This week on Inside Reproductive Health, Griffin hosts Dr. Neil Chappell of Fertility Answers. Tune in to hear what advice the brand new partner has to contribute to younger docs finding their footing in the field. What does he consider the three goals every REI should have for their first gig?
Listen to hear:
The ONLY three goals for an REI’s first job
How important Dr. Chappell thinks micro-geography should be to younger REIs when selecting their position, and Griffin push back on his qualifying factors.
What role Dr. Chappell believes research should play in a new REIs hierarchy of job “must-haves”, and how to adjust their expectations accordingly.
Transcript
Neil Chappell 0:00
I don't want to make anybody feel like I think that their dreams are silly or unrealistic. But I do think that there's a difference between compromise like just compromising on what you want to do and then having a little bit of a reality check per se on like, what's your, what's your real life is going to have to look like
Griffin Jones 0:23
my guest today is a good geezer, as the Brits say are owned by Rocco is the Colombiano se or perhaps a class act? If that's more familiar to you, you know, as opposed to the vagabonds that I regularly have on the show, Dr. Neil Chappell. He is four years out of his fellowship, which he did at Baylor. And the reason I wanted to have Dr. Chappell on the show is because he's recently bought into his practice fertility answers with Dr. John storm and has been on the show, Dr. Chappell practices out of Baton Rouge, Louisiana. And so he's part of what I might call the sophomore class here, he is neither just out of fellowship. It's not the first year or two of his job. He's grinding his teeth a little bit and gotten familiar with this system and now has bought in so I've had senior partners on the show, many of them have had many CEOs on the show. I've had some fellows on the show, I haven't had too many of this very new partner on to share her his experience. And I'm glad Dr. Chappell came on because he gives good context to what younger doctors might consider. He lays out three goals for a first job says there's three not more than that. We also talk about geography. We talk about learning the general field of business, we talk about how to integrate new processes, the process for processes, and we talk about some important education that he's found along the way, like many of you Dr. Chappell is someone that is continued his education. He went on to do chief residency when he was at University of Alabama after his program there while he was doing his fellowship training at Baylor, he also received a Master of Science in Clinical Investigation. Now he's learning the business side. And he shares some of those lessons with you. So I hope you enjoy today's episode with Dr. Neil Chappell. Dr. Chappell, Neil, welcome to Inside reproductive health.
Neil Chappell 2:21
Thanks, Griffin. It's great to see you again.
Griffin Jones 2:23
Your fellow podcast hosts. So it's good to have you on the show. I will tell you, Neil that I have not every week, but a couple of times a month, someone reaches out and says, I didn't like what this person said on the podcast. I didn't like this idea. And recently, I had someone called me and said, were you doing a commercial for this group? I said no. And it sounded like a commercial. And I don't think so. But I'll go back and listen. And I went back and listened. And you know, the first soundbite I was talking to my podcast manager about she said, You are borderline accusatory for that. So and so some people have views one way or another. But very often, they just want me to do their dirty work. And every single episode, I say if you if something is said on the show, you have an opportunity to come on and express a different view. And very few people have taken me up on it. One of them has been your partner, Dr. Stormont, some of them been Chasey keen from mate Dr. Brower from Shady Grove in New York and Dr. Arredondo, and those have been pretty much the only people that have said no, I didn't like this part that someone said I think rebuttal is necessary. And so there's been very few and recently that we've had some content about partnership about what new Doc's want. And there was something he said, hiding another view needs to be expressed here. So what was that?
Neil Chappell 3:56
Yeah, and I remember your podcast early on with John, my current partner here in Louisiana, about what dogs that have been out for, you know, 10 plus, or 15 plus years, what they're looking for, and, and new hires. And that was a very salient podcast for me because I was kind of in just starting his practice. And then, you know, fast forward, you interview these three fellows, and I have a little bit of a different perspective, because I've been out now for about four and a half years. So I see. I remember I'm young enough to remember what it was important as a fellow coming into the field. But I'm a little bit experienced and now certainly got a long way to go and a lot of a learning curve to climb, but old enough and experienced enough in the real world, so to speak, to have a little bit more salient view on on the reality, I guess. And so I was I was thinking a lot of the things that they said in that podcast, I remember thinking, and I remember hearing from some friends and mentors now it's not really Do what you want, or, yeah, that sounds great on paper. But that's not really how it is that those kinds of things, and then I got onto the world and I'm like, Oh, this is, this is quite a new education, the cliche of you're gonna learn a whole lot in your first month out in the real world is is a cliche for a reason. It's very true. And so I think that and I sent an email to you and something to the effect of A, we've interviewed folks that are years away from fellowship, and we've interviewed folks in fellowship, but a few folks that have been just a couple of years out to kind of see both sides of the coin and maybe shine a little light on where the middle space actually exists. You know, in this polarized day, there's this view, way over here, and this view way over here. And the truth is probably somewhere in the middle, that somewhere in the middle voice was, I think, just maybe a viewpoint that was missing from the conversation. So I thought that might be something to do.
Griffin Jones 5:49
You're right, that we haven't had so many from the sophomore class. So this year, four and a half years out of fellowship, you're you're now a partner with Dr. sermonette, fertility answers in Louisiana. And so what was it? What were those points that were made in that interview that you remember thinking as a fellow or as an incoming Rei that you thought that you that you now think are off base or off base
Neil Chappell 6:19
is harsh? There's just there's just more to it than than that. So well, what were that. So, you know, I think first of all, anybody can have the practice that they want to have. This field is nuanced enough and diverse enough. I mean, it's reproductive endocrinology and infertility and everybody else in the rest of the world thinks so they're just IVF dogs, but that's not true. We do so many things, we're trained in so many things, that we have the capacity to have very different lives. And, you know, I've just reached out to the other 40 folks that graduated with me, and all of our lives are very different. So I don't want to make anybody feel like I think that their dreams are silly or unrealistic. But I do think that there's a difference between compromise like just compromising on what you want to do, and then having a little bit of a, of a reality check per se on like, what your, what your real life is going to have to look like. And so for example, you know, I think everybody's big on geography. Everyone says, I need to live in these places, or live in the city or live in this thing. Or, you know, I want to be by mountains or beach or river or or, you know, by my favorite sports team or something like that. And, and my feelings on on geography are, there's probably only one reason why it's important. Well, two reasons why it may be important. If your spouse can only work in one city, you're your host, you got to go there unless you've got a very interesting relationship. And to if you're if you really need to be close to, to certain family, and I guess that's kind of like a one, B because it's Same difference. You you want to be close to your spouse or your family, and they're limited in their geography. Okay, fine. You need to be limited in your geography. But I think I think our generation might undervalue the importance of micro geography, that's kind of the concept that I think, because at the end of the day, what are you going to do, you're going to go to your house, you're going to go to where you work, and you're going to go to your kids school, if that's, if that's part of your family dynamic. And that's kind of it, that's what most of your days are going to look like. And the days off, you're going to, you know, you're gonna go out to eat at restaurants, or you're going to go see a show, but most cities in America have those things, you can build a really nice life and just about any town, go where the market needs you to go. And then from there, build a little microcosm of your world and then go explore the world when you're on vacation, that that, to me seems the most realistic way to think about geography. So I think geography is just, it's just over emphasizes that important thing, I don't think that in the day to day it is as important to me. So by
Griffin Jones 8:46
micro geography Neela you are you talking about community, building your own community, wherever it is that you and your, your own routine? Your your home? Is that what you're referencing? By
Neil Chappell 8:58
kind? I mean, you know, they were like, Why did you go to South Louisiana to start your practice to build your career? And my answer that is because this is where I was needed. This is where there was a large market demand. And I knew that, you know, my life was going to be my house, and my job and my immediate family here. And so that was, you know, I don't I don't care that I'm not in a big time city or on the coast or whatever, because I've got I've got a really nice patient, you know, market and I've also got my little microcosm of of a family life here.
Griffin Jones 9:30
Are you also close to the family that you're originally from or that you're your spouse's?
Neil Chappell 9:37
Yes. So family was one of the reasons why we were like, okay, it's okay to move here. But that honestly wasn't in my top five, because I spent the majority of my my training away their families not listening.
Griffin Jones 9:47
In the top,
Neil Chappell 9:51
because, you know, it's not hard to travel to family. And I spent, I spent the majority of my, you know, adult training, you know, 10 years or plus years. Whenever not close to family, so it's it's nice to have them nearby. But it wasn't necessarily a deal breaker if the same position was true in Omaha or buffalo or whatever, then that would be that would be the case.
Griffin Jones 10:12
Well, I don't want to just, I don't want to go too far into this point. But I'm would disagree that it's hard that it's not hard to travel to family, I think once you have once you have your family established, once you have your spouse's family, and you have other obligations, it's not the same thing as being close to them. And the only reason I'm staying on this point is because I am a huge proponent of people moving to small markets. And I think that small cities are where the quality of life is, there's a difference between a small city and a small town. And there's a difference between a small city and a big city. And I think for most people, small cities have the quality of life that you're describing, which is when you're a busy professional, you're a busy professional in Lafayette, Louisiana, or in Manhattan, or in Los Angeles, or in Buffalo, New York. But do you want to have a 50 minute commute? Do you want to have all of the other considerations that come into play in most of those big city amenities you can't take advantage of anyway. But I think it's easier to travel to the big city amenities, those things that don't really happen in small city and maybe like big shows are specific restaurant scenes or social scenes that might be really important to you, these type of these type of niches, I don't think it's as easy to travel to family, depending on what level you want to have access to them. But I, when I see Rei is moving to markets, like Lafayette like buffalo, like all of this, the the markets that are not in the top 20 It's almost universally because either they or their spouse are from within three hours. Well, that's
Neil Chappell 12:06
why I say that one reason why geography should be important to spouse and family. So on this I agree, I guess to your point, maybe a better return instead of micro geography is that the quality of life you can have in a mid range city as opposed to the top 20. Really should should. It's really under emphasized. I think. So I think from a geography standpoint, unless you have to be in a city. Think about those other mid range cities, because they offer quite a bit. And yeah, I wish that another person would would go with would grow up in Louisiana and become a fertility Doc, I would love to have another partner here because that seems to be the only way to get them. Get them down here. That's true
Griffin Jones 12:43
in this and it's true for for small markets across the country, I think it's a big access to care issue. And I'll keep talking about it on the show. Because one, I want more people to consider it for access to care, too. I'm biased, I'm from small cities, and I love it. And if you're a top wage earner, and the places that we're from your royalty, I mean, life is really good in places like Karen is, is interest rates go up across the country that that that house that is now a third affordable of what it used to me because mortgage rates were around 3% last year, and they might be 10% next year, well, guess what, that's not gonna be a problem for you in a small city. Because if you're willing to live in, in the intermediate house for three or four years anyway, you're gonna be able to buy the next one, you're gonna be able to buy it in cash. And in those smaller markets, that dream house that that would cost you three or four times as much in one of the larger cities. But so Okay, so geography was one of
Neil Chappell 13:46
the other things. You know, I think there's the the other double edged sword is research. And I think that the where, where a middle a median conversation could be had is, you know, I think a lot of folks that have been out for a lot of years, they're so used to the high demand for the workload, that research and not that it's not a priority for them, but they want to hire somebody to be able to produce they want to bring somebody on to to see the 1000 new patients that are on their six month waiting list. We need somebody to see patients and graduating fellows, we're trained so heavily in research, because I mean, our Fellowships are that much longer. We're with that it's just ingrained in us that research is critical. So it's rare to hear a fellow say I want nothing to do with research, I want to join a program that has the capability or the capacity to do good research and to contribute to the literature. And they'll help progress the field. And that may be in strict research and grant writing and papers or in in an industry. Any one of those capacities could be because again, there's a lot of ways to do that. But I think that the where where the truth is between those two is that that's just the way these our generation is as being trained, and that's the way the field was moving, there's so much in genetics or so much in AI, there's so much data out there, that we're just we're trained to think about that. It with this, this impetus, and this emphasis on on urgency, and we, you know, this is our duty, this is our responsibility, this is our privilege to be the stewards of these data to put out good stuff. And, and so we come out of fellowship, where like, we want to, we want to do research. And then the folks are trying to hire us are saying, We don't want you to do research we want you to, we want you to just kill we need people to see patients, let's go. And I think probably the truth is we do as a field have a have a responsibility to produce good research, but from our standpoint, we need to be thoughtful about it, I think it's it's not necessarily realistic for you to go into a negotiation saying, I want my Friday's completely off to not see patients so I can just work on my research. That's a difficult thing, it doesn't pay the bills, it doesn't pay your salary. But at the same time, we are responsible for making sure that all of this industry stuff and all these new technology and all this new AI is coming to the field, is it really beneficial benefiting patients, that's our job to say. So we have a very real responsibility that not to mention the responsibility to the next generation to provide them the research that they need to be able to apply for this very rigorous and competitive fellowship. So for the for the doc's that are looking at hiring somebody that tells them they want to do research, Don't roll your eyes. That's an important part of who we are, we had to find a way to build time without compromising the bottom line in the business. And for the graduating fellows, I would say, yes, research and in that capacity is important. But you have to understand that you need to be in the clinic. And so what you need to learn now is not how to do good research, but how to delegate good research. And I've had I've had fellows tell me, Oh, I can't wait to be back in the lab pipetting I'm like, if you're pipetting, you're making a mistake. Because your your job is not to pipette anymore, your job is to let someone else pipette on your behalf so that they can get the they can get the accolades that they need to earn, they can earn their stripes to so they can advance in their field and you're now their mentor. So you're you're making that transition from fellow to attending, you got to see patients you got to work. Research can be a part of your job, but you got to you got to learn how to delegate that research to the residents and the fellows. And the other lab folks, you know, behind you and let them get their names on papers, while you for the field and see patients. And to me, that's probably where the truth lies.
Griffin Jones 17:29
Have you done something like that in private practice? Because I could see that perhaps being less easy to do in private practice, if you're not affiliated with an academic center that has a follow up? And yeah, you might have residents that rotate in but how have you done that?
Neil Chappell 17:46
I don't even really have residents rotate. And there's a residency here, but they don't really rotate with us much I do I teach lectures for them. And then if I can, and basically if I have a clinical question about what we're doing and making sure we're doing it well, or if I'm reading a paper that says, hey, this is out and I want to validate those data inside our own practice, and I talk to the residency, I've got a good relationship with them. I find a resident that's interested in doing that research with me, I build out the database, I've got a statistician that I've befriended. And I've got a PhD researcher through LSU system that I've made good friends with. And together, we kind of collaborate on ideas. And yeah, we we publish a paper to a year. And it's not I'm not shaking the earth with with with amazing science down here. But I'm validating my data with what we know, and making sure that we're providing good quality care down in Baton Rouge, Louisiana. And I'm also helping residents get a few papers, and doing good things for our patients in our practice. So, you know, John published a editorial this month, and we published a couple of papers earlier this year. So we're doing a little bit, but you know, I'm still seeing patients Monday to Friday and some weekends, you know, depending on how people ovulate, that's still my primary thing. But I do feel a responsibility to do the research. I just build those meetings, you know, either during that, you know, half an hour in between patients between the morning in the afternoon, or in the afternoons after I'm done seeing patients.
Griffin Jones 19:08
It's not a full day off for doing research every week.
Neil Chappell 19:11
I yeah, that's I mean, you have a responsibility to your patients, just like you have a responsibility to the field. And I think having an having a healthy appreciation for the fact that you have to pay the bills, and you are the person who pays the bills, you make you current you crank the factory to make the widgets that pay the bills, but at the same time, I mean, we're called to a higher calling out, you know, fertility is a reproductive endocrinology and infertility or just physician in general, by definition, higher calling, you've got to give some of yourself to do in those other things too. But if you're thoughtful and mindful about it, and you use the training that we've had, you can build a system that sustains itself. We all know how to do a good retrospective cohort study, build a database, teach them how to go through one chart, and then send them kind of loose, you know, and then have monthly check ins via email where you see how they're doing it. doesn't require a whole lot of work. It just requires some thoughtful work. And I think there's there's a space to have both. It just takes some effort to build.
I'm, I'm dubious that a lot of the places that may have said, Oh, sure, you can come here and do one day a week of research actually ended up allowing for that, because I've been on both sides of these discussions with where I've been with just the younger Doc's and just letting them sound off on what it is that they want. And I've been with the partners and CEOs with a lot of the biggest practices and groups in, in North America. And I hear the differences in conversation. And on the younger doc sides very often, like, Yeah, you told me that I can, that I'll just be able to have research. And this is what this is what I'm hoping for, and I want to have this kind of time off. And on the other side, it is very clear, like, there's an expectation for them to produce, there's an expectation for them to do volume, and, and they're on them if they're not.
Neil Chappell 21:08
But of course, that's what a fella would think, of course, that's what a fella would think we're given 20 months to sit in a room and think, mean that 20 months of our fellowship, or 18 to 20 months of our fellowship, we're supposed to sit in a room in the dark and think. And so that's all we've done for a year and a half, of course, we're going to come out and want to do that more. That's why how we were trained, that's our comfort zone. This is our happy place. We sit and we think we read, And we pontificate on what could be the next big thing because we want to help patients and there's nothing that gets us lit up like reading about, you know, ovulation. So of course, we think that, but again, coming out into the real world for a few years, not that I'm the sage, I mean, your your your recent podcasts with Eduardo, of course, was was flawless, that guy's very, very good. He thinks very, very well rounded in a good 360 degree space. So I don't know if I have anything to contribute, after what he said if he has a hard act to follow. But, you know, we we, we think that that's our comfort zone, we need to kind of move to the real world and say, Oh, but we also have to pay the bills. And research really doesn't pay the bills, not not in this space, like like that. So that's just kind of that thing. And then the other thing, you know, the other thing, I think, by nature of fellowship, we all love surgery, and we all love onco fertility. And I remember telling somebody that I was coming out of fellowship, and I was interested in kind of helping to, you know, build out a good onco fertility program and build out a good reproductive surgery program. And this particular person was like, Don't tell anybody that that's not what people that are hiring you want to hear, because it doesn't really give you much in terms of revenue. And it takes a lot of time. And I thought to myself, That's kind of a jaded thought, like, why would you say that these are really important things. And then I got into the real world. And I was like, oh, yeah, surgery takes a lot of time, it does not pay the bills, it's, it is still a major part of my practice, I still do surgery every week, several days a week. But it's not because I think it brings revenue to the practice, but it does bring some value to the practice. And I think that you have to understand the difference. So like I'm in a small town, you know, market or whatever, or small city market and small towns and small city market, there's really nobody else that does the surgeries here. So it's incumbent upon me, it's my responsibility to provide that care, because the market demands it. So that's really kind of why I'm here doing surgery as well. But it does keep me from being here seeing the IVF patients, right. So if you say I want to go to a program and tell them, I'm going to build out the reproductive surgery program, they're gonna say, Great, then I don't have to do surgery, I can go see more IVF patients, but don't think that you're coming. They're saying, that's not the same thing as saying, I'm gonna come here, I'm gonna do 400 IVF cycles, those are two very different values to the practice that you're joining. And you have to just understand that what you're saying, I'm going to build out your Onko fertility program. Well, what that says to what that says to some of the staff is now we got to be on call 24/7. For whenever you get a Onko for a call, and we're gonna have to come in, we're gonna have to do things and figure stuff out. That's a lot of paperwork. And that's not how we feel as physicians because it's a blessing to be able to help people in a time of need, but the staff and the the framework of how the business runs, that's what they see. And for better or for worse, you just kind of have to know that when you bring when you bring uncomfort and repress surgery or things like that to the table. It's not the same thing as saying you're going to do 400 cycles.
Griffin Jones 24:31
So we're talking about expectations and the reality of what's on the other side of them. But let's also maybe take a little sidebar to talk about when is it time to say no, this is really important as part of my vocation and I did an episode probably two years ago now with Dr. Matt Retzlaff. About surgery and about how much surgery is still in the purview of the RAF I and and always should be and, and in your view, we don't have to go too far down this rabbit hole, but I just, I can picture some people listening and then thinking, but that's what I want to do. And so when is it time to say no, this is my vocation, this is what I'm going to do versus it's perhaps not realistic for the REI to do some of this anymore.
Neil Chappell 25:23
Well, again, I don't want to sound, I don't want anybody to think that I'm jaded. By any means. I mean, the people that know me know that I'm the happiest, like eternal optimist incapable of feeling sad, love my job and feel privileged to do it every day. But I think to answer your question, is it I think it just requires a mutual understanding of what your passions are, what the market in your area demands, and how that affects how the business runs, those are the three things you have to think about all at once. And that's, that was kind of the point of that of maybe having this conversation be a part of your series is that you need to talk about all three at the same time. So I do surgery, and I have helped build out a few different ACO fertility programs and a few of the cancer centers here in this area. And we're working on helping to bring good legislature to the to the Louisiana government to help to provide better access to care for folks with onco fertility diagnosis. So we're, we're actively working in all those spaces, because this market needs access to care. And this market needs good reproductive surgery. So here we are doing it, but we just have we're we're doing that cognizant of the fact that there we are, we are compromising our ability to just do straight up drive revenue and do IVF cycles, because it's important to us, that our practice be that access to care for those people. And I think anybody can do anything that they want, just to understand that if you're joining a big, you know, fertility machine, and you tell them, I want to just do surgery, they may or may not be the most thrilled to hear that. And I think that that's, that's, that's part of the genuine conversation that needs to be on the on the table, but you have unique training, and you have a unique, you know, skill set for in this subspecialty that should be leveraged. And so if that's something that is your passion, you just have to understand that your your seat at the table will look different than the person that's doing 700 IVF cycles.
Griffin Jones 27:20
If not the REI, then who, who would be doing the oncofertility cases?
Neil Chappell 27:27
Oh, no, I mean, well, I don't know that I'm gonna go down that rabbit hole with you. That's that's a different, that's a different podcast is a different question. As far as as far as fixing access to care. I don't. I don't know how to I don't know how to fix access to care. And I do. And I do think it's our responsibility. I'm very, I'm very big on doing what what your patients and your area need you to do you do. So I just I just think that you just need to understand that there is a compromise in and and how you are reimbursed based on the models in your area. And this is different for an academic setting where they're paid on our views. And this is different, and mandated states versus not mandated states.
Griffin Jones 28:14
And thinking about it back in the frame of expectations, could it be the case that okay, if this is your vocation, and and this area for Access to care is extremely important, then perhaps that more traditional academic model of working in a university or a hospital Rei division is still relevant. It's and that that role is how it was 15 years ago, maybe still is relevant today. Perhaps just don't expect these big signing bonuses, this big type of partnership, and maybe salary or bonus opportunities that these new big companies are offering, if that's what you want to do, is that a fair way of looking? Yeah,
Neil Chappell 28:59
generally speaking, but it may be that you find somebody that just hates surgery, but knows that they need somebody to come down and do surgery with them, and then they're going to see major value in you. So maybe we could go down the hypothetical, you know, we there's hypothetical A, B, C, all the way down to, you know, 123. There's a whole there's a scenario out there, there's a job out there. I mean, there's so many jobs out there you can you're in the bargaining seat just just being a board eligible. Ari. I'm just saying that I think that it's a reasonable thing to say, Hang on. You really need to think about this from both perspectives. If you're going to every interview saying I only want to do surgery, or I want a day and a half to sit and think about research those those particular values to you can happen but they have different implications that no one's really talking about.
Griffin Jones 29:48
I know a retiring doc of a private practice that does a lot of surgery. And the one of the partners does almost not really doesn't like doing it. And so that could be an opportunity for someone. Yeah, like surgery because that the now senior partner isn't doing it and there's still the need there. So that's a possibility. Okay, so we've talked about geography. We've talked about research, we've talked about surgery and ankle fertility. Were there other expectations that you've heard from incoming ducks on the show that you also had when you were an incoming doc that you now see, perhaps need more context?
Neil Chappell 30:30
No, not really. But I would say that the things that I always tell the fellows that call me now that I'm now that I'm in my fifth year out less and less fellas, I knew more back when I was a little closer, but five years out, I know less. But in the times that I've had conversation of graduating fellows, I tell him, You got three goals in your in your in your job number one, and many folks don't stay in job number one, I've been really happy in my first job, I don't see myself leaving ever. But that's not common man, you know, half of us leave. And within two to three years, I think is a statistic. I don't know if it's still true. But that was that was the case back when I graduated. But But I tell him, You got three goals in your first job, pass your boards, learn the business, and pay off some debt. Those are those are the three things you have to do. And so people take this job hunt so seriously, because interviewing for medical school and interviewing for residency and interviewing for fellowship was so serious, there was so much stress, and there was so much heaviness in it. But this is a very different interview process. You're interviewing for a marriage, but these are not dates. This is this is you coming together with someone on business to business, just talking business, do our goals, alignments, values match, you know, be honest and open with them. Because, you know, I interviewed with some practices, and I was so scared of telling them that it wasn't gonna work out. And I just waited and waited and waited to tell them, then that hurts them, that makes them more angry with me. And I could have just said, Hey, this is not gonna work out, you know, you don't even need to give them a reason to say this is not gonna work out. And they would have been like, great, thanks for letting us know, we're gonna move on. And that would have been probably the right thing to do. But I was so scared to tell them that that it was, you know, it became not great. So, yes, taking a job as a marriage. But interviewing for jobs is just business, just be honest with folks about your values and what you're looking for. And keep in mind that really, those first few years, I'll pass your boards, learn about it, learn a bit about the reality of business and pay off some debt, both both financial debt and family debt, take some time to to, you know, thank your thank your family for supporting you through those that decade plus of of work and take them someplace nice for a few days, and then get back to work. Right? So. But that's kind of what I what I tell folks.
Griffin Jones 32:49
Let's talk about the learning the business presentation and goals in your first job as pastor boards, learn business and pay off debt. Let's talk about the learning the business part, what were some of the things that you learned.
Neil Chappell 32:59
So the there's kind of three aspects of learning business, right, so learn the general field of business. And if you treat it like learning a new language, it's really quite straightforward. I what I've learned, the more I've learned about business, the more I realize that it's actually not that terribly complicated, it's kind of just algebra, you just have to learn what they call each of the variables. So a p&l statement looks very intimidating and very confusing. But it's just simple algebra, you just have to learn what P stands for and what L stands for. And if you just sit down with the CPA, or the or the, you know, the manager or the administrator of the of the practice, and is taken our with them early on, and say what is this? What's this line item? How do we how do we calculate and just have them tell you, then you'll catch on pretty quick. So learning the language of business, read a few books and ask, you know, ask a lot of questions early and often on the admin side, that'll help learn your practice. That So learn, learn the language of business, learn your practice, how do they do things? How did they treat their Oli cycles? How do they treat their IVF cycles? How did the nurses work? How do you communicate with them? How do you write in the EMR system? How do you how do you do check out with your fellow physicians when someone else is on call? Is there a doc of the day thing? Or is it eat what you kill and you do all your retrievals and like most of this stuff, you'll know in the interview process, but when you actually show up and you're like, Okay, I want to do surgery on this person. How do I post that case? Learning how to go about communicating with nurses so that you integrate into their workflow. That's key, showing up on day one and saying this how I want to do everything can be quite disruptive. So for me when I came in, I was like, okay, copy, paste, whatever John does, and and I'll, I'll start there. And then as we grow, and learn and find, you know, new ways to do things or this is what I learned in fellowship, I go to storm and said, Hey, this is something we've been trying to do. It's been really effective was trying to integrate that we solely integrated cuz you you rock the boat with the nurses and that's a surefire way to get get thrown off the boat. So learn how the practice works, and then sort of integrate what your training brings to the table. Because you do know things that can help that practice be better. Just don't try and change everything on day one, and then learn your area. And in the first, you know, when I say learn business, learning the area means you've got to go knock on doors, you've got to shake hands, you got to be friends with all all of the the referral people there, you need an alert, you need to know the oncologist, the OBGYN the pediatricians, the general medical market. How does how does how does it work there? Is it owned by you know, big entities? Are there a bunch of small, small locally owned private clinics? And you know, where were all the babies being born? Where the OBC things were in a surgery done? You know, what's their? What's their taste for fertility some some areas, they want nothing to do with fertility patients, they immediately refer them out. Some places like to do a whole bunch of ovulation induction cycles themselves, and then refer them out. Who's your competition? And and, you know, what are the what are the market needs there? Do they have a bunch of people that do minimally invasive gyn surgery, you're not gonna need to do much surgery, you need to probably refer all your surgeries to them? Or you're gonna make some folks very upset? Or is there nobody there doing surgery? And that's going to need to be a major part of your of your market? And what are your competitors doing there? And how do you need to think about offering a new option or new solution, because they've already got the market cornered on X, Y, or Z,
Griffin Jones 36:29
we can talk about that know your area, a bit more about it make a whole episode about that. But I think it bears exploring a little bit here, because that's a huge opportunity when you're in your first second year of practice, because you've got a little bit more time. And as you become more established, and when you really get busy, and you have the partnership responsibilities, and you have a long wait list of patients and, and different obligations, then you often need a physician liaison system. And so the whole infrastructure is a lot more robust you need like a CRM or at least system in your EMR, that you're making sure that you're you're following up with the people that you're calling on they need, they need good educational materials, they need access to that Doc, because they're the liaison between the REI and then the referring providers, where when you're young, you're new, it's you, and you don't need as much of that system it very often, it's just going in, you can go back into the office now in in late 2022. And you will often be seen a lot more quickly than a than a physician liaison. Well, if you come in and say I'm the doctor, and I just want to come in, I just want to introduce myself, I just want to drop off my cell phone number, you can do that as a younger guy, you can do that with every single OBGYN office in your area. And you don't need to build out all of the materials don't need to build the CRM of this is when I followed up with them last and this is this is our last point of contact there. You can just go and give people your cell phone number and, and you will build relationships by doing that. Yep,
Neil Chappell 38:29
we just, I mean, it's very low tech over here, I just had the Excel spreadsheet, I had the names of the local OBGYN, and when I would visit them, and then when as I got their cell phones kind of had him down. And you just when when you when you send them a baby, you text them, you know, and and they will now they've got your number, whether or not you gave it to them or not. And now it's in their phone, and they'll text you questions. And that's how you develop that relationship. But does it does, it does take time.
Griffin Jones 38:56
Here's another little tip for people that are listening, we know that 60% of REI patients are referred by a provider. That means that 40% are not referred by a provider, but guess what, they're all going to an OB afterwards. So that that might also be that might also practice gynecology, or at the very least they're in an OB GYN office. And so you reach out to that person after whether they referred you or not doesn't matter. There's 40% That did not refer to you. And so you, but you still share a patient, and that's a great reason to be able to, to connect with those folks.
Neil Chappell 39:39
We definitely we definitely do that.
Griffin Jones 39:40
Go ahead. Sorry. Well, you talked about some of integrating things after you establish and I think that copy and paste model is the way to go when you're starting out was a guy that started a firm completely from scratch. It's like wow, I could definitely see that. value, you know, having have worked for somebody for two years first and then in and then modified that, you know, not having done that I can see the value of copy and paste, there's just a lot of shortcuts. And it isn't to say that everything that you're copying is valid for the future, or maybe even Val, even the best way of doing things now, but it gives you a framework, because then you're optimizing as opposed to inventing, and you can decide what you want to go on to invent. And you talked about the things that you help to integrate are that that you started to integrate things after that, what were some of those things,
Neil Chappell 40:42
just very small variations on stimulation. Standardizing how we did post operative pain meds, and just just different optimizing ways that we were drawing labs on certain diagnoses, things like that. I mean, nothing, nothing major. I mean, one of the reasons that I decided that joining Rajon was the right thing to do is because he'd been out for over 15 years, but in our interview, we were talking about papers and research that had come out the month before. So I knew that he was very mindful of the literature and evidence based medicine, and that's somebody that I could work with. So, you know, I knew that we would continue to challenge each other. And, you know, we don't, we don't have journal clubs every other week, where we sit down and you know, tear apart FNS but but we do continue to send each other a paper about this, or a paper about that, and, and continue to push ourselves to deliver quality evidence based medicine in a thoughtful manner. And, and so, you know, it wasn't anything revolutionary, but I would come to him and say, hey, you know, we're, we're drawing these two labs here, I don't find them as instrumental listing by doing it this way, or, Hey, let's change our Stimulation Protocol to shorten this window to this and then we can try try this. And and, you know, what he taught me was how to implement a change in a clinic without really making everybody upset. And and that was
Griffin Jones 42:03
that's worth exploring, how do you implement a change in a clinic without getting everybody upset?
Neil Chappell 42:08
Two patients at a time, so So what you do is you have a meeting with your nurses about it, you have your make sure your head nurse is there, and everybody and all the other staff that implements good clinical workflow is there. And this can be done, you know, after IVF plans in one afternoon, and you say, hey, this, this research, this literature, these findings are starting to show real promise. And I think that it can benefit our patients in our area this way. This is what it would look like if I did it. What do you guys see as barriers to us being able to do this, because inevitably, your IVF nurse will think of something that you're not thinking of? And that's very valuable. And then you say, Okay, how do we build this protocol to be maximally efficient, but also be maximally beneficial to the patient, and you kind of you mock up a play patient, and then you say, Okay, who's the perfect patient for us to try this on? Get in, I'm not saying that you just like, hey, I just want to start doing this, like, I wait for good literature to come out and verify that this is a good thing. And then we say, how do we get to how we bring this into clinic, and then we pick a patient or two in one particular month, and one particular cycle, not that we batch but like in one month, and we do it. And if it works, then maybe we do three or four. And then the next month, we do half of our half the patients or whatever. And then before you know it, you've got a good number of folks going. And then the last critical thing you do, of course, and any Rei is going to know this is you keep track of those patients and you do the analysis. As you go through you keep a running list of those patients in a HIPAA protected database that you're that allows you to thoughtfully keep track of those metrics and compare them to traditional metrics. Not only is that the responsible, right way to make sure that what you're doing is the best thing for your patients. But that's also a perfect research opportunity for for your residents. When I perfect example, when I came in, John was doing there was a paper published in the early 2000s, that you could just give 2020 milligrams of letrozole on cycle day three. And that was all you needed to do for ovulation induction instead of, you know, five minutes for five days. And so I saw that product I've never seen before. And the gentleman was this. He's like, Oh, yeah, so it's something that we saw were doing and helps with compliance and patients love it. And I said, What are the outcomes any different, he's like, I've really not ever had the time to check. I got a resident, she went through, you know, 2000 cycles of IUI by chipping through the data and show that actually, the pregnancy rates are exactly the same. And so the one paper that was published is now two, you know, so that's just an example of how you can thoughtfully implement change. Keep your clinic running efficient, not upset your nurses. And then on the back end, you've got a research project for a resident to get a poster or an abstract or even a paper on,
Griffin Jones 44:50
you're clearing your line of sight by involving your nurses early to because
Neil Chappell 44:55
yes, you have to do that before so if you come in and say hey, we're gonna do drop the Integrity doing progesterone, it's, you're gonna, you're gonna get the laser eyes to your soul. So you kind of have to be thoughtful about that, because they, they see these patients day in and day out, they do what they do very thoughtfully, and they're gonna see they're gonna see the speed bumps you don't see because they implement those small details in the patient's day to day workflow that you don't necessarily have to think about because you're your high level. So you absolutely lean on them. I don't see how people don't, you can also
Griffin Jones 45:29
you can apply that to other areas of operational change other areas of business change with the relevant departments, teams there. Here's the benefit that I'm seeing by doing this change that I've seen other places. What barriers do you see here? And then what are the one or two use cases that you see as being able to apply it here?
Neil Chappell 45:53
And then you slowly build it? Yeah. You talked
Griffin Jones 45:55
about some, you said, read a few good books. As you were learning the general field of business. Do you remember some of the books that were most helpful to you?
Neil Chappell 46:07
The first one that John gave me was good to great. Jim Collins, and so I wrote Good to Great, I read Good to Great and built to last, and then, you know, this day and age, it's, you have there's so much, there's so many ways to take in information. You know, I do Harvard Business Review, and, and basically all the books that were all my dad's bookshelf, and there, there's there's sometimes helpful, there's sometimes not, he was a big fan attraction. And so I read that and that, that was that was okay for, for what we do. A lot of the stuff that I that I gather from specific books are, are a lot of just really just sitting and thinking about things that I hear on, on your podcast or on other things that are unrelated. So talking to other people about their how they do business. And what they do is more of a helpful thought exercise than necessarily anything about business, the reading the business books is most helpful and learning the language. It's kind of like reading a book in Spanish to learn Spanish, I'm not necessarily absorbing the content of the book, but I'm learning new words in Spanish, if that makes sense.
Griffin Jones 47:17
Learning a new language is a good way of thinking about it too. Because don't beat yourself up when you sound like a baby at first, you know?
Neil Chappell 47:27
What that means? What are you talking about? Wait, does it just mean this? Why don't you just say this? Well, that's not what we call it. Yeah.
Griffin Jones 47:34
Okay. Yeah. Yeah. And it can be one of those things where it's like, you know, an adolescent or sometimes even in adulthood, there'll be a word and say, I've been using that word. How many years?
Neil Chappell 47:46
That's been which language for you. It's okay. There's a lot, there's a lot of it's forgiven.
Griffin Jones 47:50
And, and that's, that's true for for business, too. I, I would be interested in getting your opinion on traction a little bit, what you said is okay, for what you for what you all do, and you're talking about traction by Gino Wickman. That
Neil Chappell 48:05
I don't remember the name of the author, embarrassingly. And it's been probably five years since I since I read that because I read it coming out of fellowship. But the biggest takeaway for me was just understand what seats you need as far as drivers and then make sure that the right person has the right values that are filling that seat to make sure that they're, that they're doing what they need to be doing. And that that was the takeaway for me. And so I do think about that a lot. But the rest of the book was just kind of washed over me, if you will. But I remember because I think about that now is as I'm zooming into the year evals. With my staff, I'm thinking, Okay, here's all the things that you embody as value and these are what's important to you, and this is how this benefits who you are in this seat. And so yeah, man, I feel like we've got a good team in that capacity.
Griffin Jones 48:53
So I've wondered about this a lot. So the book that we're referencing is called Traction by Gino Wickman. It's about Eos, which is the Entrepreneurial Operating System. It is an operating system for businesses typically of 10 to 200 people. And I, I have used it a lot for giving some counsel to REI practice, but I know that there's a limitation and it has been extremely fundamental for my firm. So the book posits and the operating system posits really, two or three cardinal arguments one of which is that it takes two people to run a business it takes the visionary the person that is responsible for the future value of the organization. And an integrator, the person that is responsible for actually executing the day to day operation. So as those translate to contemporary business titles, you might think ce o, ce o but that structure It isn't totally possible in the same way, in a medical practice, because you have, very often when you have a CEO as a business person, they're not the physician. So they they can't be the sole owner, at least have a have a practice group around. And if they are of a network, then then the organization structure is different. So I see that as a as a potential seat limitation. And but I do think it is, I think it's really useful for looking at the accountability chart of Eos, which you can email me for it's on the fertility bridge website, in a lot of places, and I and I've said that I want to make one for REIpractices. And I still haven't yet maybe
Neil Chappell 50:46
you're not far I've seen I've seen you try.
Griffin Jones 50:49
So I but but I think it's useful to look at because you can see yourself as an REI in multiple seats, you can see in one of the seats that you're going to be in is you're going to be under the visionary and integrator seats are going to be even under the three main seats of Operation sales and marketing, finance and compliance, you're going to be under one of the operations seats as a as a producer. And so you can be in multiple seats, you can be in that operation seat when you're thinking of yourself as the medical director as the practice director. And if you're the senior partner in a different one is the visionary and possibly also the integrator. So I think it's just it's useful, even if it doesn't translate 100% to be able to see, okay, I'm in a lot of different seats here, which ones can I get out of?
Neil Chappell 51:44
Or it's just the wrong, it's the wrong model. So don't think of it in that simplistic of a term, it's just having seats, maybe, maybe the RV is a giant circle around the whole model. And the practice itself is each of the people that you employ in each of those seats, and then draw a big circle around the whole thing. And just write Rei, because we're just, we're over and around and integrated through each of the seats.
Griffin Jones 52:10
Which makes trying to map it a nightmare.
Neil Chappell 52:14
No, it's just one more circle, just just draw a circle around the whole thing. There you go, you're done.
Griffin Jones 52:18
But the point, the point of disease is to be able to delineate the whole point of a seat is to be able to say this person is accountable for this. And the reason why our them is so successful is because you can have one person in more than one seat because a lot of organizations are small, but no seat is occupied by more than one person. That's what allows you to say this is who's finally accountable for this domain. And because the RSI is in instrumental, irreplaceable throughout the circle, it is harder to solely assign accountability to different folks in different seats,
Neil Chappell 53:04
unless unless the Ari delineates what tasks you are responsible for in each of the C's very, very, very, very precisely. And very, very clearly. Yeah, I agree.
Griffin Jones 53:14
Another book, when you were talking about the profit and loss thing, I think of a recommendation that was given to me by Dr. Sabel, just called how to read a financial report. It's as interesting as it sounds. But it is, is it's fundamental. And if you have an MBA, you don't need to read this book, probably but there. But again, sometimes it doesn't hurt to go back to fundamentals. And you may have missed something. But if if you are really getting into the financial reports and profit and loss, which is the income statement being one of them Cash Flow Report being another balance sheet being another, then it's a good book to read. Do you remember any lessons that really stood out to you as you were learning the income statement?
Neil Chappell 54:05
No. To be honest, it's not so much a specific lesson. It's just making sure that you understand how your items are lined out, and how each of the buckets are filled, and how you are responsible for each of the different revenue drivers. And that's going to be individual to each practice, which I mean, it bears repeating that this conversation is really is not. These are overarching things to general generally think about, it's going to be different for an academic model. It's going to be different for an employee model. It's going to be different for a private practice and a hybrid model. All these things are very different. So a shady grove and an RMA and end up in a University of Alabama, and fertility answers in Baton Rouge are all are all for very different conversations. And for even me it's even more complicated than a private practice in Baton Rouge because we're you know, fill We ended with ovation. So that's, you know that that further complicates my model. But that was a, that was an active decision that we made together about about that. And there's certainly, you know, pros and cons to that relationship to I, in my opinion, more pros than cons.
Griffin Jones 55:15
We could talk about those Pros and Cons. I did an episode with that a couple years ago with Dr. Storm and, and we can link to that episode for people to, to go back to today, we talked about the expectations of incoming docs around geography, research, surgery, and onco fertility, the three goals that they have in their first job, which is pass the boards, learn the business, pay off debt. And I think that's a useful way of thinking about that. And you know, that maybe I need to adopt a little bit more, because I am very diligent in telling people how they should remove the mutual mystification in their negotiations, try to button down what's going to work out for them. But what you're describing is, it might be okay, if it doesn't work out, because in that first job, because you have three goals, you have you, and one of them is to learn the business. And if you if you pass your boards, if you learn the business, and you pay off some debt significantly, two years and three years into working for a group, and then you end up going on to somebody else, it's probably a pretty okay, thank you don't
Neil Chappell 56:35
go to jail, you know, you don't go to jail. I mean, it's just your life, we'll have another move. But good lord, you've been moving every three to four years anyway. So don't go into a job thinking that you that you want to move in two to three years, but go into a job, that that you have a reasonable chance at loving in a place that you probably won't hate. And I feel like with micro geography, you probably won't hate where you live, no matter where you live. Because there's there you can find happiness just about anywhere here in America, which is a wonderful place. And and then if it doesn't work out, then Lord knows there's another job available somewhere and somewhere down the road. And that that is that is okay. Now, granted that there's the noncompetes and the people that have to be in this area, that's a different conversation that's different for them if that I have to live in Atlanta, and I have to sign a non compete. They have a very different sort of stressors on them. But but that situation, I think is not as common as the folks that can be a little bit more flexible with with their geography.
Griffin Jones 57:37
We talked about learning the general field of business, the financial reports, the the operational workflow, learning how you've been right in the EMR. Easy step wise process for implementing some changes that you learned and then even a bit about the operational structure, we probably also could have explored your criteria for partnership because you're now a partner with Dr. Stormont in at fertility answers. We can save that for another episode. You can include that in your concluding thoughts if you'd like but how would you like to conclude?
Neil Chappell 58:18
Yeah, no, I think I think you you did a great job. And you've done a great job in talking about different practice models and how people buy in, I don't know that I can contribute anything to that. I'm happy with my practice partnership. Took some lessons from some stuff that you talked about. It took some lessons from some stuff that, you know, my dad taught me and that I just learned on the fly and, and to your point, talking to John neutral demystification. We said, well, we didn't didn't one that worked out well. And I've been happy been being an affiliate with Ovation I've been able to buy into the parent company. And that, to me is like a great way to leverage risk. If you know, my, if my numbers are lower in one quarter, because and less people are doing IVF in that month, I'm still doing well, by being invested in the other IVF centers around the country. I get to do research with the Ovation network, and we get to get really access to top quality embryology staff and some beautiful embryos. So I've been happy with my partnership on both fronts there. But like you said, you've done podcasts on all of that. So I don't want to belabor those points. I would say that the one other thing that I would say to the graduating Fellows is it does take a few years to build, what you want does not happen on day one. Even if even if you do want that day and a half to sit and do research, that shouldn't happen on day one. The day and a half for research, when you come out needs to be shaking hands meeting people learning the clinic workflow, learning the business, becoming becoming a contributing member of the to the partnership, you know, so a lot of folks say, oh, I want you know, look at their lifestyle, look at what they're doing, you know, look at look at how your partners live and see if that's how you want to do things. That's only kind of true because the the folks that work there been working there for years, I'm in my fifth year now. And so now I'm able to bring my kids to school come to work, see patients do surgery do IVF and then, you know, leave at a reasonable hour because I've spent the last four years developing a good clinical workflow with my nurses and having a good understanding with my administrative staff, and in grading on a really good mid level to help me integrate patients when I'm not here. And so like now I have a really balanced life. My first four years were not balanced, I worked harder in those four years than I did in you know, in a lot of a lot of residency, because it takes time to build so so you you can have the life you want visualize the life that you want, think about what's important to you and what you want to contribute to the to the place but understand your contribution is going to be equal to your say at the table. And understand those those differences in values are real and they have to be respected and just compromised on and then you got to put in the work to build the infrastructure to have what you want. And that's okay that but just understand that that's, that's gonna come it takes it takes a few extra years of hard work, but it's totally worth it because this is the best job on Earth.
Griffin Jones 1:01:10
I think your advice about paying off debt parallels that it takes time meaning so many physician after going through 15 years of higher education and training where you either totally racked up debt in undergrad and medical school or then made not much more money than a junior marketing person in for residency and fellowship. And now it's okay you're finally starting to realize some income potential and maybe you want that car you want that big house but there is something to be said for taking that time to pay off the debt and then the cars and the House and the the big vacations and the the other nice to haves can come a little bit later.
Neil Chappell 1:02:01
Yeah, and and Tom you built, be thoughtful about how you're building things. And if you will, in a short amount of time, it'll pay off and it flies by but it does it doesn't happen. It doesn't happen right when you start your clinic you have to put in the work to build the patient load to build the build the rapport with the referring Doc's and to understand your market and then and then from there, be intentional understand what you're bringing to the table and and then and then have a great life.
Griffin Jones 1:02:31
You've mentioned earlier in the show that now that you're four or five years out of fellowship that you hear less from people because you're your peers aren't in fellowship anymore. I hope that this episode plugs you back in and you representing the sophomore class the the those that have bought into partnership within the last year or two that had been out of fellowship about five years that have been underrepresented on inside reproductive health you're a really good person for those folks to reach out to and I can speak to your character and I hope that they do so if people want to reach out to Dr. Chappell please feel if you want an email me I'll happily make the connection and and I hope they do know they would be there would be wise to talk to you.
Neil Chappell 1:03:20
My cell phone is out there with most people so anybody can feel free to text or call me to I don't care. We could
Griffin Jones 1:03:26
Chappell thank you so much for coming on inside reproductive health.
Neil Chappell 1:03:30
Thanks for all you do, Griffin.
You've been listening to the inside reproductive health podcast with Griffin Jones. If you're ready to take action to make sure that your practice thrives beyond the revolutionary changes that are happening in our field and in society. Visit fertility bridge.com To begin the first piece of the fertility marketing system, the goal and competitive diagnostic. Thank you for listening to inside reproductive health