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Selecting the right path in fertility is hard. Each type of practice: private, network, or academic, each has its own pros and cons and it’s easy to get lost in the details of each. On this episode of Inside Reproductive Health, Griffin spoke with Dr. Eve Feinberg, Medical Director at Northwestern Fertility and Reproductive Medicine and Associate Professor at Northwestern University. Dr. Feinberg shares her story of leaving private practice as a full equity partner to pursue her love of teaching and mentoring fellows by entering academia. She share her thoughts on the benefits of working in each and offers advice to anyone looking to switch their current trajectory.
Learn more about Dr. Feinberg and her department at Northwestern Fertility.
Other episodes mentioned:
Episode 41, Eduardo Hariton
Episode 50, Pietro Bortoletto
Kenan Omurtag, upcoming episode
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES 0:59
Today on Inside Reproductive Health, I'm joined by Dr. Eve Feinberg. Dr. Feinberg is an Associate Professor at Northwestern University Feinberg School of Medicine--coincidence, we will find out today--and serves as the Medical Director for Northwestern Fertility and Reproductive Medicine. She's the current President of SREI, the Society for Reproductive Endocrinology and Infertility. She’s a special editor for Fertility and Sterility. She's also the current Chair of the ASRM Access to Care special interest group. She's a member of the National Medical Committee for Planned Parenthood. And Dr. Feinberg is also the Founder and President of the Life Foundation, which is a collaborative Chicago foundation that provides financial assistance to individuals and couples who are struggling with infertility. Dr. Feinberg, Eve, welcome to Inside Reproductive Health.
EVE FEINBERG 1:47
Thanks, Griffin, and thank you so much for having me.
JONES 1:49
I wanted to have you on because I remember seeing you speak last year at PCRS--Pacific Coast Reproductive Society--it was to the fellows and it was about the different types of practice that they can go into and you gave this amazing overview. And there were two people with questions and one was a practice owner that I came with and the other one was me. And I think about this because all the time I hear fellows say that we haven't been trained in business, we have a lack of education. In fact, last night, I got an Instagram message from a second year fellow that said, Griffin, “Thanks so much for your content, we get so little training on this. Will you please cover x next?” And luckily you and I can talk a little bit more about that. But this is in such demand, you give this amazing overview and I think--I don't know if people were just kind of--it was so cursory to them or their mind was on something else or people come up and talk to you separately, but what are you normally hearing from fellows? And why was this even an impetus of we have to at least give some sort of overview, and I know that SREI does that as well, but what was the impetus behind that?
FEINBERG 3:12
I think the impetus is really that it's a very much a changing landscape in the field of REI right now. I think historically, REI was practiced within a university setting and as more and more private practices are emerging, and more and more private practice models are emerging, and furthermore, as more practices are becoming a hybrid between private and academic, those lines are really blurry right now. And so I think it's really good to understand how medical practices work, how they're structured, and what you're walking into when you're graduating from fellowship.
JONES 3:49
I've had Eduardo Hariton on the show who is a friend of mine, first year fellow at UCSF, and in my conversation with him, asking him why don't fellows get more training or why don't doctors get more training in medical school? Or could there be some sort of program in residency? And he very accurately pointed out that where's the time? There is no time. And so do you think that this is something--SREI does a retreat, I believe once a year, maybe has a little bit extra programming, but even if we had a more robust program coming from anywhere, where would it fit in?
FEINBERG 4:32
That’s a great question. So SREI does two retreats: we do one retreat that's geared towards fellows, and that's the Fellow Park City Symposium and that is for first and third year fellows, and that really focuses more on career development, things like work-life balance, how to choose a practice model, contracts, and that agenda is ever changing. The other retreat that SREI puts on is a Members Retreat, and that's really geared towards members that have been in practice for at least three to five years, who have passed their boards and are really starting to look at the broader picture of SREI. I think the confusing part of all of this is that no two practices are set up the same way. And so while you can learn the general ins and outs of how to run an REI practice, I think there are so many different regional differences--there are legal differences between states, insurance payer mix is very different from state to state and it's not a one size fits all. And so I think it's a tough topic to tackle and sometimes the learning is best done on that job with proper mentorship from the people that built and run that practice.
JONES 5:46
And there's different structures of practice, historically, they've been academic versus private. Now we're seeing a lot more stratification within private practice. There's large groups, there's large networks that own groups, there's single physician practices, there's independent partnerships. You have practiced in REI medicine and now at Northwestern, can you give us a bit of a history of your own career and what led you to one and the other?
FEINBERG 6:22
Sure. I graduated fellowship in 2007. I was a Northwestern OB/GYN resident and then went on to complete a fellowship in REI at the National Institutes of Health, which I loved. It's like an academic playground for nerds. In fact, some people argue that NIH stands for “nerds in heaven,” and it was a wonderful fellowship. It was very academically minded, it was clinically busy, the fellows got to do a lot of the cycle management and a lot of the hands on IVF cycles. We did all the retrievals and transfers for the program, but we also had research access at the NIH. I worked in a basic science lab. And I think the entire time I was in fellowship, I really thought I wanted to pursue a career in academic medicine. But the reality of it, when I started looking for jobs was there were not academic jobs that were in locations that were desirable for me. I'm from Chicago, my husband's from Chicago, we very much wanted to return to our families and we’re so much geographically restricted by that. And so I started to look outside of the academic model, and really fell in love with Fertility Centers of Illinois, which was my first job. And I felt like I wanted to be involved in teaching education, which is a passion of mine and I found a way. I joined FCI in 2007, I became a full equity partner in 2011 and I remained at FCI until 2016. And I found a way within my practice to pursue the things that I really love to pursue. My partners were very open and flexible. I established a teaching relationship with the University of Chicago and became a Clinical Assistant Professor and was able to have medical students rotate in my office.
JONES 8:12
At UC?
FEINBERG 8:14
Yes. Yep, so the University of Chicago has a satellite hospital called Northshore University Hospital Systems and I became the Division Director for Reproductive Endocrinology at the satellite hospital, at Evanston Hospital. And so through that affiliation, and through that network, I got to know the chairman of the OB/GYN department. He was very enthusiastic about sending the students and sending some of the other learners, like the residents, out to my office and I was able to mentor the medical students in my office and I was able to give lectures to the residents. I would sometimes go down to Hyde Park for grand rounds, or I got involved in the hysteroscopy teaching course and the OSCE medical exams and I really had a very fulfilling role as a teacher within the OB/GYN department at the University of Chicago. And so in my own experience, to me, it seemed very satisfying. I had a thriving busy, very well functioning, private practice with the ability to pursue the things that I really wanted to pursue. And to be honest, I was not looking for another opportunity. It came to me--some of my former mentors at Northwestern and the then-Division Director came to me and said, Hey, it seems like you're really enthusiastic about teaching. What if we were to bring you into Northwestern and groom you to become the next fellowship director and you would be able to do all of this under one roof? You could have your clinical practice and your medical school and your academic appointment, all within one system. And when I really looked at the direction that I wanted my career to take I'm extremely passionate about teaching and education, and felt like that would be an exciting opportunity and I made that transition.
JONES 10:10
So it's fairly common to leave academic medicine to go into private practice, it might be common enough for someone that goes into private practice as an employee, leave as an associate after their contract is up to go to academic medicine, but it isn't common for--at least to the best of my knowledge--for people that are partners in private practice to go to academic and you were an employee for four years and a partner for five. Is that right?
FEINBERG 10:46
Correct.
JONES 10:47
What was it like to exit partnership or sell that equity back or pass it on to an incoming partner, whatever that process was like?
FEINBERG 10:54
It was difficult. I think my partners looked at me like I had three heads when I told them that I wanted to leave to go back into academics. I think on one hand, they weren't very surprised. It was something that I had talked about on and off for a long time. It's complicated. Being a partner is a relationship and there are legal implications of it. At the time that I was making this transition, there were also some transitions within our practice. So IntegraMed was trying to work an equity deal with FCI at that time and so it was--there were some other transitions that were going on in our practice, there were some other changes that were happening within the practice that made it easier on some level to break away at that point in time. And so it was really the combination of timing of Northwestern coming to me at the time that IntegraMed was approaching FCI to work on this other equity deal. And I think with everything, it's a negotiation. There were things that I left on the table and things that FCI left on the table. And it was complicated, but I think everybody approached it from the right point of view. I wasn't leaving to start a practice that would compete against my former practice. I was really leaving for very different reasons. And so I think they had a lot of respect for that. I have a lot of respect for what they do as a group. And I think that the exit was really the best that it possibly could be.
JONES 12:30
A negotiation in and then a negotiation out! You’re doing it both ways. Is this something that you think is viable for people or do you think it's generally something that people might not want to do? Nine years at a particular institution, in most segments of the workforce, is a long time, especially now that we've got Millennials and Gen Z in the picture. Nine years is a good run for any one person in any one company, generally speaking, but partnership is a different story. Do you think--and you left because your dream job opened and you wanted to be in the market that you were at academic path that you wanted to pursue, so you did it and it was worth it for you. But in general, do you think that that's something that people would consider a viable option that I will go some place for five years and be a partner and then maybe not be?
FEINBERG 13:33
I think it's a rare choice. And the elephant in the room is probably the financial aspects of going from a private practice to an academic practice. It's definitely not a financially lucrative move. And so I think that for most people, once you get into the income bracket of a full equity partner in a private practice, it's very difficult to walk away to leave that for academic practice. There's some pretty sizable differences in income between the two.
JONES 14:04
So what are some of the--those are the material or I guess financial advantages of private practice--what are other pros and cons of private practice in an economic sense?
FEINBERG 14:18
Yeah, to be clear, every private practice is going to be set up very differently and every academic practice is going to be set up very differently. And because I've only had experience in two practices--at FCI and at Northwestern--I can speak very clearly about the differences between those two practices. But I do want to lend a disclaimer that my experience may not be typical of all academic practices or of all private practices. And so I think the audience just needs to take that with a grain of salt.
JONES 14:51
Well said.
FEINBERG 14:53
For me, I think some of the biggest differences have been autonomy and decision making capability, aside from income. And what I mean by that specifically is in private practice, things are not generally decided by committee or committees. It's very easy to get things done. If you decide that you want to hire somebody or fire somebody, it's generally a conversation among the partners and you post a job and you hire an additional staff member. In the scope of an academic practice, you have to go through multiple committees. There's often a budget season, you plan for things a year in advance, you set a budget, you stick to the budget, and there's not my experience has been that there's not a whole lot of flexibility in terms of hiring additional staff on an off budget season and the justification for it needs to be by committee. And so sometimes, you may want to grow your practice in a different direction or you may want to grow your practice, but you don't have the infrastructure or the capability to rapidly expand in the way that a private practice can.
JONES 16:07
It's funny to juxtapose our perspectives on private and academic practice. You being out there working in practice and myself owning an operating a sole proprietor, privately-held company, because to your point, private practice is easy to get things done. It's much more difficult in academic practice. From my perspective, it is very difficult to get things done with private practice and damn near impossible with health systems or university academic centers.
FEINBERG 16:44
Yeah! So another example is just that electronic medical record. The EMR in private practice tends to be--at least on that we used, which was ARTworks--was built for reproductive endocrinologist and it was solely used by REIs and when I opened the patient's chart, it was just the notes that were pertaining to that area of medicine. At Northwestern, we use Epic, which was designed for hospital-based care and then later adapted for outpatient clinical settings and it's very generic in that it's not built by Reproductive Endocrinologists for Reproductive Endocrinologists. And when I open the chart, not only do I see all of the notes from our clinics, but I see the notes from every clinic within our hospital system that the patient has visited. And you can also click on a tab called Care Everywhere that will show you every hospital encounter every clinical visit from any center in the United States that uses Epic. And so sometimes finding what you need within that electronic medical record can be really challenging. And there have been a lot of--there's been a lot of attention to EMR and the impact on patient and physician burnout and I think that that threat is very real. The number of hours spent charting on an EMR that's inefficient is significant. And I've spent a lot of time within my practice trying to optimize how do I write notes in the EMR that are streamlined and efficient, but there are a lot of inefficiencies in the system that I'm having trouble overcoming that quite simply, we're just not there within the EMR that we used to use at FCI.
JONES 18:27
I want to talk about burnout because I think it's a really interesting topic and I know you're speaking on it this year, but I want to stay for a moment on the other threats. You mentioned one threat to academic practice might be the burnout that comes from administrative work and EMR. What other threats are there to the academic center? Because I was pretty negligent in talking about the academic side of medical because this is a business show, I tend to focus more on private practice, and the new players coming into the field, but I sort of realized I haven't covered a lot on academic centers. And now I've had you on the show, I've had Pietro Bortoletto on the show, Kenan Omurtag, and we’ve talked about this and this type of maybe an existential threat to academic career, but at what point are one's hands so tightly bound behind one's back that they're less able to compete with private practice? And the example of an EMR is, well, there are very few people that really love their EMR, but for those that are figuring it out right now, when there's a more robust patient portal when there's dynamic communication via a website, when there's a really good informational drip system that the best private practices can put into place, and meanwhile, universities are still waiting to get approval on a very simple change or a very small initiative. At what point does this type of structure inherently self sabotage the academic centers ability to keep up with the standard of care?
FEINBERG 20:12
Yeah, I don't have any concerns about the standard of care. I think it's more concerns about the administrative burden that's placed on physicians. And I, again, I am speaking heavily on burnout at PCRS and so I don't want to, I don't want to give away my entire talk! But I think when we think about burnout, we think about burnout at the level of the individual, at the level of the system in which one practices, and then in the global sphere of the field in which one practices. So for me, that’s Eve Feinberg as an individual, that's Northwestern Medicine as a system, and then the greater field of Reproductive Endocrinology at the level of ASRM and globally from that point forward. And those individual demands are mitigated in part by resilience. But resilience can only take you so far. yYou have to be able to meet those demands. And so some of those demands are administrative, but some of those demands are universal. I mean, the patient demands, I think, are no different for somebody who's in academic medicine versus private practice. And I think most of us have a love hate relationship with the patient portals where patients are expecting and hoping for answers really quickly. The number of messages that we get through the patient portal can be overwhelming on some days. And I think that those key differences don't really matter between private and academic. But I think at the end of the day, the key driver to avoiding physician burnout is how much you really engage with your patients and how much you really love your job. And I would argue that in an academic setting where you have more than just patient care, there's actually less opportunity for burnout because you have so many more opportunities to pursue the things that you love within the field of medicine, or at least that's been my experience. And so, while patient care is a huge part of what I do, I also have some amazing opportunities with education both on a local level with our fellowship program, our residents, the medical students, but also on a national level through my leadership in SREI and being a part of SREI, which is a tremendous organization. And then the bigger playing field with Fertility and Sterility and ASRM. Being part of an academic practice enables me the time to devote to some of those other opportunities and it provides a wonderful balance to the demands of patient care. And I think it also really helps to keep me engaged and excited about the field and the science in the field on a level that I don't think I had the same amount of time to devote when I was in private practice and bogged down by some of the business aspect of running a practice.
JONES 23:09
Yeah, I wanted to ask about that because you mentioned that physician burnout might be less than academic practice because you have the opportunity to pursue these other tracks and other endeavors with societies and publications. And is it also the case that having less autonomy--with the reason why we can't decide our new website or EMR this particular initiative is because the university or the health system is doing--is that less autonomy, also responsible for, well, less responsibility that leads to burnout? Could that be the case? It’s a double edged sword--you know, you might be less free in this sense, but you're also less burdened in a certain sense.
FEINBERG 23:52
I agree. And I think some days, it depends on how bright I want that silver lining to be. I think on some days, it is a blessing not to be able to make the decision on high level decisions on what PGF labs are we going to use? Right? So I think it's, it's wonderful to be able to meet with everybody and really compare all the different outcomes and dive in deep to the data. But I think on some level, it's nice to have other people to help with that task. And so I think that the administrative burden of running a private practice, while you get your independence, you get that independence that a huge price of time and energy and effort. And so I don't think that one is better. I think there are certainly people that really thrive on the business aspects of running a practice and find those challenges to be rewarding. For me, I didn't find that to be as rewarding as I find other opportunities, but I don't think one is better than the other. And so my advice to the fellows coming out of practice or even those that have been in practice is you have to take a really honest look within yourself.
JONES 25:08
Know thyself.
FEINBERG 25:09
Yeah, like what makes you--what is going to make you excited to get up and go to work in the morning? Are you going to be excited that you have a business meeting and you can sit around the table and figure out new codes that you can bill things in different ways so that you can capture more revenue? Certainly people think that that's challenging and exciting and we made some great headway in our private practice on discovering new codes and new things that we could bill for and that definitely benefited the practice as a whole. But for me, personally, that wasn't what excited me. I was more excited about the new episode of a podcast coming out or the new issue of Fertility and Sterility being published than I was about different billing codes and ways to get revenue and that's important. It's really important. At the end of the day, that's what enables practices to run, but whether you do that as a physician or you have a hospital system that's well-oiled that figures that out for you, I think that some of the autonomy that I was willing to give up.
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JONES 28:14
I think it cannot be understated your point that one is not inherently better than the other. One can be wildly successful in different tracks and their trajectory of success will likely depend on how natural of a fit it is to their personality. Both society and the economy and healthcare and the fertility field all need people who are higher on the entrepreneurial skill scale and lower and more experts in other domains and that there is now a wider range in the field for people to plug into than there has ever been. And so for myself, I don't own a practice, but owning a company is a stress that I want. I would rather have that stress. When I meet with other friends in the field who work for practices or work for other groups with their executives or the directors--they've got their stresses because they're in their systems dealing with their bosses and their programs. And I don't have any of those, but I've got to make payroll and I've got to hire people and I've got to decide what the offering is, I've got to keep up with what the future value of the company is. That's the stress that I want, because I know myself and other people don't want that, to your point of taking a good look. That's somewhat of a spectrum. And I think in any given institution, it's good to have intrapreneurs people, that say okay, I don't want to start my entire new thing. But you know what, I do have a vision for this division, this program. So what is the future for someone who's on the entrepreneurial scales, not so much that they want to go start their own group. They do want to be in academics, but they are an intrapreneur, what's the future for them?
FEINBERG 30:07
Well, I think again, this is where it depends on your particular academic practice and the model that is set up for compensation. And so I think that there are academic practices that are productivity-based where you can--you may not have equity in the practice in the same way that you would have equity in an independent private practice, but there are certainly ways that you can increase your revenue or increase your income in a productivity model academic center. And you can also bring value to that academic center. You can help on the business side to help run that practice better, so that at the end of the day, you make more money. And so it's not to say that we don't look at the dollars and the cents. We do in our practice. We are productivity-based. And so we're not negotiating the contracts with the insurance company, we're not necessarily getting into the weeds, figuring out which emulate machine to purchase, but there are ways that you can create different compensation models, even within an academic practice that benefit the physician partners in that practice.
JONES 31:21
And that can vary widely depending on which practice it is, no?
FEINBERG 31:27
Absolutely. And I think that the old models of having a salary and being paid to show up for work, I think those models are long gone. And so many of the models really look at productivity. And one of the nice things is there are protections on your time in an academic model, where you have a target that you have to hit and then if you have certain roles within the hospital system or certain roles within the university, you can have protected time meaning that a certain percentage of your target, you don't actually have to bill for, you get credit for some of the other things that you do. And so there are lots of creative ways where you can structure the employment agreement in a way that not only meets your academic goals, but can meet some of your financial goals. I'm not trying to say that being in an academic practice is going to compare to being in a private practice, but I don't think it's as black and white or as cut and dry as many people imagine that it would be.
JONES 32:34
The flip side to that is I think that there are some people that despite being employees, take such ownership of their positions of their roles at whatever institution there at and they fancy their institution as though it were their company. Is there a downside to that within academic practice of you know, there are probably division chiefs and others who it's like it's their practice. They're putting in so much work and going to meetings and communicating with the university or the hospital, but they're not seeing the benefit of being an equity owner. Is that possible?
FEINBERG 33:14
Yeah, absolutely and I think one of the very scary things about being an employed physician and it doesn't matter who your employer is, is that you have the ability to be fired. And that, unfortunately, is a very realistic position for many of us in academics, where the job security is not what it is when you're your own boss. You hear of Division Directors, and even of Department Chairs, being asked to step down from their roles. And I think that's really hard. That's definitely one of my fears in my position is that what do I have to do to maintain my position and secure my future in a way that I quite honestly didn't really think about when I was in private practice.
JONES 34:02
And I think that is contrary to what the public might assume--that we think private business, less security more likely to see a layoff or to be terminated with or without cause. And we're used to hearing about university faculty and tenure and you can only fire them if they do something publicly egregious. And that isn't the case with contracts in academic REI is it?
FEINBERG 34:33
Not really I mean, there are very few tenure track positions, most of those are research-based and not clinical positions. And I think the the old notion of you're in academics and you just have to show up, I think that's long gone. You really have to work to maintain your position and to maintain your roles and those who are not doing so may be asked to step down. And I think sometimes the scary thing in our field is, there are some really good and very talented people who are in Division Director or even Chair positions that have been asked to step down for reasons that aren't widely known or aren't widely understood. And so there's a lack of transparency, sometimes in academics that can be frustrating.
JONES 35:25
And can you talk a little bit about just different ranges of contract terms that you’ve heard. I was speaking with one individual, one academic program who said that their program was--it was all one year contracts and to this individual’s knowledge that most academic centers were like that. I spoke with someone else who they do three year terms and said it very much not the case that it's one year contracts. Are you familiar with different ranges in academic medicine of contract terms?
FEINBERG 35:58
don't know admittedly, I don't know what the scope of what's out there. When I was brought into my current role, I had a five year contract. I've been here four years, it came up for renewal and we agreed to a three year term and to be reevaluated again three years later. Even with partnerships, there are still contracts that are in play when it comes time to do a contract for a partner and most of those contracts have a period that renew or that end where you can renegotiate terms. I admittedly don't know the answer to that.
JONES 36:35
Well that at least gave us some idea that added to the two that I had up to three, so slightly wider range in our sample size. So it isn't the tenure track that exists in the other realms of the university that that's typically only reserved for those in research positions. Can you talk a little bit more about the differences between Professor, Associate Professor, which tend to be teaching tracks, or those of Clinical Professor, of Clinical Associate Professor who some of their work sometimes is entirely clinical with very little protected time for teaching. Can you talk about those different tracks?
FEINBERG 37:16
Yeah, and I think those are really University specific, I will say. So when I was at the University of Chicago, there was a clinical track and the clinical track was really for those physicians that had more of a clinical teaching role. So I was brought in as a Clinical Associate or a Clinical Assistant Professor, and then you would progress to a Clinical Associate and then to a Clinical Professor. And those, at least at the University of Chicago that were eligible to be an Assistant Professor Associate, were really employed by the university. Northwestern has a slightly different system in that faculty are already in on the Assistant Associate full Professor tract and then there are adjunct positions in the clinical adjunct positions. But what determines what track somebody is on really has to do with how much time they're spending teaching, at least in our institution, that's really at the medical school level. So you could teach a lot in the residency program or in the fellowship program, but it's really Northwestern University and the medical school that determines your teaching role within that. And so just generally speaking, most are brought in as Assistant Professors. Assistant Professorship is usually five years five to six years at that level, and then you're eligible for promotion to Associate. And in general, we say that an Assistant Professor is very well known locally. An Associate Professor is known on a national level, and to achieve the level of Professor you have to be known on an international level. And there are certain benchmarks that you have to hit to move forward through the ranks of promotion. And so we have three domains that we look at: one is clinical operations, one is education, and one is research. And you have to pick two domains in which you want to focus and build your career upon. And then in order to be promoted through the ranks, it requires excellence in those domains, as well as publications, teaching appointments, and invitations to speak both locally, nationally, and internationally. And so it tends to be, like I said, about six years at the Assistant level, a minimum of five years at the Associate level, though many people are Associates for far longer than that, and then you eventually hopefully make it to the rank of full Professor at some point in your career,
JONES 40:04
Just by you describing these different tracks and the benchmarks used to advance within them, a self-aware doctor, a self-aware person can listen and identify what is important to them. So, know thyself is a recurring theme from this episode. I want to take advantage of your experience having worked in private and academic practice, especially private practice as a partner some more because it's so uncommon. You mentioned that you knew you wanted to be in Chicago, they weren't academic positions open when you entered the workforce. And so you chose a position in private practice. But there are also lots of practices in Chicagoland, talk about how you made the decision to go with the practice group that you decided.
FEINBERG 40:58
Yeah, so I spent some time speaking with a lot of the different private practices in Chicago and there are a lot, from one person practices to two people practices to four people practices to FCI, when I joined, was an eight person practice and they came--there were two, there were two of us that joined at the same time when we became a 10 physician practice. I looked at a lot of different factors. I looked not just at geography, but I looked at infrastructure, support, and I looked at mentorship--that was very important to me beginning in practice that I would have some mentors that could still teach. I feel like you learn a lot in fellowship, but there's still a tremendous amount to learn. And when I really looked at who are the different players in the different practices, I felt like I would get the best continuing education in my role at FCI. And I think that that was a really wise choice for me. I found that I learned so much from the different partners. Everyone had something to teach whether it was one partner working on research projects, another partner who was brilliant when it came to the business of running a practice, and one partner who is an absolute genius when it came to marketing. I felt like there was so much that I learned by being exposed to so many different people and so many different people at different phases in their career. And I think that that's probably the most important advice to physicians are in that practice and look at what they have to offer and how much they're willing to teach you because while you know a lot coming out of fellowship, you know a lot about the science of REI, but there's so much more to learn about marketing and social media and business and insurance contracts and just the politics of being a subspecialist and how to grow and build your practice. And those are all the things that we can try to teach you in fellowship, but oftentimes it's sink or swim once you’re out there on your own.
JONES 43:08
How often do you find that fellows are very hungry for continued mentorship in the forms that you just described versus are you kidding me? I've already gone through 15 years of higher ed, what was that three years of training for? Just let me get in and let me actually be a doctor the way I want to be! And maybe there's less of a focus on desire for mentorship.
FEINBERG 43:32
I think the former is much more common. I think people in our field tend to be more self aware and understand the limitations of fellowship training. I spend a lot of time on the phone with graduating fellows who reach out for advice, or a lot of time at meetings, giving advice to graduating fellows, and I think many of them are very attracted to the idea of mentorship. I think it's--we find mentors in different aspects of our career in different ways and I think many of us realize the importance of continuing that mentorship relationship. I also think it's fun when the former fellows from Northwestern will reach out and text me questions and one thing that I say to them when they graduate as our relationship does not end here. I will continue to be your mentor as long as you allow me to. And so it's quite common that I get texted random questions at random hours about random things, and I really enjoy being able to give back to those who are more junior because those who are more senior than me gave me so much in my career path.
JONES 44:45
Especially because you've done so much in your career! You’re now the Medical Director at Northwestern, you were in private practice, but also found a way to include teaching into that private practice. You chose the group that you did, because the learning and mentorship that was available to them and you were a partner there. So how did that decision come about? Because you were an employee for four years and you maybe could have said, I'll continue to be an employee, but how was that decision for you? And what would you want people who are listening to this show right now, going through discussions with their potential partners to think about?
FEINBERG 45:25
Well, my group, FCI, had a very defined path to partnership, which I think is really important when you're looking at practices. I think that sometimes more so than academic versus private, I encourage people to think about it as employed versus equity partner. And when you're joining a practice, you want to know what is that opportunity for partnership and what does it take to become a partner and the practice that I joined one of the things that I thought was really attractive about it was it was a defined path to partnership: four years as an associate and you had the opportunity to buy into partnership. And I felt like if I was going to go the route of private practice or employed physician, I didn't want that to be employed in perpetuity. It was a very different decision than joining an academic practice where I knew that I was now employed, kind of, in perpetuity. But I think it's really important for people to understand what the implications are of being an employee versus being an owner of the practice, and not just the financial implications. So certainly, those are really important, but what are the responsibilities and what is that decision making? And certainly, you can opt out of partnership and you can opt out of decisions. But again, it's that double edged sword that we talked about earlier. Then you have somebody else who's making those decisions for you. And particularly when you're in an independent private practice and your financial well-being is very much tied to those decisions, I would argue that you want to be the person who's making those decisions that are going to impact you so profoundly. And so I think it's really important for those who are entering practice to understand not just to look at the year one salary and bonus and are they going to pay me a signing bonus, but really to look at what does joining this practice mean, and what is not just my short term, but my long term opportunity for growth and development in my career path.
JONES 47:39
I really, really want to talk to you about physician burnout because I think it's such an important topic, but Eve, I am getting better at not going off on so many topics in one episode. I've been pretty good about keeping this streamlined. So I would love to have you back on for another episode after PCRS to talk about physician burnout and I plan on attending that talk myself. So if you would graciously oblige us, we'd love to have you back to talk about that. But in keeping with your experiences in partnership as as an equity owning partner of the group, as an employee of a practice group, as someone at a higher position at academic center, employee at an academic center, how would you want to conclude for those that are either in fellowship right now, or they know that they're going to make a change in their group and these options are still available to them? How would you want to conclude on this topic of self awareness that anyone might be able to tap into your experience for how they map out their career path?
FEINBERG 48:44
I think it all ties in together and I think it does tie into the idea of physician burnout that you have--to spend so much time at work--we spend more time at work that we do at home in many situations and on many days--that I think that you have to absolutely love what you do and do I love every second of every day? No, but the good far outweighs the not-so-pleasant. And I think you have to find an environment in which you're going to thrive personally and professionally, where you're going to really enjoy taking care of patients, and you're going to enjoy interacting with your partners. And I think you have to look at all of those factors. And at the end of the day, I think you have to realize you live once and there are no do overs and you have to be mindful of where your passion lies, where your strengths lie, and really try to play to those strengths and those passions and at the end of the day, I think you're going to be far happier, doing the things that you love to do, than doing the things that other people expect you to do.
JONES 49:53
Hang in there Inside Reproductive Health audience, we're going to talk about physician burnout on a coming episode, you've just heard the prequel. So if you can start to figure it out for yourself by being self aware, great, if not just put up with that stress for a couple extra months. We've got you covered when we have Dr. Feinberg back on the show, Eve. Thank you so much for coming on Inside Reproductive Health.
FEINBERG 50:15
Thank you so much, Griffin, it was my pleasure.
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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.