In this episode, Griffin hosts Dr. Rhonda Zwingerman, a fellow OB-GYN and REI at the Royal Surgeons of Canada and an assistant professor of OB-GYN at the University of Toronto. Jones and Dr. Zwingerman talk about the factors shifting the entrepreneurial landscape for incoming REIs including the funding of fertility treatments, the recruiting of REIs, and the risks involved. Tune in to find out more!
Welcome to Inside Reproductive Health, the Shop Talk 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 https://www.fertilitybridge.com/goal-and-competitive-diagnostic 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: Today on the program, I'm joined by Dr. Rhonda Zwingerman. Dr. Zwingerman is a fellow at the Royal Surgeons of Canada both OB-GYN and REI. She is a full-time professor of OB-GYN at the University of Toronto. She is also a member of the department of OB-GYN at Mount Sinai Hospital. Dr. Zwingerman pursued her undergraduate and medical degree at Queen's University. She went on to complete her residency and training in OB-GYN at the University of Alberta. She then moved back to Toronto and obtained a master's degree in health services research and then pursued her REI fellowship at Mount Sinai Fertility where she currently practices. Dr. Zwingerman, welcome to Inside Reproductive Health.
ZWINGERMAN: Thank you so much for having me. And sorry, I'll just say that I’m not a full professor, of course, at this stage. Assistant professor.
JONES: Well, thank you for the humility and clarification. We wouldn’t want our listening audience.
ZWINGERMAN: That would be quite the achievement, wouldn’t it?
JONES: I remember the first time that you and I spoke was at CFAS and if I’m remembering correctly, it was in 2016 because it was in Toronto.
ZWINGERMAN: That’s right.
JONES: For me, it was a pretty enlightening conversation because it tuned me into one of the patterns that I’ve seen across the field with hiring doctors and doctors coming out of fellowship. On one hand, retiring doctors that I know or, I should say, just recruiting doctors. Maybe they are within five years of retirement or maybe they have fifteen to twenty more years left in their career, but everyone is having difficulty recruiting new doctors, it seems. When I spoke to you, were you still in fellowship, at that time?
ZWINGERMAN: Yes.
JONES: We were talking about where you were going to go afterwards and were you going to open up a private practice and/or did you want to take over someone else’s. One of the things that you had mentioned was after so many years of medical school and training and, in your case, master's degree and then residency and fellowship that there's so much risk for someone who has gone through all of that, to then take on an entrepreneurial endeavor. Am I paraphrasing that okay?
ZWINGERMAN: Yeah, I mean, I think that there’s a lot of issues at play for new grads and I’ve listened to some of your previous guests talk about what some of those issues are south of the border and some are transferable up here in Canada and some are different. I think one of the things that we probably spoke about was that there’s not a lot of business training in medical training, and I know that’s something that you feel strongly about and I also feel like that's missing from the curriculum of young doctors today, really at all levels of training, and it does make it harder to envision yourself in the role of running a business when you don't have any training or experience or mentorship and how to do that. When you're going out and getting your first job when you’re already in your mid-30s, which is obviously a lot later than most other people in the workforce. So I think that’s part of it. I think the other consideration in terms of the landscape for new REIs which is somewhat unique here, is that the funding for fertility treatment. Ontario is a unique situation and the way that the government pays for some of the IVF services has really put a moratorium on opening new clinics as an unintended consequence if you will, because they've tied the funding, the ability to provide funded IVF services and IUI services to existing clinics.
JONES: Let's give some context for that because this is probably two or three years old at this bet. Ontario came in for funding for IVF. It had not existed for IVF previously in the province and there’s a certain either cycle limit or dollar limit per clinic is that correct, that the province provides?
ZWINGERMAN: Yeah, so the province started, obviously health care insurance is provided by the province, by a single pair which is the province and starting in December of 2015, they kind of created a pot of money that would specifically would go towards funding IUI and IVF and every person gets one cycle, one complete cycle of IVF, and they've basically distributed that pot of money amongst the existing clinics.
JONES: It is by the person? If I’m remembering correctly, in the beginning, some clinics were doing the lottery system, some clinics were offering it to new patients, and that was a challenge of how clinics were going to distribute. So is it by the individual now and not by the clinic?
ZWINGERMAN: The money is still allotted per clinic, but then each patient only gets to have one funded IVF cycle.
JONES: And this has put a moratorium on new clinics in Ontario. Why do you suppose?
ZWINGERMAN: Well, you can open a new clinic but if you aren’t eligible to receive a piece of that pie, it's going to be nearly impossible to attract patients because people don't want to pay for IVF if they can have their first cycle be paid for. Same for IUI. It’s difficult, if not nearly impossible, to set up a new practice where you don’t have a piece of that funded pie. And right now, as far as I'm concerned, there's not a good mechanism to reallocate that money or to change that. Now, I expect eventually the government will have to evolve and deal with that situation. But for now it has made it hard for new REIs and that's part of the landscape. I think part of the other landscape is things that are a little more generalized, well that you’ve talked about, different clinics are being bought up by bigger companies and just the need for REIs matching the demand, in terms of geography of the country, is also fairly complex. The big cities are fairly saturated and yet the smaller cities have a hard time recruiting, which I'm sure is not unique to Canada.
JONES: No, that’s very much the case in the United States as well which I think is going to become another podcast episode because we could have an episode just about that particular phenomenon in access to care because it is becoming a real access to care issue. When I speak to people completing their REI fellowship, almost universally speaking, the only ones that are going back to markets like upstate New York, where I live or Missouri or Ohio or a lot of the interior of the country or just outside of the large cosmopolitan cities, are almost exclusively those folks that are from there that want to go back home to be close by their families. But the recruitment power of those clinics in San Francisco and New York and Boston, Los Angeles is much higher than it is in a lot of the smaller markets in the country.
ZWINGERMAN: Of course, that’s a medicine problem, more generally, and not an unique-to-REI problem so, yes, I agree that’s probably it’s own podcast, for sure.
JONES: One of the other things that I see is that so many people coming out of fellowship have job offers real early on. I just got back from the Pacific Coast Reproductive Society Meeting. By the time this podcast episode airs, it might be a couple of months after, but almost all of the fellows there had offers by their second year. In the US, it’s a 3-year fellowship. In Canada, it’s only 2, right?
ZWINGERMAN: Right. But our residency is five years instead of four so it equals out.
JONES: The total time equals out but by the second year, almost everyone had signed with a recruiting clinic including some in discussions in their first year of fellowship. So clinics now are reaching out to people who are in residency who may or may not go into REI fellowship and trying to build those relationships now and recruit people that haven't even chosen REI yet because the supply is so small relative to the demands. When you're thinking back to your last year or two of fellowship, did you have a job already?
ZWINGERMAN: Yeah, that doesn’t ring true to the experiences I think of myself and my co-fellows, here at least. I certainly feel like it's more been the onus on the fellows to reach out and contact the clinics to see what opportunities are available. Certainly, there are. The landscape is just very small in Canada. There’s just not that many clinics. A lot of cities have one. So most people with their ear to the ground know what cities are looking and what cities aren’t and what opportunities may be available and not, but it certainly doesn't feel like Fellows are being proactively approached a lot of the time and eagerly recruited. That would be a nice feeling.
JONES: How many REI fellowship programs are there in Canada?
ZWINGERMAN: There are, I have to count them. There’s for sure less than 10 and some of those will be French-speaking programs.
JONES: So maybe there’s 10 REIs.
ZWINGERMAN: There’s probably about 10 grads every year.
JONES: 10 grads every year. Okay so in the United States which is a much larger country, there is about 40.
ZWINGERMAN: Right.
JONES: So relatively speaking, maybe there are more REIs coming out of fellowship at a per capita level in Canada. You heard it, listening audience, the Canadian clinics are sleeping on recruiting their fellows. There might be an additional little pot for you to explore up here in Canada. You chose your position. Was it because you were training at Mount Sinai and you liked the program and you wanted to continue there?
ZWINGERMAN: Part of it was the academic aspect. Where I work now is affiliated with the university and it’s where the fellowship program is and the residency program and there’s an expectation of research productivity. For me, that’s something that I wanted that obviously appeals to a subset of REI grads but not the majority in terms of wanting an academic position. So that was a big part of it. For personal reasons, which is almost always the case, I wanted to stay in Toronto where I’m from. And the benefit of having trained somewhere is that you go into a job with your eyes wide open about the group of people you're working with and what the job’s going to be like so it just seemed like it was a good fit for me so I'm very, very glad that it all worked out so well.
JONES: That helps take away some of the surprise because one can never know for sure what it's like to work with a team or in a culture or within an organization until they actually do and that would be a big advantage. One of the tenants that I took away from when you and I first spoke and that I've been exploring a lot more with my writing and with talking to clients and creating content for the field is that I don’t necessarily think it’s a fair criticism of younger doctors or of people leaving fellowship, to say that they are not entrepreneurial or that they are less entrepreneurial. Maybe there are arguments for that. What I see is a much different landscape than the previous generation. And if I’m calling the previous generation those that were part of that wave that started REI practices in the mid and late 90’s, that left the health systems and universities in the mid 90’s to open their own practices, because what I see there is inheriting the old model of what a healthcare practice is from the mid-twentieth century of there's a doctor who is the business owner who hires a practice manager who runs the practice and that's it. It is a business because it is a for-profit entity and there are private individuals that own it, but it is not the same schema of entrepreneurship that exists today with private-equity and venture capital and I think that has completely changed the risk and I think that is what you were saying when you were analyzing the risk and I think that’s what many young doctors are seeing as well.
ZWINGERMAN: No, I agree. I think that the landscape has shifted both in terms of what it means to run a practice but also in terms of the practice of medicine and the complexity of the medicine itself that we’re doing in compared to REI a few decades ago. So what it would mean to actually run a full-service to open your own full-service ARP facility and the number of people you would need and the number of technologies you would need to be able to offer to a certain standard, I think has also just really ballooned in complexity than what you were saying in the 90s what it would’ve taken to open a clinic. I think there’s been changes in the landscape in many ways.
JONES: Being an entrepreneur is very difficult and it’s a rare talent set to begin with. In parallel, you have another rare talent set by definition. 10 new fertility doctors coming out in Canada, forty to fifty in the United States per year. That’s rare. Eleven hundred board-certified REIs in the United States. You’re having two very rare qualities in parallel and I think every time that I'm swamped with owning my business, I think what if I also had to do [inaudible] a year on top of this? That’s the case for them.
ZWINGERMAN: It serves you well as a physician to be very risk-averse because you want your doctor to be very risk-averse and yet as an entrepreneur, you need to be very comfortable with risk and I have not yet figured out how. Those two things don't comfortably coexist in that many people. Even people who, like me, have a significant interest in the business side of medicine, I constantly want to learn more about the business-side of medicine, and I want to engage in that part of my professional life, but I still find that because of all my training and because of inherently who I am, that risk aversion makes it much harder to think about taking big leaps into an entrepreneurial endeavor. I think that's also part of the issue.
JONES: That is such a keen observation because I see those two tenants in conflict with one another very often. And I see it taking the form of not wanting to post a Facebook Live video because it doesn’t look aesthetically perfect or we’re not going to do this because the logo is on the right and we won’t change it until it’s on the left. And the color of the border of this image is turquoise and we want it to be teal. That risk aversion, which is describing it sort of cheekily, but that really slows down the speed of the progress of the business against companies that are moving at full-speed with optimal resources. That really is a business challenge because, in medicine, you don’t just try and do an operation. There’s a scientific method, there’s peer-reviews, there are entire processes for beginning and attempting new techniques. In entrepreneurship, the name of the game is do something, iterate, do it again because testing and focus groups in hypothetical situations is not relevant. The information that is yielded from that in most entrepreneurial settings is irrelevant by the time that you’re actually ready to go to market with something. And going to market with something is where you get the real information. So I see those two things, in contrast, all the time. I think you’re right. There’s not a lot of people that can do both extremely well.
ZWINGERMAN: No. I think that’s a good summary of it. I think the other challenge that I see or inherent conflict is in medicine, we’re also taught like you said, you want to evaluate the evidence systemically and you really don’t want to offer things to patients that you feel like aren’t proven, aren’t well-established, have a risk of harm. We want to practice evidence-based medicine, something I’ve heard you talk about on the pod with other guests. Yet that can also come in conflict with the business aspect of medicine. Because if you’re competing with the other clinics down the street that are offering fancy add-on X and Y and Z, there’s obviously a lot of pressure from patients and from the industry as a whole to start offering things before they’re as proven as you want. And certainly practicing in an academic center, we feel that pressure as well.
JONES: I see the ying and yang that come from that and how one could possibly be beneficial to the other or vice versa in that there probably are certainly things outside of the clinic space if we look on Instagram and different fertility solutions that are not evidence-based at all, that are not scientifically based, that patients are exploring because they are so desperate for a positive outcome. And then they’re coming to the clinic and saying, “Why don’t you do this? Why don’t you offer this” I think, I really respect when clinicians hold their ground if they don’t believe in something, just because it’s validated by the market. It does not mean that they should always be offered the clinical solution. Conversely, I just think sometimes that if the market was not driving the response, that clinics would still be doing the exact same things that they were in 1996, which they already are in some cases, and the market is what is forcing some providers that would otherwise really not adapt to current demographics and current habits to update and stay abreast.
ZWINGERMAN: Yeah, it’s a hard balance. The clear answer is not the extreme on either end, it’s somewhere in the middle and that’s a hard balance to strike. All of this is making me think that part of the solution has to be really good partnerships at the top of your organization. You need the medicine. You need the person with the medical expertise. And you need the business expertise too. It’s probably hard to find that in one person a lot of the times. You’re best off in finding a partner to take on some of those attributes that don’t come as naturally to people doing the medicine.
JONES: One of the things with respect to partnership, with respect to who owns individual seats of accountability within the organizations. I run my company off an operating system called the Entrepreneurial Operating System. It’s called EOS for anyone who wants to Google it. I’ve written a little bit about it in the blog. The thesis of EOS is that it takes two people to run a company. At the top, there’s the visionary. That’s the person who usually maintains the culture, decides the direction of the company, is the key relationship on the most important vendors and clients. Then there’s the integrator who if you think of the visionaries, the CEO, the integrator is the COO. The problem for most independent practices that are in business is that they’re in both of those seats, but they’re also in the three main seats that come beneath it which is operations. In our field, you may split operations between clinic-side and lab-side. There’s what you do in operations. There’s how you make your money, sales and marketing, the revenue coming in. And then there’s finance which is money coming in, money coming out. So often, the practice owner or the principal partner is in all five of those seats as well as they’re in that physician seat of seeing 500 patients a year as well as doing 150-250 egg retrievals and oh, by the way, they might want to see their family at some point. I see a really big problem. If you’re going to be in that top seat, there are some of those other seats that you have to let go of. And I still have, some of our clients, still pay us by paper checks that they’re signing themselves and that’s the case of a CFO seat that has not been let go of. In most cases, we don’t talk to the marketing director when people reach out to us directly because we know either the marketing director or the practice manager cannot make marketing decisions. They can’t sign off on a million-dollar marketing program or a hundred-thousand-dollar marketing program or even a ten-thousand-dollar-marketing program. They don’t have that decision-making authority. And that’s another seat that has not been let go of by the principal. I see that as one of the biggest impediments to speed. I wonder if you see that in other areas in the clinical side or more the administration of care side because I see it everywhere on the business side.
ZWINGERMAN: Yeah. It’s hard for me to answer that question exactly because I’m sure it’s different in every different clinic, how they structure their organization. Where I work is a little bit unique because it is a hospital-affiliated clinic so there is some extra bureaucracy inherent in that, which are staff or hospital employees and the like, but certainly having a clear hierarchy and organizational structure and knowing who does what is foundational to a smooth-running organization. I think it’s very true what you said. You need someone at the top who is the big picture person, who is setting the culture and looking at the long-term strategy and the long-term business plan and that person needs time to do those things and they won’t also necessarily have time to be doing all the operational things as well.
JONES: I think that is exactly what you were saying with, going back to the entrepreneurial risk, or the responsibilities that young doctors are assessing. They see all of this and I don’t want to deal with all of that. I much rather a health system like you did or a large practice group where they do have that corporate infrastructure in place, the C-suite that is running the practice and I just have to be a doctor and maybe I have to hit the payment and build relationships with referring providers and build my own practice in that sense. There are other people taking care of the rest and I think that is a lot more attractive to most people. I don’t think that it’s a decision that the previous generation of practice owners would not have made if they were up against the exact same landscape looking at the landscape in the same way.
ZWINGERMAN: I think that’s right. I think that’s exactly what it is. It’s not that people inherently are averse to starting their own thing. The landscape has been such that this is the way that the practice has kinda gone. And truthfully, doing good medicine, building your own practice in terms of how you run your own little clinic with your own close group of immediate staff, reaching out to those referring providers, making your own relationships, and also having your own life, that’s a lot in and of itself these days. Also, in my case, adding the academic component. It’s not like there’s a big void in your day to take on this whole other job, basically.
JONES: Right.
ZWINGERMAN: For sure there are a lot of physicians that graduate and they want to practice medicine and that’s all they want to do. And that’s good. We need those people to practice medicine and to see the patients and to have someone else who can't do the medicine do the business side of it just inherently makes sense from an efficiency point of view. And even those of us who are more interested in the business side of medicine, there are still all these structural and systemic reasons why it doesn’t make sense necessarily to go on your own and start your own thing but rather to integrate yourself into an existing structure and then maybe get more involved on the business side as you grow and learn.
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JONES: Do you feel that you’ve gotten the opportunity to do that because I remember the concept of being entrepreneurial was important to you. Even if you weren’t going to take the risk of starting a brand new IVF practice in Ontario or taking someone else’s over, you did have this interest in the business side or some more interest in practice management. Have you found the opportunity within a large health system, within academia, to be able to explore the entrepreneurial interest you have?
ZWINGERMAN: Just making the transition from fellowship to staff and, now that I’ve been staff for over a year now, you certainly just by paying attention and asking the right questions, there’s certainly a lot that’s out there that I have to learn and I plan to continue that. It’s like anything. Someone usually doesn’t walk up to you and say, “Hey, I’d like to mentor you.” You have to seek those people out and ask the right questions and pay attention and show an eagerness to learn. That’s what I’m trying to do. I think, it’s not like there’s a lot of formal mechanisms to learn these sorts of skills. Some of it obviously through doing my Master’s in health services research. Some of the courses I took about organizational behavior and some of those things were certainly quite applicable to what we’re talking about now. But, otherwise, I do think it’s more about seeking out the people who are in those roles that have those skills who can mentor you and teach you as you go. And just from being in it and practicing medicine, you learn.
JONES: What more could we do for residents and fellows, and maybe even in medical school, maybe you’re right and it’s at every single level, to provide more business training? When I meet these fellows, here’s the writing that we’ve done, it’s hardly a business course at least here’s an eBook, a podcast and a blog about what’s going on in the field. But what could we do across or throughout education and training to at least give people a certain degree of literacy and education about the business side?
ZWINGERMAN: I think it should start in medical school actually. There should be a floor, a baseline level of business literacy that we teach to all medical students and it doesn’t have to be a lot. Very basic accounting. Very basic how an organization is set up. What does an org chart look like. Very basic stuff so people have that knowledge. I think personally it should continue in residency and fellowship tailored more to that specialty. I think it can be somewhat streamed so people can self-identify, who are particularly interested in gaining that skill set and people who aren’t as much, don’t need to train as much. But I do think that there should be business courses and business curriculum integrated into medical training. To me, it’s a little crazy that there isn’t any.
JONES: Right.
ZWINGERMAN: Even the number of grads who come out who don’t know a lot about billing which isn’t business, it’s just how you get paid. A lot of that is taught and learned informally as you go. That’s even just a small part that can be integrated into a larger curriculum of fairly basic tenants of being part of a business, running a business, hiring people, how do you make sure your clinic has all of the supplies it needs. It’s not complicated subjects that we need. I do think that would be a huge service to physicians everywhere if we could integrate that training from an early stage.
JONES: It would certainly help the prospect of starting one’s own practice, at least make that option more attractive, if people knew how to consider that option. Maybe one of the reasons why it’s not so highly considered now is not just because it’s being perceived as high risk but also just being perceived as such a foreign concept.
ZWINGERMAN: And overwhelming, right, if you don’t know where to start.
JONES: Overwhelming. What would you say to conclude that I haven’t asked you about? You want to share your thoughts with the audience about recruiting young doctors or new doctors choosing their career path?
ZWINGERMAN: I think the thing we haven’t talked about at all, yet, which I figured would come up at some point would be that push and pull between people’s life and people’s professional aspirations. I think that’s also an important aspect not to forget about when we’re talking about recruiting and we’re talking about which cities people want to go to and people’s willingness to take risks which often include financial risks. The demographics of grads today are such that people often have a professional partner as well. And they want to have families if they don’t already, and that’s important too. I think we see a lot of, I don’t want to make generalizations or speak for other millennials, but I think we see a lot of the Baby Boomer Generation of doctors above us and how their work in many cases is their life and while we aspire to be like that in many ways, we also see some of the sacrifices. No, I don’t think that’s fair. There’s just a generational aspect to it all.
JONES: That is where I see more of a generational cleavage. There is certainly more of an interest in work-life balance, for lack of a better word.
ZWINGERMAN: Yeah, I hate that term too.
JONES: Some folks might say entitlement. And maybe it is. I think it’s an entitlement, to a degree, when the expectations are so far off. Someone expects to make X amount of dollars per year because another physician is but that other physician is seeing seven hundred patients a year and doing 400 retrievals by themselves. That is a much different life than someone who wants to do under 120 retrievals a year and wants to go to Thailand or Cartagena or a number of places. And that level of travel, I think, is a subsegment of work-life balance. It’s something that we all see much more common among millennials.
ZWINGERMAN: I think, I certainly don’t see it as entitlement. I think people want to feel like they’re being treated fairly in terms of a job. I think people don’t want to burn out.
JONES: That’s where it becomes an entitlement if the expectation is too far one way.
ZWINGERMAN: Which I agree is not the majority. Most people are realistic in terms of what they want. I don’t even know what to call it because I don’t like the “work-life balance”. To me, it’s not a great phrase because I don’t think it’s unrealistic for people to want to have a good relationship and with their partner and to have a family and to spend time with their family if they want. I don’t think it’s bad for people to work all the time if that’s what they way. People should be able to have some autonomy to try to find a job that gives them that. In the end, that will make for happier doctors which will make for better doctors which will make for doctors who work longer. I think it’s actually mutually beneficial. There’s a lot of talk now about burnout and how to combat it. And all of this kinda ties into everything.
JONES: It’s one of our company values. Work hard and recharge. It’s our fifth company value because we are really strict about respecting people’s time outside of work. And I understand that all of this can’t translate to an REI practice necessarily because people have patients and there are urgent situations. Just as an example, one of our team members was on vacation last week and my expectation with her before she went was that she was not going to check her emails. You’re not going to come into the project management software and answer our questions. We’ll get by for a week and a half with you being out. That’s true for all of our team members. It’s true after hours. I don’t want my team members in bed at 11:30 not getting a good night’s sleep because right up before their head hits the pillows they’re responding to my emails or client emails. The way we manage that is with really strict project management. It also puts more onus on the times that we are working. We are not playing Candy Crush. We are not surfing Facebook or going through Sports Center while we are supposed to be working because we have to get that stuff done because we’re strict about the other side. By respecting one we also respect the other. I know that all of those tenants wouldn’t translate to managing a practice, but there really is something to be said for prioritization and how much more clear priorities come when certain blocks of time are blocked off for different responsibilities or for one’s personal life.
ZWINGERMAN: It’s not a one-size fits all, right? Not for different industries or different types of businesses or not obviously within different types of medicine or even between different REIs. Everyone has to find the way that works for them. What people want is a job that respects those differences, right. Finding the thing that works for them so when people come to work they are ready to be there and engaged and working hard and happy. It’s complicated, obviously.
JONES: But it’s a huge tenant of the discussion that has to happen when we’re talking with not just younger doctors and not just younger employees, but I think with the entire team. This has become part and parcel of managing teams.
ZWINGERMAN: Absolutely.
JONES: Dr. Zwingerman. Rhonda. Thank you so much for coming on Inside Reproductive Health.
ZWINGERMAN: Thank you for having me, Griffin. It’s been a pleasure.
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 our industry, visit https://www.fertilitybridge.com/goal-and-competitive-diagnostic to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.