Creating a succession plan can be a daunting task for both new REIs entering the field and docs who are ready to retire. New REIs are looking for a place to call “home” that will help them meet their goals, while retiring docs want someone who will carry on their legacy and maintain their core values.
On this episode, Griffin talks to Dr. Paul Brezina, Director of Reproductive Genetics at the Fertility Associates of Memphis. After finishing his fellowship, Dr. Paul Brezina set out to find a private practice to join with the hopes of one day being a managing partner. From day one at Fertility Associates of Memphis, he knew what needed to be done to join the two founding partners of the clinic. While sharing his story, Dr. Paul Brezina shares his thoughts about creating succession plans and what new REIs should be looking and asking for as they set out in their careers in the fertility field.
Learn more about Dr. Paul Brezina and Fertility Associates of Memphis by visiting FertilityMemphis.com.
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 2:45
Dr. Brezina, Paul, welcome to Inside Reproductive Health.
BREZINA 2:48
Thank you for having me. It's a real pleasure to be here. I appreciate you making the time to have me on.
JONES 2:54
I'm interested because I know a little bit about your history of partnership within your practice. And I want to give that as an insight to younger doctors. So maybe we start with how did you choose your practice to begin with? What are the most important factors in choosing And specifically, what were they for you?
BREZINA 3:16
So I think that from my perspective, I took an analytical approach, or tried to take an analytical approach to it, and tried to actually get data to help kind of narrow down the focus of where I was looking. So what I did is I actually made like an Excel spreadsheet, and punched in all sorts of data for the region that I was looking in, which is pretty broad, basically the southeast. So every major Metro Center in the southeast, I made an attractiveness quotient and be like the population, the number of docs there, the number of cycles that are being done, how many major industrial centers were there, how many major fortune 500 companies were there, average annual income, anything I could think of that would make it give me some data for that. And then I--
JONES 4:01
You made your own market analysis in doing this, why? How did you know to do that? Why was that important to you?
BREZINA 4:09
Well, I don't know. I guess a long time ago, I got an MBA and so I guess I kind of thought that I would try to apply something that I learned from that. So I got a shortlist of markets that I thought would be likely to benefit from somebody coming out. And then once I got that kind of shortlist of four or five cities, which I thought might be markets where you can see a lot of growth potential, I went and talked to my faculty members, my advisors, and asked them, “You know people in these markets?” And pretty much all of them knew people in those markets and my mentor from my research who I spent the most time with, knew the principal here pretty well and said reached out. And they said, “Yeah, come down for an interview.” And that worked out, I looked at several other cities as well. But I felt that on balance after coming here for the interview, this made a lot of sense. And I could see it being a really good fit. And so then I just focused on developing the relationships here. And so I didn't, you know, I talked to several different people. But as far as like, actually, I found a match pretty quickly with that process.
JONES 5:28
And so it sounds like you had partnership, at least in the back of your mind, it sounds like to me, it was at the forefront of your mind, because if I were just an associate, or wanted to be an associate, I would probably say, “Okay, who's going to give me the salary and what city is going to have the amenities that I like,” but it sounds like you were looking at something a bit longer term with the market. Am I inferring correctly?
BREZINA 5:52
My goal going into this was to make one move after fellowship, set it up the way that it needs to be set up, aka a mutually beneficial arrangement for the people that were there. And for myself, and my family, and hopefully come up with a win-win where you could have a transition, so to speak, over time. I think that the model that I pursued is a whole lot easier to pursue in a smaller practice of two to six people. And I think it's harder to pursue the strategy that I did, and you know, a larger group.
JONES 6:28
Tell me more about that. What do you mean by that, that it's easier with a two to six physician group?
BREZINA 6:32
I think they're just fewer people that you have to--but so it was also unique here because they'd never brought on a partner ever. So there have been three or four people that had come through that were really good people, for whatever reason, though, they had family arrangements or whatever that took them away after being here for a couple years and never really got to the partnership conversation. You know, my goal was to have the partnership conversation before I even started. So, we had, I think, a pretty well working arrangement for what that looked like, in the longer term before I even set foot here. I think that I approached it in a little bit of a different way than people that had come before me. But I think that also, I was also signaling to the folks here, that I had a real commitment to making this. And that, I think it was almost reassuring, that I don't want to speak for for for my other partners, but it would be reassuring for me, if somebody was coming to me and saying, “Hey, I'm committed to this, I don't just want to have a stopgap job for a couple years. Like I'm committed to this, I want to make this work. What makes sense for everybody here?”
JONES 7:38
That profiles what a lot of physicians are looking for--partner physicians are looking for, they want someone to come out with that type of gusto and you had a plan. So you said that they hadn't brought on any partners before, but was it already a two partner group at that point? Was it the founding partners--It was the two founding initial partners, and then there had been a number of people that had come in, stayed for two or three years and left come in and stay for two or three years--
BREZINA 8:10
Before me, I came on, coming on nine years now can't believe it's been that long. But nine years and then two years after I came on, Dr. Bailey, who you know, as a young doctor, Amelia Bailey came on. And I could, so to speak, sell this product as a “Hey, this is really worked well for me, I think this is a good deal for you.” And I can honestly tell her that because she was a friend of mine, I wouldn't have told her something that wasn't that I didn't believe.
JONES 8:38
I think I'm gonna write an entire article about that particular concept someday, Paul, which is there is a certain amount for the people listening, if you can be the doctor Brezina in this situation, I think your leverage goes way up. And what I mean by that is there are a lot of groups that are having a hard time bridging the gap, because they are maybe like two or three original founding partners. They're all within three years of retirement. And it is harder to recruit a younger partner at that stage. But if you are that younger partner, and you've gotten in, and now you're the one that's going to be left in three years, and I'm not speaking to your situation, I'm just speaking in general here. But you can do exactly what you just said, which is okay, now I know other people and I can start to bring them in. I think there's tremendous leverage in that position that you just described.
BREZINA 9:30
I mean, I think it's a good thing here. And it's certainly borne out to be, I hope, a mutually beneficial thing for everybody involved in our practice. And we're getting to a point now where, you know, we're even looking to expand further. And I think that hopefully the path that we've put this practice down to something that has momentum and is stable and good and attractive. I mean, that'll be my hope. I think that the market’s changed a good bit in the last 10 years with the number of practices that have sold at least some of their value, either in the lab or the practice, to private equity. And that I think, changes--the landscape is a little different now than it was before. It's just always a moving target. Right?
JONES 10:14
Was that on your radar when you were starting this partnership?
BREZINA 10:19
Yeah, I didn't. And I know, plenty of people that have done phenomenally well joining big groups that have sold some to private equity. So I'm not disparaging that decision in any way. And every person has their own decision to make and there's pros and cons. You know, I think there's a lot of stability having a stock portfolio for lack of a better term. And what you have, which is, you know, it's a little more fluid here, it's a private practice. But I think that for me, I didn't entertain talking to anybody that had sold a significant portion of the practice, because I think that they seize a lot of control. And I think that it also--I think it's nice to be able to buy into some of that equity before it sells to some private equity that and that's a big reason why, I think we've been a little hesitant to do that, although, clearly, there's some very attractive partnerships out there in that in that realm. And it's not a good or bad decision or anything, and who knows where our practice goes in the future. But I do think that you have--I think it would be fair to say that you always have the most flexibility being small and nimble. But there's other things that you lose with that. I think it's more of a personal decision. And I'm not saying to go one way or the other with that.
JONES 11:40
Now, there are definitely pros and cons. There's definitely people that should do it. And I think there's also people that shouldn't. You are starting to see that when this when you said nine years ago, when you were
BREZINA 11:54
I've been here nine years. I was actually negotiating this contract midway through my second year of fellowship. So I mean, negotiation for this was a full 10 years plus.
JONES 12:04
But at the time, are you negotiating partnership? You’re negotiating employment agreement with a buy-in option in the agreement?
BREZINA 12:12
Yeah, right. So what we negotiated was a three year period where I was salary, but the terms for actual buy in and partnership were made at that time.
JONES 12:24
Okay, let's talk a little bit about those terms. And if you don't want to talk about your specific situation, we can speak a little bit more generally. But I am trying to get specific, at least with what prospective partners and selling partners need to agree on, because I've seen so many darn times and I mean, more than two hands of associates that were out of practice for two or three years. And at that two or three year mark, they went one way and partners went another way because the partner said, “Nope, you're not ready to buy.” And they said, “What the heck are you talking about? Yes, I am.” And there was a discrepancy. And whatever that discrepancy was, Paul, it wasn't clear that they weren't going back to something that said, this is exactly what we agreed on. The partners had one thing in their mind, the associates had something else in their mind. How specific can we get about what needs to be agreed upon in that agreement, explicit and redundant ad nauseum so that there aren't any surprises, whether we're there or not, in two to three years?
BREZINA 13:30
I think the way ours worked was at the end of one year, they had to tell me whether or not we're going to execute the partnership agreement in two years. So that it wasn't the sort of thing where I was there for three years and then all of a sudden, and this was all--I mean, the guys I dealt with, I was very fortunate that guys I dealt with were very, very, very reasonable and honest and true to the word. I don't think that's universally true of all people. I mean, I think that I got kind of dumb luck to a certain degree of just being with really good people. But at the end of one year, I said, you know me well enough at one year, you know whether or not I'm a dud, or you don't like me, or whatever. So you should be able to tell me if this is on or off in one year. So at the end of one year, I got a letter saying, No, you're good. At the end of three years, you will have the option in the initial contract. I had a number and schedule. So that was locked in as a number before I came. What I tried to say was, I don't want there to be any--I want everybody to be able to agree on this. And I want to be able to have a clear path for exit when people retire as well. I'm not going to get into specific numbers. But, you know, basically using practice valuations at the time, we came up with what this looks like over a 10-15 year period. So it's not like that there was a lot of there's intersecting interest in that as I come on. And they come out to make sure this is taken care of. But it was all worked out before I got here.
JONES 15:07
So is that something that partners and associates need to be agreeing upon, like, this is the volume that you're expected to do before you can buy and this is the number of new patients or procedures you're expected to do, these are the outside responsibilities that you might have, you know, you might be in charge of the marketing seat or in charge of the accounting seat or, or some other business function. What are those metrics that should be specified?
BREZINA 15:36
Yeah, I mean, for us, I think that the mechanics for partnership, I really wanted very, very clear on the front end. So it wasn't like colleagues I've talked to where, Oh, yeah, you can become partner here. Give us $30 million. You know, I mean, it's just some ridiculous thing. So I think that that mechanism was clearly defined, what was not as clearly defined, was exactly how good I had to perform, to be offered execution of the contract. But I thought that was okay. Because I had put in there that after one year, I know where things are. And I know everybody's different. But I know myself, and I knew that I was going to work harder than anybody else anyway. So like, I never had in my mind, and never had to worry about that. And I knew we took on Dr. Bailey, she's gonna work hard and have to worry about that. So I think we've also been blessed to be in a position where I've never liked during this whole process, we've never dealt with anybody that's not excellent. So I think that it would stress the rubric that we've made, if we were dealing with that situation, which, fortunately, we haven't.
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JONES
You mentioned something that of other physicians that had worked with this group before and there are perfectly good reasons to leave practices but I recommend that for current associate docs and for ones that had worked for your prospective practices, the person who's going to be joining the practice to contact both of them people that are still at the practice and outside. Did you speak with those folks?
BREZINA 19:30
I did. I tracked down two of the people not that weren't there anymore. And both of them said that it was basically their wives wanted to be in different locations. And that was what was driving the decision in both cases. They said that the people were stand-up people, that they never felt, you know that they were misrepresented or mistreated. And they liked the people there and they liked the practice. So yeah, I did do my due diligence, I hope, on that a little bit.
JONES 19:58
So when you start, you're the third partner to join up with the two founding partners. But this is nine years ago. And then you said you worked for three years as an employee. And then so you bought in six years ago, presumably. But that's still, Hey, we've got at least six years to work with each other. And there's probably a couple more on there. And now you're at a point where, whether it's not necessarily now, but in the future, there is this age differential between yourself and the two other partners, right? How does succession start?
BREZINA 20:34
Again, I feel like half of my situation, I chalk up to just God looking out for me, good luck, not me. But we've started to transition responsibilities. And I take over as much as makes sense. Honestly, I mean, I'm a reasonably independent person, but I really love having a senior partner who helped me with contracts, because he's done it for like 30 years. It's like looking at contracts with him is really, really helpful. We're just getting going on eIVF aAnd, you know, that couldn't imagine a better group of people to be working with either because they've been fantastic. But going through the contract, looking at all of that, handling some of that negotiation, that's something we're doing right now, handling interviews for new employees. And starting to do more of that, I think that I see it, instead of one person just taking over what I think makes the most sense, is maybe good to have two people kind of co-administrating for a period of time. And then, you know, kind of going from there. Because, you know, frankly, there's just an awful lot that I've learned from each of these interactions that I have, with these different responsibilities from the senior folks here that--I mean, I don't want to reinvent the wheel and make mistakes. And then I just have them kind of teach me so it's almost kind of like another mentorship or fellowship or whatever, from my perspective. And I think that the other thing too, is that I think it's a little different, as it's just a hunch, this is not something I know for sure, but I think it's probably a little different with founding partners versus senior partner. The difference there is that the two guys that made this practice, built it from the ground from nothing. And I think that there's an emotional attachment and a visceral attachment to the practice and the place and the people that started this with them and all of that, that is it's a little different than just taking over a job for another person. And I think that whenever you're in a position where you're taking over something like that, just being really mindful of how much emotional attachment people have to the place and how much passion they have for the place. What I've tried to do is allow as much responsibility as people are comfortable with, but knowing that, it has to feel right for everybody.
JONES 22:56
That concept is something I want to explore more because I think your hunch is correct. It is different when you have founding partners. In this case, we're talking about Dr. Ke and Dr. Kutteh, for those listeners that recognize their colleagues. But when you have someone that starts something, passing it on, it's different from starting a new and I've never purchased a business, I've only started my own and that has tremendous challenges, just starting something from nothing has its own challenges. But one thing that is easy about it is that what I say goes, Well, this is the thing I started, this is where we're going, this is how we do things. And that would be different if I were to sell this business in 20 years, because of the people that had been involved in it and the client relationships. And if a new visionary were to take over and say, Okay, well, now we're going to go with this direction. It's a total, maybe a total readjustment of buying, at least a partial readjustment of buying. And so what's that like? Because I think of all the organizations that I've been a part of, most of which are nonprofit charities, but when we pass down from one generation to another, it is hard to adjust and stay relevant. And that is why a lot of businesses, a lot of organizations just don't because it's harder to change than to be replaced by something that can start anew sometimes. So what is that like? And okay, you have the benefit of the apprenticeship, as you've discussed. But eventually, you're going to want to take a direction that is relevant for 2022 as opposed to the year the practice started. And you've got to get buy in. So how does that impact succession?
BREZINA 24:39
My vision for the future, my goals for the future. I was transparent on day one, like when I came down here, this is this is, you know, like 20 years from now, where do you see results? Oh, well, okay 20 years from now, here's the goals that I want to have kind of implemented. I want to have ABCD and a lot of that was also trying to grow the practice and I think we've even done that while I've been here with bringing on Dr. Bailey, because we've never had four practitioners here before. And we're wanting to go further with that and that's great. I think that the fact that they were amenable to bringing on another person two years after hearing me speaks a lot to their incorporation of my goals and meshing them with. And I think that that's not--I don't think that's a given. I think that was a conscious decision by them to try to merge both of our visions for the future. Again, I think that I got really lucky with people that actually cared what I said, like, you know, tried to incorporate that into what the plan was for the future. I think what's going on is, we're both kind of blending our visions together, and the things that I think are really valuable for their vision of how things have been done, I've modified the way I see things for those things, and for, you know, things that that they think that hey, you know, maybe this is this is makes sense, or whatever they've modified their things. And even the succession plan in my head, it was always like, okay, somebody is going to retire, they're going to take a while that may be true in the global long term, 20 year sense, what's functionally happening is more of we're merging together, and then one person is going to drop off at their own comfort level and I'll take what comes up at that time. And I think that in that way, nobody has this jarring realignment of all of their goals. And I think that, to accomplish that, you have to have communication, you have to have mutual respect, and you really can't have a situation where you have somebody that's just autocratic, and dictatorship and what it has to be more collaborative than that. So that's just the way that and I don't think that, like, we sat down and said, this is the way it's gonna be, it's just the way it's organically kind of evolved. And, again, going back to kind of the smaller practice, I think that that's a lot easier with four actors versus 30. And Dr. Bailey being on, you know, me and her meet every Wednesday, talk about everything, make sure that we're doing everything in a way that we're all comfortable with. So there's an incredible amount of communication that we put into all this or that, try to put into all this to make sure that everybody feels a representative, everybody's concerns are being addressed. And everybody feels like we're going in the same direction and pulling on the same side of the group.
JONES 27:21
It sounds like you got lucky in the fact that you're doing this with that it was a little less explicit in the beginning. You had the global vision in your mind, but then ends up being a longer term merger and diversion. And I encourage people to stress this to stress test, this succession plan, at least somewhat, and I can give you an example. I was making an introduction between younger REI who may want to go into independent practice for themselves and with a group that is probably looking to retire within the next few years. And I know both of these parties very well, both wonderful people. And as they're talking, I just wanted to start to stress test some of the places where they might diverge in this time period, whether it's two years or five, where the incoming party starts to make the decisions. And I wanted to pick out things that I knew would be deliberately controversial. And the retiring party, let's call them Dr. B, has an individual that works for them. That is just the sweetest person and administrative person that is the sweetest person. And let's call this person Dorothy, for the sake of this conversation. I said, Okay, we're in two years. And Dr. A, wants to fire Dorothy. Dr. B, you've had Dorothy for years, how do you feel about this? And so they actually talked through that kind of stuff a little bit. So I do recommend stress testing the succession plan, to the extent that you can think of examples that are important to you. And it sounds like you had at least what was important to you, you knew what vision you wanted to take.
BREZINA 29:13
I think that just comparing the way things have worked out, versus the way they've worked out for other people that I've known that were my year, I think that a major stress that we didn't have was a lot of the negotiation about how the ownership of the practice and all of that looks. I think having that workout on the front end, it's hard to overstate, because I think that that allows everybody to be comfortable in the front end. And it also is a time where fellows coming out. I think you have your most leverage really, really coming in during the negotiation part at the beginning. Because once you're there and you've already moved your family and you have, like, a house and all that, it's hard. And I think that I would encourage people to be very deliberate and intentional about what the expectations are in the long run before you move there. And I think that really, if somebody--say, I'm looking at a new partner, I want them to have a clear expectation on the front end, too, because I want people to be here long term. I'm like, everybody's different. I mean, I know of practices that basically, they're there to squeeze with a lot of people for two or three years that have been leaving. That's it. And I think that if that works for them, great, but that's certainly not what I would want taking on somebody. I would want somebody that's going to be there for 30 years. So I think that it's in the best interest of people looking at positions to try to get as much clarity as they can on the front end. Because I don't think that's the norm. At least that's not what I see.
JONES 30:38
I believe that about marriage too. But that principle that you just discussed, we call prolonging investment in the deal. And so if you invest too much in the deal upfront, you're more likely to make poor decisions because of sunk cost. And so what Dr. Brezina is talking about is if you put this off, and then you said, “Well, you know, we can talk about that later and I'm just going to buy my house here and we're going to enroll our kids in this school here and now we're packing up the Uhaul,” there's a lot of sunk costs. And it's hard to go back from. Add that the more you invest if you're putting off these bigger discussions for later. So to the extent that you have them upfront and repeat them, as you're starting to invest before you start to invest emotionally, the more likely someone is going to make the correct decision. And I can't stress that enough either.
BREZINA 31:37
It was really important, I think, looking back at the course of the lesson, you know, hindsight is always easier than and prospectively, but I think that we made a conscious decision coming out to buy a inexpensive home, used cars, take on as little debt as humanly possible. And I think that that really made things less stressful going, the whole buy in, and whatever. And, frankly, made me feel more that if things didn't work out, I didn't have just less investment on the front end, which for me, worked out well and made me feel more comfortable. I think in the long run, you know, everybody's different with that. I do think it's different if you go out and you buy a million dollar house and $100,000 car and all this other stuff. And then I feel like you've lost a little bit of your impersonal leverage in the future if people do decide to be dishonest and not follow up on what they're saying--they're going to do things like that. So I think that coming out and being--I mean, enjoy yourself, but not being overextended.
JONES 32:40
I'm trying to think of what Jack Bogle calls this but it's any time someone has a something like waterfall of money, you know, it's not just winning the lottery, it can be if you get an inheritance or you get a raise, you get a new job, your income spikes at one point. And I think for a lot of people that you don't need 55 grand in residency and not much more in fellowship and all of that medical student debt. And now finally, after all that 15 years of debt/low salary, there's, all right it's car time, it's house time. And I think your wisdom is very poignant of ‘not so fast kemosabe!’
BREZINA 33:19
I just think you're leveraging a little bit of your security and ability to be flexible. I mean, we bought a house for $90 a square foot, we still live in it.
JONES 33:30
And you're in Tennessee, so you might be a little easier--
BREZINA 33:34
[inaudible]
JONES 33:35
Well, you might also be familiar with Dave Ramsey. That's my kind of train of financial planning as well. So we talked about how to do the secession plan, Paul, when do we start doing it?
BREZINA 33:48
I guess it depends, or would it? I think it's born out to be in my experience anyway. And I think this is different for other people. But, you know, there's two different things. There's one is the practice ownership, you know, how salaries are divided? I mean, are we just putting everything on this one person and fades out? Are we keeping it pro rata? Are we doing some sort of mix of it? So I think there's the financial side of it. That's kind of one thing. And then I think there's the decision making part of it. And I think that for us, the financial part of it was reasonably clearly defined on the front end, roadmap to that and not just my by end, but also how it works when senior people decide to step back and not work as much. So I think that having that on the front end kind of being defined, has just been a huge stress relief just on our personal relationships, because it's just one thing, that it's not something that we have to hash out again, like everybody agreed on. I think that who makes final decisions and everything. It's a little harder, because I think there's the functionality of people that are really good at what they do that are running the practice. There's also an emotional attachment where it like you said with the Dorothy person, I think people that started the practice with Dorothy would feel that they kind of feel like they gotta protect Dorothy. And, you know, it's kind of heavy, like saying, you're gonna fire somebody's kid like, ‘No, that's my kid, you're not gonna fire them.’ There's an emotional bond with these people, it makes it great, because people really care about the practice, too. But that part of it, I think, is harder. And I think, I think the only way that that really works is to have people when they're ready, start to cede control. And I think the only way that happens is if people have confidence and trust and faith that the people that they're passing it off to, because this is their baby, it's going to be looking out for the best interest and not just their personal interest for the practice as a whole. I think that people have to, the senior folks have to believe that they're not handing the people that have built this with them over to the walls, and they're going to be taken care of.
JONES 35:59
And that would be I guess, addressed as this succession plan is unfolding. You've given so much to prospective listeners. And I say if there's 150 fellows out that at least a third of them listen to this show at one point or another. And anyone that is listening to the show as a huge advantage from all of the partners that have been on who are telling what you know, what's important to them, what they went through, I mean, you've basically given someone at least a little bit of coaching, if they're interested in coming to Memphis and being a partner, that you've given them some insight of what's important to you, and how they can approach you. But let's expand that coaching a little bit further. How would you coach someone on coming to you, if they're in fellowship right now, let's say their second year, and they've just started peeking around, you know, they maybe got like a call from a network or something or friend, but they're starting to make this decision. What would you recommend that they do if they were approaching you?
BREZINA 37:02
Well, I think that the first thing that I would do looking around is everybody's got their own list of I think priorities for them, you know, and you could probably tell from the way that I approached this, that it was, at least on the front end driven a good bit by, I want the math to be behind me to where I'm relevant, wherever I go, you know, so I think that that was something that, you know, my wife and I, I think I'm also just incredibly blessed to have like, the best wife, like in the universe, like, you know, we've known each other since college, we've done everything together, growing up and everything, and I'm, so we really approached this collaboratively. You know, when I found a place that I wanted to approach, they said, Oh, we'll fly you out as a not without my wife. Like, there's no point like you're wasting your time. And I don't think it really matters. If people are, you know, if it's husband or wife, I think that everybody has to be on board for wherever you can. Certainly, for Dr. Bailey, you know, it was really important that her husband, who's an incredibly talented finance guy found something here too, to make sure that both parties can find something in where you're going. So I think that unless you're you and your spouse are both on the same page, I wouldn't really entertain going someplace. Now that said, up until I went to fellowship in Baltimore, I've never been out in North Carolina, I'd never. I mean, I thought I'd exploded. You know, our families in North Carolina, my wife's family's in North Carolina, I done everything in North Carolina. And before I went to fellowship, I would have done anything to get back in North Carolina, because that's the only place that I really could ever see myself. I think that expanding that a little bit was healthy for us. Now. It's not healthy, healthy for everybody. But it was healthy for us being I think being drivable is important. I don't know, if there's a huge difference, and five hours away versus 10 hours away. I mean, we were five hours away from our home in Baltimore, and we're 10 hours away here. But the frequency of visits and everything doesn't seem to matter that much. I mean, you could have been sixth year there by mid-afternoon. It's not it hasn't been functionally that big of a deal. But I think that being driving distance from family is important. I think that being with people that you think you're going to know, and trust is important, and I think being a market, you're gonna be relevant, important. I mean, like, you know, if you go to a place, you know, there's a lot of major Metro centers, I'm not gonna name one. But I mean, we all know of Metro centers that are frankly over populated with our ease. And I think that to go into a market where you're going to be, I think, a little bit more relevant on the front end, while you're building a practice, I think I think that it has some value. I think it has more, everybody's looking at different things. But for people that are valuing the idea of a practice that hasn't been bought by a private equity, at least partly whatever. I think that has some worth to for some people, people should look for opportunities that are beneficial in the long run. I don't like looking for opportunities that are quick return, but kind of stagnant. You know, I think that just my personality has never been to do that. First and foremost, talk to your spouse. I talked to my spouse, I didn't really talk to my family, like so my family is like Now you need to come back. Yeah, I'm being serious.
JONES 40:04
I know the distinction that you're making right now.
BREZINA 40:07
I think that your spouse, your partner, that's who you talked to. And that's who you really make these decisions with. I think that if you and your spouse are doing things together, and you're all kind of on the same page with what your goals are, and that's what makes this work, right, it doesn't work. If somebody's like, hey, unilaterally—
JONES 40:23
I think that's really sound advice that can absolutely derail even the best arrangement that you have professionally, if ultimately, if it doesn't work out for the person that you've agreed to spend the rest of your life with. That's gonna, that's gonna be a wrench. And so I think that's a really solid piece of advice. So in conclusion, would you want to conclude with some coaching of how you would recommend this is how you get Dr. Brezina his attention if you're interested in possibly with us getting it.
BREZINA 40:57
For us, I mean, just call me on my cell phone and just drop me a line. I think that for some folks, I think that for me and my practice, like we'll do our vetting, you feel comfortable contacting me, I'm comfortable with you contacting me, you know, and then we'll call your fellowship director and make sure that everything's okay. And we'll do that too. But I think that, I think just open dialogue and honesty, I think the one thing that would I just can't tolerate from really anybody friends or otherwise, it's just being dishonest. Right? So I mean, I think that people have to be open, they have to be honest, they have to be transparent. And I think that if people, you know, contact us with, hey, here are what our goals are, we'll tell you, hey, we can or can't do that, or whatever. Um, I think that there's a lot of if people are thinking about contacting other practices, especially if they're, you know, not advertising and things like that, I think, doing what I did, finding people that know people is a great door. So I read Dr. Keaton, I said, Hey, Dr. x, told me that you were a great practice, would you have any interest in starting a dialogue? So it wasn't just from zero? I think that some people really respond, I think maybe better to that. And they feel more comfortable with that. Really, though, I just look at it. As you know, I'm a person we're bringing on somebody else, that's gonna be a partner. They're a person. We have mutual respect for folks, and we want to build something together. And if that's the vision that people want to explore, then let's explore it.
JONES 42:29
Thank you so much for your transparency on the show. That's tremendously transparent. I hope that it results in, you know, in a few conversations, and I know that it will be helpful for a lot of younger doctors listening. Dr. Paul Brezina, thanks so much for coming on Inside Reproductive Health.
BREZINA 42:45
Griffin, thank you for having me. I really appreciate you making the time for 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.