246 M&A Strategies For Small Fertility Practices, Before It's Too Late. Dr. Brijinder Minhas, Robert Goodman, Richard Groberg

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What’s your exit strategy?

For single providers and small fertility practice owners, the difference between a multi-million dollar sale and walking away with nothing often comes down to timing and preparation.

This week on Inside Reproductive Health, I sit down with Bob Goodman, Richard Groberg, and Dr. Brijinder Minhas of MidCap Advisors to discuss:

• The current state of fertility clinic mergers & acquisitions

• Why many fertility MSOs are preparing to sell their networks

• When it’s too late to maximize your practice’s value

• How selling with a competitor could radically increase your exit price

• The biggest risks that lower your practice’s valuation

If you think you might sell your practice in the next 10-15 years, now is the time to start planning. MidCap’s team works with clinic owners to increase their valuation and secure the best possible deal—and they don’t charge fees unless you get paid.

Don’t leave money on the table. Listen now to learn how to secure your financial future.

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• Transcript

  Brijinder S Minhas (00:00)

  In our field, in the fertility world, outcomes, clinical outcomes are extremely important. You know, no network, no buyer wants to take on a practice that has substandard outcomes. And so we look at that very carefully. We look at

  Personnel costs, know, personnel costs are one of the biggest costs in a practice. We look at that. Marketing costs, you know, is the marketing effective? are you getting a payback on your Are you doing enough marketing? Are you doing too much? So all of these things feed into the equation and that's, you know,

  Richard Groberg (00:29)

  may not be doing enough.

  Robert Goodman (00:32)

  Yeah.

  Brijinder S Minhas (00:37)

  that all feeds into our assessment. And we do all of that prior to being engaged by the client.

  Griffin Jones (00:54)

  Make a couple million dollars or close up shop with nothing. That can be the stakes for single providers or small practices. For some, it might simply be too late. For others, my guests point out what you might do as a small fertility practice owner or single provider to prepare for a much better financial picture with far more and far better options during the last decade of your career.

  It's Bob Goodman, Richard Groberg and Dr. Briginder Minhas. Bob was a health system operator. Richard was the chief development officer of Clinic Network and Briginder was an embryology lab director and fertility practice owner among many other things for all of them. Today, all three of them work for MidCap Advisors. Richard is a recent addition, though he's done a lot of deals in the fertility space on both sides. They give us an update on the fertility mergers and acquisitions market and

  what the fertility clinic MSOs are doing. Did you know right now many of them are preparing to sell their networks? So they share with us what they're doing to prepare. But we tailor this conversation to the small practice owner, the single provider. We talk about when it's too late for a practice owner looking to sell, when they need to start preparing to have a successful exit, how they might be able to radically improve their sale value by going to market with one of their competitors.

  how MidCap has done that multiple times and how they help competitors get their financial house in order and come together before a sell. Other factors that buyers of clinics perceive as risks that decrease the value of your practice.

  If you think you might sell your practice in even the next 10 years, even next 15 years, talk to any or all three of these gentlemen. There's no risk to you. Midcap doesn't charge any fees unless you have a payday. Take advantage of their knowledge. They are very patient, very knowledgeable, very consultative because they know it's a long-term relationship. They know all this takes time. Connect with any of them through our channels. We'll have different links.

  tell them you heard them on Inside Reproductive Health, or just ask me and I'll make a warm introduction for you. Whatever you do, don't put it off until it's too late. You worked hard to build a practice. Don't walk away with nothing, or don't walk away with hundreds of thousands of dollars or millions of dollars less than what you could have walked away with. The earlier you take some of these actions, the much greater return, so get in touch with MidCap.

  and enjoy the conversation with Robert Goodman, Richard Groberg, and Brijinder Minhas.

  Griffin Jones (03:43)

  Dr. Minhas, Mr. Groberg, Mr. Goodman, Brijinder, Richard, Bob, welcome back to the Inside Reproductive Health Podcast.

  Brijinder S Minhas (03:51)

  Thank you.

  Richard Groberg (03:51)

  Good morning.

  Griffin Jones (03:52)

  Richard,

  what's happening in the fertility marketplace with regards to mergers, acquisitions, deals? How does it look in the broader context of the market? How does it look and feel compared to how it may have two or three years ago?

  Robert Goodman (03:53)

  That's good.

  Richard Groberg (04:06)

  Well, there's still significant investor interest in backing what we call the PE back groups. It's still a well-regarded area. Having said that, a number of the PE back groups seem to be positioning for sale or trade at some point this year or perhaps next year. Between that factor and

  Thoughts about recession and interest rates are still high. There's less &A activity than there was two years ago, but there's still selective groups that are very interested in strategic acquisitions, whether it fits within their existing network or it's an area that they want to be in.

  So that still remains fine. I will say that over time, as these PE back groups either merge or trade, whoever's buying them is probably not buying them to own a static business, but to buy a business that will grow. So at some point, the growth surge of &A activity will revive again to where it was two and three years ago.

  Griffin Jones (05:06)

  For those that are still selling, there might be less activity, but for those practices that are still being bought, are they going at similar multiples to where they were two or three years ago or have we seen a drop?

  Richard Groberg (05:20)

  Back in late 22 and 23, multiples started to come back to reality. This past year for acquisitions that made sense for the buyer. In multi-doctor practices, multiples started to move back up a little bit when it made strategic sense. And since there were fewer multi-doctor practices out there anymore, the laws of supplies and demand were such that

  They started to trade back at premiums, not where they were in 22 and late 21, but still started to trade back up again.

  Griffin Jones (05:54)

  For those network groups that may be going to sell, do you think you'll see them merge with each other and some will sell to each other? Or do you think that it'll simply be their private equity partners selling to some other private equity group that might not be in the space yet?

  Richard Groberg (06:12)

  Well, if we look at the trends over the last couple of years, most of the major transactions were one group merging with another, often backed by new PE money. So I think we'll see both. The largest PE firms in the world are still looking at the fertility market, but they're also trying to rationalize where's the growth with the changing environment of fertility with more third party payers, lower reimbursement rates and more mandates.

  So I think we'll see a combination of both. But when, for example, when two groups merge, their economies of scale at the macro level of those groups. So we'll still see some of that.

  Griffin Jones (06:54)

  Are we waiting to see who goes first? Is that why we haven't seen a lot of too many of these networks sell yet, or at least those that have been trying to sell for a couple years? Is the marketplace trying to see who goes first and sets the stage for the multiple? What's happening there?

  Richard Groberg (07:11)

  I think there's some of that and I think with some deals that didn't happen last year, some of the groups are, okay, let's focus on improving performance, tightening up the ship, much like MidCap does when it's working with its clients so that when the market does start to open up again with the first transaction happening, other groups then are likely to follow.

  Yeah, I think that.

  Griffin Jones (07:37)

  Bob and Briginder, what's going on with single physician REI practices? Are they straight out of luck?

  Robert Goodman (07:43)

  I'll take that. No, they're not straight out of luck at all. Although there are some limited opportunities in some respects, when you look at the practices, you know, if it's someone who's 65 or 68 years old that says, maybe now I should do something, that's a little problematic. If you've got a relatively young or young REI, a single

  practitioner and a practice, but he or she is interested in growth, looking at new opportunities. I think then we've got somebody to work with, not on an individual basis, but to look to combine them with some others who are in the same general geographic area that are of like mind. And I think that's where we have opportunity to kind of virtually bring them together and then take them to market together.

  One of the things that we do at MidCap when we look at combining practices is that we look for economies of scale. We look for their opportunities to reduce lab costs, reduce staffing. And just as importantly to see if over time, if there's a way that we can improve reimbursement as well for them. So they're not out of luck, but you got to be very creative.

  and they have to be a lot more open to ideas that maybe they weren't open to previously.

  Richard Groberg (09:00)

  If might add, I've worked on and seen a few transactions over the last couple of years, even where a PE back group has strategic reason for acquiring a practice, either because they have enough practices and physicians in reasonable area where they can provide the support for that practice, or they're merging it into an existing practice, closing down the smaller practices lab and providing significant economies of scale to both the seller

  and the buyer in terms of both economics and work-life balance.

  Griffin Jones (09:34)

  Is that pretty much their only option? If they don't go in that route, are they pretty much looking at hoping for luck and having a younger doc come in and buy them out or just closing up and getting nothing? Is that pretty much the alternative if they don't... If they're either not a strategic choice for a network or going to market with another group close to their area?

  Brijinder S Minhas (09:55)

  Well, you know, it's been a bit of a mindset as well. And I think it's imperative that the single doc practices out there start thinking creatively, start thinking earlier on. I was just thinking about it a minute ago.

  If you're in a marketplace, you've been competitors all your lives. There comes a point when you start thinking of an exit or start thinking of a sale that it would behoove you to improve your relations with your colleagues in the marketplace. mean, even CAP, during a lab inspection, one of the questions is,

  Do you have a backup for your lab? So this is not just a backup for a lab, this is a backup for the practice. So I think start thinking about improving your relationships with your colleagues in your areas and start opening dialogue and start thinking about economies of scale. How can you come together? Where can you save? How can you improve the EBITDA?

  Richard Groberg (11:09)

  Yeah, mean, Griffin, we're working on a couple of situations at MidCap with a physician who might be five years or seven years from retirement, but a one physician practice. And if he or she doesn't find an alternative, her practice has no value at exit. But if that physician is willing to partner with an existing competitor, then...

  In addition to the economy's scale, in addition to the better productivity and work-life balance, instead of being worth zero, that physician is part of a combined business that's now more profitable and gets the multiple of a healthy multi-doctor practice at exit. So can be a tremendous win-win across the board if the physicians are open. We've seen this in other industries as well, where competitors suddenly join together.

  and then have a much better situation professionally and financially.

  Robert Goodman (12:08)

  Yeah, we've also seen the other side of it. Where there's markets where the doctors have competed against each other fiercely throughout the years and have, you know, it becomes very personal sometimes. And in some cases, especially if they're, I'd say, especially if they're a little bit older, because it's gone on for much longer. It's impossible to sometimes to crack through those old issues.

  and to have them see sort of the light that could be attained for them. so, you know, they're going to, it's not going to work for them. you know, where there's an opportunity to create a wealth strategy for themselves as a result of selling their practice, that's just, it's not going to happen. So we try as hard as we can to make them

  see the light, but it doesn't always work.

  Brijinder S Minhas (13:00)

  But with age comes wisdom as well. When you're looking at the end goal, if you can see that your competitor has a bigger lab or a better lab, we've got to realize that most of the cost is in the lab. Closing down one lab and functioning out of the larger lab

  Richard Groberg (13:03)

  Let's hope.

  Brijinder S Minhas (13:27)

  would be better in terms of outcomes, clinical outcomes. That's why the patients come to us, is to have a baby. And secondly, it also positions both practices to exit and get a much better multiple and a much better transaction value.

  Griffin Jones (13:47)

  Are you recommending that they merge together and become one business or can they go to market together without having merged?

  Robert Goodman (13:57)

  We tend to try to bring them together virtually for a variety of reasons, not the least of which is the cost. If we can virtually market them to one of the platforms or someone else for that matter, they will go through a merger and the cost of expense for that, the legal expenses and that sort of thing, but they'll do it in effect once and not twice. And so there's some economy.

  in that regard.

  Richard Groberg (14:24)

  I mean, there's a balancing act there, Griffin. If I'm a buyer and you're merging simultaneously with the transaction, then you don't know whether the cultural fit that Robert talked about will make sense and all the economies to scale are pro forma. Now, you might be able to overcome that. Whereas if they've merged and they've been working together for three months or six months, then you actually have demonstrable proof that it's working.

  and it's easier to then market to an acquirer.

  Griffin Jones (14:53)

  How do you get them to get their act together to portray this possibility to a buyer? I'm picturing the three of you guys sitting two people down and saying, no, you're going to sit down and you're going to like each other and you're to be on your best freaking behavior when these people come to meet with you. How do you do that?

  Richard Groberg (15:12)

  even in a fertility practice where physicians have been practicing together for a while, they don't necessarily all get along or do things the same way. But the advantage we have is we've got lot of gray-haired people who've got a lot of experience with &A, and Briginda and I who've actually worked in fertility practices, sold fertility practices from both sides of the table.

  So we bring an insider's perspective to what needs to get done and what the pitfalls are and the landscape and what it means if you do it right. So it takes some hand holding and yes, it takes some proper counseling. But again, we've got some gray hairs who've been there and done that.

  Robert Goodman (15:54)

  Yeah,

  and my experience has less been in the fertility space in terms of being an owner and a buyer or a seller, but I've done it in other healthcare sectors throughout the years. And in many respects, it's no different. Obviously, specifics of how does a fertility practice operate versus diagnostic imaging center or a FCT business or whatever it might be, those are obviously those.

  but the dynamics of selling and the purpose behind them and everything else, all of that is largely the same.

  Richard Groberg (16:26)

  especially when you're dealing with positions.

  Brijinder S Minhas (16:29)

  When our team goes in, know, we can look at it with a fresh pair of eyes. And just because you've been doing something for the past 20 years in a particular way, there are other ways to do it. And if the clinicians and the practice owners are agreeable to that,

  We can show them ways that eventually will help them, will improve their outcomes, and will set them on track for a good, nice transaction.

  Griffin Jones (17:04)

  Tell me about how you do that specifically. How do you bring two competitors, or people who had historically been competitors, together virtually, as you say, how do you do that specifically before you bring them to potential buyers?

  Richard Groberg (17:04)

  And also frankly,

  Robert Goodman (17:17)

  Well, we run what we call process. And so what we do is we asked for a lot of data, financial data mostly, but staffing data and whatever. And so we look at that, we ask for that data using NDA and everything else, we'll say with it from both of the practices, as as we use this too. so as we get to understand the...

  dynamics, the financial dynamics and everything else associated with a given practice and we do it simultaneously with another one, that's when we can begin to say, hey, let's look at this. Maybe here are some economies, here are some things that we can do, some adjustments we can make in this practice in and of itself and the same thing in this practice. But boy, if we can put these together and as Brijinder has mentioned, as has Richard,

  that we shut down a lab in one of them and that sort of thing. That's when we begin to sort of mold everything together. And at the same time, we try to be, not try to be, we are, we're open with both groups and they have NDAs between themselves as well. And so, everybody likes to hold things for as long as they can in terms of disclosure. so we are sensitive to that and we allow for that in the process.

  up until a certain point in which we have to say, guys, we need to share certain things among you. And so we kind of try and do it that way.

  Richard Groberg (18:45)

  It's a little bit easier though, Griffin, because...

  Brijinder S Minhas (18:45)

  And we don't want folks

  to get the idea that the only way to do this, get two groups together is to shut down the lab. No, not at all. It may be that they are miles apart in terms of just travel distances and it's sharing of staff, sharing of responsibilities. And you know.

  the age-old saying, you you can't always control your revenue, but you can always control your expenses. So bringing your expenses down improves the financial picture for the combined entity. And that's what I think we can bring to the table very easily and very quickly and effectively.

  Robert Goodman (19:29)

  Yeah.

  Richard Groberg (19:30)

  when you put two practices together like that, you're no longer going to market with a one physician practice. You have multiple physicians, so you've taken away, relieved the biggest risk for a buyer of acquiring a one physician practice. I just want to make one more comment, Robert, sorry. Is that Griffin, when two groups are actually in this discussion with us, it's because they're thinking about selling.

  Robert Goodman (19:47)

  See you.

  Richard Groberg (19:55)

  So there's a predisposition that opens them up to possibilities that they wouldn't otherwise think of because they're thinking about selling and understand that as a one physician practice, they don't have a lot of options.

  Griffin Jones (20:07)

  Brijinder you talked about reducing expenditures. And I'm wondering if there are expenditures that are more common among single doc groups or they tend to maybe waste money or have to spend more money on certain things. Richard, I'm thinking of one of the first interviews I did with you and you talked about how business owners often they'll put this expense that's really more of a personal expense on the business and that vacation that's a business trip, they'll put...

  and it shows up as an expense and that can affect their multiple because of how it looks with their EBITDA. Is that more common? Are there other expenditures that are more common among single-dot groups?

  Richard Groberg (20:45)

  Well, that's the case with most practices of any size and part of MidCap or any other investment banking group working with them. The QV analysis will figure out what those are, add those back to show true profitability. you take a one, I'll give you an example. There was a one doctor practice that I worked with a couple of years ago that was potentially merging into a multi-doctor practice. This one doctor practice was generating a million and a half dollars a year.

  of revenues, of collections, but not profitable between their lab costs, their staff costs, their marketing, insurance, all the overhead, apart from those personal expenses. And if that practice had successfully merged into the other practice and generated the same volume, it would have probably generated half a million dollars a year of profit to the combined group because

  To pick up another 100 or 200 cycles, you don't need significant incremental front desk staff, nursing staff, lab staff. You might need a little bit of incremental. You combine marketing. You don't need more insurance. So all those expenses that are duplicative get saved when you're putting two groups together into one.

  Griffin Jones (22:02)

  Are there times where you all have to have hard conversations with people because especially if they've been competitors for a long time, they're probably thinking, my group is definitely way more valuable than this guy's. And then you get into things and is it sometimes the case that even though they might be the similar size that one group just has a lot more?

  economic value than the other and you have to have hard conversations with folks.

  Richard Groberg (22:31)

  I think the better question is when do you not have to do that if you've got two competitors merging? Of course.

  Brijinder S Minhas (22:33)

  Yeah.

  Robert Goodman (22:37)

  Yeah, yeah, I mean, there is a formula. You you've mentioned EBITDA a few minutes ago. And so what we try to do in terms of valuing things is say, look, combined, you guys generate $2 million in EBITDA, but a million and half of it comes from this group and a half of a million comes from this group. And that's how things are going to be split. As odd as that sounds in terms of

  of that seems pretty straightforward in terms of value. That's still a difficult conversation.

  Richard Groberg (23:08)

  yeah, might, again, a one doctor practice that's not making much money still thinks it's worth.

  Robert Goodman (23:15)

  Right. A whole lot more.

  Richard Groberg (23:16)

  much

  more than the economics. And there are some creative ways to structure. They've got a surgery center that can be sold to a third party, non-related to the business, selling off equipment, what happens to their AR. So there's a lot of creative financial engineering that we help with.

  Griffin Jones (23:34)

  We're talking about single doc groups, can we kind of put like two doctor groups? Are they generally in the same bucket, especially if both the docs are older? Are they often in this situation? And I can think of a situation where it was a two, maybe a three doctor group and was going to sell and there was a younger doc who was an associate and one of the partners was saying,

  I don't know if we can continue with this doc. I think we might have to part ways. And I was saying, try to avoid that at all costs because that's probably gonna be the tune of a lot of money for you with regard to multiple. Is that the case? And what advice would you have for those that are maybe two docs or maybe they've gotten associate, but we're not sure if this is working out.

  Do they need to make it work out?

  Robert Goodman (24:21)

  I'd say for the most part, yeah, they probably do because one of the biggest concerns I think that any of the buyers have is who's going to take over this practice in two years or three years or whatever. And we've got to transition it over even before that. And if you bring to the table somebody, you the seller, bring that person to the table, that adds value. And I think you said that before yourself. And if you don't have that...

  It's not a showstopper. It just makes the transaction that much harder at the end of the day because they have the recruitment is is you know becomes a big factor and as you know as we all know, know the number of REIs that are available is somewhat limited and despite the fact that OBGYNs or GYNs are are coming into the mix and providing certain services you know, they're not they're not they're not REIs and and

  You know, they add value up to a point and some add value fully, but they're still not necessarily board certified REIs, most folks.

  Richard Groberg (25:21)

  Yeah, I can

  tell you from two doctor practices to four doctor practices from when I was selling practices to having recently been on the buy side. If you're not, if the transaction itself is not taking care of and locking in the younger physicians, the buyers either are going to pay a lower valuation because they're going to take care of the lower physicians or require you to. And I've seen a lot of transactions recently where

  The sellers, the buyers have required the seller to give some of the rollover equity or bonuses to the younger physicians, vesting over time to lock them in. Again, otherwise, you're buying something where your principal asset is getting ready to retire and leave after cashing out. So it's important to be able to have, lock in the next generation of leadership.

  Griffin Jones (26:10)

  Bridginder, what's the timing that doctors should begin to think about this? you'd said a bit further out, think people often think, well, I'm not gonna retire soon. But to them, they think, I'm not gonna retire within two years. And so therefore, I don't need to think about it. But it's further out that they need to start thinking about this, isn't it?

  Brijinder S Minhas (26:34)

  I would say if the thought process is that you want to retire between 65 and 70, you should start this process of start talking to folks or get your house in gear. I'd say start at 55.

  Griffin Jones (26:51)

  That's a lot of time in advance. Why so much time?

  Brijinder S Minhas (26:54)

  because it takes time. It takes time to get your mind hewn into the whole concept of, know, suddenly I'm gonna be working with other people. I'm gonna have to be more mindful of colleagues. I'm not gonna be calling all the shots. And if you've been doing that all your life, it takes time to...

  get that mindset ready. you know, even in a situation where we've got the physicians have a reasonably long runway, the buyers want five-year contracts, you know.

  And if the contract is any less, like it's three years, the valuation goes down.

  So are there others?

  Griffin Jones (27:41)

  How do

  people react to this idea when you talk to them about it? You've worked with a lot of different fertility doctors in big markets and maybe they're a single-doc group, but there's a couple other single-doc groups in that market. When you talk to them about the idea of, maybe we should also try to find someone else for you to go to market with.

  Are they familiar with this idea typically? Have they thought about it in depth typically by the time you've talked to them? Or are you dropping a bomb on them that they've hardly considered?

  Brijinder S Minhas (28:12)

  It works both ways, but I think it's, we've all three of us have been having conversations and in fact, Scott as well, conversations in the field. And slowly, I think it's really, it's catching on. It's not that much of a bombshell. I think folks are coming to the realization that this is probably one of the best ways.

  that they are gonna achieve their goal.

  Robert Goodman (28:39)

  Yeah, we've been for the last few years doing email blasts pre-ASRM, even pre-MRSI and especially in the ones pre-ASRM. We try and talk about different topics and we always talk about one of them, the single doc practices and the things to look for and the things to think about. And so we've been trying to plant that

  seed, others too, not certainly up to us. And so I think to Brijinder's point, we try and get that out there. And even in the podcast, Griffin, that you did with Brijinder and I last year, we had some discussion about this as well. So we really try and point this stuff out as early as possible that they should consider these combinations as well as

  other physician recruitment for themselves as early as possible. It's daunting to consider a single doc practice hiring another REI. It's very expensive and they don't typically have the resources to do it. And so that's, we try to soften the blow by at least having, hopefully having these people read about it and think about it.

  Richard Groberg (29:45)

  The closer they are to retirement, Griffin, or the closer they are to thinking about retirement, the more receptive they become to this idea. And I've seen this in other areas of healthcare, because if you're 10 years from retirement, the thought of partnering with your competitor isn't attractive. But if you're thinking about it and it's getting closer to reality, and you see that you've got no alternative, other than perhaps bringing in a

  a junior partner who's going to cost you money upfront and wants their equity for next to nothing, they become more more receptive to the concept because there are fewer alternative scenarios.

  Robert Goodman (30:20)

  Right,

  because the alternative, if they don't do any of those things, is close up shop and, you know, sell somebody your chart or something like that. And, you you'll get $14 and that's about it.

  Griffin Jones (30:34)

  Yeah, that was going to be my question, Bob. Do you meet with people sometimes and you're just like, I'm sorry, it's too late. I can't help you. Does that ever happen?

  Robert Goodman (30:44)

  It's happened to me even prior to coming to MidCap. I spent some time working in the dental roll-up space and I definitely found it there where there were single dentist practices out of their homes, that sort of thing. We've all seen those and maybe we've even gone to those kinds of docs. And they're 65, 68 years old and it's like,

  Okay, I'm ready to go. Now what do I do? The ship has sailed.

  Griffin Jones (31:16)

  Yeah. Donate your equipment

  to a medical brigade going down to South America. That's pretty much what you can do at this point. How far apart can clinics be and still do this strategy? Like, do they have to be within 50 miles of each other? Can a clinic in Cleveland do this with a clinic in Detroit or do they have to be much closer typically?

  Robert Goodman (31:21)

  Yeah.

  Richard Groberg (31:38)

  geography is different if you live in New York City or LA or Chicago. Ten miles is a lifetime. But in other areas where, again, I've seen situations like Brijinder mentioned before, where they're far enough away that the labs make sense to stay open. But if one practice has three physicians and it's an hour, an hour and a half drive,

  Brijinder S Minhas (31:49)

  Yeah

  Richard Groberg (32:07)

  then you suddenly have physician support so that a one doctor practice, he or she can take a vacation. If they've got a big batch, they've got help with it. And there are some economies of scale. So every situation is unique. And sometimes it makes sense to merge them. And sometimes there are enough economies to scale without merging and closing facilities that it still works.

  Griffin Jones (32:33)

  You guys, MidCap has a reputation for being very helpful. From my experience, you all are very patient. Sometimes I feel like too patient. I want to come in and tell them like, wrap this up, move stuff along. But you all have this reputation for coming in and helping people even if they're not quite sure if they're going to sell. they're thinking, well, maybe we'll think about it in a year or two. You all have this sort of MO about earning the business and just

  building relationships. And so I've seen it where you all have come in and helped people with different things, even though they might not be engaged with you or they might not be selling their practice right now. Why do you do that?

  Robert Goodman (33:16)

  Well, I've been at MidCap the longest, so maybe I can answer that a little bit. It's a little bit of the philosophy within MidCap to do that. The healthcare vertical within MidCap is just one of the verticals. And MidCap's been around a lot longer than the healthcare vertical. And so I think some of it comes out of the philosophy of the original founders.

  And some of it, I think, comes out of our other managing director who's been there longer than I have, Scott Yoder. Obviously, know you know him and hopefully the audience that is listening to this knows Scott as well. So it comes out of him as well. And I think it's done him well during his years as a banker. I think

  I think it's the right way to go because selling your practice is like selling your child. And so it's a very emotional sort of thing. I mean, there a lot of people that are definitely dollars and cents focused and that's it. But people in the fertility space are way more emotional about things, I'd say, than some others, some other areas.

  Brijinder S Minhas (34:09)

  Very emotional.

  Robert Goodman (34:25)

  So it just takes time for people to get to really get comfortable with the idea of doing this. now that being said, do we try and push hard at different times? Of course we do. Because it's sooner or later, you know, we want to get a transaction done and we want to be compensated because the approach that we take is that we only get paid when a deal closes. And so

  We try to make sure that the folks that we connect with are of the right mindset. They have the business quality as well as the financial quality that will ultimately yield a good result for us. But we've got to push them along sometimes. But it does take time. And I think people do appreciate that.

  Richard Groberg (35:08)

  There's another reason why it's important to build a relationship. Selling a healthcare practice is not like you sell your home and the day it closes, you move out. Okay. In this case, when you sell a healthcare practice, in most cases, the next morning, you wake up and go back to work. But now you're not the landlord who owns your practice. You have a partner that paid a lot of money to buy your practice. There are some things that are going to change.

  and you have to coexist. So it's not just the dollars and cents of the deal. It's also finding the right partner and the working relationship and subtleties in the terms. And I've talked about this in some of my past podcasts with you and the fact that we've got people with significant healthcare experience and Bridginder and I have been in the industry, having those relationships formed over time helps.

  work the sellers through this very complicated once in a lifetime process that's not just I'm selling my house and I'm moving out tomorrow and I never have to deal with this again.

  Griffin Jones (36:12)

  What do you do when you come in and your incentives, your interests are very aligned with the practice owner because you're not taking some sort of retainer engagement upfront, you're being paid when they get paid. So it's in your interest to make sure that they have a healthy business. What are you doing in those times before they're ready to sell to get them prepared for whatever option they might choose in the future?

  Brijinder S Minhas (36:40)

  It really depends on the individual situation, know, the needs of the of the practice. I mean, we we look at it with multiple eyes and we look at every aspect of the practice. We get a lot of data, a lot of data, financial data, clinical data, and then come up with a a so-called composite picture, a composite evaluation.

  And sometimes, and we've experienced this, the time is not right, you know. All three of us have seen it where we say, well, I think you need to wait six months or wait a year, or this needs to be fixed, or this needs to be fixed, this needs to be fixed to be in a much better situation.

  Robert Goodman (37:28)

  And sometimes those same people, Brijinder's referring to, they have, they've already set some plans in motion for growth. And so we encourage them to continue those activities and let's see how that growth plays out. Cause if it does play out in the way that they think it plays out, that just puts them in a better position, puts us in a better position to help them as well.

  Richard Groberg (37:50)

  Yeah, and Griffin, if you go back to my selling a house analogy, before practice actually goes to market, that significant work we do is like, again, when you're selling a house, you don't just put it on the market. Someone comes in and sees where there are nicks or cracks or things that need to be cleaned up or touched up or improved or or, you know, something we need to wait six months until the market's better in order to do something. But.

  Unlike some of the other groups in the industry that represent sellers, we actually have experience in the industry. You can roll up our sleeves and work with those practices to position them at the right time and with the right, again, cleanup and modifications and posturing.

  Robert Goodman (38:34)

  Yeah, and I've been talking at various conferences over the years on behalf of MidCap and always talking about getting your house in order. And typically we are using it, selling your house as an example. In some cases, it's, you know, changing out furniture or bringing the landscaper in to make some changes outside, you know, or whatever it might be. But some of it's cosmetic and a lot of it's not. Richard talked about things that are not cosmetic.

  although maybe a little bit, but some of it's not cosmic. Some of it's like, you should get that radon test done maybe beforehand or something like that to see if you've got a problem.

  Griffin Jones (39:11)

  What specific advice would each of you give to practice owners?

  Richard Groberg (39:17)

  Every situation is unique. It's just like a fertility doctor can't prescribe the treatment for a patient without blood tests and lab tests and consultation and a diagnosis. And that's part of what we do is we've got to diagnose the practice. then those specific recommendations are custom designed and tailored.

  by analyzing each practice discussion with the owners and our understanding of the markets and who potential buyers are and what they're looking for.

  Robert Goodman (39:46)

  Right.

  If you've seen one practice, you've seen one practice. They're not all the same. There's obviously a lot of similarity. so and we all draw from our experiences and whether they're from the fertility space or working with dentists and ophthalmologists and others where I've dealt with from time to time in the past or surgery centers, whatever it might be. There are so many things that you can draw from and try to work with these folks on.

  And we have the credibility, we have the experience. I've been involved with four businesses and have successfully sold at least two of them. And I mean, personally. So, we've been there, we've been C-suite guys and in large healthcare businesses and other places. So, we think we have credibility and yeah, gray hair goes along with it.

  Brijinder S Minhas (40:37)

  One, two.

  Just a couple of points, know, Griffin, you ask a very important question. In our field, in the fertility world, outcomes, clinical outcomes are extremely important. You know, no network, no buyer wants to take on a practice that has substandard outcomes. And so we look at that very carefully. We look at

  Personnel costs, know, personnel costs are one of the biggest costs in a practice. We look at that. Marketing costs, you know, is the marketing effective? Is it, are you getting a payback on your marketing? Are you doing enough marketing? Are you doing too much? So all of these things feed into the equation and that's, you know,

  Richard Groberg (41:18)

  Or are you doing enough? They may not be doing enough.

  Robert Goodman (41:23)

  Yeah.

  Brijinder S Minhas (41:27)

  that all feeds into our assessment. And we do all of that prior to being engaged by the client.

  Robert Goodman (41:35)

  Yeah, and

  you know, we've had a lot of experience with a lot of practices. And now with Richard on board, I know we're going to be able to home this even more. And although we don't try to always talk about this, you know, we have a body of data that says this is what we typically see as the percentage of revenues that you're spending on marketing. And we see some people spend way above that. We see some people.

  spend way below that. I'm just using that as one example. And so, you know, we try to understand what they're trying to accomplish with whatever it is they're doing and say to them, how is it working and how are you judging whether it's working or not? In some cases, we find that, oh, yeah, we do all this stuff and blah, blah. But so, and how do you track it? Oh, I don't think we do track it. So there's a lot of things that we try to help them with.

  Griffin Jones (42:30)

  I hope that people take advantage of this and get in touch with you. I hope they do so before it's too late. I hope they do so as they're starting to think about things and not further down the line when you could have helped them even more. We'll be putting your different ways of being able to contact you in different places and people can always ask me for an introduction. But I consider myself to be someone that's pretty middle of the road.

  pleasantly persistent when it comes to sales. You all are so much more laid back than I am. And so you're all easy to talk to. Anybody that I've introduced you to has been happy that they've had a chance to talk to you. And it's just an easy, very, very low risk. I hope that some people take advantage of you. A lot of people already have.

  And I look forward to having all three of you back on the inside reproductive health podcast. Thanks for coming on gentlemen

MidCap Advisors
LinkedIn

Dr. Brijinder Minhas
LinkedIn

Robert Goodman
LinkedIn

Richerd Groberg
LinkedIn

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239 4 Must-Haves for Onboarding Fertility Doctors in 2025. Dr. Christine Mansfield and Dr. Renee Rivas

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Today’s episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free, to you! Here, the Advertiser has editorial control. Feature sponsorship is not an endorsement, and does not necessarily reflect the views of Inside Reproductive Health.

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There’s a lot for new fertility doctors to cover when they start at a new practice.

In this week’s episode of Inside Reproductive Health, Dr. Christine Mansfield and Dr. Renee Rivas discuss onboarding strategies for new REIs and share actionable advice from both the mentor and mentee perspectives.

Tune into this week’s episode to learn:

• The 4 must-haves for onboarding new fertility doctors (and what makes it effective).

• Systems for streamlining insurance authorization and patient hand-offs.

• Tips for new REIs on templates and clear patient communication.

• How physician liaisons can help connect new REIs to their community.

• What veteran REIs and practice administrators should consider for future-ready onboarding.

Whether you’re a new fellow or a seasoned practice leader, this episode offers key insights for onboarding success.

P.S. If you liked Dr. Mansfield’s perspective, email her here.

• Transcript

  [00:00:00] Christine Mansfield, MD: it should be super efficient so that you can chart, send your plan to the clinical and financial team, they take it and run with it, and then you're done, and everything's already well in the works, and the patient feels better taken care of too, that's my biggest advice, is just to maximize efficiency, like, figure out your consults, get down to, okay, here's the key things I know I have to say in this amount of time to make the patient know what I'm recommending for them or what testing I'm recommending, but also to keep your charting and all those things, just figure out automated systems for everything so that you know, you can be efficient and take care of as many patients as possible, but then, get home on time and not be home on your computer like, filling things out later 

  [00:00:45] Griffin Jones: Here's the phone book, kid. That was my onboarding for my first corporate job sales. hope have it a little bit better than that, but do they? Who does your credentialing with all the regulatory bodies and insurance companies? Who writes your policies and handbooks? Who introduces you to strategic partners egg banks and cryostorage?

  Who can you shadow? Who markets you as a brand new fertility physician? I have Dr. Christine Mansfield and Dr. Renee Rivas to answer these questions. They're colleagues at Aspire Fertility, a Prelude practice in the DFW area. I asked both of them to join because they're each at different stages in career.

  Dr. Mansfield is the on boarder and Dr. Rivas just got out of fellowship. going through all of this right now. Dr. Mansfield shares her system for insurance authorization to cue the patient from the financial team to the clinical team, to the lab team, and how Prelude then adopted that as best practice across other centers. She shares her advice for new doctors on templates, systems, having a few clear, effective things that need to be communicated patients repeatedly.

  Dr. Rivas talks about what her physician liaison does her and how Prelude's marketing system connects her to referring docs in her area. She also shares legwork that she doesn't have to do because of Prelude's onboarding system.

  If you're a veteran or a practice admin, this episode will help you map the onboarding REIs demand in a 2025 2026 world. If you're a resident or fellow or an REI looking to start at a new practice, this episode will help you prepare. You can tell that Dr. Mansfield is a mentor at heart, I suspect. Dr. Rivas may soon be too. be too shy about reaching out to them and them what you liked about their point of view. Email them, them on LinkedIn. you're more comfortable with me making the introduction, will of course oblige. send me an email a DM. Enjoy this conversation about REI physician onboarding doctors. Christine Manfield and Renee Rivas. 

  [00:02:47] Announcer: Today's episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free to you. Here, the advertiser has editorial control. Feature sponsorship is not an endorsement and does not necessarily reflect the views of Inside Reproductive Health.

  [00:03:05] Griffin Jones: Dr. Mansfield, Christine, Dr. Rivas, Renee, welcome to the Inside Reproductive Health podcast. 

  [00:03:11] Christine Mansfield, MD: Thank you for having us.

  [00:03:12] Griffin Jones: I want to talk to you about new physician onboarding because I think the days of just throwing new docs to the lions. It might be over, or at least it's probably a good idea if they are. you are not so new to the field, but also the old timers would still probably consider you pretty new. So I'm wondering how much has changed in the last five, ten years. Maybe we start off with a baseline of what what's changed. Onboarding typically is for docs. You've done it a couple of times at different practices, at fellowship. What does it usually involve? 

  [00:03:52] Christine Mansfield, MD: Well, it's kind of a process of steps from all the physical aspects of getting set up to be, you know, practicing, credentialed, have the right equipment, have the right logins, to, knowing how the practice flow is, how the systems that operate in the practice, how you fit in and what your role is, and, also, your own practices that you integrate into your daily clinical practice.

  So it's a pretty broad from the nuts and bolts of, having insurance contracts and all of those things to what's your system when you see patients and how does the clinic system work. You know, effect around you. So, It's changed a lot over the years and practices have changed a lot in general. you know, It used to be more, mom and pop, private practices. And now there's large clinic networks that all work together. So there's been some big shifts over, my career, even in just in our field. and it's still changing.

  [00:04:41] Griffin Jones: Those systems, is that just getting trained on the EMR or tell me more about that? 

  [00:04:47] Christine Mansfield, MD: I would say of a whole, you know, set of things that, you know, just to get up to speed with being able to practice, knowing the EMR, knowing how to chart the EMR, like with note templates you know, resources are there that you could use and what you have to build of your own setting up the scheduling template, how does your Physical schedule look like when you do procedures, when you do consults, building out with your office manager, your admin team, what all of those pieces of your day to day look like all have to be done kind of at the beginning. There's quite a bit of work that goes into setting up your clinical flow right from the start.

  [00:05:18] Griffin Jones: long does that take?

  [00:05:19] Christine Mansfield, MD: easily it takes a good three months. We kind of operate in a 30, 60, 90 day goal set now that, the quicker that we know a new doc is joining us, the faster we can start to have them ready to hit the ground running. And, you know, even in Texas, just to get a license can take 8 to 12 months. And, you know, to get hospital credentials, you have to have your license and to get on insurance, to be on their network list, you have to have your license. So, know, The quicker we can start some of those, processes ahead of time with a new physician, the better off you know, and that it doesn't always work out that way So, sometimes we have to adjust our timeline based on where they're at from a licensing, moving, you know, all those. Types of standpoint, but easily it can take, you know, two to three months to have a, a new doc fully up and running.

  [00:06:05] Griffin Jones: Renee's smiling throughout these answers. Renee, are you still going through all of this? You're, so you're part of the 2024 class of fellows. I think this episode will air in January of 25. We're recording it in November of 24. Are you still doing this? Have you just finished?

  [00:06:22] Renee Rivas: Yeah, so I've been here for almost two months now, and there's still bits of this stuff that's still coming through. So she mentioned about credentialing and so on at hospitals, so there's this long application, and then you go back and forth, and then they have their committee meeting date where they go over everything, and then you get their approval, and then you have to go in and, do the badging, they want you to watch these educational videos on ramping, and then you got to go and do whatever their EHR training is as well, and so there's like all these things that at every step they come up. 

  [00:06:48] Griffin Jones: What were you expecting for onboarding, Renee?

  [00:06:53] Renee Rivas: I thought it would be somewhat like that it's a little different I've trained in all sorts of different places and there's a general kind of theme that happens with it. Actually one day I should probably get together all the different badges I've had from everywhere I've been and put them together in something. But there is, there's a bit of a theme to it the EHR, like the electronic health record is. It's very different in most places, even if they have the same system. And I've been spending a lot of time trying to get used to that. If you're even just trying to look up the basics of somebody's like cycle records and so on, there's like multiple ways to get to the same location and then click and then what's the best way if you wanted to show them what is the graphical interface that would make the most sense in somebody who doesn't know as much about it, or, there's like all these little tips and tricks and things that you don't know. You don't realize going into it, and so there's all these, I'm still like, finding all sorts of things just in the computer system. 

  [00:07:39] Griffin Jones: Who helps you with all that? Is it Christine over your shoulders? No, double click on that. No, no, no, right click and then double click.

  [00:07:47] Renee Rivas: I'll be like, this seems like this is the place where this is. And she's oh yeah, but yeah, but then you gotta click this other, there's all sorts of like weird little things, or like you gotta get it then upload it on your phone because if you want to push through meds, have to have the pin to get set up there's like all this stuff. and I'm like, I've used all these things before, but it's just a different, System for all of it and it's new numbers and new whatever, but then we actually have really nice staff here too. And so there's some people are literally, I'll be like, okay, what are, what do I do with this part? Or where do I find this?

  Or when you're looking for this, how do you get there? And then they'll just show me like, what's their different way of getting in. I'll be like, oh, I haven't gone that route yet.

  [00:08:20] Griffin Jones: Is there an orientation with a syllabus and all of the supported materials organized in one place? 

  [00:08:27] Christine Mansfield, MD: we've kind of Developed, because when I would say I've been with our network almost the beginning, like since Veer Prelude and then onto Inception and, pretty much it seemed like every time you had someone new, you were kind of rewriting. The wheel, you know, with just what to do, and there wasn't ever a system, but we've actually gotten to a pretty good place point where we have sort of a.

  so much for joining us today, and we hope to see you in the next session. Bye. Bye. And then we have like HR who has to, you know, get you in and show you, you know, they kind of go through a whole corporate culture and what do we mean and what are all the pieces of our company that function together, like, from, you know, our egg bank to our, cryo storage and, you know, just doing all those things, but then, getting you on site and knowing, typically what we did, like with Renee, the first couple of weeks, out a schedule of like, okay, before We're going to have you work with every section of the practice so you know what they do and how you'll interact with them and what their jobs are. So, like, She hung out with the admin staff and how they scheduled new patients. She, you know, got to see financial counseling and, like, what types of things they're talking about and what that side looks like. Obviously, not her specialty, but you have to know those things. And back in the lab with Dr. Stout, our, lab directors, so she can see, okay, what's their flow in paperwork and scheduling. And then we, you know, obviously have new doctors shadow our physicians, because we all have different practice styles and consult styles, way we, you know, For the most part, we all practice similarly, but just little, you know, tidbits to learn in terms of how to interact with patients and, you know, how we slightly might chart differently or, you know, what are strengths and, you know, pieces that you can pick up to match what you want to have as your own style later.

  And, then there's the whole marketing a new physician. So that's, um, It's a whole piece of, you know, getting Renee out there in the community to, you know, meet our referring doctors to raise awareness, about her background and, you know, what makes her special as a provider. And we have a whole schedule, just almost a blitz of going to different practices, meeting physicians, , potential patients out on social media, you know, so the marketing side of getting a new doctor busy is also quite important, you know, to have collateral for their business cards, their bios, their social media, their headshots, like all of that piece, you want to have those things ready as quick as you can when they hit the door.

   Yeah, that's how you make those connections that, you know, many times will bring in your first patients to, you know, directly refer to you.

  [00:11:07] Griffin Jones: Am I correct in understanding that some of the phases of this onboarding falls with the network and some falls with the practice? So like the credentialing, the HR, is that all happening at the network 

  [00:11:18] Christine Mansfield, MD: Yes, network level marketing, um, we have our onsite liaison, but it's also a whole team that actually works on onboarding new physicians to help with the, the network helps with that. Marketing collateral all goes through, pretty. , centralized process, for where to order collateral, where to upload, to where she's going and who she's meeting to just kind of maximize efficiency you know, a digital marking plan, that mainly is network based, although we do some of our own, on site social media posts and videos and those things So it is definitely a combination of on site and network based resources when we onboard.

  [00:11:53] Griffin Jones: Tell me a little bit about what happens with the credentialing team. What do they do?

  [00:11:57] Christine Mansfield, MD: We upload all of the documents, like licenses. Diplomas, certificates, and they will go through, we have to electronically designate them as our person to go through and do the actual credentialing. And then usually once the packet is done, ready to go to the medical board at the hospital, then we sign off on it electronically, usually with like a docu sign. You don't want your new doctors having to manually do this stuff. You want them to be, out learning the practice, out meeting providers. 

  [00:12:28] Griffin Jones: Did new doctors manually do this stuff? Before, prelude that had this team, like, docs were doing this on their own, they were going and filing and, and so all you have to do is give them your license and your information and designate them as your power of attorney or whatever, or just give 

  [00:12:48] Renee Rivas: they have a part on the website where you can designate them and then it gives them access and then they can log in under the same heading and adjust things for you. You have to send them your, your copies of everything in advance and so on, but then they can do that and then, particularly if you're doing credentialing at more than one place and that's super helpful. going everywhere.

  [00:13:05] Griffin Jones: what's HR onboarding been like? Renee, I am thinking of Toby in the office and, what's it been like for you? 

  [00:13:12] Renee Rivas: It's just like a normal job. But then you just have all this other documentation related to your training and, licensing and all that stuff.

  [00:13:17] Christine Mansfield, MD: They, have network contracts for those items so we don't again, not reinventing the wheel, you're just kind of sliding into what the research has already been done on how to do

  [00:13:26] Griffin Jones: how has this process evolved over years, Christine? Is Renee experiencing the same that you first experienced?

  [00:13:37] Christine Mansfield, MD: Even when I went to Tucson or came back to Dallas I had to spearhead a lot more of that than now, just as far as So, I just kind of showed up and they gave me a task and some information, but I didn't necessarily have a marketing plan. So, I sat down with the marketing, professional, and we just had to map that out ourselves. So you know, A lot of things I would say it's nice when you kind of go into a more operational practice and network because, a lot of the newer docs aren't having to do all that, which it's, it's a good learning experience for, knowing how to grow a practice. I've done it several times, but that being said, it's very time consuming and to, to go through the beginning.

  We've got a list of, every provider in Dallas. what the practices are, what, areas, you know, are going to be high yield for referrals to our particular practice. So, very strategic in getting her out to the right people. Most important places first, so that, you know, she has those relationships early on, rather than having to map out her own marketing plan, or, you know, her own social media posts, or those things, it's really nice to be automated. Because I will say, even in 2019, when I got here, we really didn't have any of that.

  [00:14:40] Griffin Jones: I want to ask about how that roadmaps evolved and I'll direct that to Renee in a second. But Christine, you were in Tucson, you moved back to Dallas. You could have went and worked for any number of practices. It's a big market. There's a lot of really good practices there. You decided to stay within the Prelude Network family. did you decide that?

  [00:15:04] Christine Mansfield, MD: We had some personal reasons, even though we we loved Arizona, the practice was doing amazingly well. It wasn't, you know, a practice issue. And in fact, it was hard to leave because it was doing so well, but, we needed to be in a bigger city for my husband's job for some needs with my children.

  And so I actually looked at several options. I looked inside the network. I looked outside the network. One of the things that I was, And the other thing that I was really you know, Dulles was one of the areas they had that it felt like would be a good match for me and it was high on our list. they also offered other leadership opportunities at some other practice locations that I did consider as well. Some physicians have a bad experience with corporate. Partnership, my particular experience has actually been good. And, the management teams I've worked with, a lot of them have actually been there now for quite a while. So, We had some background together and and I felt like that our interactions had been good and that I have been treated well during the process. So, 

  [00:15:56] Griffin Jones: What's made them Good?

  [00:15:57] Christine Mansfield, MD: I would say they may not always have things right, but they were also willing, if their systems were not good to make change and to take feedback. in my mind, a good corporate partner is not going to try to dictate your day to day, your clinical management, your protocols, and to a degree, how you run your clinic and staff, because so much has to be true leadership on site, but give you the right of things that you don't want to do as part of your practice. Billing, marketing, those things you have to be involved in. But, do I want to have to, do extensive coding on all my patients to make sure we're well paid? No, I really want to know that someone can handle that side of it for you so you can focus on growing your Practice and being a good physician because so much of medicine is still a business and nobody preps you for that when you come out of medical school you know how to be a good doctor, but nobody really knows how to run a business. you learn a lot when you've been in practice a while and you've been at several locations or built things more from the ground up, but you also know that's not what I enjoy.

  That's not where my talent is. And knowing that I have someone who can, Help with aspects of the practice to make it successful that I don't have to personally manage. I mean, that's huge, both for life quality and, for practice satisfaction and, if the relationships are structured correctly, then for income too.

  So it's a win win we both have the same goals, as long as everybody knows what their strengths and what they bring to the table as far as a partnership.

  [00:17:19] Griffin Jones: You said that there were some things that maybe they didn't get right in the beginning, but they were open to change. And I wonder if you can think of a couple examples that you'd be willing to share. And one of the things that impressed me about TJ when I've had him on the show, I probably have a favorable bias towards TJ because we've done business together and one thing that impressed me was I asked him a similar question. and he was really forthcoming. He said, look, we got this wrong. These were the consequences from it, and this is how I fixed it. it just impressed me that he would share that, and I wonder if there's examples that you can think of you know, like, you know what, this was not working before, and we changed it. 

  [00:17:55] Christine Mansfield, MD: Corporates always, in general, trying to create a system to help with things. So, whether it's, doing insurance verifications, doing financial clearances and consults and insurance offs for treatment cycles.

  And so, their goal has been to provide as much services to the clinic of those sort that are off site. So, we don't have to employ staff on site to do everything, like reinvent the wheel, just to have centralized services for a lot of those things. And when they originally started doing insurance authorizations, their system sucked, they didn't really have a tracking mechanism. And, I am a big systems person because I mean, if systems are in place, you can run efficiently. You're not rethinking everything. you know, If you're just sort of doing Head on fire kind of approach that the most urgent pressing MAG patient, because they've been waiting, is the next on the list.

  You're never getting ahead. And so there really wasn't a tracking mechanism for the staff. Okay, which offs do I need to run first? How, what's the timeline on this off for this patient to start on the date that she wants to? So one of the things that we developed here that I have always used in my practice was sort of a cue, like a, you know, a running list working document between the clinical team, the lab team, and the financial team To okay, who are the patients coming up?

  Whose insurance? Who's self pay? Have they been cleared? Clinically, is there anything we need to be prepped for? Are they, you know, Any special thing with the lab? Or do we have too many starts in one week where we might be worried about coverage or they didn't have a system for how to work the list. They just had a random list and tasks coming in and no prioritization system. So, RQ and tried to integrate it into the EMR, which has been partially successful, but it's still a work in progress. But trying to develop a tool where all three, , can interact is, You know, it's a good goal, because otherwise, most clinics just operate on a, I get a task, I get to it in a list of, but sometimes there's ones that are more high priority, a patient who needs to start in two weeks versus someone who's starting in three months.

  And if you don't work them in a priority system, it doesn't work as well. So, They've integrated that into the EMR. We've had to have some feedback on how they are tracking like where those things are at to communicate to the clinical team. So that's been a work in progress, but something they've definitely improved on.

  And so, I think having that kind of dialogue that you can take pieces of things from different practices that are well and make a tool that a lot of practices could benefit from, but you need that input and you need to be willing to take that input. So, I think that's 1 thing they're doing much better over time. 

  [00:20:20] Griffin Jones: did that Practice remain, meaning that system of operation, remain within Aspire, or was that implemented at other practices throughout the network? 

  [00:20:29] Christine Mansfield, MD: It went into EIVF for other practices. So it's actually a tool in Practice Edge, which is the, administrative tool that the financial kind of sits on top of EIVF, 

  [00:20:38] Renee Rivas: It was interesting. We get people from referrals from all over, right? And so then basically with our marketing team they have pattern and where they go and they visit people on a monthly basis. And so Diana who's our head positional liaison, she basically was like, okay, well let's go here.

  And then this one. And then like on subsequent weeks, she says she tries to keep it down to just, one day a week, and it's usually just for a few hours in like a morning or an early afternoon. We'll go around, stop in, see people try to get a few minutes with one of the physicians or a couple of them that are in the group, depending on who's there that day. It's really nice, actually, because particularly if you're in training, you're used to being able to interact with the people that, You see these referrals from and then you can reach out to them and say, oh, hey, I saw your patient, blah, blah, blah, and coordinate versus in this, it's a different kind of feel because you see that there's a referral on it and who that is, but then you're like, oh, wait, I don't have their contact info.

  And usually in like a university setting, there is a way of messaging them within Her job is to make sure that these patients are getting that same electronic medical system and that doesn't exist in this void. So it is nice to actually get to meet them so that when you see one of their patients and send them something, then you can talk about it if needed and discuss and kind of plan for things.

  Yeah, so she set up like different offices that are in the same area and generally you don't want to be driving back and forth and back and forth, as you mentioned, like To have a focused area so that you can hit a lot of different offices in that same region and then, for other places so there's like Plano, then there was like a Richardson area, and then there was like North Dallas, and we went to Louisville and Flower Mound last week, and we've been hopping around to get some of those areas in. then occasionally there's like maybe once a month or so we've been doing like a dinner so that we can meet, because like I said, I'm stopping in and if the, some of these offices have like satellites and so on, so it's not like everyone's there all the time or someone will be in the OR, so then you can actually meet everyone. 

  [00:22:28] Griffin Jones: Be honest, you can't lie it's the holiday season, so you gotta be forthcoming. Would you do that all if you didn't have a liaison , giving you that kind of structure?

  [00:22:37] Renee Rivas: I don't know, to be honest, I don't know if it would occur to me to have that level of structure. I'd like to think so. But it's just that she really knows the area, right? I wouldn't know that, I'd be like on like Google Maps or something and looking at these and being like, Oh, what about this group?

  And, asking people like, Oh, do ever see people from this area? Or, who do they refer to, or who do you even talk to, it would I don't think it would go near as smoothly.

  [00:22:59] Griffin Jones: Does that include having a relationship with some of the other docs and some of the there, so, you know, this person's office manager is really into the Yankees, and, like, do you get that kind of intel?

  [00:23:11] Renee Rivas: There's an element of we'll walk in and she'll often know the office manager that's there or She'd be like, Oh, hey, do you need this? Or, do you have this? What about this? And she'll know all the little details about a lot of the people that are there.

  [00:23:21] Griffin Jones: Do you feel like you're starting to make meaningful relationships with referring docs, or do you feel like you're just a baby step into a really long process?

  [00:23:29] Renee Rivas: I think it's probably more the second, to be honest, I'm getting to meet people, but it's still the first time usually, so it's not like I'm getting a whole lot of back and forth there and there's an element too that it's OBGYNs are kind of your people, that's often why a lot of us in medicine get into different areas, because you feel like these are your kind of people that you get along with, so that part is nice too, but I'd say it's still baby steps.

  [00:23:49] Griffin Jones: So I could see that would be useful having that kind of structure because especially if it's a longer term process, the likelihood of you sticking with it is if you have a personal trainer, right? If you have someone laying out the meal plan and the workout, it's a lot easier to stick to the protocol. I suspect that's where many docs have fallen off in the beginning is they go to an office and they say, Oh, well, I tried. And, that's not exactly how relationships are built. What advice, Christine, have you given to Dr. Rivas during this, whether it's about the marketing bootcamp or anything, what sage wisdom have you imparted on her? 

  [00:24:28] Christine Mansfield, MD: Number one, find your good work life balance. I think that, piece is super important. And, my kids are older now. Different structures, schedule, and Renee's kids are younger. So different phases of life, different, schedules work better and kind of make those things work for your long term happiness. then, as part of that, maximize your efficiency. That piece, I can't say enough, physical time doing things doesn't always mean you did it better, and you shouldn't be reinventing the wheel on a lot of things. I really most days try to take home very little charting or work. I mean, I might answer phone calls, messages, you know, but. When I leave, my notes are done. And, the way you do that is to have really good templates so you're not retyping a note every time you see a new patient. It should be most of the things we do are very protocol driven and so should our charting.

  So it should be super efficient so that you can chart, send your plan to the clinical and financial team, they take it and run with it, and then you're done, and everything's already well in the works, and the patient feels better taken care of too, that's my biggest advice, is just to maximize efficiency, like, figure out your consults, get down to, okay, here's the key things I know I have to say in this amount of time to make the patient know what I'm recommending for them or what testing I'm recommending, but also to keep your charting and all those things, just figure out automated systems for everything so that you know, you can be efficient and take care of as many patients as possible, but then, get home on time and not be home on your computer like, filling things out later.

  That's probably the biggest advice. Don't linger, just stressing over things. Just go ahead and find your systems and be efficient.

  [00:26:04] Griffin Jones: Notes is one thing, I imagine there's other things. What are some of those other systems that you have to automate?

  [00:26:09] Christine Mansfield, MD: I would say, having a system of what happens to your patient's journey, and the good thing is we kind of have that, that Renee came into that, but, sometimes that's not always there, we have sort of a clinical team that works together, some patient, some practices, you might show up and here's your MA and your team and you figure it out, most of my consults now are 30 minutes, whether it's a new patient or whether it's a follow up, you know, I always recommend that newer docs start with 45 or so, and then, see how they do, and then many of them can cut that down. If it's a brand new patient, no testing or anything, you walk through the diagnostics mention treatment steps, that plan goes to the clinical team to help, reach out and make sure they know how to get their testing scheduled, and to the financial team to check costs, same thing with a follow up, once we decide their treatment plan, IVF plan, IUI plan, it goes to the clinical team to start executing those steps, and the financial team to help the patient figure out those aspects of it A lot of those things are built, but not everyone walks into that. And I think, just having systems for those things patients know if things run well I tell them my insurance team is going to call them within a day, having those steps be really automated, you just have to make sure your team can deliver on what you're telling patients. and then also procedure wise, being efficient , back in the OR.

  And it's nice because we have our clinic and go back and forth, between the clinical side. Some practices have separate clinics and labs. So, making sure you're efficient. But, luckily we have a lot of things already here that, she can use and tailor to, schedule.

  [00:27:34] Griffin Jones: How does that level of protocols or being protocol driven in that way compare to maybe other practices or even how does it compare to years ago? it more protocol driven? How has that evolved?

  [00:27:50] Christine Mansfield, MD: Nobody dictates physicians, how they should practice, but we, try to as a group, one thing I really encourage is that we meet and talk about, okay, If we're doing an antagonist protocol, here's what our general structure is.

  You can change things, but you want the nurses to be able to know, this is how I order, this is how I take care of a patient when you give me this protocol. We really just want to try to all be in agreement about major things. Obviously you might tailor individual treatment decisions to a patient.

  That's always fine we all kind of have the same general, Types of systems so the staff can take it and run. I think having those conversations, because sometimes it changes as the science evolves. When they plan their treatment, you're not reinventing the wheel every time again.

  [00:28:30] Griffin Jones: Is it harder to as many templates or as many effective templates in the absence of having lots of partners at different practice?

  [00:28:42] Christine Mansfield, MD: We don't all have to chart the same, but just having a template you can take and tailor to your own, like we have an note. Most docs aren't going to need to change that. It's pretty basic. It's got all the right information. You can add anything and you need. Now, on a consult note, your consult language be slightly different than what I chart.

  Yeah, but you can still take my note and alter that. To tailor to what you're documenting but a lot of the procedure notes and things like that, once they're there, they're great resources. So that's what I told all the docs. The one good thing about EIVF, you can access Any clinical template in our network.

  You just have to talk to them. If you meet a doc and they're telling you about some templates that they have, which I always share my templates, they can upload them right in and you can take those notes and tailor them. So don't rewrite things. Just take the resources that are there and make them what you need.

  [00:29:30] Griffin Jones: Maximizing efficiency in these ways is partly in service to making it work with regard to your schedule. So what's that been like, Renee? What is making it work with regard to your schedule? 

  [00:29:42] Renee Rivas: There's an awful lot of different notes to go through and things that we have, and they're so useful, you have no idea, like you go do a procedure, you need to go do a documentation on it, a lot of them are really straightforward, you tend to do the same kind of things, maybe we'll put a note in there like an extra little note. Tidbit on something that you did about it that made it easier or something like that. But, for the most part they're very similar and so it's nice just to be able to go in and I'll be like, Oh, wait, did E& D, so where's that little note at? And I can just go through, click through, it makes it very straightforward in terms of having that set up. In terms of finding out like why it was done and things like that's also helpful too because sometimes when you go in they'll want to talk to you about it. In terms of getting like new notes set up, that's usually, there's a couple of ones. DR. And it maybe you spend a little more time where you want to make sure when I want to talk about it in this order and so like mentally this is my arrangement.

  So maybe I want to somewhat how this note is structured a bit, so that like when I'm going through it makes a bit more sense because that's just how I'm thinking through the discussion. So I've made like tweaks and stuff like that to some of the templates and I found that It's pretty helpful but, there are a lot of ones that are available, and so it's not like I have to completely reinvent it.

  I can often find bits of that in other people's, or if I look and see what different consults are about, or a patient who had this thing, and I look at their notes, and I'll say, oh wait, they have this sort of language or phrasing or whatever that's used, and you can borrow that and adjust it, and it just makes it a little bit easier, I think, to have much available already. 

  [00:31:01] Griffin Jones: How has the workload been with regard to using efficiency as a means of making the workload manageable and still having a life outside of work? So, You've been on a bit of a seesaw the last 15 years, undergrad, then med school is pretty intense, and maybe fourth year of med school is a little bit less intense, but then you're in residency, which is ultra intense, and then you're in fellowship, which is maybe a little bit less, especially third year.

  Now you're in the workforce. What has that been like, and, does it feel really intense, and how do you use the efficiency to make it work? 

  [00:31:39] Renee Rivas: Residency is definitely the worst part of it. But, once you get used to doing 24 and longer hour shifts and figure out how that goes I don't really do those anymore. I'm not on the OP floor.

  Honestly, all of it just seems so much better. I had my oldest daughter when I was a resident, and so, there were a lot of times where I'd be like, oh, look, there she is, she's going to bed now, and I still have to finish charting and so on, and then in fellowship I had my second child, and so it was.

  I got to spend more time with her when she was younger and it just feels I have a third one now. But I feel like I get a lot more time as it's gone on because a lot of the demands outside are not so terrible and then honestly OBGYN, whole thing is just all about efficiency. Like I can't tell you how many people are like, oh you got to have like your note system set up right or what's your template or people will talk about their different like Epic is a common one that you use when you're in training and stuff and Residency and Fellowship was like a EMR. It's just one of those things that you have to use in order to have all that efficiency down. So it's, it's a huge part of everything. And honestly, for me, I feel like I probably have been stressing about that aspect more because I spent so much time trying to make sure that I had that down to make it easier. The other end of it, too, is that even though I know what I'm writing in, I'm used to doing a lot more of the legwork myself to make sure these things happen when I'm putting this here, I'm like, oh, follow this and make sure they have the schedule. I'm used to opening up their schedule and making them that appointment slot and putting it in and here, that's a lot more. Or I can ask somebody else to do it, or I can just put it in my note and then send that to someone and there's a way of like making tasks and things like that. And so a lot of that gets offloaded and so realizing the amount of things that I can shift around like that and get help from the other staff in terms of doing this is like so amazing. So it's just learning all those different things and delegating and learning how to use that system. Another part of it too is just like in learning all this so I'm thinking when I'm putting in my note to do these steps next and I'm sending it to someone, one of the nice things about when I was onboarding initially and seeing people in all the different departments was I was like, okay, so you see this, what does this mean to you? Like how do you interpret what this is used? So that I know what they're getting out of it. So that I'm not asking them to do something, but they don't realize that's exactly what I mean. So having that time in the beginning just to make sure that those messages are clear, and so I can see, Dr. Mansfield does her consult and puts that in, that she's actually asking them to do this part or not to do this part, or, you get all the subtleties of that little bit of communication as well. 

  [00:33:59] Griffin Jones: and so all of these you might take for granted, this legwork that you don't have to do now, but they're the results of systems, right? Like you can't just delegate it to somebody else without a system, right? You need some sort of operational infrastructure to train that tell them what to do. We've we've talked a lot about it, but can you tell me more about that?

  [00:34:19] Renee Rivas: Sometimes we'll do some of our diagnostic testing on someone, and they haven't been, They've been referred to us to do like an HSG, so like a tube check. And this is often a test that's hard to schedule. It's not set up for your OBGYN generalist to have in their office to do it themselves. If you try to have it done at a radiology department, it's not offered in a lot of places. It's one of those things that we're really good at doing. That it's hard to get in a lot of other places, but sometimes, another provider will be seeing this patient and have an infertility concern and they'll want to make sure their tubes are open but maybe they're not quite ready to do like a full referral and have you take over their care in that regard.

  They'll just want an HSG. and so they will refer for that and then you can meet them, meet the patient do their HSG, but then that record has to get back to them. And so you're like, oh, that makes sense, right? But the thing is, again, the different medical systems. And so I see the patient, I talk to the patient, I introduce myself.

  If they didn't, they wanted to come in for treatment, then I've already had that. I can tell the provider, oh, I saw your patient, thanks for, referring them, whatever. So there's that kind of back and forth. But then there's the other part of like, how does that. Information then get back to the provider, so that's referral, right?

  So then I have to know which office staff to reach out to, to send them my note, to send them the documentation, to send them images so that it gets back to them, and then how's that all process work? Each of those is like a learning point of how to it's like the nitty gritty stuff, but it's how to make all that happen. 

  [00:35:34] Griffin Jones: You've alluded to some of the lessons that Dr. Mansfield has shared with you along the way, but does any advice really stick out in your mind, or is there something that you watched her do you thought, that's an example that I want to emulate?

  [00:35:49] Renee Rivas: So many things. Just that like what I just mentioned to you, she's been so thoughtful when I first started I was like, where is this at? Who are these people? Everything is so new, right? once you get more comfortable being in the office. And it's been so nice because it's like, it doesn't feel like it's all coming at me at once.

  It doesn't feel overwhelming. It's like she seems to sense like right when I'm, Getting the stage figured out, then you're like, add another little level to it. I don't know. It's been so great.

  [00:36:12] Griffin Jones: What further things do you think will come into onboarding, like if you could wave a magic wand and either get rid of some steps or have more structure around certain steps across the field, what do you think? need more support with, with regard to onboarding.

  [00:36:28] Renee Rivas: There's a lot of like components that go into that, to be honest. It's really amazing to have that kind of admin. I can't tell you how nice it is to have that admin support. Especially with the credentialing, that's the stuff that takes so long. As much as it gets offloaded for me in this process, there's still a lot, because I have all the documents, right?

  They don't just have those, so I have to send it to them. But that is such a huge part of it, and then I mentioned credentialing, and I was talking about hospital, but it's also, like, all the insurance carriers. You have to get credentials for each and every single one of those I mean, That's what it means that somebody's in network, out of network, takes that insurance. such a huge thing. It would be so nice if we had a way of on ramping that, or just in general, I mean, if you're talking about massive systems the credentialing process for each hospital, they all want the same information, but you have to fill out a separate application for each and every one that you Like, Wouldn't it be nice if you had an actual unified system? There's a common application for medical licensing, but it still has state specific requirements, I filled out the universal one before, but it still wasn't enough, because I had to do all this extra stuff that was specific to Texas there's a jurisprudence exam that you have to take that nobody else does. We're talking about systems here, but if this existed on a larger scale, so that they could just look at your other records. at hospitals before, other hospitals wouldn't it be nice if they could just see that, you've done X number of cystoscopies, and you don't have to go back and find the number of records of those that you actually did, and it's just there?

  Wouldn't that be so amazing? know, that's a bigger issue. 

  [00:37:49] Griffin Jones: There's an AI opportunity for someone listening. Christine, it seems like I've gleaned from this conversation that you enjoy this mentorship role. If I'm not inferring too much, why is that?

  [00:38:01] Christine Mansfield, MD: When you go through training, you end up just working with different providers who just have, like, such an impact even when you choose a specialty, like, Renee was saying, you meet your people and you just, find those special people who kind of help.

  And I don't know if that's what kind of drew me, but I do enjoy working with new physicians. When I first came out, we, operated with the residents, set my first practice, and I kind of missed that interaction so, one of the things I have really enjoyed is getting to work with a lot of new physicians and to kind of, ramp them up.

  I worked with our Austin physicians, and we actually are putting together peer groups, like the. Group of docs who started with the Inception Network. We had, kind of a whole like day down in Houston that we got to talk about everything and being a new doc and efficiencies and, then even look at my schedule and walk through things.

  And it was a mix of brand new doctors and some who were just changing And, you know, I just, really, You know, enjoy it because you get new ideas. You got new things from, I learned from them. And when we all are doing well, it's a good thing. Everyone's happy. I would say, I think it's, probably something I've just always enjoyed. I'm kind of a problem fixer and trying to put things into systems and get people in the right places. And so I think it appeals to, that side of me, trying to help each physician figure out their own path. It's helped me grow too. So I think Personally and professionally, it's been a great thing.

  [00:39:18] Griffin Jones: You gave an overview of ideas and best practices, but dig a little bit more into specifics, if you will, about that. What big takeaways Did you come away from that? 

  [00:39:28] Christine Mansfield, MD: The most valuable part was, the whole afternoon we spent with just that group. we walked through everything from how do you run your team? Each team might look a little different. I really encouraged each of them to kind of map out, okay, from when the patient was in your office. How do they get from point A to point B? Like, Do you know each step of that? And is that going to be smooth for the patient? Making sure those things, if they're not already there, are set up. And then we talked about, like, just general schedules in person versus online consults. That's a whole other area. Like, I told Renee, I was like, have as many people as you can listen to your consults. Just from different levels of understanding about, process and the more feedback you can take, the better. You're only going to get better when Asked for the feedback. Just walking through every aspect that could come up and being able to answer questions and show them real time. We pulled up my schedule. We looked at things. We looked at notes. How do you make a template? How do you get in touch with the IT people to help you look at the templates? But then once you get there, all sorts of things come up. So, Mentoring, I think, is something that in training, it happens naturally. You're in a training environment, but when you get out into practice, you can get really isolated and not keep learning and not keep learning best ways to do things as practices and science and all of it changes. So For me, just having those conversations in our network has been super valuable. And new docs coming in, bring new ideas and new ways of doing things too. So, you know, You can just keep getting better at what you're doing. And so I think just having that dialogue all afternoon walking through all sorts of different aspects about integrating into the practice you know, marketing and everything and what that looks like and what resources are there, what they can do. it was Really great actually, so 

  [00:41:01] Griffin Jones: I think that's sage wisdom, having as many people as possible listen to your consults and I think that I could ask you for 45 minutes to an hour just about that. So I wrote it down as a future podcast episode topic. I won't take us down that rabbit hole today, but I imagine that having worked with some younger docs now in this capacity, you've seen them be surprised by certain things.

  What do you find that they're either surprised by, or not prepared for, or their expectations were different? 

  [00:41:31] Christine Mansfield, MD: what you underestimate going into practice a little bit is just your day is going to be structured in some way with some procedures, doing ultrasounds, retrievals, you know, those things, and then you're doing a lot more face to face with patients than you ever thought, especially once your schedule gets busy.

  And when you're in the midst of talking to patients, I think the biggest learning curve that first two years is just learning. How do you take a patient with a middle school grade education or a PhD who came in with every science article on egg freezing that you can imagine and wants to freeze 50 eggs?

  How do you go from one patient to the other and get that? The right information to them to make their best decisions. And that piece, it's probably more mentally exhausting than anything else because, some patients you can do a consult and they're going to listen, take notes and do exactly what you've mapped out for them or recommend to them.

  Some patients you're going to really get drilled and the mental back to back of that it's more tiring than you expect. Emotionally tiring than you expect. You know, Nothing that we're doing is life or death, but to patients it feels that way. And it's as stressful as a cancer diagnosis.

  So they, sometimes they come in like knowing nothing and some of them come in with a lot of emotion and, preparation and, being able to handle that pressure from patients, I think is probably one of the harder parts. 

  [00:42:44] Griffin Jones: How do you prepare new docs for that? Do you just lay out the scenario for them? 

  [00:42:48] Christine Mansfield, MD: Finding a few ways to communicate ideas that are really effective and using that same language repeatedly, that's a good thing. You don't want to have a new conversation every time sometimes figuring out a way to tell the patient, how do you decide between IUI and IVF and you walk them through both sides, both success rates, but here's the pros of this versus that I want you to take it and decide in your heart, what's your next best step?

  And patients don't feel like they're being pressured. So you just really have to find good ways of communicating to patients. And we're not taught that real well. It's really just takes practice. Like even when I went to Tucson, I had been practicing five years and I still had two of the HFI came out and they gave me pointers.

  Okay. Try these things with your practice. Try these things. Try breaking your consult up into two instead of one big one. All of the coaching and mentoring, you just keep getting better if you just are open to kind of looking at other ways and constantly trying to get better. 

  [00:43:41] Griffin Jones: And after action review is really useful for some of that stuff, isn't it? Like taking the time to actually sit down and write it out. I was, I've been asked this three times and each time I felt like I was caught on the back foot or I stuttered, or I gave an inconsistent answer in each scenario. And I did that in my own consulting and sales practice of that every time that I run into that, my, okay, this is something that I need to sit down, 

  [00:44:05] Christine Mansfield, MD: right. 

  [00:44:06] Griffin Jones: and write about.

  [00:44:07] Christine Mansfield, MD: And just have a set answer that is a good answer. You're not reinventing the wheel. The patient feels, okay, I feel much better now hearing that. I am concerned about having extra embryos. You have a very set, here's the things we do. Here's options we can do to make sure that we complete your family, but don't have too many left over. Having those answers ready at your fingertip, not having to think about it, that, Take some time, and sometimes some real intention, sometimes writing out certain phrases and just learning them. Honestly, it's one of the most efficient things you can do, especially on a consult where you might meet that patient on a video call.

  And you have to make that connection with them in a way that you can't always make face to face, and you have to practice. Practice, because it doesn't always feel natural when you first start. And, I've mentored some docs who were struggling in their practice it's not just being knowledgeable, but you have to make the patient believe in.

  So, It's really about the information you're giving them that it's going to have a good chance to work or the expected chance to work, being able to communicate that. I mean, It really does go back to communication and a lot of levels because we all have the knowledge, but not everyone can relay that in the most effective ways. 

  [00:45:11] Griffin Jones: Docs listening might think I don't want to read from a script, but after a while, it won't Be a script. And you make the script as concise as possible, but the more you practice your lines, going to be able to, ad lib. You're going to be able to, to riv off of it goes back to what you were saying about templates. You want to have a replicable solution to a replicable challenge, and then you can. Custom tailor it accordingly. I think that's really good advice for young docs. And you better be thinking about what each of those are, Christine, when you come back, we're going to go over what those different set points are for effectively communicating to patients.

  renee, This is a little bit of the blind leading the blind. I mean, You've been at this place for 10 years. for two months, but you are in the thick of it, and so I think that there are probably things that you can think of that here's what people should be doing to be prepared, and we've got a lot of fellows, first year fellows, a lot of residents that listen to this show, what advice do you have for them?

  [00:46:11] Renee Rivas: I said, just say, take it in. People have so many different ways of communicating. All the time now, I will be thinking about how to describe something and I'll hear. Thank I hear somebody else's voice in my head, you know, particular words of advice or phrasing or things like that. I would say just Listen to the people around you listen to the words that they're saying, think about how they're saying it, thinking about how the patient might respond to it, and maybe what they're hearing isn't the same thing as what is being said, appreciating those sort of differences in terms of what their experience can be I think so much of that is, is so valid. I just so appreciate a lot of those subtleties that are there and listening to the ways that people have of making themselves heard and then the ways that sometimes maybe it's not happening the way you think it is at times. 

  [00:46:54] Griffin Jones: I hope that to the younger docs listening, take advantage of this and they're not too shy to reach out to each of you. If they did reach out, would you be opposed to that? 

  [00:47:04] Christine Mansfield, MD: I'm always happy to talk to and I think that's the 1 thing that, again, being in private practice, you don't want to get isolated. You want, that peer group just learning new things from each other. And So, no, I would definitely welcome it.

  [00:47:16] Griffin Jones: Well, if they are too shy, you can email me and I will connect you with Dr. Mansfield and Dr. Revis. Dr.

  Christine Mansfield, Dr. Renee Revis. Thank you both for coming on the Inside Reproductive Health Podcast. ​

  [00:47:28]Announcer: Today's episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free to you. Here, the advertiser has editorial control. Feature sponsorship is not an endorsement and does not necessarily reflect the views of Inside Reproductive Health.

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