to be a part of a fertility network that is either publicly traded or partly owned by private equity, because I want to be able to make those decisions. But I never hear people talk about that dynamic in an academic medicine, whether they feel like someone's telling them or not. What is it like in academic medicine? Is it on either side of those two? Or is it in the middle?
FORMAN 33:01
Man, I think it just varies so much that there's so many different kinds of models where some REI divisions are, you know, more integrated with the academic medical center. And like you said, their website is varied and they follow exactly the way everything else is done. And there's other that that are allowed to be somewhat more autonomous. So I don't know that there's an answer that applies to all. I think, you know, there are some academic settings where it probably is difficult to change things. And then there's others where the leadership has given the division more autonomy, and then depends on who's making those decisions. You know, is it just one person like the division director, who sets everything from above? Or is it more collaborative, where all the doctors have input? I think that that's true and private practices as well, whether it's a network and there's some protocols or ways of doing things that come from above, or it's even a smaller practice, but there's the one person who founded it or someone that sets everything. So, again, like I said before, a lot of these dichotomies, I think are not really dichotomies, I think they do kind of dynamic can exist in either setting. I think one thing that's different, though, I mean, as a fellow coming out thinking about that idea about being part of a practice, or is it going to be taken over in some way by a larger network or private equity? I think there is, I mean, there have been a lot of changes and you know, probably better than me in this field, so that may create some uncertainty, you know, academics--there's I mean, there's always uncertainty and everything, but an academic center. I think it's less common that it's taken over by some outside entity unless, like you said there was--it has happened.
JONES 35:14 ]
I was going to say, is that still true? And that maybe segues to a question I have about what's the future for academic? Are we going to see more of that? We've seen some of that where REI divisions essentially acquired by fertility networks, they maintain their relationship with the university, and I'm not talking about the fellowship programs, necessarily, I'm talking about the IVF centers of REI divisions in academic centers being owned by private equity, they still have an academic, maybe a research or a teaching obligation to the university, but their salary comes from the network. And I wonder is that the future of academic practice is we're going to see lots of IVF centers being sold off or partly sold off, because it's the health systems like, you know what, we're spending a lot of our attention on the oncology division, that's where we make most of our money, we could make more money by just letting this part be partly controlled by another entity. Is that the future of academic practice? And if it isn't, what is it?
FORMAN 36:20
I mean, it's hard to say, but I think, you know, if this private equity is coming in, it must be because they view it as a profitable area of medical treatment, otherwise, they wouldn't go into it. So it just, to me doesn't make sense, like, why the university or academic setting would want to give that up. And if they can't do it well and it's failing, that's the problem. And you know, I think, then the choice of either just give it up completely and not have fertility or reproductive services, or to improve it and maybe modernize it and be able to compete with those private practices, or to spin it off, like you said. I mean, I think, the model, that we have, of being able to make improvements and work within the Medical Center, I think it could work. And I think there's advantages, where I think we know we have to train future reproductive endocrinologists, and that's usually done within an academic setting and if we grow, you know, hopefully, some of those people will stay and like, I stayed where I trained, and some will go and they'll move and train and other places, potentially, I mean, I think have some advantages that private practices don't have, which we haven't talked about yet. But we have name recognition. I know you do a lot of marketing, but, you know, if you did a survey of people before they ever know that they're going to need fertility services, people have heard of Columbia or Northwestern or Stanford, like, they live in that area, where there are private practices or networks that those of us who are in this field, we know these names, and they're very brand names. But someone who is just trying to get pregnant for a year and ask their doctor, you know, that's how they find--there's different ways people find us. But that's an advantage that I think, you know, we can use to improve our centers and make them better. So there's usually OB/GYNs within the academic center who are seeing patients who are trying to get pregnant and wind up needing fertility services or single women who are thinking about preserving their eggs. And that's a referral source that outside private practices, you have to work really hard to make those connections. And, and I did--
JONES 39:01
Even then, it's not always guaranteed that that referral source. I've looked at some academic centers’ referral patterns, and it's like, wow, you have a fraction of what your health system is doing in terms of, you know, OB deliveries, for example, or just total OB/GYN volumes, you have a much smaller fraction of that then against the marketplace.
FORMAN 39:21
Yeah--you can’t use that and become complacent and say, Oh, you know, we're in Columbia, and there's all these OB/GYNs so we're automatically going to get the patient. No, that's not what I'm saying. I'm saying though, that if you do provide as good or better care than anyone else, and you still have to internally market and give patients the best experience, but if you get to a point that you're just as good or better than anyone else, you know, then I think you can accrue a higher proportion of those internal referrals and have those patients stay within the system for delivery and other medical care. I mean, we get patients who, you know, they go to Columbia for their other medical care and they want to keep everything within the same system. Yeah, if we didn't provide good services, they wouldn't say or their doctor wouldn't hear them here. But because I think we do provide really great care, it's easy to stay within the same system. Same as when I'm referring someone who doesn't have an OB/GYN or you know, just moved to the area, obviously, an OB/GYN refers at the patient, they should stay with that doctor, they have a relationship, but if they don't have an affiliation, you know, I know, we have great Obstetricians and maternal fetal medicine specialist and minimally invasive surgeons, and, you know, I would, you know, refer to those people. So it helps the department and in other ways versus, you know, potentially missing out on some of that, if you could use the name, but you're sort of separated, maybe there's not as much of an incentive to try to keep patients within the system. So I think a case could be made that if the time and resources are invested to, to make the academic practice as good as it could possibly be, that that benefits that division, it benefits the OB/GYN department to benefit the whole medical center by keeping more services within, again, I think that's a model that can work and make sense. I don't know, it's hard to predict. I'm not a hospital administrator, maybe you're right, maybe it's such a small piece compared to cardiology, and oncology. But I think if you're looking at trying to just overall provide the best care and be as productive as possible, I think there's a role for keeping fertility treatment within an academic setting.
JONES 41:56
There were some other advantages, what other advantages would academic centers lose by selling off the network or breaking off?
FORMAN 42:05
What would they think--I was thinking more from a physician standpoint first. When choosing to work in a place, I think that I had a very rewarding experience. And, and I think it can be, but there's also some advantages of being part of a larger department and medical center that, you know, it's easy to, to get other opinions, not saying you couldn't do this outside, but you're, you know, more separate than, you know, I have dozens of other doctors within this department. And then, even within this Medical Center, if a patient, you don't need an end medical endocrinologist, the neurologist or something, you know, to easily be able to look up and reach out to someone in that department or division, or collaborate within the Medical Center, you know, on research idea. I think we all like want to want to feel like we're part of some, some, something bigger and greater, and I've been feeling again, I think the Academic Center provides an important role and you know, in training and service and caring for patients in the community, and it's rewarding, you know, it's rewarding on our level to take care of patients and help them build their families or preserve their fertility. But it's also rewarding to know that we're part of a bigger center that has a really important mission. And again, I think is stable, you're right. And again, it's possible, anything is possible that it could be sold off or spun off. But, you know, it's a large university that hopefully, it's not going to get sold or bought or go out of business or something like that, even though things can change. I think there is some stability there. So that's something that you know, I think about when I talk to other doctors, or fellows applying a common question that comes up in private practice revolves around like, partnership and ownership and future and I think it creates a lot of stress. And a lot of time is spent on this topic. I don't think any--most of us didn't go into medicine to own a business or run a business. That's just my opinion, I think we went into it because we were interested in some medicine in general or some area of it or, again, becoming a physician and kind of evolved that those of us who were in this field the way the way it is that that has become and probably in other areas as well, but we know that there is definitely a business side of medicine, but I feel less stressed like I know I'm never going to own Columbia like the trustees at Columbia University, in our who pay me or whatever. But there was always the discussion of like, when do you become a part Now what does that mean? How do you pay for that? What if you change your mind? What if you don't want to do it, and how clear--my clinic has very clearly defined, some clinics, it's not so clearly defined. So I think some people that's really important, and they want to own something, and they want to and others that I think gorgeous, the status like that for what it's thought like you should do if you've been out for a while, and you should have that, because that's the way our field has evolved. I think it's, in some ways, being part of an academic center, as long as you're, you know, compensated fairly and, and that's a whole nother topic. And again, you feel like you're doing well, and you have good benefits, and I think, are really good benefits of being part of a large organization to take that stress off. And rather than worrying about you have to take a loan and buy into a practice or something, that's just not even a thing. For better or worse.
JONES 46:04
I think you've made an impassioned argument for the benefits of private or excuse me of academic REI practice, how would you like to conclude, is there anything I didn't ask you that you'd like to add?
FORMAN 46:17
I mean, I don't know if this is relevant. But I think there's some things. And I can give one example of like HIV, which was an interest of Colombia, even before I came here, where there, there may be some areas that are kind of small, a small number of patients may be affected by and, and it may just be easier or less risky for private practice to just not deal with that. There are a lot of private practice, they just don't treat patients if one of their partners is HIV positive. And when really like, there are protocols out there that are safe, that it could be done, but it's a little bit of extra work and, and maybe some risk. And although I think that's really overstated, even if you have good protocols in place, but I think my opinion that there is some inertia, like we don't do that. I mean, it's not like it's going to generate a huge amount of revenue. We don't really need to do that. Maybe leave that to the Academic Center. Well, we do that because we feel like again, I mean, you can safely treat these patients and why shouldn't they have access to care? And I'd rather have a broad net and still safely and have protocols, but be able to take care of different patients and maybe fall through the cracks or maybe aren't profitable. But if we don't do that, you know, who will? And it also makes it more interesting, I think, and then having certain rules like we don't we don't do that. We don't do that here. Let's see if we could find a way to do it because I think there's a role for it. So I think, as I mentioned before, I mean, we all went into this to help couples, help individuals, build their family and then and I think, you know, all of us are intellectually curious. And I think it's an interesting environment to practice in when we can solve problems and expand access to care and maybe not restricted because it might not be profitable for the network or whatever that holds the practice.
JONES 48:26
Dr. Eric Forman, thank you so much for adding your perspective on Inside Reproductive Health.
FORMAN 48:29
Good talking to you. Thanks.
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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.