/*Accordion Page Settings*/

Strategy

155 Where does the money go? What's new? What's different? With Executive Director, Dr. Jared Robins

This week on Inside Reproductive Health, Griffin Jones hosts guest Dr. Jared Robins, Executive Director at ASRM, to discuss all things conference. Tune in to hear what innovations are coming to the annual gathering for 2022, where all that endowment money comes from (and what it goes toward), desired outcomes for the future of ASRM, as well as an exchange of ideas on the business of business in medicine.

Listen now to hear:

  • What Dr. Robins has been working on since being named Executive Director of ASRM.

  • What the new and improved events and features will be at the conference, and how you can benefit from them. (Hint: fireside chat, networking lounge, interactive e-posters, Med-Talks, and more).

  • Where ASRM endowment money is procured and what it funds.

  • Griffin question Dr. Robins on the validity of disclosures in the medical field regarding business interests.

  • Griffin press about the level of influence business and medicine should have on each other, both financially and philosophically.


Dr. Robins’ information:

LinkedIn: https://www.linkedin.com/in/jared-robins-68a2825b/

Transcript


Dr. Jared Robins  00:00

As the healthcare providers and the business people should can't work, can't make decisions in isolation of each other. And they need a forum by which to come together and make those decisions.


Griffin Jones  00:14

Dr. Robbins, Jared, welcome to Inside Reproductive Health.


Dr. Jared Robins  00:19

Thanks, I appreciate you having me. Having me. join you. I'm excited to be here.


Griffin Jones  00:25

Your motto could be I'm not always the executive director of professional societies. But when I am, it's ironic because I don't want to call you the most interesting guy, Jared, because I don't like I don't like inflating egos that much. But I think it bears a little bit of talking about on the show you and I had dinner together in Atlanta, and I got to learn a little bit about your life. And I always say, Wow, this is like the Dos Equis guy. Is it you know, you said oh, yeah, I used to live in Atlanta. Oh, yeah. What? When was that? Oh, back in the 80s when I was a firefighter what? Oh, yeah, I was a firefighter for five years before I went to film school. What? And so let's can we tell people a little bit about your life before med school before we get into your trajectory as around?


Dr. Jared Robins  01:09

Sure. So I was doing some fire did some work because mostly working as a paramedic with the fire department in the northern suburb of Atlanta, what,


Griffin Jones  01:21

what brought you down there because you grew up in New Yorker, Long Island. Yeah, I


Dr. Jared Robins  01:25

i grew up on Long Island, I always wanted to be a firefighter paramedic, long wait to do such in the New York area, was looking at schools in order to really in most fire departments. In order to advance through the ranks, you had to have an associate's degree or a bachelor's degree, depending on how high you want to join the ranks. I always wanted to be chief, you know, and so I knew I needed a bachelor's degree. And I applied to schools, Emory was one of the schools I applied to the firefighting magazine was advertising heavily for fire departments in and around the Atlanta area. And so I applied to needed to pay for school. And also, I mean, I think that that was a big, big concern for me, as I wanted to go to


Griffin Jones  02:09

college, I had to pay for college. So you were a paramedic while you were at school. Correct? Yeah. And that why film school.


Dr. Jared Robins  02:19

So I was a, I was had an interest in in film and arts, and, you know, what creative thinker, and, you know, it was going to college really, for the degree more than for the knowledge and so I thought I would do something that was gonna be really fun. So I was a film studies major with the bio minor, and then, you know, as kind of progressing through school, decided, I think, really, through my experiences, as a paramedic, really decided that that medicine was going to the way I was going to be the way I went. And so, you know, made sure I hit my medical school prereqs. But I'm not really sure that that was the way I was gonna go when I was when I started the application process, but wanted to make sure I had those prereqs in case I decided that that was an avenue that I wanted to pursue.


Griffin Jones  03:05

Do you ever end up working on any films or TV? Do you


Dr. Jared Robins  03:09

did some short, you know, some short school type programs, but never anything professionally? Now?


Griffin Jones  03:14

How did the transition to medicine happen?


Dr. Jared Robins  03:18

Really. So, you know, had a strong interest in science. And so was taking some of those science classes along, you know, in school nature, like I said, I hit those prereqs I was in a fraternity as well, a lot of my fraternity brothers, were taking the MCAT, my girlfriend at the time was studying for the MCAT. So I thought I would take the MCAT to just see how I did and did well on the MCAT and just, you know, sort of almost out of fun applied for to Emory into state university of Stony Brook for to see if I would get into medical school and I did and had a long, you know, sort of inner conversation, you know, deciding is this really what I wanted to do talk to my friends, my advisers, my parents, you know, prayed on it a little bit and decided, you know, I thought let's go to medical school and see what happens. It doesn't mean I can't be a fireman in the end. But let's see how back to school goes. So State University of New York at Stony Brook was relatively inexpensive at the time. Not anymore. But and so I would be able to go there to school and not have to worry about taking out a whole bunch of loans. And so I went to medical school and I loved it.


Griffin Jones  04:29

So that brought you back to Long Island and then and then did the did you immediately do residency and OB GYN and then immediately sub specialize or was there a time between no being an OB GYN and sub specializing?


Dr. Jared Robins  04:45

So it's interesting. So obviously, when I went to medical school, I thought I would, at first I didn't know what I wanted to do, you know, my interests were trauma and, you know, trauma surgery, you know, and those sorts of things and you know, So I took my you know, in medical school, for those that don't know you do in your third year, you do what's called clerkships where you essentially spend time on the wards in the different fields. And knowing that I wanted to do surgery, and OB GYN is a surgical subspecialty. And this is actually a common story about what we do when I scheduled my OBGYN rotation immediately before my surgical rotation. So I would have that surgical experience, I would feel like you know, more confident when I walked into the AOR to impress the surgeons, and I loved OB GYN, I felt like there was a lot of some of the things that OBGYN had that that surgery really didn't have, is that idea of really being part of really developing a relationship with you, with your patients being part of the family. And, and I really love that idea of having that, that, that closeness with your patients with that ability to really impact, you know, someone's life over the course of their life. And so, but I also wanted to be a surgeon, so obviously weren't really was the best of both of those worlds, you had that ability to, to, to be a doctor, you know, to be a part of their family as a doctor and to also, you know, be a surgeon. And then we presented the chronology, which was relatively new, you know, this is now 1990, early 1990s. So it's a relatively new field. And there's this that ton of creativity currently going back to those roots of I was a film studies major. You know, there was that idea of being able to be creative and innovative and really thinking, you know, long term about how to solve problems. And so I was really drawn to that reproductive endocrinology can making families what can be more fun and exciting and rewarding than building families and, and at the same time, being creative and innovative and being able to do surgery that so it really


Griffin Jones  06:56

was often here are you guys that like surgery say that Rei isn't enough surgery for them that they miss surgery? Do you find that to be the case?


Dr. Jared Robins  07:05

So you know, I think that the art, the art world has definitely changed a lot. Since the 1990s. We did a lot more medicine back in the 1990s. You know, we we were this you know, we started laparoscopic, laparoscopic surgery in many ways, it's was started by the RBIs. And so, a lot of that, you know, we now consider make surgeon make surgery. It's it was an offshoot of REI I think that um, you know, we become very, we become less surgical, surgically focused a lot of the reprogramming chronologist out there, there's still a bunch of us that still do a lot of surgery now. And so I think it's, you know, I think we as individuals have to sort of find our way, ASRM, through the Society for Reproductive surgeons actually has a surgical track that surgical scholars track for reproductive endocrinology fellows. So those fellows that really do want to be more surgically involved can be part of that reproductive surgical tract. And and, you know, these are programs that have higher volumes of surgery. So there is so it is out there for a lot. I mean, my practice certainly became much less surgically heavy as I as I got older.


Griffin Jones  08:11

Well, that's a good thing for the fellows and residents to learn about. If you're listening, if you've been on the show before and you're wondering, Hey, Griffin didn't ask me that much about my backstory. Why not? I don't know go to film school and be a fire department paramedic for years and and tell me about it dinner sometime because I think it's interesting. So let's fast forward a bit. And, and let's get to the position that you are that you now hold that ASRM, which is a full time position as executive director for the American Society for Reproductive Medicine. And let's talk about how that came to be.


Dr. Jared Robins  08:51

So gosh, so you know, I, I went to business school. I graduated from Kellogg with my MBA in 2020. And was thinking about ways in which to really have an impact on, you know, on our health system. Really my interest in,


Griffin Jones  09:12

in what did you decide to do the MBA, so I


Dr. Jared Robins  09:16

really wanted to learn to be more involved in healthcare operations that I felt like to after the healthcare system is rapidly changing. You know, big health systems are not run by physicians, they're run by MBAs and attorneys. And and but why


Griffin Jones  09:33

why an MBA and not an M H A, then if it was healthcare operations that interested you. Yeah.


Dr. Jared Robins  09:39

I mean, it's its business. It's really these big businesses that are having such an impact on our health system, not just in reproductive biology, but throughout the whole entire health system. For me, getting my MBA was just learning a language right? I never had any business classes again, film studies many directly weren't, you know, we weren't looking at business classes. And so, you know, as a division chief, so I was division director of reprogramming chronology at Northwestern. And, you know, so much of my job was understanding business. And, you know, we all Northwestern worked as a dyad. So it was a physician and a business person sharing the role of running these practices. And I really felt like there was a language that I understand that, you know, medicine has its own language. And we know that when we talk to patients, we have to remember that we have to read, you know, think in lay language, not not thinking in medical language, and business has its own language as well. And I just didn't need to know what that business language was in order to really be able to effectively run a practice.


Griffin Jones  10:48

And you say business language, what are you referring to financial modeling? What do you answer


Dr. Jared Robins  10:52

modeling, p&l sheets, even in marketing, I mean, there's just a whole, you know, the way in which the way in which people spoke was very business oriented, right, it had its own focus. You know, when when they're talking about the price setting, and that and I cannot economic, the economic modeling behind that, and when, when we're dealing with insurance companies, and you know, talking about how, you know, to negotiate, and all of that was stuff that I had really never learned, I was terrible negotiator, 233 courses, and, you know, I took 12 negotiation credits at business school, I think that was really important to understand that and really looking at the system, even how to do things like how to affect change, how to how to lead up, you know, these are all business concepts that physicians really never learn. And so I really felt if I was going to be effective at changing the way the health system is that there needed to be more doctors involved in that. And in order to be at the table, we needed to know the language. And because, you know, we were being told as physicians by these health care, business practitioners, that you know, we should stay in our lane, you do the doctoring, and we'll do the operations. But I felt like how can they do the operations if they don't really understand what we do? And so they really needed to have that physician voice at the table until we understood the language, we wouldn't get that voice. And so really, I was like going to language school for me to go to business school.


Griffin Jones  12:30

Were there any other physicians in your class at Kellogg at that time?


Dr. Jared Robins  12:33

So Kellogg actually has an interesting program. So first of all, there's a lot of business there's so the executive Health Program has a bunch of doctors in it. And then they also have a joint MBA residency program with a couple of the residency programs at Northwestern. I wasn't in any of those because I really didn't know anything about business. I felt really like a blank slate. I wanted to do a traditional MBA school. So, you know, Kellogg was like, Are you sure you want to do this? You don't want to be in the executive program, you know, you're kind of old. And I said, No, I really want to do a traditional program. So I actually did what they call the managers program, which is a part time evening and weekends program, where it's typically young managers, the average age in the class is around 27. It was definitely the oldest by far. I didn't have any other doctors although after I joined the program, a couple of doctors joined a couple of young doctors behind me. So but it was not a program that was aimed at physicians, it was really aimed at managers. And so for me, it was really getting that basics. I mean, basic accounting, right? Financial accounting and managerial accounting. It's one of those real basics that they may not have covered as in depth and a more senior program.


Griffin Jones  13:51

I want to talk about how that led you day is around. But I do you think it's interesting enough for the audience to sidebar for a moment on the type of negotiation that taught you at Kellogg, because from what I've come, Kellogg seems to be the greater proponent or perhaps a louder proponent of anchoring in negotiation. Whereas mo very often negotiation schools and teachers in negotiation will say, Never say the first number never give a number first. And I've done both in my career a lot. And I see that there are uses for each tactic. But generally speaking, I think it does make sense to say the first number in many cases. What were you taught there?


Dr. Jared Robins  14:41

Yeah, so College definitely is about first of all, Win Win, win win win win negotiations, right? I mean, that's a big belief in the Kellogg community is that your negotiation should always be win win. But but they do focus a lot on anchoring. I think that you do. You know, I think the anchor thing is important because it sets the tone of the negotiation. But you know, the fear of anchoring is that you could, you can anchor yourself out of a negotiation as well, right? If you, you know, if you think, all right, I'm gonna anchor high because I know we're gonna settle somewhere in the middle, you got to make sure you're not too high, because that just, you know, anchor yourself out. And so I think anchoring is definitely a big focus of, you know, and being the first to make an offer, I think it's often a really good strategy doesn't always work. And, you know, in a lot of ways that I took 12 credits, I took a bunch of negotiation classes. You know, it doesn't always, you don't always want to be the first anchor, there are definitely situations where you where that may work against you. But, you know, I think that there is definitely a focus on making that first offer. And making it realistic.


Griffin Jones  15:52

Negotiation is interesting, because you have so much to gain in a negotiation. You know, when you come by, if you go and buy a car, you buy a house, you buy a mattress, it doesn't matter, just by asking, sometimes one question can save you hundreds of 1000s of dollars, but you can, and you couldn't make that money in that in in a 10 second timeframe doing anything else. And that's what makes negotiation so valuable. And then on the other end of the spectrum, is that sometimes it's negotiation can just really hamper speed and say you want to you want to get out of there. And so anchoring does have to do with with that sometimes, sometimes you don't, it ties back to value based pricing, too, right? Yes. Let's use an example outside of medicine, so that we're not putting anybody on the spot. But let's pretend we're a web development agency. And we are a niche agency for financial institutions. If we're just selling website development, that we're being commoditized against every other web developer, that's an area where we actually do want to do value based pricing, because we want to see how many more loans do you want to sell? How many more? How many, how many more credit card applications do you want to bring on, because we know how to increase those by X percent. And so you would want you do want to do value based pricing. And you might, you probably don't want to anchor in a situation like that, because you want to see what it's really worth to that person because you're going to help them get a certain amount of outcome. And then there's other times where you just want to move as quickly as possible, and maybe not as quickly as possible. But you but it is better just to have a good position, say this is what the price is either you want it you don't and you can move through engagements more rapidly. Do you have a view on two views?


Dr. Jared Robins  17:49

So I think, you know, the kind of bring it back to kind of the question as to how I got to SRM. You know, or what, you know, what did my MBA teach me that brought me to SRM. I think that what negotiations to me was more was not only learning about how to, you know, work your way through a dealings, it's, you know, in order to be to be good at negotiations, you have to ask good questions of your of the person with whom you're working. And that brings you back to that whole idea of values, like, what's important to you, you know, where you're under, you know, really understanding where, what, what is what's critical to them, and that in their need, so that you can make your offer, you know, to fit that what that value structure is. And so it's for me negotiations was about how to ask good questions about person's values, and what's important to them, and, and, you know, where they're, you know, where their needs are. And that's what I feel like, I have to do a lot of this around, like, you know, my goal is to create value for our members. And that's about, you know, arrows say that I'm negotiating with them, because I don't, it's not like, you know, again, it is that idea of a win win. But, you know, it's about understanding where their needs are and what and, and what their values are. And developing programming and value based on those needs.


Griffin Jones  19:10

Depends on how semantic we're being right, expansive enough definition, everything's in negotiation. But tell me about the Win Win concept. And what did you learn there at Kellogg, and how do you think you're into that? How do you think you're using that principle in your position today? So I'm the Win Win concept of negotiation?


Dr. Jared Robins  19:33

Yeah, I think that. Again, I think we have a very diverse membership that, you know, very interesting and diverse membership, and we, you know, we need to make sure where we're fitting a lot of different needs, right. And as ROM, you know, it's we're not just an organization of physicians, where, you know, we're an organization that's actually 50% of us are physicians, and the remainder of the organization are business people and, you know, nurses and radiologists, mental health professionals, genetic counselors, and we have this diverse group of people, and we need to be really, you know, make sure that we're fitting everyone's needs. And so we know and with limited resources, and so there is definitely that negotiation among, you know, I often negotiate with my, with my, with my executive team as to, you know, what is going to be the next thing that we do have to negotiate with our, with our, with the board, right, to make sure that we're, you know, that we're, you know, fitting everyone's needs and, and, you know, and with members who are, you know, went when, you know, who, who want things done now, or, you know, what is, you know, who, you know, to develop the right programming, I think that there's, there's, there's lots of opportunities for negotiation. But, you know, we definitely don't want to see any of that negotiation is adversarial, right, I think that we, you know, my job is to is for everyone to, to get what there was to meet everyone's needs here. Right. And so, definitely thinking about ways in which to try to, you know, accomplish that with limited resources, limited time, small staff.


Griffin Jones  21:17

I want to talk about what you're trying to accomplish, given those considerations in wrapping up this, this negotiation side segue, did Kellogg teach you all to use the word fair, early? And often? I forget where I picked that up, but I find that it is it's perhaps even more for me than it is for the other person using the word fair, when I'm talking to them. Do you find this to be fair? Do you would you agree that this is fair? I when I do that, it makes me scrutinize my interests more. Is this really is, is the other party really going to gain from this and and then I'm also detaching from something where if it just isn't a good fit for me that we part ways friends. And so I find it really, really useful. Did that come up at all?


Dr. Jared Robins  22:10

Again, values, that idea of when we're in fairness, using the term is this fair, it's something that we definitely do a lot.


Griffin Jones  22:19

So, so I'm getting how, like, you had this interest for really figuring out how the healthcare system works, not not just your fertility practice, but like really getting a handle on how healthcare works, and that it's inseparable from business in many ways. And in order to understand that language, you had to get your MBA and that gave you a foundation for being able to run SRM and being able to bring in this this Win Win sense from of negotiation and and problem solving. But how did like, but how did like it actually be the SRM position.


Dr. Jared Robins  23:03

So the SRM position was available. As firms and organization I've been involved in over 20 years, I think that it has a great opportunity to have a strong impact on the field of women's health and men and construction of the Women's Health Organization. Let me back that up and say, on reproductive health, both for men and women, and from an advocate education standpoint, from an advocacy standpoint, from a research standpoint, but like it really answer him encompasses everything that that has been important to me, as I move through my career as a Republican technologist. And so given the opportunity to lead an organization that that has such breadth and reach was, was just an office and opportunity I couldn't pass up I'm really excited to, to be here. It's been eight months now, drinking from the firehose really learning about the organization from the inside. You know, I think that I mean, I've done the organization, I've been a part of this organization and a leader in this organization for a long time. But being on this side of the curtain has really been been eye opening in terms of just opportunities and creation of opportunities. And it's been really fun. It's been a great, it's been a great eight months. So I'm hoping that it's a lot longer. And it will see some of the fruits of that of that work as we get to our annual meeting in a couple of weeks.


Griffin Jones  24:33

And so everyone listening knows you're not doing this remotely from Chicago, you moved down to Birmingham. I did


Dr. Jared Robins  24:39

I happen to be in Chicago today because I'm going to be at a Chicago meeting tomorrow, but But yeah, I moved to Birmingham and I'm living you know, our headquarters are in Washington DC, but we have administrative offices in campus in Birmingham as well. And you know, because of the fact that that are so much of our operations happen out of Birmingham, I felt it was important to be close. To those people and so I'm living in Birmingham. Now,


Griffin Jones  25:02

I want to hear about the fire hose that you're drinking out of. But I thought this could be interesting as from history, because I bet you most people don't know how did alstrom end up being headquartered in Birmingham, Alabama,


Dr. Jared Robins  25:16

we had a, we had a leader, you know, a CMO that was part of UAB. And so that's how that's how it became part of it. Yeah,


Griffin Jones  25:27

it was, it was the inception of the society or years after,


Dr. Jared Robins  25:32

sorry, it's actually been around since the mid 1940s. But the headquarters was actually, you know, it. It rotated from sort of President to President and you know, before it became, you know, before it became established, you know, with a full staff and, but when it when it finally got headquarters, and when it finally really bought a building in the 1970s in Birmingham, so it was that building that that started at sort of headquartered,


Griffin Jones  26:01

low, some, you know, you sponsors that do all of these little events for trivia night, go ahead and stick that one in there for your for


Dr. Jared Robins  26:09

your whole answer. I'm trivia. Either do with our board, we'll do


Griffin Jones  26:15

a whole episode on SRM trivia. Somebody would somebody would sponsor it. Anyway, let's let's talk about like you said, you're drinking from the firehose, which is the case in many leadership positions, and certainly one with society's largest ASRM. What, what are the things that you're like getting your hands around right now?


Dr. Jared Robins  26:38

Yeah, so, you know, I think that, um, obviously, you know, we have a, I had to learn a lot about, about our budget, about our endowments. So that was a, that was learning a lot, I learned a lot about, you know, where the money goes. So that was a, that was certainly something we can talk about, you know, focusing on our meeting coming up really how the meeting is run, you know, I think that we all go to this meeting, I've been going, I've been at this meeting every year for almost the last 20 years. And, and the meeting just just happens, right? I mean, we have no idea when we're attending this meeting, the amount of work that goes on behind the scenes to get to make this meeting happen, the numbers of vendors that we that we have that necessary in order to make sure the meeting runs properly, from the electronics and the lighting to, you know, to staffing the rooms, I mean, it's just, there's so much that goes on in running this meeting, and I just had no idea how just how much there was and how hard these people work, in order to really, you know, the SRM staff is just unbelievable, when it comes to me, you know, when it comes to running this meeting, and, you know, the entire staff is, is actually at this meeting, making sure that it runs smoothly. And so, you know, I suggested changes, as you know, because you're involved in some of these changes at this meeting. And to make these happen, I was like, Oh, this will be so easy, let's just do that. Let's just do this. And, you know, the dominoes that that suggestion created, and in order to make it happen, and the staff did, I mean, you know, I came in with this idea that I wasn't going to make any changes, because I really just wanted to learn the organization. You know, I came in at a time when it was sort of at the end of the planning of the meeting in January, because the meeting is planned at months in advance. And, and I was like, oh, you know, we should really have more of this at the meeting. And we should really do this at the meeting. And, you know, my staff was like, alright, well, we're just gonna listen to this crazy guy and make these things happen. And, and I think that, you know, learning what, what actually took to me, these small, what seemed to me to be small changes happen was, was amazing. And I'm so lucky to have this incredible staff that I work with


Griffin Jones  28:50

every day. I want to talk about a couple of those. Let's let's you said we could talk about where where the money goes. So where does the money go? Jared?


Dr. Jared Robins  28:59

Yeah, so, you know, we we have? We have a lot of endowments. Right. So a big focus of our money is the Research Institute. Right? We have, we've established the Research Institute was established in 2019. By committee, and, and that, and that is to put that the purpose for the research institute is to make sure we're getting projects funded that wouldn't be funded through traditional funding mechanisms. So, you know, stem cell research, we know we can't get funded through through the NIH, or we're trying to do nursing research. We have, you know, funds set aside for that. I mean, really, you know, things that are very relevant to our field that are going to move our field forward, but when they get funded through traditional funding mechanisms this year would give me over, you know, over a million I want to say, as close to a million behalf, but I don't want to overstate the truth, but it's definitely over a billion dollars in grants this year. And so a large part of our endowment. You know, when you look at how much money we have, you know, a large part of that is committed to the Research Institute, in order to make sure that we can do that funding, and in order to really have that endowment fully funded, we needed a whole lot more money. Right now, you know, we're trying to only use, you know, interest generated from the research institute in order so that we don't have to touch the endowment. But we all know what's happening in the financial world right now. And so, you know, our endowment is certainly not going to last, that market doesn't turn around. You know, another big part of our endowment is the Center for Policy and Leadership that that recently launched, we're really we're pushing the launch for the Center for Policy Leadership at the at the annual meeting this year. And that is a nonpartisan Think Tank. Right, we know that reproductive policy happens. And and there are a few things tanks out there that are that are helping to inform our policymakers and the public about what the implications of these policies have the of developing this, this policy and law, we, you know, a lot of them are biased. And these think tanks and a lot and none of them are really run by reproductive medicine specialists. And so we have put together a Center for Policy and Leadership to the SRM to be a nonpartisan at, you know, think tank to help provide policymakers with data. I think the PERT the example that we're that, that they're focusing on a lot now is just data to access to care. So we, you know, the we're helping the military to develop an Access to Care policy for Reproductive Medicine. And, you know, our one of the white papers that we put out is what would that cost the government in order to do that, so again, it's non partisan, partisan, and just information, research developing concept. And so that's, you know, that's a lot of went in depth. So we have some educational endowment. So you know, this money isn't just available for us to use, when we look at our endowment, we have about two and a half times our operating budget and on declared funds. But that's fairly modest for organization of our size. You know, the rest of that the rest of that the money that we have sort of as our as our, you know, money in the bank, they're committed or dominant. So, you know, people have donated that money for specific purposes, and we really can't touch that, but except for the purposes for which they're, you know, have been, have been endowed.


Griffin Jones  32:34

Did the endowment, did the damage just come from donor funds? They also come from sponsor funds. How does that work?


Dr. Jared Robins  32:41

Yeah, so some sponsor funds, some donor funds, it's also it's donated money, right, where we're a 5013 c organization. And so it's money that's been donated to answer for for these purposes.


Griffin Jones  32:55

So but it does, like, when a company gets a big boost, or does a Ruby sponsorship at SRAM, does that ever go to the endowment? Does that go to OP X for earmark for the event? How does that work?


Dr. Jared Robins  33:08

Yeah, so the funds that we raised, say, I thought at the Expo at Amsterdam, that's all going towards operating funds.


Griffin Jones  33:16

So he talked a little bit about the things that you want to do. And you did. The Research Institute was established in 2019. Before you there's also the Center for Policy Leadership. But you also said that I want to start doing some things that ASRM and your staff said, Okay, well listen to the crazy guy and do what he wants. I know what a couple of those things are, because you did the SRM med talks, for example, business of medicine. There's probably others that I don't know about. So why don't we start with those to tell us what's going on?


Dr. Jared Robins  33:55

Yeah, so let's talk about SRM med talks. One of the criticisms I've heard in my years as an SRM member is that we should have, you know, some, some might some some small clinical focus, right, let's let's focus on what can we do clinically? And so what we conceived of was these short macro learning this, you know, short talks, 15 minute lectures on clinical topic. I wish I had them in front of me, I would have been really smart to have for this meeting. So one of them is like disasters in the in the IVF. Center, right? So we have someone who is going to talk about how to prepare your lab, you know, your to protect your cryopreserved tissues in the case of a disaster. We're going to talk about, you know, the what, how, how Kerrygold medicine talked about how she responded to Hurricane Sandy at NYU when they had to worry about, you know, protecting their tissues. And so we're going to do these short 15 minute talks. That like crossover, the different specialties, right? So we're going to have maybe a talk from our urology group, talk from our we're going to be chronology group, and maybe a talk from the nurses, you know, so that we're covering all the areas,


Griffin Jones  35:13

I'm giving a talk on how to use messaging to engage patients and staff,


Dr. Jared Robins  35:17

so I could have helped you. One of our topics is, is actually how to improve patient engagement. And so you're going to be talking about patient engagement, we're talking the urology group, and that same lecture group is going to talk about when you know, appropriate referrals to the urologist and how the urology in the REI should partner to, you know, improve patient engagement and in that fashion. So, again, so that way, we have a business person, we have virologist, you know, we're trying to cross over, I think that same group, we have a talk on, on the use of EMR, for instance, I think in that group, as well. And so, you know, this idea of the EMR portal, so this whole, this whole idea of how, you know, we want to be we want to a group of talks that have clinically oriented, but that span the whole society, so that the our business people, our medical people, and our nurses, for instance, could get together here a group of talks, and that would spark conversation about ways in which we could practice better. And that was really the idea behind the that talks is, you know, is to create, just to create a conversation, where everyone is where all the different areas of our field are able to get together. And here are a series of talks that that can, that really could could interest all of them. And spark conversations, sparking conversations is right next to where the man talks are going to be in the exhibit hall, we've developed that networking lounge. Again, one of the can, one of the concerns and complaints about SRM is that there's no place to just network with people that you know, there's, there's often like, chairs or tables set up in the in the hallways, but not really, you know, those could often be taken, you know, if you want to sit down with a group of like minded people, there wasn't really a good place to do that at the meeting. And networking, when we when we polled people about what they're what the value they get out of the meeting, a big part of that is networking. And that's why it was so important for us to be back in person this year. Because, you know, the online meetings were great from a content perspective, but miss that idea of being able to just network with your colleagues. And so this year at the meeting, we've established a networking lounge, that networking lounges will have some some programming there. So we're going to do, for example, meet the editors. So you have an opportunity to get together with the editors in an informal setting. But the whole idea is it's it'll be a place for us to be able to sit down and talk and network with each other without having to go searching for a place somewhere in the convention center. You know, if you want to get a group together, you can say, you know, meet us in the networking lounge at 1030. And, and I think that that is sitting right next to these med talks. So you'll be able to if you know, we just had a really great talk, let's all go chat about it. Now. You know, let's we're you know, we're going to talk about it the business of medicine session, too. So we did create the business of medicine session, the our association for reproductive managers, which Griff is a very, I think it's I think you're on the board right? Is a board member of that organization and really important organization to ASRM, it's, you know, it's a group of managers of IVF programs and of REI programs. And we turn to to arm and said, we need to we need to have more business at this meeting that, you know, I think one of the things that we hear often is that our physicians and again, I can speak personally about this don't have an opportunity to learn much about the business of medicine. And we we have a lot of business people that come to the meeting, we want to make sure we're creating value for them as well. And so we're, this year we're doing two sessions on the business of medicine is involved in involved with them. We're doing a TED talk session, four or five hours for five sessions, rather five TED talks, I think it's five TED talks, maybe three TED Talks. We're doing a group of TED talks like God, we're doing a group of TED talks on the business of medicine on Monday. So with question and answer sessions, we have some excellent speakers that are coming to give those TED Talks and then the following day, so that's Monday and then on Tuesday, we're doing a CEO fireside chat that Griffin's gonna be moderating for us, where you have an opportunity to talk to we have representatives from a variety of different types of practices from private equity to physician owned academic practices, and private Demmick and private dynamic practices and we're going to talk about how we how What the What the similarities are and differences are and really give an opportunity for people to ask questions of these leaders. And the second half of that session, we're going to do an open brainstorming session about how to create a business of medicine track today is around. So really trying to engage our members to tell us, what do you want, right? I mean, I think, you know, I can sit down and figure out what I think you want. But, but more importantly, we want to sit down and hear from you say, what do you want and learning about business of medicine so that in 2023, we can, we can have a real business of medicine tract at our meeting,


Griffin Jones  40:39

I want to introduce a philosophical question for that, it will be useful as people come to show up and give feedback on the business of medicine track, I'm interested in what you think about it. I remember, years before I ever got involved, before I ever worked in health care, one to one of my more hippie cousins, were sitting around and said health care shouldn't be a businessman, you know, my family leans a certain way. You know, I'll nodded and, and, and I remember thinking, but, but how can that be? And I think that attitude still prevails a little bit even in our field. And in many cases, I don't think it's useful. But but the first one, the first is, is that it? How could How could it not be a business, it's in it, there are craftsmen and craftswomen there, there are people that are providing services, and there is a race to constantly improve and, and provide advantages, and by nature, that is business. And so how could you ever totally remove it? And the second one is, how much harm are we doing when we pretend that that it isn't intact? Because we want to, we want to, we want to, we want to make sure that the tone is right. And we do have did providers certainly have a responsibility to patients, patients have a certain set of rights, and those have to be protected? But I don't I don't see it as being useful to say that it isn't a business I'd see that as being disingenuous almost like, you know, abstinent, you know, it's, it's 100% abstinence on sex because sex is sex can be dangerous, it sure can. But, but pretending that people aren't doing it often leads to all kinds of perversions. So what is your view on the role of, of, of how much business and medicine should be constrained versus should be facilitated in some way like this?


Dr. Jared Robins  42:45

Look, there's all kinds of philosophies about how you know about how we should have medicine should be. I don't, I don't want to wax philosophical about that. I think right now in the world of rebirth of Endocrinology, whether you're in the US or abroad and can serve as an international society, it is a business. And, you know, I think whether whether that is a government run business, or it's a private equity run business, or it's a physician owned business, there's, we have to, you know, we have an obligation we I think we do as physicians have an obligation to meet the needs of our patients, but we have to do that in a way that, that it's, you know, economically feasible, in order to, to achieve that. And I think that the business of medicine is changing over time, you know, I think that the, that we need to understand as physicians and not even just as physicians, as a society, we need to understand that we have to understand we have to negotiate and come back to negotiations, we have to be able to negotiate and negotiate with our insurance industry, and we have to be able to negotiate with our, with our media providers, right with our, with the people of whom we're going to buy our band aids from, you know, I think that there there are, there are needs that we have, as a group of, you know, have have providers in order to in order to be able to give the best quality care, which is what we all want, right? I don't care what type of practice you're in our ultimate goal is that we want to give the best quality of care to our patients. We have to figure out a way to do that without, you know, with was still being able to make a living and keep are and you know, we all have employees. I mean, as I have nurses, we have nurses that that work for us and embryologist and, you know, cleaning people that are that we need to make sure clean our rooms. I mean, I think everyone is equally important. So we need to make sure that we can stay solvent and the way in which to do that is changing dramatically and as a society, we need to understand that In order to make sure that we can keep our practices afloat. And that's what we want to make sure SRM is providing value to help us to do that, as that business of medicine changes, we, we will continue to evolve. I think that, you know, that idea of evolving as a society is really, really important to make sure that we're constantly meeting the needs of our of our members. And I think right now, the needs of our members are to understand how to do better business.


Griffin Jones  45:28

Maybe it's always been a business, right? In the 19 centuries, somebody still made the blinkers, right. So it was just all business was smaller back then. And some businesses have gotten so good at providing certain needs, whether it be entertainment or food, that the frontier really is madness, as human beings, we don't want to die, and we don't want to get sick. And medicine is the is what allows us to constantly push the limit of those two otherwise, natural limits. And and so the the things that contribute to that, and you said, you know, it's it's affecting reproductive medicine, I think it's it's affecting all medicine, whether it's single payer, whether it's public payer, that how many companies are in Israel alone, right now working on artificial intelligence, they're not, they're not doing it just for they're doing it as part of because they know that by innovating this way, that's going to give them a competitive advantage. The people that creates laparoscopic technologies and improves the quality of health care, they're doing it because it's going to give them a competitive advantage. And so to for systems like engaged MD that didn't exist 10 years ago, improves the quality of the experience for patients. And, and, and it's a value for them to enter the marketplace. But what constraints Jared need to be in place, say, Okay, you guys aren't running the show. And I think it during COVID, we saw pharma companies take a little bit of say, doctors eventually had to say, so it's like, alright, slow down, like, Okay, once we look at the research, then we'll tell you, it's safe. You're telling us it's safe early, like we'll agree, or we won't, but But it's us that make the call. So what constraints need to be in place so that it isn't just businesses manipulating? The system for lack of a better word?


Dr. Jared Robins  47:36

Yeah, that's a really hard question. I think that, you know, I think society is like, like the American Society of Reproductive Medicine is a great could provide a really great vehicle by which people to bring people together to have those conversations. Right. I think that


Griffin Jones  47:54

lets you and I have the conversation now.


Dr. Jared Robins  47:58

Even about where what I don't know, I think the constraints are gonna be really situational. Right? I think that, um, I don't think that, you know, I think that we need to make sure we're again, we're meeting everyone's needs, right. And so, you know, I think COVID was a really difficult COVID was a unique and really difficult situation where we were getting, were we getting lots of different inputs of information. And not everyone was getting that same information, and there was a ton of misinformation. And so, right, I think that I think, ultimately, it should be, again, I think the physicians and the health, the health care providers should control healthcare, right. And it shouldn't be a bunch of attorneys and business people that necessarily tell us how to take care of patients. But we need the input of everybody, right, we need the input of the of the health, that's where that dyad, if it would work would really be a good diet, where you have a healthcare provider and a business person sort of working together. I think that neither one of those, the healthcare providers and the business people should can't work, can't make decisions in isolation of each other. And they need a forum by which to come together and make those decisions. I think that, you know, the government also had there was biases in the government and COVID was incredibly politicized. And so, you know, what I think is what the I think the can, I don't I wouldn't say constraints. I think it's about decision making and being you know, intelligent and decision makers and having a a buyer and not a non partisan like an unbiased forum like our Center for Policy of leadership being a place where we can bring those leaders together to have conversations because you know, I think that that none of those groups should be able to work in isolation of each other.


Griffin Jones  49:46

I'm going through this same how I don't know exercise, I guess you would say because I want to expand inside reproductive health beyond the podcast that it's been. It's it has been so Serving as a trade media outlet. So I want to make it more of a trade media like Wall Street Journal for the fertility field. And that means I've been working on the sponsorship structure, the advertiser structure, I haven't had many I've had very few advertisers on because I don't, I don't want to do an endorsement for most people, I simply can't. So I couldn't sell advertisers until I came up with an advertising structure. But now the audience is there and, and I'm, I'm ready to do that. But I've been putting in the policy like we have editorial control. We're going to cover the news that's at mergers, acquisitions, layoffs, lawsuits, think sometimes it's going to be flattering for businesses, sometimes it's not going to be flattering for businesses, and you get editorial control over a featured content piece, where it says sponsored feature content, and nothing else you don't get to tell me not to write about these other folks are. And I know that we're probably going to write some things about sponsors that aren't great for this company sponsors, and then they just laid off 500 people. That's but but so that's one constraint that I that I view, is there any place that you think, like we should have no industry side, industry citing quotes representation in this part of ASRM or in this type of policy?


Dr. Jared Robins  51:23

I don't know. I have to, I'd have to think about that more. Nothing really, honestly, I feel like disclosure is the key there. Right. I think that when when there is industry sponsorship, that that conflict should be disclosed. But I feel that industry is a big part of our organization, and, you know, and a big part of our of our field. And, you know, I enjoy talking to the industry and learning from them. from the business perspective, do I think that they, you know, industry should be teaching physicians how to practice, you know, no, I mean, I think there's a bias there. But I do think that, you know, we learn a lot, even when we get, you know, our industry, you know, salespeople come tell us about a product. And so, you know, do you think that, you know, as long as that disclosure is there, and people have the ability to to, you know, to hear the that, that perspective, without understanding that it's a bias perspective, it's a sales oriented perspective.


Griffin Jones  52:29

Well, this is a great question for you then and then I'll let you conclude how you want to conclude, but is, is the scope for disclosures, too narrow Jared, because I don't remember if it was asked from or PCRs or both. But I had in my disclosure, in my speaker disclosure, I own a client services firm called fertility bridge, I am a paid endorser of engaged MD, I just felt like people should know those things. And it was either ASM or PCs or both. That said, take that out of your slide. You don't you don't need that. It's just It's just if you're, if you're related to pharma, and I think as I high if you want me to take it out, I'll take it out. But I still tell people in the talk I because I think they should know, I think they should know any financial interest that I have. So is our is our disclosure system or a rubric to limited in scope?


Dr. Jared Robins  53:21

So are, so we follow the rules that are set out by the ACC or VI. Right. And so that, so our disclosures for our particular, are there,


Griffin Jones  53:29

are there rules?


Dr. Jared Robins  53:30

I do think that, you know, I think it's important to know, I mean, if you're not talking about something that, you know, you're really engaged in D, as you mentioned, and, you know, then maybe it's not as important to me to know that. But I think it's important to know, those disclosures, you know, and one of the questions that we ask is, you know, are is are you going to discuss anything that is involved in one of your conflicts of interest, essentially? Right, I mean, that is part of the disclosure. So it may be that they asked you to check it out, just because the answer that question was no, but, but, but yeah, I do think that being aware of, of educators, speakers, conflicts of interest is important, because it creates wealth, it creates a bias that's both conscious and unconscious, right? I mean, you know, I think that unconscious bias is something we really need to think about.


Griffin Jones  54:23

I want to let you conclude, and I'm gonna, I'm gonna work hard to make sure that this episode comes out before the ASRM meeting, especially you sweat. You spent half the episode talking about the meeting. So I want to, we might be able to squeak it out the week before, which would be perfect timing. And knowing that the majority of our audience are members of ASRM. How do you want to conclude either about the meeting to come or just what you'd like to see from them in the coming year?


Dr. Jared Robins  54:52

Yeah, so let me say first of all, thank you for allowing me to be on definitely I thought we were going to talk only about the meeting. So this is It's really fun to sort of talk to wax more philosophically around a number of different items and topics. I do think that I, what I do want people to know about the meeting is that we do have a bunch of new things. In the meeting, we talked a little bit about the networking lounge, we talked about the business medicine track, but I think it's really important. We, we are doing things to try to appeal to younger members and to create to creating greater values. So we are having an electronic poster hall this year, so no more printing of the posters, that's all going to be electronic. And we'll see how that works like flat screens, flat screens, yep. Flat Screen poster presentations, everyone's gonna have a specific time to present. So you're not just standing there for an hour waiting, hoping that someone's going to find interest in your poster, smaller groups of poster presentations, but, but also we're going to have the posters are going to be available throughout the meeting. So if for instance, you go to that you are scrolling through the posters, and you see my poster, I don't really have a poster. So that one happened. But you know, you see a poster from Dr. Robbins or whatever and you want to speak to that person, you can contact him through the app. And I'd say aren't, you know, I like to speak to you about your poster, can we meet in the networking lounge and chat about it. So that is hopefully going to change the way in which we view our posters. And we were going to get feedback from that at this meeting and continue to adjust that for the next for next year's meeting. We are doing, one of the big value that our organization provides, I think is through our special interest groups. And only 50% of members are are a part of a special interest group. And so we aren't trying to highlight the special interest groups by doing a what we're calling are all in reception. And that is going to be on Monday night. Where we are highest, where we're going to have our special interest groups and our professional groups and our affiliate societies all present sort of as a career fair, where you get to go around and talk to people about the different special interests and find a place that you might, you know, create more value for yourself in our organization. We're doing we talked about answering trivia, we are doing what we call live cube boost. Cube boost is a product that we've had available for answering for a while now. It's a just in time, just in time micro learning platform where you get a question sent to your email every day. And then you get to answer that question. It tells you if you're right or wrong, and then gives you links and other information around that question. Yes, my turn off. Notifications. So so. So Q boost is this micro learning platform, you get opportunities, you get a daily email, which is sent to your inbox, you get to answer the question tells you if you're right or wrong. If it's if you're wrong answering that question, it goes back into that question bank for you. And you'll get asked that question again later, and then it gives you a bunch of links to further information about that question. And in addition to a brief summary. So in cumulus has been available, it's not many of our members are really aware that keeping us out there. So we're actually going to do live cube news this year. Where we're going to it's going to be trivia, you're willing to do it as a big trivia contest, five to 10 questions and with prizes, so really trying to promote that educational opportunity. And then the last thing I just wanted to mention it is camp SRM. So again, trying to appeal to young to young families, again, we were all about building families, and we want to make sure that we're, you know, supporting our families. And one of the biggest challenges I think, to come into the meeting for many young families is they're having childcare. So this year, we're sponsoring camp Amsterdam, where


Griffin Jones  58:54

we had to big deal I didn't know about that. Yeah,


Dr. Jared Robins  58:57

and we've been advertising and advertising and people keep telling me they don't know about it, so


Griffin Jones  59:01

well don't don't know about it, when they is going to be at the convention centers, they're gonna be


Dr. Jared Robins  59:06

it's actually gonna be in the hotel, and I think in the Hilton because we didn't have room we're with all of our new with all of the new offerings and our meeting we didn't have any space for it at the meeting itself, but we will be marketing it at the meeting as well. But we want people to know about it so that you know if one of the reasons they're not coming to the meeting, I mean, the meetings in Anaheim it's across the street from Disney, you know, come to the meeting, bring your kids put them in camp ask around and at the end of the meeting, head over to Disney with them or spend an extra day before after the meeting and, you know, go over that to to Disney and


Griffin Jones  59:39

I wonder if Disneyland be being there will mean more people staying through Wednesday. You know how a lot of people often leave Tuesday or they'll leave Wednesday morning or I wonder if if Disneyland being there means more people staying through Wednesday because they want to take the rest of the week with their family at Disneyland. But that's it Yeah, you know, the in 2020 I was like, how much are in person events gonna come back? And so, you know, I think that there's always going to be a need for them they'll have to be redone in different ways than they were done previously. And you're coming back to in a big way. This is like rocket just like you're like Rocky for with in person events. Jerry, you like it coming back in a big way? Well, so this episode, we will make sure that it airs beforehand. And part of the reason why you're covering so much is because you have so much to cover. And there's just so much into those interesting side. rabbit holes for for me to go down. I hope the audience agrees. But everyone will be able to hear this episode before the meeting. It should be in great time. Dr. Jared Robins, Executive Director of VA SRM. Thank you very much for coming on inside reproductive health.


Dr. Jared Robins  1:01:06

Griffin, thank you so much for having me.


1:01:10

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


Revisiting the Affordable IVF Model

This episode, originally released in 2020, Griffin revisits Secrets of The Affordable IVF Model, as we head into what could be another recession. Is your practice prepared for the potential downturn? Listen now, as Dr. Robert Kiltz, Dr. Paul Magarelli, and Dr. Mark Amols discuss their implementation of the Affordable IVF Model, and how it benefited their programs.

This episode was recorded during a live webinar, originally released in 2020

On this special live episode of Inside Reproductive Health, Griffin spoke with three leading doctors whose clinics follow the Affordable IVF Model: Dr. Robert Kiltz of CNY Fertility, Dr. Paul Magarelli of Magarelli Fertility, and Dr. Mark Amols of New Direction Fertility Centers. Together, they talk about just how they make the Affordable IVF Model work, as well as answer common objections to their services. 




Transcript

Griffin Jones:

CEOs are preparing for recession, and they don't think it will be short. That's the headline that I'm looking at on CNN RIGHT NOW. Headline Schmedline, Griffin, you can't predict the future. I cannot I have thought that the recession much sooner than it's happened, it does appear that it's here could be a bad moment. I've been preparing for recession since 2008. Because I'm Irish Catholic, from Buffalo, New York, and you should always be prepared for the worst things to happen. Some of you are also prepared for a recession, and some of you are not. And when recessions happen, bad things can happen. People lose their livelihoods, the impact that that has on health and family for people is really sad. And so for those people and those concerns, it's something I take very seriously. And then there's a part of me that for some people, I don't feel bad for when the fat cap that they had before, is no longer before them, because they could have made so much better structural improvement when times were good. Their design. No, we're getting patients now. We're getting customers now, people are offering us six 810 times, done now. And I don't feel bad for those people. In either case, now is a new time, you can decide what you're going to do. So I want to revisit this episode of Secrets of the Affordable IVF Model, how it's totally poised to win market share. Because originally did this as COVID was breaking, clinics were shut down. We didn't know how much money the government was going to pump in how long that effect would be for. And so we talked about market downturns and what's behind the affordable IVF model. And this was a really popular app. So we actually did it live first did live with Dr. Paul Magarelli, Dr. Kiltz, Dr. Mark Amols, from Colorado Springs, New York State and Phoenix respectively. And we had we had over I remember, you know, I only had 100 People limit on the zoom at that time that we, we felt that we had to turn people away and then made it into a podcast episode. So as you start to think of what it's going to be like if if companies might maybe drop coverage or if people lose employment, they don't have fertility benefits. So people have less discretionary and disposable income. And waitlists aren't eight weeks, and they start to drop down and more. How will you respond? I hope this episode is useful for you and your possible recession planning. 

GRIFFIN JONES  0:55  

I just want to maybe start the conversation off with the reason why I invited the guests that I did-- Dr. Kiltz, Dr. Magarelli, and Dr. Amols--is because they've all used the affordable IVF model in different parts of the country. And I have said for years that I think that it's going to be an economic downturn that makes that model scale. And I want to explore what that is like for those that are curious, for those that think that it's the end of IVF as we know it, for those that think it’s the best thing, I want to solicit the experience of our guests that are on board. I want to start with this concept of timing and Dr. Amols before this kicked off, you and I were talking about the fact that you were surprised that this hadn't taken off sooner. Meaning, I think what you meant by that, and I'm paraphrasing, that there hasn't been a scale of affordable IVF. What did you mean by that? And why do you suppose that is?

DR. MARK AMOLS  1:54  

Yeah, you know, I think if you look at the industry in other places they'll say like, plastic surgery, look at dentistry, almost all of those medical treatments had to eventually go down to kind of a more affordable scale and more volume. And usually when you have something that's a high cost, eventually people find a way to make it lower cost, and then it takes over, because volume will always make more money in the end over just a few cycles at a high cost. And so I'm surprised it hasn't because, again, we're doing it very well, Dr. Kiltz is doing very well, Dr. Magarelli is doing very well. It's not a hard model. And eventually, I mean, like I said, like anything, even when it comes to all the other fields of medicine, people seem to eventually narrow it down to lower cost, you know, and help more people. And it’s the concept of a big pond versus small pond, do you get a lot more fish for a lower price and then you have more patients or do you keep going after these individual fish? And it's just harder. So like I said, What's nice About our model is you really benefit from a downturn like this. So you know, when when things go down, we still do fine when people are doing well, we still do well. And so I'm surprised the model hasn't taken off more. I mean, look at Target, WalMart, those are examples of, again, high volume, affordable cost.

JONES  3:17  

And so for those that aren't familiar with you, Dr. Amols, you are in suburban Phoenix, is that right?

AMOLS  3:22  

Correct. We're in one of the suburbs of the Phoenix Metropolitan.

JONES  3:26  

So you're in one of the largest markets in the country. Dr. Magarelli and Dr. Kiltz have both done this model in smaller markets. Dr. Mag, you're in Colorado Springs, why did you decide that this model could work in a market that size?

DR. PAUL MAGARELLI  3:42  

Well, I wasn't looking at it as simply a market issue. I was looking at more of an access issue. So for me, when I sort of gravitated towards doing an affordable model, I mean, I live near Denver, I mean, I'm 45 minutes outside of Denver, so that’s certainly a big market, a famous IVF market.

JONES  4:03  

Well, now that Denver has grown out so damn far!

MAGARELLI  4:09  

Yeah, so  it was more--I have about 40,000 military folks who every two years go through the bases here in Colorado Springs. So we have an influx of very young, reproductively-active couples. So that was a resource that I knew that A) didn't have a lot of money, you know. B) at the time when I introduced it, we were in the middle of the Iraq and Afghanistan war, and so a lot of folks really needed help gaining access to what I consider one of the best fields of medicine. So it was a risk. I mean, I don't have a population 2-3, 5 million, but it turned out we grew 600% in less than four months in terms of my market. So as Dr. Amols was describing, once you give access to care, you'll be surprised at the number of folks that want it. And we, as a country, have one of the lowest utilization rates for IVF compared to most industrialized countries. And that is because of the fees. Really no other reason we have high success rates, so it's not performance, but it's really just access. And so by making access available, instead of doing, which we've done in the United States, 200,000 cycles, that hasn't changed really in about 15 years. 2 hospitals in China to do approximately 200,000 cycles! So it was more a matter of let's get more folks care.

JONES  5:38  

Dr. Kiltz, you have one of the most-known operations for the affordable model in the East Coast. And people might think New York, and they might hear Central New York and think of the New York part of it, but Syracuse is a small market--600,000 in the metro of Syracuse and maybe some more throughout Central New York. And you have one of the highest volume programs in the country because you're bringing in people from out of state and from New York City. When did that start to happen?

DR. ROBERT KILTZ  6:11  

25 years ago, nearly when we started. Obviously, Syracuse is a small market, small town. I'm from Los Angeles, been here, and I came up here to get away from the big city! But the recognition that people are travelling--

JONES  6:27

Mission Accomplished!

KILTZ  6:29

Well, that wasn't my intention, though. My intention was to come and practice medicine, do what I love to do. But I realized that there were some barriers from the way we were doing it. When I started IVF in 1997, here in Syracuse, I charged $2,000 for a self pay IVF. We have gone up a little bit over the years, but we've always been focused on affordability, access, and quality, and people are traveling for medical care and have been for many years. In IVF and Fertility Care, for sure they're traveling. And we know the very largest programs in America bring people from all over the world, and all over the country. So just like the more expensive places do that, recognizing that there's a much greater pie in the lower cost IVF than there is in a more expensive IVF. If, as Mark was saying, you know, the models of Target, and you can just say Walmart, and many other companies that are highly successful. And so that wasn't our plan, in our mission. Again, we became doctors and I became a physician in order to help people not, you know, sit around and do five cases a month, which made no sense. And if you look at the ability to be efficient, we are highly inefficient in this fertility world. And so that's not to tell anyone that they should do it differently. I just chose to do it this way. And I know Paul and Mark did the same thing. So I think there's plenty of access opportunities, but in general, most people are not going to lower the prices because there's so few of us that do what we do. There's not a need to do that.

JONES  8:12  

We have a question that came in from that discussion of quality. And I'll let any of the three of you take a stab, but I want to give it to Dr. Mag first because he talks often about making the state-of-the-art the standard and the question Dr. Mag is how is quality defined?

MAGARELLI  8:28  

Well, for me, quality is defined as performing a medical procedure in a method that has been demonstrated to be most effective for the outcome desired. So for me, quality is utilizing all of our technology and techniques for that patient, to optimize the response to the medications, to optimize the growth and development of the blastocysts, to optimize the way in which you do the transfers, and you manage the patients, to optimize and use all of the systems that have been known to be effective like ICSI, like a 5, 6, 7 blastocyst culture. vitrification, you know, frozen embryo transfers, use everything possible. It's like, if you break an arm and you go to the emergency room, quality care would be a cast. Something that isn't quality would be a bunch of band aids to help you. It'll work. With enough band aids, it might help your broken arm, but no other field in medicine can give what I consider less care and consider it good care. So to me, quality is providing what we all know and all of us here are board-certified, all of us have been in this for many years. We know what works, the patient doesn't. So let's provide them with the best of the best that we have to offer, and then let their biology determine their success. So for me, quality is defined that way.

JONES  9:59  

I'm not a clinician, but I know that not all of our clients use ICSI on every cycle for example, what about those that say, well doing ICSI on every cycle, that's not necessary? Or do we really know how much PGT impacts successful pregnancy rates? Should we really be doing that on every cycle? How do you respond to questions like those?

MAGARELLI  10:18  

Generally? Or just me?

JONES  10:24  

I brought you on because I want to hear the Magarelli answer!

MAGARELLI  10:28  

Okay! Well, the answer is yes and no. The answer is not every technology works for every person in every situation in every circumstance. You can offer it, you can offer it in those circumstances. We are a learning profession. It’s the art of medicine. We grow and discover and yes, when ICSI first came out, it was considered only for a certain subset of male factor. And then it was broadly used and it is broadly used in about 80% of most are somewhere between 60 and 80% of most IVF cycles, not because it's better for the sperm, it’s because you make more embryos. PGT-A was hailed as a miracle and I embrace it completely--85% of my patients do PGT-A. However, with increasing data there may be a loss function to wastage--they call it embryo wastage--where you may lose a high quality embryo because it was misread. So you have to be flexible, you have to--you don't just fix it. But my issue with those who are detractors is that they may not offer it to all patients because they “want a low cost IVF” rather than is that right for the patient? To me, there's a big difference between How can I make it look cheap, and then hence possibly have a poor outcome, versus How do I make it optimal and let the patients choose. It’s not going to discount their cycle. You don't have to do ICSI in my place. There's no charge for it up and there's no charge for it down. It's your choice. But it's easy to say, Oh, well, I only grow to day one, because that's the most optimal. Whereas for someone, a day five transfer might be the best for them, you have to look at that and offer all of it. And then the patient can subtract. Or the experience. I know all of the doctors here have had the same experience where some folks just magically do better with a day three transfer. And, and it goes against logic, but they do. So you offer it. I had a patient today who failed a day five and now I'm going to try a day three transfer. Why? It might save me a little money. But the goal is how do I get her a baby? So that's kind of my short answer to that detractor.

JONES  12:46  

So this concept of quality comes a lot when we're talking about the Affordable model. Dr. Amols, you mentioned earlier the Target model, the Walmart model, if we're thinking of just bringing something to bare at scale. And some people will say, well, Walmart that's not Saks Fifth Avenue, that's not Barney's, it's a lower quality in their mind. How do you respond to this issue of cost must be related to quality?

AMOLS  13:14  

So I wanted to take a step back. So earlier you asked me, we talked about why I didn't think this model had taken off. I'm just talking from a business standpoint, when you see these CCRM’s down building on their stuff. From a business standpoint, I meant, I'm surprised it hasn't. When I use Walmart/Target example. I'm purely only talking about the example of volume. Okay? You're absolutely right when you said I think what you were asking earlier about the quality issue is that we're under the gun more than any other clinic. When the other clinic pays $15-20,000, amazingly, they get nothing out of that cycle. They walk away and go, Ah, this didn't work. They go to a clinic like mine, Dr. Kiltz, Dr. Magarelli’s, and they don't get through they go Oh, it's probably because it was lower cost. So we are really actually under the gun more than I think most clinics because we're always against that. And that's one of the reasons you rarely hear anybody say we're the cheapest. Our goal has never been to be the cheapest. We've been wanting to be affordable. And the definition of quality is if you're doing best practices, and as long as we're doing best practices, you know, I would consider us quality Now, one thing I want to talk about is, what got me into this actually is because my own personal IVF story. So my wife and I spent $20,000, my wife doesn't make many eggs. And so we had to go through IVF. And we spent a lot of money and we barely got pregnant, but we did. We were very fortunate. And it just was curious. I've always been a numbers person, I’ve always been a business mind, I wanted to figure out how much does it cost per IVF cycle? Why is there a difference in cost between clinics? And when I looked it up, what was surprising was it actually isn't that expensive. And so it's interesting, like your title is Secrets of the Affordable IVF Model. But really, there's not a secret. None of us are doing anything tricky. None of us are getting less. If anything, we're probably getting more than most clinics. We're just not overpriced. So when I first started and people said to me, You know what’s the trick? What are you doing? I said there's no trick, I just make less. And I'll even give you another thing that's really interesting about my client is that I love what they're doing. In fact, when I was going to start, I was scared to death I called up Dr. Magarelli and I said that I had this idea, I heard you're doing it. I'm scared to death, am I gonna go poor? Like what's gonna happen here and he told me, Don't worry, it's gonna go fine. It works. And so one of the things I wanted to do was, I actually want to be one of the top clinics in the country, meaning success rates. So if you look at all of us, you look at national rates, we're doing well, but we're-- the 2018--we’ll probably be in the top 10-15. So it has nothing to do with quality and anyone who says that is just saying that to distract from it. Again, we have some of the highest rates in the country. And yet we're a third the cost of the most of them. This is about all of us are in this for the same reason, which is we want to help more people. We want to be able, as you said, more accessibility for people who can't afford it. Dr. Kiltz said, and I agree hundred percent, there are people who come to us and say, “I would have never had a kid if it wasn't for you. I could never afford to go anywhere else.” And that's a great feeling when you know that someone who scrounged up from family members to make $5,000 and have a baby, it's a great feeling. 

JONES  16:14  

Dr. Kiltz, this concept, you and I have talked about it before, which is who's responsible for making care affordable. And as Mark says, maybe it's maybe I'm making a little bit less money. And you have mentioned that before. But I remember one thing that you said to me, that always stands out to my mind, Rob, is you and I were in Washington, DC a few years ago. We were there for access to care, and we're advocating for insurance coverage. And at that time, we're advocating for benefits for veterans. But you said at the end of the day, these folks, meaning everyone that was there, and I'm paraphrasing, so I'll let you clarify that, but who's responsible? It's us and so talk a bit more about how you're able to do that.

KILTZ  17:04  

So the question is, why does it cost what it does? And I got paid $2,000 for nine months of OB care and deliver a baby. And when I started my practice, I was delivering babies. And I was trying to come up with a price of IVF. And I realized, well, I no longer do a nine months of care, up at two in the morning to deliver a baby, why should it cost more than it did? And I actually didn't know what it cost around the country. I just charged $2,000. But I would say ultimately, we're all running our own businesses. We're all practicing medicine. I think on the quality side, we're all members of the societies, we’re inspected by every organization, and our numbers are all reported. And we understand that outcomes that are shown in the statistics aren't always apples to apples, and we all know that. But, it's really a decision of how do we want to practice and how do we want to run our businesses? And the model of of how many IVF cycles do you do in a day, or in a month, or in a year, each of us has to pinpoint that for ourselves, and the amount of people that we work with and the team members we have and putting it all together. I know that I run a very large ship today, that our overhead is very different than it used to be. So when it was just me in a smaller space and fewer employees, 14, it was easier than now it's 300 employees and having all of that to run. So you got to keep the machine working a little bit in the process. But ultimately, we each decide. You know, there's no magic, that some big something in the skies, gonna, you know, tell us all what to do. We just have decided to do it the way we do it. And sometimes it's difficult as human beings to do it that way because we all feel like we have to conform. But really, all new things, changing things happen through nonconformity. And no one's here to try and tell everyone else they should do it this way, I wouldn't suggest it actually. But you know, it's something we are passionate about and enjoy doing. And we definitely--we do internal financing for everyone. We sell IVF on Shopify, and really just kind of offering new and different things, which aren't so crazy when you look at medicine in so many other areas or selling any other widget. But at the end of the day, it's not a Ford, a Porsche Ferrari, we're comparing, it's a baby. And they're all babies. And ultimately, people are traveling to Europe and all of the places to get affordable IVF. We just happen to put it right here in our backyard.

JONES  19:48  

So I want to come back to some of those new and different things and how you do some things in house, so I've made a note of it. We've had a couple of questions that are coming back to the same thing. It has to do with this issue of quality, and so I feel like we need to address it some more because one question, one person asked, What about pregnancy rates? And then the other person asked if rates would indicate that someone would need to go two or three times at one center and only one time at another center? How is that more affordable? That sounds like a loaded question to me. But I think it also goes back to Dr. Amol’s point. So you can look at at the success or you have the same data that everyone else does on CDC--

KILTZ  20:34  

May I interrupt, Grif?

JONES  20:35

Please!

KILTZ  20:36

So first of all, should we be comparing clinics outcomes? 

JONES  20:40

Not according to start for marketing,

KILTZ  20:46

Then why are we having this conversation? 

JONES  20:47

Because that's the--

KILTZ  20:28

But it is not true. Because it depends on the patient population, if it depends on many, many things, okay? And so it also depends when you're doing PGS or freeze all or not, whether you're doing blasto--there's so many things that come into this, that we can spend the rest of our lives talking about that. I would say, in general, across America, the real numbers are probably very, very similar. It's just a matter of who you're taking care of as much as anything else.

MAGARELLI  21:18  

If I can interject--I agree with Dr. Kiltz completely. That's been the biggest bugaboo since the 1980s when this idea of we're going to report data, and that data is going to be put out there, but please, please, please don't compare clinics. And of course, what is the first thing that happens is people compare. But I want to get to the heart of the issue. Look at the CDC data. Look at the live births since 2010. And the live births per IVF start is declining. It is not increasing. pregnancy rates are increasing and they're impressive, but live births per cycle stored has been declining precipitously, almost 30% since 2010 with the onset of a lot of technologies. So there may be a biologic potential there that we're hitting. But if you really--if let's say we homogenize all 400 IVF centers in the United States, and it comes out to approximately 2.2 IVF cycles if you do a fresh, untested embryo transfer. If you look across the board for the past 10 years it’s 2.2 IVF cycles per baby. And that's not counting regions, that's the United States: 200,000. If you do IVF with PGT-A, it's approximately 1.8. So let's say in every case, everyone's going to do two cycles to make a baby, regardless of where you are, what country, what elevation, New York, California--it doesn't matter. If that's the case and just let's flatten--I hate to use the term flatten the curve--but let's just let's just look at that number. In Denver, it's approximately $25,000 per cycle, two cycles, let's say two cycles is $50,000 to a baby. My clinic, that would be probably around $14,000 to a baby. Very different, very different model, but still, it's 2.2 tries to make a baby. In Dr. Kiltz’s situation, it would probably be about $6,000 to a baby. Now, as Rob said, it's to a baby. So if nationally our numbers are 2.2, it hasn't changed or even gotten worse to a baby over the past 10 years, that supposition of quality is in error because it's to a baby. It hasn't changed. There aren't really that many--there might be five or six outliers, but that doesn't count for the field. So if you go to the field, 2.2 is a good number. Just figure out what it's going to cost you, if it's in your budget and you want to go to a place that has a two story waterfall, and it's got a, you know, Mercedes outside, great. Or you just go to the regular folks, get your baby, and that's what you do.

AMOLS  24:06  

So I don't mind being the devil's advocate here. I think that Dr. Kiltz is absolutely right. When we talk about statistics, you have to look at the patient population, there's no question about it. And when you're doing what we're doing, you get people who have failed multiple times, who are coming in now for their six, seventh, eighth IVF. So you have to understand it is a different population. And none of us--one thing that's really unique, all three of us--none of us turn patients away. We take all the CCRM patients that they get canceled in the middle of their cycle, and we take them over. So he's right. However, it's a fair question. Because the point is people do know the difference between Walmart, and you know, a really high-quality store. And so I think the thing here is, is that, in the end, as Dr. Kiltz said, we're using the same places they are. We use the same equipment, my clinic, we use only benchtop incubators. That's it. Every patient gets their own incubator. And if anyone's concerned about the rates, the thing is that again, you have to look at is donors, that would be the only thing I would tell you to never really compare donors, because that's really the same population. But it's a fair question to ask. It's one of the things when I started, I felt there was a thing I had to defend more than anything. And that's one of the reasons like I said, that we want to be better. So just for the people who are asking that I just want to--I got the statistics here. So the national average in 2018, for the percent of live births for retrieval was 54.5%. For transfer, and it was 48.5%. Now, I'm not going to talk about other clinics, I’m just going to talk about mine. But just to show you, our retrieval percentage for live birth was 64.1%. So we were 10% above the national average, when we look at the transfers were 61.4%, almost 15% higher than the national average. So the point I want to make here is that being low cost doesn't mean low quality. They have nothing to do with each other. Now, can another clinic have lower rates? Well, yeah, if they're seeing more older women. We're very fortunate, I'm in the population where I see a lot of young people. And matter of fact, we don't even tell our patients our actual pregnancy rate because we don't think it's fair. You know, when I'm getting same sex couples who I'm doing, you know, reciprocal IVF on, that's not a fair rate to give to someone who's been trying for six years. So we actually give a lower rate than with our actual real--we have a very high percentage--but we give a lower rate because we know it's not a fair number. And so that's why he's right. You can't compare it. But what I would say to people is, if we have this high rate, and we're this affordable as well, and then other places have a lower rate and they charge the full amount. Clearly, cost and quality are not together. And I think another thing that's really important is not just that we're lower cost, we're transparent. I mean, if there's anything that I think is great about us, all of us have our costs on our websites, you know, we're not trying to hide anything, we're telling everything and we're packages. That's the thing I love about what we all do is no one comes to my place and goes okay, so is $6,000 for IVF, $3,000 the walk in the door, $4,000 to ICSI by the time they get done, they're like, oh, wow, I thought was only $6,000? And it's $18,000. Whereas all of us, you can look at our website and go, that's what I'm walking out the door with. Other than medications, obviously no one is selling their medication, other than that, that's separate. That's another thing that I think makes us a really unique model. And so when I go back to the point of why I say, I'm surprised everyone hasn't got there yet. We are going to become a mandated country, it's going to happen. It's just a matter of time. And we talk about the secrets of the affordable model, one of the things that's most important, Kiltz hit on it earlier, it’s got to be efficient. There is so much inefficiency in IVF. The places I worked at before, I can’t imagine going back to what we used to do--spending an hour with someone talking about something that literally in five minutes, we could talk about or my nurse could do in 15 minutes. The point is, is that the reason everyone should start doing this model is because when it goes to a mandated country, and they're only making $4,000, $5,000 per IVF cycle, you're going to need more volume, and if you can't do it, then you're going to be in trouble. And so one of the things we are poised I think to do well, no matter what happens. And I do have one question I’d like to ask them as well. One of the things that's funny when I started with everything included. Matter of fact, we included anesthesia, ICSI, it was hundred percent out the door, and we had to remove it, not because we needed money, but I actually ran into issues that when you are a low cost model, people for some reason don't see the worth in things. And so for example, I would have a patient perfect sperm, I'd say we did standard insemination, hundred percent fertilization, and they get mad at us and say, I'm so upset. Why didn't you do ICSI? Well, we had 100% fertilization that seems pretty good. And they're like, Yeah, but I wouldn't have done this if I would have known you weren't gonna do ICSI. And, and so we finally had to charge even $500 for it, just to make it worth something. And so I wanted to talk to you guys and ask you, do you run into those same problems where something so goofy as ICSI with someone at 100% and they're saying, you know, Why didn't you do it? And I just wonder if you guys run into those issues, too?

KILTZ  29:06  

It’s the nature of human beings to find something to complain about. If you just accept it and listen to it and move on, that works really well. So no matter what you do--and I wanted to make a point that almost all clothing is made in Bangladesh or Pakistan, it doesn't matter whose label is on it. So ultimately, there's no difference in quality, in general, in most everything and anything. Walmart, that has the same stuff that's sold pretty much everywhere else. So I think that we're all really just out here to practice what we do and help people out. And the fact that we are lower cost, and I don't think the higher cost models are going to go away. They will continue to be successful as we will continue to be successful because it's a blue ocean and blue sky, it's huge. The amount of people that don't get served by what we do is tremendous. And so there's plenty of room for everyone. And I always come back to you can never compare the numbers, because there's so many variables and as scientists, and the fact that we are members of a society that say you can't compare them, I'm still always amazed by the fact that we try to.

JONES  30:30  

What about this idea? Because it harkens back to what Dr. Amols was talking about, and Dr. Magarelli, you mentioned, when you're talking about per baby price, if you're thinking of it in terms of outcome, and Dr. Amols, you’re talking about different packages. One thing that--a hypothesis I have is that if you are goingfor  the affordable model, you can't half-ass it, at least from a marketing perspective. What I've seen is you--let's say someone's in the backyard of someone doing $13,000 average cycle price and they say we're gonna market that we do 10, that it doesn't work. That what makes it work is having a huge delta and really letting that be a big part of the differentiator that you all are using. Do you think that that's true? That's what I've found to be the case. That I don't recommend people say yeah, we've got a $9,500 base IVF cycle price that I think people get killed in the middle. What do you all think?

MAGARELLI  31:36  

Oh, I think people get killed in the middle. And I think that what happens is that they substitute or subtract services to get to that number. That's what I think. And then it’s like half in half out. When I decided to do this high quality, affordable model, I just have to say this out loud because Mark mentioned that he called me, well I called Robert, so this troika we have here is how this all--it started with the man on the bottom of my screen, Robert Kiltz, then it came to me then it went to Dr. Amols and it's amazing that you've got us all here because this is the family, The Three Musketeers. And what I had to do, and it took a lot of conversations with Dr. Kiltz was, this doesn't make sense. He’d say Okay, let's do the numbers. So you have to jump in. When I jumped in, I told my team, ti's very likely all of us are going to take a pay cut. Absolutely, everybody across the board took a 15% pay cut. And I said, and all of us have to be in it. Because quite frankly, I don't know if the volume is going to be growing fast enough to meet the bills. You know, and at that time, I was a fairly large program. And so you can't just discount a little. You have to make--if this is the area you want to be, look at your numbers, look at your costs, your real cost--not your cost plus profit--your real costs, figure out what margin you want and then probably don't accept the margin, subtract that margin and just go for the raw score. I don't think you can do this one toe here, one toe there, and you can't do it by subtracting services. I mean, I know I'm harping on that. But that's the key is none of us subtract services. All of us have all services at the highest level. And I think that would be my answer to your question about the middleman doesn't work. Because I had a marketing person who told me to raise my prices, which put me in the middle and my volume immediately fell. So I had to scurry back to where I had been. And so that's would be my recommendation.

KILTZ  33:42  

Fixed costs. We have a tremendous amount of fixed costs in this business. The variable costs are actually small. So our buildings, the rent, insurance, the staffing. And so I equate us like a bus or an airplane. You have seats that are empty, and you have capacity to grow. It's just basic economics of running a business, right? Obviously, if you're charging $20,000, you know, people can do that. But I looked at my model where I was and what I was doing and made a decision that my capacity was greater and we can do more. I even lowered my prices more in order to fill the capacity, at the same time, was able to meet our goals and greater.

AMOLS  34:36  

I want to address your question. So you were asking the question about the middleman. 

JONES  34:40

Yeah, do people get squashed in the middle?

AMOLS  34:42

From a business standpoint, this is actually very common for humans. If you have a great steak that costs 20 bucks, and then the other guy says to you, Hey, I got steak, too. It's 15 bucks. It's pretty common sense. Most people go, You know what, for 25% more, I'm just gonna go with what I know works better. I'm going to go with the filet mignon. But when you drop down to let's say, five bucks or six bucks, then most people go, you know, it's worth the risk. It's worth at least trying. And I used to even tell patients, I used to love when they came to me and they said, Oh, well, what if your lower rates. I said, well, let's do an experiment, let's say I am 20% lower, you can do three cycles at my clinic for the cost of one cycle there. So if you actually look at cumulative pregnancy rate, we would actually have a higher rate than them at the same cost. And I want to make one comment about Dr. Kiltz said, and I'm just gonna give a real world example versus using a plane. If I put one person's embryo in my liquid nitrogen containers, I still pay the same amount to keep that liquid nitrogen in that container. So if I don't fill that thing up, it's just wasted money. And that's what he's talking about. You know, when you buy equipment, when you buy a media, they don’t give you one one per patient. You get a whole bunch. Remember, if you buy more of it, you get a better discount, and so it actually lowers your costs. So as Dr. Magarelli said, you got to jump into this. You can't do this kind of half in, half-assed type of thing. You got to do it 100%. You jump in. And like I said, your costs will go down, your overhead will go down at first, because, again, you're spraying it over more patients, and you're being cost efficient. And I ran to the problem, unlike Dr. Kiltz, we actually are so packed, I can't take any more patients. So really the smartest thing for me, I'm a bad business person, I should raise my prices. But again, that was never my goal. My goal has always been to make it affordable. So I'm also looking to get more doctors to build on to what he does. And that's he's right. I mean, you just keep it full like a plane, don't let it be half empty.

JONES  36:34  

Well, that's I think that's a really good way of describing why the middle gets squashed. Because to that point earlier, when someone asked, well, isn't doing three cycles at one place, less cost effective than doing it one elsewhere. That's probably why the middle doesn't work so well because that would be true if it were the middle, but when you're talking about $4,000 IVF base cycle prices, or you’re talking about real affordable, that'd still be more cost effective--doing three with one model than doing one at another place. I think that's a really good way of putting it. You also--Go ahead.

AMOLS  37:16  

Are you familiar with the concept of cost-disruptive model in business?

JONES  37:20  

In business? No, not if it's the same thing as price anchoring.

AMOLS  37:24  

So when you look at the Walmarts and the Target, one of the things they looked at in businesses, is that when you just went a little bit lower, you looked cheap. When you went ultra lower, then what happened is people were willing to take the risk. And what ended up happening was a lot of your competition had a more difficult time because now people were going there. And so this is actually a very common model in business called the cost-disruptive model that is used and like I said, it works. It's worked in every industry.

JONES  37:54  

It's a really great point. And for those--there are some people on this call that I have counseled  against marketing towards that middle. And now you know why!

**COMMERCIAL**

Hi everyone, it's Griffin. This is the break in the show where normally, I do a little commercial for our small engagement. And we do have a small engagement that's relevant to the COVID-19 business response. If you're cutting marketing. if you're trying to bring back your people as quickly as possible. If you're trying to build a cache of treatment ready patients. We do have that, but I would rather use this break to just ask if you find this useful if you would share it with a colleague, either via email or on social media. We're doing everything we can to put out as many webinars, articles, free podcasts, all free resources to include as many people from the field as we possibly can to give you resources on how to manage and operate a fertility business or an IVF center during this time. And it's changing so quickly. 

So if you find this useful, I would really appreciate it if you would please share it with a colleague via email or via social media and help us grow the audience, but only if you find it valuable, and hopefully you are. Now, back to your program.

JONES  39:12

You concluded your point with another point, which is now I'm at a point where I'm so busy, I can't even see all of the patients. One way would be to raise prices and make demand go down a bit. The other is to scale and Dr. Kiltz, that's probably what you have really, that you've really focused on the last some years and when I had you on my show last year, you talked about the bottleneck often being the REI. And you've talked about training, OB/GYNs and Physician Assistants and perhaps Nurse Practitioners or just advanced providers in general. And when I sometimes will, we work with groups and we will get them to a point where it's like, what more do you want? You’re at a four week waiting list and we got to do a six week waiting list, it's like there's a bottleneck here. Does the use of advanced providers and other physicians--is it requisite to scaling a model like this?

KILTZ  40:13  

Well, it's not requisite, it's just another way to do it. There are a limited number of REs and our model has typically been to spend an hour with the patient and do our consultations and our follow ups. That gives us limited time due to retrievals and transfers and maybe surgical and other things. And as we're seeing this shifting and changing the way we practice medicine, just in the last several months, we realized that to do an ultrasound and IUI and even managing and monitoring our patients can be done a lot more efficiently. That can be done by a skilled fertility RN and also our practitioners. And also as we've utilized gynecologists for a number of years to do retrievals and transfers that can be well trained and do an excellent job at it. So we know some of the top fertility doctors in the nation, in the world, are not board-certified or even trained in a fellowship in REI, which I think is unnecessary, but it just happens to be where we're at. But I think the way to scale and provide more access, more affordability is to look to those methods to do that. My practitioners will do consults, either video, phone or in person in the past. Our gynecologist will help us with our surgery, retrievals, and transfers. At the same time, we’re able to focus on the things that I think we're really trained to do, which is manage and develop and teach and train others to be part of this because the only way we're going to make it more affordable and more accessible for more people is more of us to be able to do that. And it's happening in more and more areas of medicine all the time. That's where it's branching out. Anesthesiologists, I have mostly Nurse Anesthetists doing the anesthesia today. And we can look at that in every other area of medicine. I think we need to open that up and even trained practitioners to do potentially retrievals and transfers. I'm throwing it out there. I think certainly, they're doing IUI and most everything else in our practice.

JONES  42:22  

I see a little bit of reluctance to accept this. I also see a general acknowledgement that this is the case. I can't consult on it because it's clinical. The only reason it touches my purview is because it has to do with capacity and how many people we bring in. And if that capacity is raised, we bring in more people. But I have heard people raise the objection, or the concern that they'll be--well is the REI just going to be useless in 20 years? And I don't see that unless, you know, Watson and artificial intelligence has evolved to the point where we're all useless and that's going to happen eventually, hopefully not in 20 years. But I see a little bit of this idea that well, I need to--as the REI, the patient is paying to see me or expects to see me. And I don't know that that's always true. And I use this analogy and I know it's gonna piss off every REI on this webinar because I know you're not dentists and we're not talking about dental and I know that Fertility Care is much different from dental. So I'm providing that--I'm laying that down right now. But I went to Inspire Dental which is one of these large scale affordable dentists backed by or owned by either private equity or on the public market. And I go in, it's a nice experience. It's very standardized. I go back, the dental hygienist almost diagnoses me. He's cleaning my teeth, says what he thinks it is. The dentist comes in for two minutes, really confirms that, leaves and then when my follow up is scheduled. It's the dental hygienist doing the advanced cleaning. And I as a patient, I'm okay with that. And I think the bottom line is that patient needs to be and feel cared for. And I think that there's a little bit of reluctance. The doctor feels like, well, I need to be--I need to be in every ultrasound. I need to be doing retrievals, whatever it might be. And I don't know that the patient necessarily sees it that way. Can you all talk a little bit more about what really should be the role versus what should be support staff or advanced providers?

MAGARELLI  44:33  

Well, I'm not going to say what should be, but I will tell you my thoughts about that. I was one of those Duke-trained, UCLA-trained, big headed, egocentric, narcissistic physicians who felt if I didn't do it, it wasn't done and it wasn't done right. And that does work if in a model in which you're seeing very few patients and you're all getting that personal care, and as long as you're not worried about that many 10s of thousands or millions of people who aren't getting care, you can feed your ego that way. Over time, what I've come to learn is, it is really my responsibility as a professor or professional, to make my team provide the service, make my team be able to manage issues, and I be the guy who takes care of the fascinomas or the oddities to allow for efficiency that Dr. Kiltz was mentioning. And I will tell you like Dr. Kiltz, I have been fascinated and scared at first, but fascinated with the use of gynecologists, but these gynecologists are doing major surgeries that I wouldn't do and why would I be concerned about them sucking some eggs through a small little needle through the vagina. It doesn't make--it's almost illogical that they couldn't do it. So by utilizing them, I was able to grow the practice rapidly. Patients were getting care and I followed them point by point, number of eggs retrieved, number of embryos created, embryo transfer rates, pregnancy rates, and I could not find a difference. We both went up and down 1% depending on the month because we split it. So from the standpoint of it is always going to be the reproductive endocrinologist, just like any captain of a ship, you don't expect the captain of the ship to be down in the in the propeller room and in the ballast tanks and in the mess, you expect the captain of that ship to manage the ship to go in the direction and reach the port safely. That's what our jobs are as reproductive endocrinologists and we are a lucky field. We deal with healthy folks. So it's even less risky because we are not dealing with sick folks. We're dealing with very vigorous young, 18 to 40 year old folks. So that risk equation is lower than persons dealing, you know, 90 to 100 years old with a cardiac condition. So it does work. It is safe. As Dr. Kiltz mentioned, the 1, 2, 3, or 4 most famous reproductive programs in the country are run by either gynecologists, Maternal Fetal Medicine doc, or a perinatologist and yet, the impression is they're the best and they're the ones we should go to for because they're good marketers. So that is not going to give you the qualification. It is exactly like Dr. Kiltz said, my job is to train them, to follow up on them, to QA QC on them, and to ensure that the quality is always there, and to innovate. That's the other part. You don't expect your gynecologist or your practitioners to innovate, to take a new concept to apply it. And that's my job as the professor or Captain, down the future, is to help them just to separate the wheat from the chaff about what are the technologies that are effective, cost-effective, efficient, and perform. I can't have everybody in my clinic doing that. But I can do that if I had them doing these other tests, which are easily trained as well. And they're actually better at it because they're focused on one thing. We have to be focused on 100 things. So that would be my answer to that situation.

JONES  48:17  

Dr. Amols, you want to add to that?

AMOLS  48:19  

Yeah, I can. So I think there's a couple things there. It depends on the patient that's coming in, right. So obviously, if someone's going for egg freezing, they don't care [inaudible] they just want to freeze eggs. You have a person trying to come for a baby, they want that kind of touchy, touchy feeling. And I think that's a normal thing. As a doctor, we want to have that. And I would say it's not so much--there's almost nothing that has to have a doctor. I mean, I think nurse anesthetists have shown, if you teach someone a specialty, they can do it very well and as well as a physician. So I think there is this point where there's nothing we really have to do, but we do still have to be involved. And I think part of the art of what we do is being able to make the patient feel where they're 100% when we’re not. I have patients tell me all the time. I'm in the room for five minutes sometimes. And you know, I tell them sorry, if you felt rushed or like, No, I never feel rushed with you. But I'm with them for five minutes. They're with another doctor for 20-30 minutes in the room. And then they come back and tell me that they learned more from me in five minutes than they did from them in 20-30 minutes. So I think part of what you're seeing is true. You have to as a doctor be able to engage your patients. And I agree completely with what Dr. Kitlz said earlier. I mean, you could have practitioners doing I mean, you really could there's no reason they couldn't. It's not like this skill is this amazing skill that we learned in fellowship. I mean, most of us didn't even do some of them in fellowship. But the point is, is that there are these certain patients though, who absolutely want the doctor every visit so at my clinic, it's a little bit different. Everyone does it different. Doesn't make a right or wrong. I do all the ultrasounds for IVF. Only IVF. Everything else I do have people doing for me. So I have an ultrasonographer checking for cysts. Nurse Practitioner helps me. There are patients who I tell them right from beginning, if you are wanting me at every visit or you wanting 20 minutes from every time, I'm not the right clinic for you. You're better off going down the street paying someone $20,000 who can do it. And that's where I'd agree with Dr. Kiltz because they're gonna be clinics like that forever. These clinics that people want the doctor doing everything 100%. But in reality, there are studies that have shown a nurse, nurse practitioner doctor during the IUI, no difference in pregnancy rate. And I'm pretty sure if you look at even the nurse practitioner probably doing the retrieval, there probably would be no difference at some point, you know, if again, if they've been taught the skill set. So it really doesn't need all of us. None of us are that powerful. It's the lab. The lab is what gets people pregnant. Our job is very miniscule, maybe 20-30% at most, when it comes to stimulation. But in the end, we can still do that without physically doing that. And so what I would say to those patients are, I mean, those other doctors who want to do this, engage with your patients, talk to them, be a human, and they're not going to feel like they're not getting care because when you are with them, you give them 100% of your attention.

JONES  51:00  

And I might even take that a little bit further from the patient's perspective of feeling cared for. The not just advanced providers or the nurses, but all the way down to the welcome staff. It is the aggregate of everyone involved. And I won't say who it was if this person wants to acknowledge that it was their clinic, they can do so because they're in the webinar--but we worked with a client for years, that when we did their social media for them, the the celebrity of their group was the phlebotomist. People just adored this phlebotomist and she's drawing blood the same way that all phlebotomists do physically, but she did something to really touch people and that can come from multiple people in the practice. So we just have a few minutes left. And so I'd like to conclude with your opinion from all three of you on this because Dr. Kiltz you were talking about doing new different things. You know, you like doing so many things in house and you mentioned a lot of the things just take away and add to the cost. You mentioned in-house financing, you talked about IVF on Shopify. And I want to get your opinion in closing from each of you, either what innovations will come from the affordable care model? Or what innovations will impact and allow the affordable care model to scale even further. So what innovations will come from or aid the affordable care model?

KILTZ  52:29  

Well, first of all, thank you guys very much for being part of this and inviting m.e I really enjoyed it tremendously. I don't know many of the answers. And I think what we're doing is we're learning by doing something different. But we're also learning from many different models, but change is the most critical thing that we must learn as practitioners. If we cannot change, we will die. And it's always learning from others what they're doing. Fertility just happens to be this thing that we've sort of felt that this is the way it is and when we see these changes going on, it's uncomfortable. I wasn't trained as a business person. I didn't know anything about business when I started my practice almost 25 years ago, but I've learned and I continue to look at other areas and what are people doing in business that I can utilize in changing and growing what we do. And whether it's going to be more artificial intelligence, but ultimately, as you mentioned about the phlebotomist is, is really the person that people are drawn to. We're all in some ways--ultimately, the human touch is so important, as Mark talks about, you know, the patients and going and meeting them. We love that! We don't want to lose that. In many ways, we created something that so many people wanted to come to, so we need to always be innovative, and making it accessible and affordable. And that's some of the things that I really love to do more than anything, but we all need to be doing something we're passionate about. Every single day, and if you're not passionate and having fun in this business, there's plenty of other things to do in life.

AMOLS  54:06  

You know, I don't know if I can answer your question either about how to make it scale. I think what I would like to maybe give us the people who are interested in doing this, want to know a little bit about how to do it, I think, you know, again, hopefully, they're not scared to go into this. But one of the things that's interesting is that, once you start it, the biggest fear, I think the getting into is someone looks at my cycles and goes, Oh, my God, I don't think that Dr. Amols ever gets to go out and see his family. And it's actually not true. I mean, I come in at 8, I leave by 5pm, I get almost every weekend off, I get to work one or two weekends a month at most for a few hours. And I don't want anyone else to think that I'm making very little money. I do very well. And I'm pretty sure they do very well as well. And that's because again, it comes down to volume. And so what this is about is if you want to open the practice, where you're able to now allow more people to do IVF, who originally couldn't. And what's interesting is those people usually are pretty healthy. I mean, I get people who don't even need IVF who do IVF. And I even tried to talk them out of it. But the point is, is that it's not hard to get into. The trick is being efficient, and being able to talk to patients. Now, if you're not able to talk to patients, I don't think you're gonna do well anywhere, whether in our model or someone else's model, because who cares if you get to spend 20 minutes with a doctor. If they suck, and they don't like talking to them, it's still gonna be the same bad 20 minutes, whether it's five minutes or 20 minutes. So I think the biggest thing for people who are wanting to know about this is don't be afraid that you're working forever till the end of night. You won't be. But you’ve got to make sure you get a nice efficient system. Definitely talk to all of us. We've gone through the pains and stuff in the grind. And don't be afraid you're not gonna make money either because you will, because again, you may not make as much per patient, but you're so efficient, that you're able to make more. You're just doing it with more patients.

MAGARELLI  55:53  

So doing it with love, is what Dr. Kiltz is saying. Dr. Amols is saying is do it with the business acumen. And the question is can and all of us are saying this, we are successful in what we do. I think COVID has taught us something, and it certainly has taught me something is that I am actually more intimate with my patients now doing a Zoom meeting with them. And I'm much more efficient in terms of my office and functionality than I would ever have imagined ever in my career. I can tell you that probably 40% of them are still in bed as a couple talking to me on my Zoom. And to have the husband there and to have the partners there to have that intimate discussion, so I'm not going to lose that, but I probably am going to be able to double or triple the number of interfaces I have with them. And then as we all have said, hand them off to trained professionals to do the next steps. And then when we need to be involved, if it is the retrieval, and if it is the transfer, if it is the surgery, we do it, but if it turns out we have even a practitioner, a gynecologist who could do it just as well, trust that they can, track it--I'm a researcher--track it, and then as long as they can, you can assure the patient they're going to get the result. So I think Rob said change, change, change, but you know act with love. My dear friend, Dr. Amols is saying there's a business component to this, we can do it. He likes to be in there every minute to touch his patients so that he can show them he's there. I can tell you I've spent many a day with Dr. Kiltz walking up and down the clinic. He knows every patient, he knows every person, he knows every every staff member and what's happening with their children. It is being personal and interacting. We all are well-trained. We all have a passion to help people. And if that is your--and by the way, you will work hard. You have to also be willing to work hard. This is not something you're going to do half time. This is long hours. And yes, you can design a Sunday off or a weekend off or two. But this is long hours. And if you don't want to do long hours, this won't work for you.

JONES  58:12  

Well, gentlemen, it's been a great conversation. We’ve gotten lots of thanks and kudos in the comments. And I say, gentlemen, because people might say, why are there four men on a panel? Well, you're stuck with yours truly, and these are the three guys that are doing it. These are the three people that I know that are doing it. And I would love to have you all back on because I do think that this model is going to advance even further as near as six to 18 months. And so I'd love to have you back on in six months and revisit this because we had so many questions that we didn't have time to get to a lot of them. And Dr. Amols, Dr. Magarelli, Dr. Kiltz, thank you all so much for coming on this live show for Inside Reproductive Health. I look forward to having you back.

You've been listening to the Coronavirus Business Response Series on Inside Reproductive Health. If you find our free resources to be valuable, we ask that you share this episode on social media or with a colleague in the fertility field. Subscribe for the latest insights on managing and owning an IVF center or fertility business during the COVID-19 pandemic at FertilityBridge.com or anywhere you listen to podcasts.






154 What is Oma Fertility Doing With $37.5 Million?

This week, Griffin hosts Drs. Gurjeet Singh and Sahil Gupta, founders of Oma Fertility and Oma Robotics, to discuss their plans for utilizing $37.5 M in venture capital. Who will have access to the tech? How much automation can they bring to the industry? Tune in to the latest episode of Inside Reproductive Health, as Griffin Jones presses these entrepreneurs on their plans to scale their company.

Tune in to hear:

  • How Oma Fertility and Oma Robotics came to be, how they raised so much capital, and what role debt plays in their plans to scale their organization.

  • What Drs. Sahil Gupta and Gurjeet Singh have to say about the role of AI in increasing productivity and reliability in the labs.

  • Griffin ask about their growth, especially the pros and cons of purchasing clinics vs. beginning de novo, and where their footprint is expanding.


Gurjeet’s information:

CEO and Co-founder at Oma Fertility

LinkedIn: https://www.linkedin.com/in/gurjeetsingh/

Website: https://omafertility.com/


Sahil’s information:

Chief Commercial Officer & Co-Founder at Oma Robotics

LinkedIn: https://www.linkedin.com/in/sahilgup/

Website: https://www.omarobotics.com/


Transcript


Griffin Jones  00:00

So let's talk about the debt side for a second, because maybe I'm making an assumption. But my assumption is that many people aren't leveraging debt in that way, like directly from the financier that they're often they're either selling to private equity and then they might be leveraging some debt or, or they're selling equity to a venture capital firm. But it seems like people forget that you don't necessarily have to sell part of your company. If you want to get more money to invest in expansion. You can do it the old you can do it the old fashioned way. One way of getting your technology adapted in the field of reproductive health to advance assisted reproductive technology is to build clinics yourself and put it in those clinics. That's where Oma Fertility is. I have their co-founders Sahil Gupta, Gurjeet Singh on and they are the co-founders of Omar fertility and Omar robotics, they just raised 37 and a half million dollars, both in equity through venture capital. And in debt. We talk about the pros and cons of those two tools. We talk about how debt is often underused, and why they were able to get access to more debt than many people can often get from banks, we talk about their strategy of opening new centers as a means of advancing the technology that they're aiming to improve on the lab side trying to automate the lab trying to use artificial intelligence to dramatically increase the the productivity and reliability of embryologist. We talked about how they are buying clinics in order to be able to do that, how they're starting clinics de novo, the pros and cons of doing each of those things. So this is an interesting model guys, I think of all of the AI companies that are coming in and they might have excellent value to add, but they're kind of struggling to get adopted. This is one way of doing it and a lot of people are talking about some of the newer private equity backed fertility networks. I think you might be interested in this. I hope you enjoy this episode with Sahil Gupta and Gurjeet Singh. Mr. or Dr. Gupta Mr. or Dr. Saying Sahil Gurjeet Welcome to Inside reproductive health.


Gurjeet Singh  02:45

Thanks so much for having us.


Griffin Jones  02:47

So the that little joke for the audience was that Singh, he was a he was trained as a physician and Gurjeet has a PhD in mathematics. They both said they don't normally go by doctor but guess what on inside reproductive health you do you get the full honor of your previous degrees in training. And the reason why I think it was my team that reached out to you all to talk was that as we started to cover more of just what's happening in the field, like more of the current events, the name OMA fertility popped up. And the name Alma robotics is associated with that. But I want to stick on OMA Fertility for a second, because I think it wasn't really familiar with the group outside of your location, Southern California and then saw Oh, they're in St. Louis now. And so us deciding where to start this conversation is interesting enough, but let's start there. Where did OMA Fertility come from? And then what's the expansion that's happening? Is it fair to start there?


Gurjeet Singh  03:57

Yeah, that sounds great. I can give you a little backstory on OMA Fertility, and then I can tell you where we are and where we plan to go. Great. So we, you know, I had a friend of my wife's, I believe, of my wife, who was going through IVF. They went through six cycles of IVF treatments, didn't succeed, paid about $45,000 per cycle and ended up having to file for bankruptcy. You know, it completely destroyed their life. And very coincidentally, as all of this was going on, my wife was helping them think through how to put their life back together. cyl was visiting us as a family friend, both cyl and I had grown up in Delhi in India. And you know, Sahil as a physician, he had built a chain of IVF clinics in India where they see 15,000 patients a year and do 6000 cycles a year. And so my wife and I were venting at him about this whole thing. And he said, Why don't you come visit a lab? You know, just so you can see how it works, you know, you can get a sense for perspective. So I went to India and saw an IVF lab, and I was just completely blown away. You know, my I didn't know anything At the time, I'm a mathematician, as you mentioned, my expectation was that, you know, there will be some science fiction stuff going on behind the scenes, you know, but it turns out it was like a high school biology lab right at the same microscopes, incubators, the same kind of equipment that I had seen in a high school biology setting.


Griffin Jones  05:18

You were disappointed at the lack of sci-fi? Yeah, I was


Gurjeet Singh  05:21

like I was expecting there would be some science fiction stuff going on. They'd be like, some sequences of some sort. I'm gonna be naive. I didn't know it was so disappointing. I came back to the US, I visited a bunch of labs here, because I just couldn't believe it. And you know, I will say, perhaps they were slightly cleaner in the US the labs, but they had the same exact equipment, the same media, the same manufacturers, the same procedures. And I think there's something wrong, and then science had, you know, he had been going to fertility conferences for a decade, and he was like, they just don't change. That's just it's the same people show up every year, the same equipment, it just doesn't evolve. So tell


Griffin Jones  06:01

me what was wrong other than the aesthetics other than okay, that it looks so tell me what's wrong about it?


Gurjeet Singh  06:06

Yeah. So first of all, nothing is wrong, right. Like the labs are obviously doing well, you know, people who are struggling with infertility, babies are getting created, you know, so, so nothing is objectively wrong. It's just that it felt super manual, right. So when I, when I looked at the embryologist looking under a microscope, they are literally hunched over, right, looking at a petri dish, moving cells around manually with manipulators. It just felt super subjective. Right? What if somebody was having a bad day? What if they were tired? What if it was late in the evening, and they've been working since seven in the morning? So like, a lot of the decisions that they were making, with all of their great experience, felt so subjective, that anything could go wrong? Like not even the intent would always be great. But you could always make, you know, a mistake. And so I want it to be more automated. Sorry,


Sahil Gupta  07:03

yeah. I just wanted to add that one of the conversations, early conversations we had with between us was Gurjeet is asking, Where do embryologist train? Where are training schools? And, you know, I literally had no answer because the embryologist actually trained inside the labs. And you know, they are probably the most important part of the IVF process and the lab and, and then having to make subjective calls was really surprising to him at the time. Like how could such important decisions be made, you know, subjectively and cannot like, are not consistent. So I think that's probably where it started, where we decided that our focus, you know, as a company would be to make tools for embryologists to make it more consistent in order to give them tools to make it more consistent, and the results being more consistent.


Griffin Jones  07:58

Who and what are the tools that they needed in your view?


Gurjeet Singh  08:02

So I'm gonna go ahead.


Sahil Gupta  08:07

No, I was trying to break down the IVF process into two parts. The first being, you know, where the embryos are created. And once the embryos, embryos are created, the second half is about grading and biopsy. So I think we as a company started to focus on the starting part of the process, on creation of embryos, where embryologists have to sort of make this subjective call on which sperm to decide on when they pick it for ICSI and then ICSI iitself, you know, different embryologists trained differently. Some are better than others while doing xe, I think these are the steps we thought were the most objective. And we we decided to go after them first. But I think we can talk about more details on the technology. But sponsor elections and Ixy are the first thing that we are going after. But our Northstar as a company is to is to automate the entire thing. And just have a human in the loop. You know who can oversee the process? Good. Yeah.


Griffin Jones  09:17

What would you add? Well, where does where does the math background come in?


Gurjeet Singh  09:22

Yeah, so the math background is right, basically, let's do some math. So for sperm selection, as I was just describing, you know, in a typical IVF cycle, you're dealing with a handful of eggs, that's 20 eggs. And you know, the eggs are extremely precious. Right eggs become embryos, they are physically challenging for the patient. They are all with the egg retrievals which are obviously financially expensive and emotionally challenging. So eggs are you know, very, very precious, and you kind of get what you get right so the physician works with the patient, you get the eggs that you get, and you have to use all the exotic and get your hands on in a cycle. Right. On the other hand, on the male side, in a typical healthy male sperm sample, there are 100 million sperm cells also vary typically 4% normal morphology is considered good, which means that only 4% of those 100 million cells have normal morphology. Today, an embryologist looks at 20 cells, maybe 30 cells order of 20 to 30 cells out of 100 million for about 10 seconds before they pick one sperm cell to fertilize an egg. And if you again do the math, right, the probability that 20 cells seen out of 100 million would even contain one of the 4 million normal sperm cells is so abysmally small, that it's, uh, you know, it basically speaks volumes about the robustness of biology that it still works. So that's kind of where the math comes in. And using machine learning and AI to help embryologist make the determination would fit sperm cells to pink.


Griffin Jones  10:58

So, so the lab side is making sense, the AI side is making sense, how the heck does this end you up with a clinic in Southern California and in St. Louis?


Gurjeet Singh  11:11

Yeah. So then I think the main question is, what is the best way of building the tech? Right? Okay, you got up, the tech is important to build. And so how do you best build it? And what we, you know, I have I have done business in healthcare before I've sold into healthcare before. You know, there's a lot of potential benefits that AI brings to healthcare, which I've seen firsthand in my previous company. And so when we started building Omar, basically, we had a cold start problem, right? When you start to build this device, you need data to machine to, you know, for machine learning to train the systems. And so we decided that the most efficient way of getting this data would be actually to start a clinic, capture the data, because it needed, we needed some special hardware that we have developed to do this. So to the beginning, install the hardware, capture the data, build machine learning systems, and then deploy it in the in the lab can sort of see results in real time and then tweak it. So that's kind of how we initially decided on building the clinics. But then as we started building, we also noticed that patients or families who had gone through IVF, in the past, you know, we did user interviews, we spoke to them, even people who had been successful, you know, felt like there were a number in the system. They felt like they were just there to enrich the clinic, they did not feel empowered or educated. You know, they felt like they had lost power in sort of going into this whole situation. And so we then decide that we're going to double down and we're going to build a chain of fertility clinics. Where, you know, we will bring our technology to bear in in helping embryologist work consistently as well as serving patients in a in a consumer first customer first mindset.


Griffin Jones  13:02

Such an interesting, it's an interesting concept, because the challenge. Well, I've been selling to Fertility Centers for eight years, and I know how difficult it is I've gotten pretty good at it. But we're just a little client services firm. There are so many tech companies that are that, you know, there weren't like how are we going to get this into use? And you just said, eff it will buy it will buy one and we'll do it ourselves. So, so Did it start? So it started with one clinic, the clinic in Santa Barbara?


Gurjeet Singh  13:34

Yeah, yeah. It started with a clinic in Santa Barbara. And we've just started a clinic in St. Louis. We are actually we are about to announce an acquisition next week. We have acquired a clinic that's based out of Long Island. We are building one in Atlanta. We are building one in New York. And then we are hoping to launch two more clinics next year in LA. Yeah.


Griffin Jones  13:57

So who is this where you're coming in? So you've done this in in India before it was a via the group that you? You have seriously?


Sahil Gupta  14:07

Yeah, I started awareness in 2015 with one clinic. And affordability was kind of like the core of that clinic as well and accessibility. And by the time I sold it in 2019. It was a network of eight clinics in India and Nepal. And as Gurjeet mentioned, you know, we started with Santa Barbara and by the end of March 2023, will have seven, seven operations.


Griffin Jones  14:34

And so I help people chart the timeline. When did when did Santa Barbara take its inception?


Sahil Gupta  14:39

So Santa Barbara started somewhere in January of 2021. And I think this year, we are launching three clinics by the end of this year. So Atlanta, St. Louis and New York. Go live by the end of this year. As Gucci mentioned we have acquired a clinic in Long Island in New York, this, you know, hopefully in the next week or so it will be live. And then we are building the two clinics in LA, which will go live in March 2023.


Griffin Jones  15:15

Was Santa Barbara, was that an acquisition?


Sahil Gupta  15:18

No, no. So apart from Long Island, all the other six clinics are served in all those, we are building it from the ground up.


Griffin Jones  15:27

Why did you decide to go that route?


Sahil Gupta  15:33

So I think there are multiple reasons why we decided to do that. First of all, I think it's always easier to sign up, sort of bring about the change that we want to in terms of experience, when we are building things ground up, there's not only we also wanted to make the physical space, you know, change the digital and both digital and physical space that we were building, I think in terms of in terms of just the build, you know, I had experience building these clinics in India. So I knew what it takes the systems that are required. And then we found great physicians to partner with, with whom we could, you know, launch these clinics from from ground up.


Griffin Jones  16:26

Oh, why do you say this? I'm asking you to speculate about other folks. But most of the people coming into the unless they're already an established group, most of them are going acquisition, why do you think more people haven't tried the VC, venture capital de novo route?


Gurjeet Singh  16:48

So I think from a venture capital perspective, right the to do the de novo route, your venture capitalist model requires some tech innovation, it requires some step change that you can foresee in the future. And so I think if you're just going to start fertility clinics, without any tech innovation, inside it, that can lead to a step change in the, you know, along some metric, you know, it's not a venture scale business otherwise.


Griffin Jones  17:19

So what about us if you've done this before? Is it? Is this a model that could be that we're going to see more replicate? Like, are we going to see companies like Cooper, for example, or whoever the new AI companies, whoever IBM might spin off of a healthcare division, are they gonna start going this route of a build of, okay, we want to get our technology adapted, and we want to have a full tech stack, we're going to build, we're going to build the clinics ourselves.


Sahil Gupta  17:55

So again, you know, as you had mentioned, there's been a lot of private equity, you know, activity in this space over the last three, four years. And I think when, when there is private equity, there's a lot of roll up acquisitions, as you had mentioned, a lot of groups trying that. I think as good as you'd mentioned, with venture capitalists, there has to be some underlying tech that fundamentally changes or disrupts the industry, which we believe we are doing. And I think if other groups come up with, you know, similar other ideas there, there might be, you know, similar companies in the future. But I think we have the right mix. As a company, as you know, with with the team, we are, we have been able to put together over the last couple of years that we see ourselves growing with both the novel and acquisitions over the next couple of years.


Griffin Jones  18:53

How are you going to interact with those Fertility Centers, I will Oma Robotics sell to service Fertility Centers that are not a part of the OMA Fertility partnership.


Gurjeet Singh  19:08

So our plan is that our technology and devices are for exclusive use of Oma clinics, we're not selling our technology or devices into any other clinics, and don't plan to either. But there are several clinical practices across the US. You know, where the practice is great, but we do but they don't have their own lab, or they want to use a third party lab. So we definitely want to approach clinical practices, you know, that don't have their own lab or want to switch labs or want to use our technology to come use our labs. So that we are okay with but we are not, we are not selling technology into any other clinic.


Griffin Jones  19:47

Tell me about that decision.


Sahil Gupta  19:50

I think part of it. Part of what we are building and we have seen in different clinics in larger chains, is that if you go to let's say an A We see clinic on the East Coast versus, like the same ABC clinic on the West Coast, their results are different, just because they have the same name, but results are different from in all their clinics is because of the embryologist or could be any number of reasons. We believe that we are building a network, it doesn't matter if you go to St. Louis, or Santa Barbara, or New York, you're going to get the same consistent results and same consistent OMA experience. And that's going to be our differentiator, as we continue to build our own clinics and acquire clinics that have similar mindset or clinics that align with our mission and vision.


Griffin Jones  20:45

You don't see any application within the device other than the entire lab itself. But we could license this technology to these other surely you must have had that discussion with each other, hey, let's break off this piece. Let's license it. What was that conversation like when you decided against that


Sahil Gupta  21:04

our North Star as a company with in terms of building tech is full automation. And I think it was that time we reach there this this isn't a conversation that, you know, we want to have it next we want to make sure that we are able to build all these steps along the way. And I think we're at full automation, then the conversation to be had with other clinics or clinics outside the US where we might be willing to, you know, probably sell it to other clinics outside or inside the US.


Griffin Jones  21:40

You talked about it a little bit before but I think I need a clearer picture of what you mean when you say full automation?


Gurjeet Singh  21:50

Yeah, I think that's all we can say on that at this point, as we see a future in which we sort of build much, much more automated devices that do more than just bomb selection or just to automatic See, we want to sort of build more of the automation, the embryology process, to help embryologist basically get consistent results, even outside of just the fertilization and sperm selection where we are focused today.


Griffin Jones  22:18

So this is on the lab side. What about on the clinic side?


Gurjeet Singh  22:23

Yeah, I think thus far, I think AI has a role to play on the clinic side. And what we are planning to do is we are planning on mining data from the clinic to help physicians with better protocols, or to kind of have a better standard of care that we deliver to our patients. But at this stage, our focus is squarely on on the lab side.


Griffin Jones  22:48

So if you're not selling to clinics, and you're not, like you said for those clinics that don't have labs, or they want to switch labs that, that that's an opportunity. But if you're not going to be sending to clinics, how much of other companies will be up using in your labs?


Gurjeet Singh  23:07

Yeah, so for example, if you look at our Omar lab, today, it looks it basically I'm a little horrified to say it looks the same as any other lab, except that our devices are kind of, you know, built inside the microscopes and so on. So we, we buy equipment off the shelf, and then we install our hardware inside that equipment. So it from from the external viewpoint, it looks exactly the same, but kind of all the magic is inside.


Griffin Jones  23:34

Oh, are you working with? So like embryoscope? TMRW? Are those companies that are using the tomorrow tank? Or are those things that you all are using?


Gurjeet Singh  23:43

Not yet, we want to and so we are in discussions with TMRW? And you know, we are we are optimistic we can get to an agreement.


Griffin Jones  23:52

The discussion is the discussion about how does our stuff, talk to your stuff? And vice versa?


Gurjeet Singh  23:58

Yeah, how does that stuff work to your staff? And and just the business terms? Right.


Griffin Jones  24:04

So go ahead. So are you


Sahil Gupta  24:08

saying, you know, a lot of our value proposition for our patients is about accessibility and affordability? So that's the other thing we have to think about while we form these partnerships, if we are able to, you know, pass on savings to our customers and to our patients as well.


Griffin Jones  24:31

Are you focused on the United States right now? Are you also working on opening places in India and elsewhere?


Gurjeet Singh  24:39

Yeah, we are focused in the US. But we have done partnerships with some third party agencies that are international.


Griffin Jones  24:47

What about things that are not involved with the lab tech stack because you're doing this for your own clinics as well? What about EMR Do you have your own EMR? Are you using one of the others?


Gurjeet Singh  25:05

No, we don't have our own EMR. As of now. And we don't plan to build an EMR system.


Griffin Jones  25:16

How about things on the financial side? Like, like patient financing or the guarantee backings or employer benefits? Is that in your future scope?


Gurjeet Singh  25:31

We do. We are partnered with a company in LA called capeX Md. And we offer financing to organs or, you know, families that work with us to capex MD. And on the benefit side, we currently don't have any plans on going on the benefit side.


Griffin Jones  25:47

So for you all, it's it really has to do with this this lab focus and then the patient experience in the clinic. How are you getting Doc's? Everybody's fighting for doctors right now? And in your three years old as a company, how are you? How are you getting docs for these new clinics that you're opening?


Gurjeet Singh  26:06

We are two years old..


Sahil Gupta  26:13

So I think everybody in the industry knew that this is there's, you know, there's disruption coming. Everybody has been excited about it, you know, and I think whenever I talk to doctors, 100% of them actually get intrigued by what we are building. But when they see our devices working in our labs, that's when really, you know, there, you can see their eyes open up, right. There's like so much enthusiasm in them willing to talk and wanting to, you know, start the discussion of joining the network. And in general, I think we are trying to do things differently. I truly believe that Omar clinics are different considering, like, I've seen a lot of clinics in India, I've seen a lot of clinics in the US. And I think when we present our vision to our doctors, they get really excited and thus far, you know, the doctors that are working with us are super happy with what they're seeing and what we are building. And I think we are getting a lot of referrals from our existing doctors. So three of the doctors that we have hired are referrals from our existing doctors. And I think generally there's enthusiasm to join a company that is disruptive. And I think many of our Doc's are also aligning on the mission of accessibility. I think it's important work, you know, access in the US is a problem. Only 2.1% of the births happen via IVF compared to, let's say 10%. But in Denmark, where IVF is free. So I think it's important for a lot of people to solve the access issue as well.


Griffin Jones  28:04

Let's talk about the access issue, because a lot of people say that they want to solve that issue. And then some people say you're not solving for it at all, there's still the bottleneck. And there's at least two bottlenecks. One is the bottleneck of areas, there's only 1100 in the United States. And so we've had that discussion about top about what you can train, OBGYN and advanced providers to do. And then there's also the, the bottleneck in the lab, and mean the shortage of embryologist and I will tell you guys how blown away I am by how many young embryologists want to get the heck out of the lab. They're applying to jobs at my firm and marketing jobs. And I'm like, why are you everybody trying to hire an embryologist? Why are you applying here and some version of we don't want to stand in a box all day. We don't, we just don't want to stand here all day. So there. So there's, you already have a shortage of embryologists and then you have young embryologists wanting to get out of the lab. And as Dr. Carroll Curchoe pointed out on the show. So many of these labs are run by five lab directors that oversee multiple labs. And they're going to be retiring in the next half decade. And so let's talk about the lab bottleneck first, how is the AI going to solve for are you going to be able to do more cases? How are you going to solve for the lab bottleneck?


Gurjeet Singh  29:38

Yeah, on the lab part, the main way of scaling the embryology lab is by building more AI robotics and more automation. And that's kind of what we are working on. So we sort of foresee a future in which you know, most of what happens in an IVF lab is automated. And you know you basically build systems that bring out the best in Human embryologist, but then also since you automate the physical tasks that you require fewer of them and maybe they can even be remote. That's kind of what our vision for the future of the embryology lab is. It's massively automated.


Griffin Jones  30:18

And so then though, you would, you would still hit the other bottleneck if let's and that and the clinic bottleneck happened first, by the way, the lab bottleneck really didn't happen until late 2020, early 2021, in my view, that for the most part, there were there were many clinics that were they were, they were okay at capacity for new patients, but they still felt like they could have converted more to treatment. And then by the end of 2020, early 2021, is when people said, we can't even vert, even if we converted more to treatment, we don't have the lab space, or the lab staff to be able to fulfill all those cycles. And so what if most of your tech stack is focused? On the lab side, you solve this lab bottleneck? How will you improve access to care?


Sahil Gupta  31:17

You know, just just adding one more thing to the lab pod? I think there is enough. You know, there can be enough embryologists, I think the problem is, with all the apprenticeship that happens to make them skillful. So we are also making a lot of tools that, you know, Junior embryologist could use and still get the similar or consistent results that, you know, top five percentile embryologist would get. Talking about the clinic, I think one of the things that I was surprised or almost shocked to know when I moved from India is that the average number of cases that Rei does is about 150 to 200. So that was very, that sounded very low. So we actually spend a lot of time with Rei is with physicians and really like what we did was to map their time out what you know, most of their time look like and most of the time, actually went into tasks that were not related to clinical practice. So I think what we've done in our online clinics, is to actually take a lot of the tasks from the clinics, to our central or to our head office, remotely. And for example, we are not doing a lot of like billing HR, or, you know, a lot of our chart reviews are offline. You know, even, you know, some some of the stuff that was traditionally done inside Atlanta, is now done remotely by our, you know, central team. And I think what it has done is that it's made the physicians do things that they love doing, which is to see patients. So our physicians basically focus on three things, just to see patients and do the procedures. And just, for example, in Santa Barbara, our throughput for the physician right now is roughly about 400 cycles a year. And it doesn't feel to him that, you know, he's working longer hours, just the same amount of time. We are just running this more efficiently and taking a lot of this in house to in in our central office.


Griffin Jones  33:36

What are your views on using advanced providers in this mechanism?


Gurjeet Singh  33:47

Or do we


Griffin Jones  33:49

decide by advanced practice provider, I mean, nurse practitioners and physician assistants.


Sahil Gupta  33:56

So I think that's one of the things that we are using a lot in our clinics. For example, in our clinics, we've also hired ultrasound techs, that would do all the monitoring. You know, the physician doesn't, we feel like there's important touch points in which the physician has to be there for the patient and only those important touch points or milestones the physician would meet, meet the patient, and the rest of the time, either the ultrasound tech or nurse practitioners that will deliver the care to the patient. I think one more thing that I wanted to talk about why we are unique is that we have two points of contact for our patients. One in our remote team, what we call the care advocate, and there's a point of contact in the clinic. So each time a patient goes to the clinic they only meet this person who sort of project manages their cycle or their treatment inside the clinic. Similarly, when they are not in the clinic, they are only dealing with one person outside of the clinic. Home Project manages their treatment and gets them all the answers that they need. So from the patient experience side, it doesn't feel like you know, they're just a number and we make sure that all their questions are answered and they are, you know, taken care of throughout the process.


Griffin Jones  35:25

I should have asked Sahil and Gurjeet if they use EngagedMD in the so if the OMA fertility people are listening right now, this is my question to you. If you're using EngagedMD, and I was thinking after we're recording, then I'll then I'll ask them, and I forgot, because when I think of a group like this, it's that purports to improve the patient experience. It's become so clear from talking to clinic manager, practice director, Medical Director, nursing manager after the other one right after the other of how EngagedMD is no longer just a business plus, like it might have been if it were around 15 years ago, but it's now part of the standard of care that patients have so much on their plate, and they're so overwhelmed, and putting a stack of papers in front of them right now and trying to condense a whole course of information into a 3040 60 minute console. It's just so unfair, and then not giving them the opportunity to customize that to themselves. It's so hard on the patient that it's now part of the standard of care that EngagedMD is able to provide to patients. Most recently I've been talking about engagedMD’s benefits for nurses, staff providers, because those are the people that are texting me talking about how much they love the platform, how much time it saves them how much nursing time you can get back by using EngagedMD and provider time that you can get back and time clerical time from tray tracking down informed consents that, by the way, aren't as informed as they are, when they're through a module like EngagedMD, I've spent so much time talking about this, your staff side that I forget to talk about the patient benefits. And if you go online and look at EngagedMDin these reviews, from the patient side, it's overwhelming how in powered, engage them the makes them feel, and so you can get the benefits from your staff side, the benefits from the patient side. It's one of the quickest and biggest wins that you can do for your practice. If you're not already using EngagedMD, this goes for my friends at OMA fertility, but it goes for everybody listening, go on over to engagedmd.com/griffin They will give you a free workflow assessment, they're going to show you what it looks like that you're doing that other clinics are doing, that's free, whether you decide to move forward with EngagedMD or not after that, either one is going to be valuable, that you're going to get value out of it engaged md.com/griffin. Now back to the show.


 What about training OBGYN means to be able to do retrievals and then you can have more doctors and then a board certified Rei oversees those cases that's been that people are often on one side of the fence or the other about that, and a lot more people are on the OBGYN side of the fence now than than there were five years ago. And there are people that are vehemently opposed that Dr. Anate Brauer was on the show and and she said that we How Why are we even talking about this? And so there are some people that feel like that's a big risk. Other people think that it's it's a very minimal risk, and it's necessary to expand the clinical side of care. And then Rei should be practicing at the top of their license. Where did you all fall on that?


Sahil Gupta  39:18

I think we are on this side of you know, having OBGYN to as much or train them. But I think as a company, we've decided not to do it as far. And I think it's a decision we have taken collectively along with our positions and we are open to changing that in the future. But for now we've decided to stick to our API's.


Griffin Jones  39:39

So you're so well that's a smart way of doing it. By the way Sahil is because people have said that they're categorically against it. And then they come up and when necessity merits it they they end up doing it. Did you go with that decision? Because so you think it's necessary to expand access to care but I just don't feel ready to do it at this point.


Sahil Gupta  40:04

I think for us, it's, we have to first ramp up all sort of be at a level where we are running full capacity. And we can test the elasticity of, you know, how many cycles, we can go with a single physician. And I think after that, you know, we are in that position where we have to expand even with a single physician, we might look at other options.


Gurjeet Singh  40:32

Also, I think from a training perspective, right, we are not in the training game, right? We are alike, in some sense, if there is, you know, there is a future in which, you know, there's an exceptional OB GYN who has learned to sort of do retrievers and transfers and are great at the craft at medicine, I think we would absolutely consider them having them in our network. But we are not in the game of training OB gyns to becoming REIs. So are


Sahil Gupta  41:02

doing procedures? I think it's, it's, as I said, we are open to it, but we're not doing it. I know.


Griffin Jones  41:08

Okay, yeah. So then tell me a bit about the fundraising that you've done. And that was what caught my attention. Because as inside reproductive health, we want to start becoming more of a news media outlet and just covering some of these things. And, and that's part of what made me reach out. And so you raised 37, and a half million dollars, some of it is in equity, and some of it is in debt. Our audience is mostly used to talking about private equity. And they've heard me hammer the definitions in their mind private equity, typically taking controlling stake of businesses, typically mature businesses, typically, in an exit plan of a couple years. Venture capital, usually not taking a controlling stake, usually, for something that's new, and, and aiming to scale. And so talk to us a little bit about the this mix. Why? Why this much in debt, because I don't know if people are, are not in so by debt financing, is that from one of the VC partners, or that's the old fashioned way from a bank.


Gurjeet Singh  42:26

It's from our bank, it's our banking partners, Silicon Valley Bank. And again, I've had a long relationship with them. They were our bankers, my previous company, as well. And so the debt that you've taken, it's not like a private equity model. It's like a very standard, you can think of it as a more flexible loan, if you will. Right. So it's, it essentially does not dilute us from an equity perspective. And to the sort of, you know, if we are able to get clinics up and running and scaled and profitable, you know, you can easily pay off their debt, and then continue building.


Griffin Jones  43:03

So let's talk about let's talk about the debt side for a second, because maybe I'm making an assumption, but my assumption is that many people aren't leveraging debt in that way, like directly from the financier that they're often they're either selling to private equity, and then they might be leveraging some debt or, or they're selling equity to a venture capital firm. But it seems like people forget that you don't necessarily have to sell part of your company, if you want to get more money to invest in expansion. You can do it the old, you can do it the old fashioned way, and just borrow some power, some good old money and pay some good old interest. So why aren't people doing that more?


Gurjeet Singh  43:51

I think it's difficult. So banks typically don't underwrite too much risk. So in fact, in our case, right, the reason why Silicon Valley Bank has been comfortable with this is because we've had relationships, our investors have relationships with them, I have relationships with them. But then be you know, at the same time, we also raised a bunch of money in equity capital. So you know, they were convinced that, you know, one way or another, they would get their money and their interest back. So I think if you did not if we did not have the equity raise done, we would not it would be very difficult to get this level of debt.


Griffin Jones  44:25

Did they happen concurrently? Or did the 29 million raise in equity happens first?


Gurjeet Singh  44:32

I mean, it technically happened first, but call it within two weeks of each other like it's pretty concurrent.


Griffin Jones  44:39

And why Silicon Valley? I mean, normally that question would be obvious, but you because you've had such experience, and you have relationships and partners in New Delhi, I assume that there's a again, I'm assuming so you might take me to church right now and I'm totally wrong, but that there is a burgeoning venture. Your capital ecosystem in New Delhi Am I wrong about that? If I'm not wrong about that, why Silicon Valley?


Gurjeet Singh  45:10

Why are we building the company in Silicon Valley? Or why did we?


Griffin Jones  45:13

Why raise the money there? Why not raise the money from the venture capital ecosystem in New Delhi?


Gurjeet Singh  45:21

Okay, so I think first of all this the venture capital ecosystem in Silicon Valley is beyond compare. There is no other place in the world, which is anywhere near still


Griffin Jones  45:32

still, even in 2022. Even in Singapore and Hong Kong, they're still nowhere. No one's touching them.


Gurjeet Singh  45:40

No, no, there are venture capital firms and you know, they, it's, they have VCs and they are growing and so on. But if you look at the deal volume, the investor experience, you know, the deal terms are standard, like there's a lot of muscle memory that we've built up in Silicon Valley, to actually get deals like this done easily and painlessly.


Sahil Gupta  46:01

And the other answer is that we live here. That's right. Next door, and we can do this. You both


Griffin Jones  46:09

live in the Bay Area. Yeah. Yeah. So why did you start in Santa Barbara, then why not start in? In Northern California?


Gurjeet Singh  46:18

Yeah, that's actually a great question. So when we first started out, I remember when we decided on starting our Santa Barbara clinic. We were like three guys and a dog. And we did not have the dog yet. Didn't have any resources IPI? So you know, we went out to look for physicians. We were very lucky. We found Dr. Rich lake in Santa Barbara. And, you know, he saw the vision with us. And he took some risks join us.


Griffin Jones  46:48

Did you get your dog?


Gurjeet Singh  46:51

I did. He's like, Yeah,


Sahil Gupta  46:53

I think one of the other reasons for choosing Santa Barbara was, you know, there's an interesting mix of diversity in population in Santa Barbara in surrounding areas. So it was an interesting experiment for us to learn where most of our customers would come from. And, you know, that was one of the other reasons


Griffin Jones  47:19

I want to get an education from you Gurjeet about what makes Silicon Valley so much more robust and developed than other venture capital ecosystem, because most of our audience, they're not used to us talking about VC, and I think this will be interesting to them as well, I would have thought that there's no way that that Silicon Valley or I know that there isn't a way, but I just would have thought that they likely wouldn't have had the same differential advantage that they would have had 20 years ago to the whatever this the VC ecosystem is in Hong Kong and Singapore and New Delhi and London and, and New York. And but it sounds like it's still very much the place and by a longshot, so what are the things that make it so much more developed and robust for entrepreneurs?


Gurjeet Singh  48:21

So I think the first thing is that a lot of Silicon Valley is still run by operators, right. So these are people who have operated companies in the past who have experience. And, you know, when they, when they sort of grew up, or, you know, maybe are not in an operational role anymore, you know, they're, they have a great home, in various venture capital firms to go start operating there. But then I think, second, they're just muscle memory, right. So there are, you know, if you're going to do a seed financing, or a series, a financing, a lot of the terms are pretty common. And people know that. While for example, I have a friend, you know, who's based out of Switzerland, as an example. And Zurich has a venture venture capital ecosystem. But you know, the deal terms that they get there are very, very different, right, the amount of dilution. You know, if in many European venture ecosystems, if you go for a financing meeting, typically the investor will ask you, how much are you putting in? Right? And in Silicon Valley, things are different, right, where, you know, if a company is great, and obviously, only the great companies get invested in, you know, then there's a fight. There's a fight about, you know, how much money can you put into the company to be on the cap table? So in like, in other words, right, risk capital is something that's sort of everywhere in Silicon Valley. It's what people you know, talk about, it's what they live and breathe. It's kind of like, if you're going to make movies, is there a better ecosystem to be, you know, down in LA, or if you want to be in finance, is there a better place to be compared to, let's say, New York or London? Maybe? There isn't right because that's what that's people are used to those to that ecos stem, they have muscle memory, they know how to get deals done. And there's a concentration. So like the number of investors who are available, you know, call it within a stone's throw in Silicon Valley is, you know, beyond compare.


Griffin Jones  50:13

So what was the fundraising process? Like, because you had previous relationships, but are you going to multiple firms? And you're pitching all over the place? What's that? Like?


Gurjeet Singh  50:22

Yeah, so again, it you know, it depends. In our case, we, we had relationships with root ventures, and, and jazz ventures and, you know, we met, you know, when you're raising money, since in Silicon Valley, finding people who know and want to do deals is certainly not that difficult. The main thing that you optimize for is that you want people who are with you on the journey, who pie the same vision that you have. And we'll support the build of the company and the growth of it. And you know, in route ventures and jazz ventures, we certainly found partners who are super like minded, see the same future that we do, and you and you don't want it to help us build the company.


Griffin Jones  51:10

So what are you going to do with this 37 and a half million dollars, so you're buying clinics? That's that's part of it, you're starting your buying clinic on Long Island, the other six years starting, you know, or have started yourselves? What else are you going to use the money for?


Gurjeet Singh  51:27

So a significant amount of the financing is basically earmarked for research and development. Right, we are building more devices. We went public about our sperm selection device that's already being used in our clinics. But we are building more devices to automate parts of embryology.


Griffin Jones  51:45

And that certain that sperm selection device is not going to be available to any other groups until the lab is fully automated. Is that my understanding that right?


Gurjeet Singh  51:58

We'll see. I think it's in the foreseeable future, we are not selling it.


Griffin Jones  52:03

So okay, so there's more r&d, is there more fundraising to be done in the near future?


Gurjeet Singh  52:09

There's always more fundraising. You know, every CEO is always raising money. So yeah, there will be more fundraising. If he


Griffin Jones  52:19

asks any CEO, would they say that in that IPO? Is the the end journey to is that is that on your Horizon?


Gurjeet Singh  52:29

Yeah. So I think an IPO is a tool, right? It's a tool to kind of raise a type of capital to, you know, basically go after a type of growth. And I think certainly, that's something that's on our radar, right? We want to grow the company and build a company. And at a certain scale, we see that we will need an amount of money that will be viable with an IPO. So it's a means to an end. It's not a destination in and of itself.


Griffin Jones  52:55

What about when you get big enough? Yeah, so now you all are in the game. And because you're making de novo clinics, you're full network yourself. So now there's OMA fertility, there's pinnacle, there's CCRM, which as we're speaking, I see just bought IRM S. In New Jersey, there's IV, there's us fertility, Inception, Prelude first fertility, who am I forget, I'm forgetting somebody, and they're going to be picked up Boston, IVF. And so they're not all just going to the, they're not all just going to remain independent fertility partners, they're not all going to remain independent networks, some of them are going to merge with each other. And maybe some of them will be cashless mergers. I suspect most of them will be acquisitions. But why is that in? In your essay, you said, you want to have full control of the lab, and you'll work with clinics if they're building a new lab, but would you acquire a group, and update all of their labs?


Gurjeet Singh  54:02

I mean, absolutely. It's a question of capital. Right? If we have the capital, then yeah, absolutely. That's a super attractive option. I


Sahil Gupta  54:11

you know, one thing is capital. And we also need to make sure that we are aligned on on what we are building, I think, again, like I'll pull back and say, you know, if the leadership of whoever we are merging with it's not aligned on access, so affordability, that's something that that might not be a good fit for us in terms of an acquisition or so we will continue to look for partners that believe in a lot of our core values. And we want to make sure that we partner with the right people. And one more thing that I wanted to add is I think we also want to make sure that you know, the physicians are aligned and we want to make sure that you know we create any ecosystem for them in which they thrive. I think I've heard this a lot from a lot of physicians that we've interviewed, that they've been burned by a lot of the interviews that are happening in the past couple of years. And I think we make sure that we create a system or an ecosystem in which they are also taken care of.


Griffin Jones  55:26

Tell me a bit about the brand. What's the significance behind Oma?


Gurjeet Singh  55:32

Yeah, so OMA is a is a special word, you know, in, in Sanskrit, it means “the giver of life”. In many languages, it means mother or grandmother. So we love the name, it's a very caring name. And we believe it sort of espouses our value of caring for our patients above everything else. And if you, you know, bear the name, OMA alongside our logo, you will notice our logo has built up dots, and then there is one dot that we have highlighted. And so that dot that sort of thought process behind that is that it's, it's a notion of going from many to one, which sort of significant, you know, it's a, it's a story of IVF read, you have to go from many eggs to one embryo from, you know, two people being sufficient to make a child to sort of be taking a team of people to make a child. And so I think it's sort of this notion of many to one is embedded in our logo. And we kind of knew that we wanted the logo to be scientific and precise. And so that's why we chose the name, which was, which, you know, emanated a sense of care, and empathy.


Griffin Jones  56:41

I want to let each of you conclude, knowing that our audience is mostly for utility doctors, execs in the field. At practice owners, that's mostly who listens to this show. And I've asked you so much today about venture capital about the advantage or disadvantage of using debt of your plans for the lab have the bottlenecks in the clinic and the lab as well. I probably didn't ask you for something that I could have. So I will let each of you conclude the way you'd like to


Gurjeet Singh  57:19

say your first.


Sahil Gupta  57:22

Okay. So, I think about let me talk about Omar, we started Omar with a mission to democratize IVF I think we believe in a world in which whoever wants to have a child and cannot get pregnant naturally gets access to high quality, consistent care, you know, through our clinics, leveraging our technology, I want to end it by calling out to like all your listeners, especially doctors, and, you know, physicians to come talk to us, we want to build a network will with all of you, and, you know, with people who align with our mission, and we are acquiring practice, especially smaller practices, and we would also love to chat about that as well. So it's a bit of a plug.


Gurjeet Singh  58:19

What I would say is, look, we you know, there are three kind of key things that we care about, we want to get our patients successful in as few cycles as possible. That's why we are building our tech, we want to provide empathetic care, Human Centered Care, where we educate our patients and we give them support all along their journey. And third, we want to make IVF accessible, right, these are the three things that we are after. So, to that end, similar to what I was saying anybody who you know, listens to your to the show and and is interested in, you know, working with us jamming with us talking to us in whatever capacity we are super interested in, in sort of connecting. Second, what I would say is that, you know, personally I believe, I, you know, I believe that we are kind of at the very beginning of the beginning that we are sort of looking at this process, as in particularly in the lab as something that people do today and we are building engineering to you know, help and make it more consistent. But we but we see a future in which sort of this notion of operating on single cells using robotic devices similar to what we are building is going to have many, many other applications. And we are excited for that any academics or scientists who are listening to the show who are interested in that you know, or need help. We are happy to connect.


Griffin Jones  59:47

I suspect a couple of them will so we'll we'll link to each of you your LinkedIn profiles in the in the show notes and maybe people will reach out or they can email me Griffin and fertility dot com and I'll make an email connection. Be happy to make an intro if, if some of you that I know would like to talk to our guests today. So Gupta, Gurjeet Singh. Thank you so much for coming on inside reproductive health.


Gurjeet Singh  1:00:12

Thanks for having us. We appreciate it. Thank you so much.


1:00:16

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


149 Extend Fertility’s Lessons From The Market For Egg Freezing

Dr. Joshua Klein, REI,  Chief Clinical Officer, Medical Director, and Co-founder of Extend Fertility in NYC joins Griffin this week on Inside Reproductive Health to discuss the business of getting into business. Listen as they share perspectives on risk tolerance, people-management, financial backing, and the potential to lose -or gain- it all on the path to entrepreneurial leadership.  


Tune in to hear:

  •  Dr. Joshua Klein share how he successfully cornered an underdeveloped segment of the fertility market, and what steps he took to get there.

  • Griffin question Dr. Klein on how he knew when to time the change in his career path, and what others in the same position should consider before making a move.

  • Griffin question Dr. Klein when he says “people are the hardest part.”

  • How to not get way over your head in overhead before you even start.

Dr. Klein’s information:

LinkedIn https://www.linkedin.com/in/joshuakleinmd/

Website: www.extendfertility.com

Transcript

Griffin Jones  00:04

How many ways are there to start an REI practice? How many ways are there to start fertility business? Explore that today with my guest, Dr. Joshua Klein because a lot of younger REIs think about well, do I have to go partner with somebody? Do I get a salary right at an academic center? Do I go off on my own, and I risk everything, because I've got this stupid medical school debt. And I went to some very expensive undergraduate college and maybe my parents were wealthy enough to help me but maybe they weren't. And I've got that debt to some of you who are coming out with a lot of debt. And, and so starting a venture, your own entrepreneurial venture can seem pretty daunting. And so our guest today Dr. Klein talks about another possibility is finding other people with financial backing. And in starting your own endeavor, as a piece of that you won't necessarily be a majority owner and own everything. But that's one way to do it. So we talk about the massive learning curve that you're gonna go on, if you want to learn more about the business of fertility, whether you own it or not, that it's drinking from a firehose. So Dr. Klein talks about some of the things that he picked up and the challenges of managing people, a vision for an REI practice. To start the whole thing of looking at fertility preservation is something that was underserved in the market. And what Dr. Klein thinks is the right demographic, or the more appropriate demographics for fertility preservation, and why he saw that as a need in the marketplace, and other hard lessons learned, like cost per lead cost per new patient acquisition. And so we both we talked about those things, and Dr. Klein closes with thoughts of how younger dogs might approach making that choice. So I hope you enjoy today's episode, Dr. Klein originally was a he completed his fellowship at Columbia. And then he was an associate physician at RMA of New York. And now he is a partner at Extend Fertility. And I hope you enjoy this conversation with him. Josh, welcome to Inside reproductive health. 

.

Thank you so much for having me, Griffin. I am interested in the topic for today because we have had people to talk about egg freezing on in the past. And but I'm interesting because your group extend fertility was one of the first to make a brand around. Yes, you're a comprehensive IVF practice. But you did have a special focus in fertility preservation early on. And so I want to spend some time talking about that. Maybe we get to the business second, but you were where were you in your career, when you started to feel like, you know, fertility preservation was something that was clinically viable, because, you know, that wasn't the case. 20 years ago, maybe the people just getting on board now are late. So when was it for you? Yeah, that's a question that that I thought a lot about. When we first were putting this place together.


Dr. Joshua Klein  03:31

I came out of training in 2012. So I finished my fellowship at Columbia in 2012 and took my first job at RMA New York, which is as many listeners probably know, is affiliated with Mount Sinai. It's one of the big academically affiliated programs in New York City. And part of it is just history because ASRM? Well, I should say, the studies that demonstrated that egg freezing could be done through vitrification relatively reliably and reproducibly. And with relatively good success rates really came out in the late 2000s Going into the early 2010 2011. That sort of timeframe. And then actually was at the end of 2012, technically published, I believe, in January of 2013, when he ASRM sort of put their guideline out that said that egg freezing can be offered as a method of fertility preservation without the rubric of an IRB without an experimental protocol. There was a lot of buzz around that that didn't mean that ASRM was you know, endorsing egg freezing or something that everybody should be doing. But at the very least, it wasn't considered an experimental modality anymore. And so that that was 2012 2013 which was literally the first year I was out in practice and kind of getting my feet under me. And, you know, sitting in an office in New York City and Manhattan with that The culture around us, you know, certainly being the case that most women are not getting getting pregnant and building their families in their 20s People are, are sort of young if they're getting pregnant in their 30s. It felt like to me, egg freezing is something that might be super valuable to like, a lot of women, not just a select few, but to like, sort of in some way, the average educated professional 30 something year old Manhattanites, who isn't, you know, hasn't partnered up yet, or isn't ready to settle down yet is still building their career and not at that stage of their personal or professional life where they're ready to have kids. And so, you know, at that time, egg freezing was still very small, it was still new, most people didn't know about it, and this people weren't accessing it for one reason or another. And so even at a big program, like RMA, they were doing, I think, something like 120 Egg freezing cycles a year, which means, you know, maybe 10 a month and the entire practice. So I was seeing a small handful of patients of who are interested in egg freezing. And it just felt like it didn't match the demographics of what it should. So at some point, that kind of light bulb went off that there's a disconnect between the number of like single, professional educated women who might want to do this, and then people are actually doing it. And then of course, the question became like, what's the missing link here? How come? How come it's a mismatch. And so the things that I thought about and that kind of got parlayed into building extend fertility, where people don't know about it. So there was a lack of proactive education about fertility preservation, you know, IVF, clinics, are doing a really good job of keeping busy helping people build their families, people who are struggling to get pregnant with IVF. And so egg freezing was kind of not the center of their attention. So that's one was education and awareness. Two was sort of, I think, the environment, I think egg freezing was never really thought of as like an important piece of an IVF clinic. And so I always used to say that, like, you could pick out the egg freezers in the waiting room, because you know, they were the ones sitting by themselves younger, kind of looking awkward when most of the infertility IVF waiting room is couples who, you know, kind of sad and tortured a little bit in the egg freezers, or they don't have a problem, they just are wanting to be proactive about planning their, their their reproductive life. And then third is cost because egg freezing tends to be priced as sort of like the IVF pricing, but a tiny notch less, even though technically, it's a lot less work for the lab to do so. So it kind of was overpriced, I think at that time. And so those principles were the ones that we tried to harness when we created a Extend Fertility as a center that focused on egg freezing back in 2015 2016. To kind of build a brand and a culture around the idea of making egg freezing and fertility preservation more understandable, more accessible, making the experience a little bit less unpleasant, especially if it's a sort of a purpose built environment, and then bringing the price point down in a way that that could still allow us to have a viable business model. So that's kind of the threads that went into it.


Griffin Jones  08:11

So you saw the market. You saw the the the the flaw in the market when it came to pricing and availability. What about demographics? Because that is a point of maybe contention, but that I just I don't I don't hear a lot of consensus about is what is the ideal demographic, and there are both clinicians and egg freezers did say, the younger, the better. And it it should be something that, you know, 22 year olds parents gift to them for graduating college, I hear both clinicians and egg freezers say that I also hear clinicians and egg freezer say that no way, like it's a very narrow demographic, and it's for 3839 year olds, maybe who are right, right, just before the window of have a real DOI risk, I suppose. And so, where how do you? How do you come to what you think the proper demographic is? Yeah,


Dr. Joshua Klein  09:19

it's a that's a great question, because it is something that I think gets debated hotly, and we have patients every day that say, you know, can I wait a year? Can I wait two years and sometimes it gets a little silly, you know, how can I wait six months? It's like a negotiation. But I think what, what has to be recognized to sort of think through that intelligently is that it's in arguable that in general, if someone does egg freezing younger, they're going to get a more valuable end product meaning younger woman will get or any particular woman if she doesn't younger, will probably get more eggs and more healthy eggs and that same woman who in an alternative universe does it older So, by that rationale, it's, which is oversimplified, as I'll explain, everybody should do it, like you just said at 22. Like, it should be a universal thing, the younger, the better. And so there's not much to argue about. But the reality is that even even at a place like extendable, we tried to keep it on the more affordable side, it is a luxury good meaning between the cost of of the service and the cost of the medications, and then the cost of storage, it's a, it's a, it's a significant amount of money. It's not the easiest process, we try to make it as easy as possible. But it's not the easiest process, it does take a lot of wherewithal to kind of get through it. And so it's not, you know, if if it really was something that you can get come into the doctor's office, you know, get a procedure done for 10 minutes, and it costs $100, I probably wouldn't be singing that same song of everybody should just do it when they're 22. Because kind of why not. And it could, could really be an important thing in your life. But but it's a lot different than that. And so what I what I want to point out is that every year that passes that you don't do it is another year that you might not end up having to do it, right. Because if you're 25, and thinking about doing it, but you wait. And then by 28, you actually got married and then started your family naturally, then that you want that gamble, right? Because you didn't have to do it. And now you may never have to do it, because you're already getting getting your family started naturally. And so you kind of dodged that bullet and you save the money and you save the anxiety and the investment of time, energy and resources to do it. And so in a certain way waiting to do it longer makes sense. Because the younger you are, the more likely you're going to end up starting your family in an easier way than egg freezing, if you just give it some time. And that's why I don't think that the 22 year olds should be less, there's a special situation which I'll actually get to also in a moment. But for most average healthy women, 22 Doesn't make sense because you can afford to wait because if you do it when you're in your late 20s or early 30s, you'll still get a very good end product. And there's a large percentage of women who will in fact, the majority of women who are thinking about it 22 By the time they get to 30 they won't need it anymore. So I think we're overselling it if we're selling it to 20 year olds. So that's something I think isn't always articulated clearly. But that's a reason not to do it too early, even though it's true. If you do it at 22, we'll do it at 30, you'll get more out of it 20 at 22. But you might not need to do it at 30. And so a lot of times it makes sense to wait to sort of let your life unfold. And then but then you gotta be careful not to let that slippery slope slip. Right. So if you do it at 39, I certainly would think that that's a mistake, because that's already you're sort of reacting when egg freezing works best as a proactive maneuver, right? If you're freezing eggs that are mostly not healthy already, which is when you're getting close to 40. That's the reality, it might work. But it's certainly not a great situation. The other thing Oh, the other thing I wanted to emphasize is the fact that age is only half the story, which is to say age is the best marker of egg quality. But there's another issue which is quantity, right how many eggs a woman has and we've learned over the last 1020 years, especially through how Hmh testing has become very common. And actually a symbol of a test. That is , it's been a very important development, I think, in the last 1020 years of fertility, management and treatment. Because if you're a 28 year old with a very low Hmh, which there are a lot of healthy 20 year olds that are going to have a low AMI, it's something that's very highly individual variable, it will probably make a lot more sense than thinking about freezing eggs at that point. If you're 28 year old with a very great Hi imH. You could say okay, I've waited a year. And that's not such a terrible decision. So I think that's another thing that's often overlooked is it's not only about age, it's another dimension when it comes to egg freezing, which is your egg supplier ovarian reserve and Hmh testing is so easy to get it's almost a shame that, you know, I believe that that OB GYN should just be doing it routinely, they do a lot of other health maintenance stuff that may or may not be helpful. And this is something that could be really useful. And I think slowly they are doing it more and more. But I think that's another dimension of calculus that needs to be recognized. And that can help a woman who's trying to strategize to make that kind of decision is really useful to have.


Griffin Jones  14:16

I don't think that this question is gonna go away because it doesn't seem that it doesn't seem that we have hit the plateau for the age of first birth in this country. So I think everybody remembers that headlines from earlier this year hit the first average birth. For women in the US the median age hit 30. And if my records are right from the CDC, it was even just in 2014 it was a little over 26 years old. Yeah. So it went, it went up one and a half years from just shy of 25 and 2000 to 2026 in less than 26 and a half in 2014. And then in 2022, it's 30. So I suck at math, but I think most of the people listening can see the exponential growth. So I don't think that this is going away. What do you see in the marketplace? Do you see peaks and valleys? You know, what I wondered is when you started in 2015, in New York is like, okay, are we going to see this in Charlotte in three years? And then in Cleveland, two years after that, and talk to us about what you're seeing?


Dr. Joshua Klein  15:46

Well, I think you're right, first of all, that this is still a moving target, and the market is still maturing. The, it's interesting, because there were some well publicized predictions that were made 2014, let's say I think about what the expected size of the egg freezing market would be. And there's one quote that's out in the media that said something like 85,000, or 100,000 cycles of egg freezing by 2020. The truth is, it hasn't grown that explosively. And you could think about lots of different reasons why that might be the case. But I think that egg freezing has clearly grown a lot. I do think it's going to continue to grow, I actually think that some of the kind of spin off growth that we're seeing, and that others probably are seeing as well, is more and more married couples, or not just married, but I guess more and more couples are coming in to proactively plan their families, even as couples when they're not ready to have their children yet. And also, and this gets a little hazy, where the line gets drawn between fertility treatment and fertility preservation. And sometimes it's an issue with insurance coverage, and so forth. But lots of patients who, you know, come in in their late 30s, for fertility treatment, they do IVF, and they get an embryo. And they say, Well, wait a minute, we always wanted two kids, and we struggled to even get one good embryo. So what we want to do is we want to do another stimulation cycle to at least get one more before we go ahead and use this one. And that happens all the time, these days that people are trying to bank at least, you know, not bank inventory of embryos, in some unreasonable way. But to put away one or two good embryos for the second baby if they're having their first baby in their late 30s, or 40, which is actually very logical. And so the I think the fertility preservation concept is kind of growing and branching out into other in other ways that in some way, are still evolving, by the way, another, I think, idea that will come to fruition, but I don't think it's happened yet, is I've had a handful of patients who have read about and are interested in doing proactive couples who are interested in making embryos for PGPT, which is the polygenic testing, you know, looking at, particularly if let's say, a couple comes in, the guy says, you know, my, my dad has terrible Parkinson's disease. And I know there's no gene for a consensus disease that I can screen for, but it just scares me to death that that's something that I might have a kid and it's going to be at high risk for. And so what I want to do is do these kinds of polygenic testing, you know, involving multiple genes to say which embryos have a higher or lower risk for developing, whether it's Parkinson's or Alzheimer's or diabetes or heart disease and things like that. So that's something that's not common yet. But I think that it's coming, as this sort of feeling devolves into a lot of this proactive planning your family type of and then genetics is obviously evolving and improving as well.


Griffin Jones  19:02

So you made a brand that I think is pretty well positioned for that. The brand Extend Fertility really works for both sides of fertility preservation and fertility treatment, it is because it's the extension is very intentional. And so you, you started this in 2015 is when the was when the business started, right. So you completed a fellowship at Columbia in 2012. You go work for RMA for three years. This is the point that a lot of the listeners are at they're either just leaving fellowship or their associate docks and they're thinking about the next step. You are at a place where you're at a great practice. You could pursue partnership there, or you could go off and do something risky. What was your decisions? When did it start? to appear in your mind of I could go off and do a venture like how did that originate?


Dr. Joshua Klein  20:07

That's a great question. So, yeah, I mean, without getting, I guess, too personal, I have a lot of gratitude towards my years at RMA, I learned a lot. And it's a good place. I think that for me, I think that it well, it was a hard decision, let me just say that much. The truth is that when I started speaking to one of my associates, my business partners who was interested in investing money, putting together investors to build out Extend Fertility, my original expectations that I would sort of be some kind of consultant on the project and not actually do it myself. But as we kind of continue those conversations, and I got more enthusiastic and excited about the idea, and he got more enthusiastic about me actually getting in it, it took some time, to warm to the idea, but I kind of got more excited about about doing it myself. But it's scary, you know, especially first job out of training. And I was fortunate to have, you know, good training and at large academic centers at Ivy Ivy League institutions. And so I hadn't kind of been really out in the business world before before then. But I think that my mindset essentially was that I felt like a small fish in a big pond at RMA, which isn't necessarily passing a judgement, it just the way it is, when you're working for a large institution like that. It's a big pond, it's a big pond, and to their credit, it's a big pond. And so I felt like I was young enough at that point where if I was going to ever take a risk, you know, I didn't, I probably couldn't have done it the day after I finished fellowship. Or I certainly think it's very hard to do it. The day after you finished fellowship, there are those who do it, and I give them credit, too. But I felt like having gotten my feet under me at for a couple of years. If I if I stayed for another few years, it probably would have been that much harder to leave. Probably my income, presumably would rise slowly. And so that, you know, the better you're doing the more than make it attractive to stay. And so, you know, when you're young, you're just getting started, it's a little easier, because you're not giving up so much. And so, I don't know, I guess my thought process was basically I felt like this was a good idea. And at the end of the day, I felt like, before I started my before I finished fellowship, before I started my professional career, I felt like I questioned, like everybody has self doubt, I knew I was a bright kid. But like, it's hard to see yourself doing what your what your teachers and mentors and superiors are doing, like, Can I really handle it when when stuff gets, you know, kind of difficult when there's an unhappy patient? And how do you? How do you deal with that, or when you have some issue with like an inspection and there's regulatory stuff, and hiring and firing and all that it's very intimidating as a young, you know, kind of medical trainee. But I think that what I started to realize was that the hard stuff is still hard when you get older, and everybody does their best to handle it. And so and everybody's just human, I think that's what I what I really kind of it became clear to me that everybody's doing this is doing their best and no one knows all the answers in advance and kind of everyday brings another challenge with it. But if you know if the other guy can handle it, probably so can you and you just have to kind of have that courage and have that confidence in yourself. And so that was what I think allowed me to take that leap is sort of getting out in the world seeing that nothing's perfect. Even behind the curtain, every practice, every lab has its own questions and issues and, you know, uncertainties and every practice has its own issues that come up and like that's life and you kind of do your best to keep people happy and to do to keep the patients happy and go home, you know, doing the right thing and hopefully sleeping well at night. And you know, so it kind of lost that in that side of the intimidation. And then I felt like you know what, I'm going to take the leap. And by the way, if you take the leap and you kind of just fall on the floor. So you still have your training and you're kind of embarrassed probably but you can get up and go get a job and so you know, I felt like it's it's not if you if you let that opportunity go when you're young doc it may not come back to you. But if you take it and you swing and miss Well, no one's gonna fault you for taking the swing I think and and your career isn't ruined just because you tried something it didn't work so


Griffin Jones  24:40

and if you fall flat on your face and you're humble and self aware enough, it will make you a better partner somewhere else absolutely Well, as long as you are and those are two big as. Those are two big conditions. Not everybody is onboard and self-aware. But but if you are falling flat on your face can give can can make you do that much more valuable as a as a partner somewhere else is if the gays and then you know, if you are successful, then that's then you have you've done it long before most other people have. So in your view, what's harder? owning a business or residency


Dr. Joshua Klein  25:21

apples and oranges I guess I mean, I think I think Well, the obvious answer residency is harder, because it's physically so demanding. And then you also have to kind of keep your mind sharp while you're literally exhausted. To be clear, and for the record, I don't, I'm a very small part owner of extent, but I wouldn't call myself the owner of extent, because there's a lot of investor money that went into building this place out, and that and by the way, too, for, for the, for the, for the record for the listenership here also. So I'm talking like a big shot, oh, yeah, I'm gonna, you know, go off my own and start something new. And I in some ways, that's true. But I wasn't in a position to put up tons of my own capital, because I didn't have it. And so I did start off with investor money. And I guess I had to earn their their respect and their confidence to get that investor money, but I didn't, I didn't find $5 million in my own pocket to put down and build out a lab and build out a program. So I didn't have that much courage, or I guess, wherewithal at that point. But having said that, there's no doubt that running a program is hard. And I think that the reason that that's true is because literally you feel stressed and responsible for like 1000 different things that can come up and everyday, something does come up. A lot of it's the people, the people is the hardest thing. You know, they say hiring and firing. And that's, that's the most blatant example. But, you know, people who are thinking of leaving, and people are unhappy for X, Y, or Z and people who don't get along with each other. And they're both important pieces of your, of your of your of your team, and you gotta help them get along somehow. And, you know, the day to day, team, building, Team preserving is is is is complicated, and there's no playbook and you just got to do your best to sort of read people's emotions and feelings and instincts. And that's obviously not easy. Also, the fact that you feel responsible for everything, and maybe I that's one of the things I have to continue to mature to learn, let go. But like a silly little example, there was a, someone who dropped off a gift bag for a patient letter retrieval. Was it yesterday morning or two days ago. And somehow that gift bag disappeared. And it never got to the patient in their post op, it was supposed to be like some snack. It was nothing. It was like some snacks. And some, I don't know what, maybe a heating pad or something. And the person who dropped it off was obviously not happy because the patient was was was heard about and they were expecting and and I don't even know what happened. Somehow it never, never, never made the way and so then I'm was approached by the person who dropped it off. Because of course, like, you know, I'm kind of considered responsible for everything and like, Where can we figure it out? And then I'm asking you at the security cameras and the security camera wasn't focused, it wasn't working. And then I'm asking the lab and it's just like, this is the last thing I want to be you know, working on is finding the snack bag. Like Who else am I gonna you know, I did get help and and still not figure it out. But the point is, like, from the littlest to the biggest things, you worry about it because you feel responsible for everything that happens under the under the four walls or under the roof. And so that's that's not an easy way to live. And my hair's a lot grayer than it was five years ago, that's for sure. But well good news,


Griffin Jones  28:36

Josh. That means you're not a sociopath. So you it's, it's like it to be a business owner is one I it's so hard and I'm not running a medical practice but just you know, even running a client services are it is so hard for the reasons that you describe balancing, delivery and sales and, and the people that the to do all of those things and and you have to be so you have to be receptive to people. You have to listen and then there are other times where you have to forge ahead and say okay, we're moving on and and so you have to be agreeable enough to listen to not be a sociopath AND and OR a narcissist and but also not so agreeable, that you're just Oh, okay. Yeah, I guess I guess that is too much work for you to do. Yeah, I guess. I guess the patient doesn't really need that. You know, it's you have to you have to walk a line that can be pretty heavy.


Dr. Joshua Klein  29:48

It's funny the way you frame that because I also think it sort of tangentially but it connects to, in my opinion, how to be a doctor with a good manner in terms of how you manage patients and patient make patient recommendations. In the sense that, especially with infertility, where most of our patients are, you know, relatively young, relatively educated, lots of them are doing lots of Google research. And they're on the message boards, and they're talking to their friends and their and their sisters and whoever else that that their doctor said, you have to do this or that doctor said that never should be doing them like that, or Google, you know, says X, Y, and Z. So I think it's a really hard balance to strike, you always want to be open to hearing your patients feedback, or thoughts or questions or suggestions. If you're perceived as as dismissive of their input, that's going to be the kiss of death, patients hate bad. But at the same time, and this is something that I've also learned and continue to learn is that it's not healthy to just say, Oh, you read about that, you want to try that, or your friend did this, I'm sure we'll do that. Like, I think you not only is it not good practice, but it also you lose respect. And it's not a healthy dynamic for the patient, if you're just willing to do whatever. And so, you know, you have to really strike that balance of being being open minded, willing to discuss but also firm when you know, sort of what's right and what's wrong, and make sure that you express your opinions, so that people know that you kind of have something that you kind of believe in and that you're willing to draw boundaries and give firm recommendation. So anyway, tangential to the managing a practice. But I think it's the same skill set in a certain way to be able to read people and allow them to see that you're willing to listen to them, but not kind of just they're


Griffin Jones  31:43

both examples of leadership. So the idea of partly being is that you're meant to lead me as the patient Yeah, you have to listen to me in order to be able to lead me effectively. But at the end, you you are not the pharmacist and I am not the physician, you are the physician, I am the patient. And you have to be able to lead me in the same as drew in a business and for not just fertility practice owners and other business owners in the fertility field who listen to this show. But all of us business owners across the market think the last year and a half, two years have gotten unbalanced advice from it's all been about the employee, just go on LinkedIn. And see I haven't seen one post on frickin LinkedIn sticking up for a business owner in two darn years. Everything is and we deserve this too. And we also should have that and we're finally making what we're worth. It's like, really, that's what your worth is, is right now in the most unprecedented inflated economy of all time, like, is that house really worth a million and a half dollars? Okay, but then does that mean that that's what you're worth when there's a recession or or the pendulum swings the other way. And for business owners, the advice has been do whatever you can to retain, show that you care show that. Listen, give them what what they're asking for. And in many cases, you do have to do that. It also has to be balanced with leadership and saying this is where we're going and holding people accountable. And many people, the last few years, many of us have been afraid to hold people accountable, have been afraid to, to really, you know, leverage leadership. Because it's like, well, if I lose that person, you know, we're already down three people. And, but, but it sure makes things worse. Because then it becomes a cancer in the organization. And and then nothing you do is good enough, when you are listening when you are if you don't have the other side to balance and say this is where the organization is going. And we're all accountable to it.


Dr. Joshua Klein  33:56

Right, right. Yep. And it's not easy. You know, it's and it's, I think it's probably as hard as it's ever been for the reasons that you're talking about it. We all do appreciate our employees and our colleagues and genuinely, and they do deserve what they deserve. But yes, it can get out of hand pretty quickly if you don't set sort of some framework for what's reasonable. And that's not an easy thing to do. So


Griffin Jones  34:25

other than like principles like that, about people just even like function? What are things about business that you knew nothing about when you started? Like, I think now, good advice for most people, unless they're 100 on this on the entrepreneurial spectrum, and by 100, I mean, Mark Zuckerberg, I mean, Elon Musk, I mean, that type of but you know, your average business owner might be like a 70 on that spectrum. And, and so I think for most people, unless they're the most extreme on the entrepreneurial spectrum are better off I'm going to work for someone first learning as much as they possibly can, and then starting their own business, if they still think that's a good idea. And I say that and I believe that at the same time, though, I know things like I wouldn't even Effingham County what to look for, in many cases. So what are some of those things where you're like, I didn't even know, to look for that. Before I was, before I managed to practice.


Dr. Joshua Klein  35:30

I think I mean, in a very fundamental way, I think one of the things that has become clear to me is that so much of business relies on assumptions that are necessarily loose. You know, one of the things we struggled with and as they struggled with, but but that we, that we learned along the way was, I mentioned earlier that when we started extended, we wanted to push down the price point and egg freezing to help make it more accessible. And this has been an ongoing debate that's still ongoing, you know, what's a reasonable price for for an egg freezing cycle? And even more, it might sound crazy, but what does it cost for us to deliver an egg freezing cycle, because it's not simple math. You know, there's fixed costs and variable costs. And so I think when I when I agreed to join in San fertility, and I had some really accomplished smart business, people who joined as well, and we started, you know, kind of making decisions about how we're going to set things up in the framework. I was, I think, expecting that these business business people with their MBAs, Ivy League MBAs would have some magic formula, they're going to pull out some Excel spreadsheet, and they're going to just have it all figured out. And like this is, you know, it should cost x. And as it turns out, they don't know, at best, they say, well, let's assume that this year, we're going to do this number of cycles. And let's assume we're gonna have to do X number of embryologist, doctors and obviously, you all the different things you have to put on paper. And then yes, there is some smart math you can do to sort of make a smart, smart decision and a smart assumption. But I think that it was sort of a little bit disturbing about how much of a business is done in a way that you just have to like, make thoughtful decisions based on as much available data and often there isn't a lot of available data, and kind of just try it and see what happens and then adjust along along the way. So I think that, you know, it definitely I've learned a lot about business over the last number of years. And I've learned to respect people enormously for their successes in business. At the same time, I think the my perception that there's like this business secret book that like you only get if you're a business person, and that doctors aren't privy to that, I think misconception has been, or I've been abused of that notion. So you kind of just have to get comfortable with saying, Well, this is like the best guess we're gonna make. And let's, let's go with it. So that's something I think that you only learn when you're on the other side and really see the books and know how the some of those decisions are made with regards to the dollars dollars and cents. That's one, I'd say another sort of big learning item for me was, I think, when you're on the outside and thinking about a business, from a financial perspective, in a relatively unsophisticated way, are you tend to think mostly about revenue and not about overhead, and he's out while they're doing 1000 cycles of IVF. And every cycle is, you know, they're getting 10,000 bucks. And so that's like, well, whatever that is $10 million of revenue. And so like, it's 10 million bucks, like that must be rolling in the dough, except that you don't realize that, like, your annual rent, if you're in Manhattan can be easily a million dollars or more. And then you've got, you know, four or $5 million of payroll for all of your people. And then you've got all of your equipment, and then we got like, etc, malpractice insurance. Yeah, and the insurance and not just malpractice and liability and the cyber insurance and like, and all of a sudden 10 million bucks is not exactly a ton of money anymore, you know? So I think that the to the to the uninitiated, it's easy to see a business as as a revenue entity, but it's not it's it's a it's a P&L entity. And so and there's so many more overhead items that you never dream of before you're kind of in it. And so I think that's something that I would definitely caution people to think about if they haven't gotten on the other side of the curtain yet is just you got to realize that that delivering a product and certainly a high quality product and certainly a you know, a high touch service. highly regulated product, like health care in America, for fertility patients is a very expensive thing to deliver. And it's not so easy to cut out a lot of these major major expenses and so, you know, it's for full transparency, you know, I kind of imagined we'd be able to push price points down a lot more than than is realistic before I knew what goes into it. And so you know what we charge for our server He says now is more than I thought we'd have to charge but the reality is, it's it's it's very expensive to deliver good quality care or even mediocre quality care, let alone good call quality care. And so, so don't forget the overhead it's it's it's an important other


Griffin Jones  40:14

how I remember the first time you did a budget, the first time we tried doing a budget was like, it's like, I don't know how much that's gonna like before we launch the podcast, but I don't know how much it is to podcast, like, I don't know how much we're going to end. So it does take some, like some expense tracking, which is different from budgeting that helps that informs but you know, it's a lot easier for us to do a budget and forecasting, because like, How the heck are we going to sales forecasts in the beginning? I don't know, how many clients am I going to sell this year? How many. And so that's that's two areas that I really would recommend that if somebody's thinking about starting their own business, their own practice and their their in an organization, I would I would try to do two things. And the first, well, maybe three. First is is see as much of the financials as you can some people do like that our firm is moving towards open book management, where we share that with our team. And maybe some places you can only see a piece of it. But David sable recommended a book to me last year called how to read a financial report. That's exactly what it sounds like. It's as interesting as reading New York state tax code. But it is it's the basics. And it would be great if you could do that for your own practice, or even your own Rei division if you're at an academic center, and to see what that is to have some education that the second is to know what to know, the sales and marketing pipeline, how are people coming in? That is extremely important to know, as deeply as you can. And the third is the Human Resources pipeline. How are we getting in retaining people? And like those are three areas where I think it makes sense to really delve in May, maybe even more than operations and delivery, I might even put those three areas ahead of operations and delivery. In terms of priority of learning, what do you think?


Dr. Joshua Klein  42:15

I think you're right, because that's kind of how you get to have a team that can do the things you want to do. And if you have that, then you figure out how to do you know, if you have the right team, you're gonna do the things you want to do the operations and delivery, but you can't, you can't get there without sort of getting your Human Resources figured out without getting your sales and marketing figured out. So you have you know, a customer and that you get your finances straight. So yeah, I think that's probably right. And by the way, the sales and marketing piece is also another thing. And I can reflect with our own experience that extend you know, we came in to be open and came into the market heavy on the increasing, increasing is more so than, you know, infertility treatment, an elective service line, it has less insurance coverage than IVF does. Even today, you know, even with progeny and Karen and when fertility, there's still only a very small percentage of of women will have coverage for fertility preservation, and only a minority percentage of our patients have coverage. And we were very aggressive with our marketing and our marketing spend early on. And we grew very fast. And so it was clear to us from the first couple years of doing it that marketing works when it comes to egg freezing. The problem is that that only actually works. Ultimately, in the long run, if you can spend money to get customers in a way that allows you to still have a profit margin on what you're charging for your service. Meaning if you got to spend $5,000 on marketing for every customer that you're going to convert every patient you're going to convert, that may not be a viable business model, because you're not charging enough to justify it. And so you know, how you're gonna get your patients the best way, of course, is when they show up, you know, they word of mouth, it's free. But the reality of fertility in the US right now, certainly in any major metropolitan area for sure, is that there's lots of competition, and everybody's got an angle. And most practices, even the academic practices are doing something on the sales and marketing. And so it's important to be realistic about the fact that that stuff has to be done carefully, thoughtfully, and it costs money and you have to keep track of how much money you're spending and what you're getting for that for those dollars. And once again, like maybe I was way too naive, but this isn't stuff that I thought about, you know, figuring okay, just buy some Google ads and there's your marketing and like it, you know, it's a lot more complicated than that, obviously. So that's definitely another area that that I've learned a lot about over the last number of years.


Griffin Jones  44:55

We're talking about lessons learned, you know, owning a practice or owning a business in the future. silletti field and things that you may want to learn how to do or learn about before you go and start your own venture. Another thing is some of the systems that are used, and oh people that can give really good recommendations on the different EMRs. They've shopped and the depth and scope of functions. But I would ask someone that you know, that uses engaged MD, if you're not already, if you don't use engage them D in your system, you're thinking, I want to open my own office within my own group, or I want to open my own practice, I want to go join somebody else, and I want to be able to add something to it, engage them D is one of the surest bets that you can do, but you don't take my word for it. Ask someone that you know, because more than half of your colleagues are using EngagedMD and more than half of your colleagues are extremely delighted with EngagedMD because they got real informed consent. They don't have stacks of papers that people have to sign and then account for and then keep an eye out file cabinet somewhere. They have true informed consent from patients that have a module at their convenience, so that the staff isn't overburdened with questions that they don't need to be getting that they can help the patient with the attention that needs to be devoted to that patient's case. Because the elementary the rudimentary is covered, and now it's just what that patient is stuck on or what's unique to their case that the care team can focus their care on. That's what personalized care is. And more than half of your colleagues have seen the benefit from engaged MD that way, so just reach out to any of them. Hey, guys, do you use EngagedMDin the people you want to fellowship with people that you see it ASRM? Hey, do you use engage MD? What do you think I hear Griff, talk about it. But he doesn't want to practice? What do you guys think, and see what they say. But if you want that free workflow assessment, want to see what other practices are doing, you want those insights that engagedMD has, and you want to see how your practice stacks against that ideal workflow, then you go to engage them the.com/griffin. And you mentioned that you heard them on the show, you mentioned that you heard them from me, and then you're going to get that free workflow assessment. So ask somebody else, don't take my word for it, but go to engage them db.com/griffin Or say, or an on the show. So you heard from me, so you can get that free work assessment for you. That's one of the biggest system wins that you can have right off the bat. And you can verify that just by asking people you already know, I hope you enjoy the rest of this episode about things you need to know for the fertility business, you might start, I'm gonna let you conclude on whatever topic you want to but before that, because we have so many younger Doc's that listen. And they're thinking about like, how do I choose who I'm going to work with you were you chose your your business partners, and, and they chose you. And so talk about how you did that? Well,


Dr. Joshua Klein  48:21

I'd say I was probably luckier than I realized, the main person, the main business person that I that I partnered with, is a wonderful guy named Michael Kohn, whose private equity hedge fund guy, the truth is looking back, I got lucky that he is of as high integrity as he is, because I probably could have gotten really treated much more poorly or gotten abused more if I wasn't so lucky to find someone. So I think that the advice would be, you definitely have to choose we get into bed with very, very carefully, especially when it comes to business people because I think that they're not all going to be the most high integrity people. And to be fair, like business people are, their profession is to use business to make money. And that's true for doctors too, obviously, with our professionals, how we pay our bills and make a living. But I think the mindset of young doctors is a little bit more idealistic than the mindset of probably mid career fitness people is and you got to be very careful not to be too trusting or too idealistic in that sense, you know, for young blacks are coming out and looking at job opportunities. So it's, it's complicated, because I think that, you know, the people that you're going to work with day to day are the clinical team, you're going to have obviously Doctor colleagues, and then other clinical colleagues and embryology colleagues and so forth, but these days, a lot of practices are either owned or part owned or managed by business entities that you may or may not have much direct interaction with. And it's it's a very, very seen I think that I Have the level of involvement and exposure to the business behind the practice is going to be very different from one place to another. And I think that that's those are important questions to try to really investigate while you're looking at different practice opportunities, you know, if there are going to be places that are looking at the conversion metrics, you know, how many consults did you do, and how many of those turned into IVF patients, and if you're below a certain bar, maybe they're gonna get dinged, or you're not going to get your bonus. And, you know, to some degree, that's not crazy. But if that's gonna bother you, like you better you should be aware of it. And in other places, certainly in more academic environments, the culture, maybe more sleepy, but, but that might be more comfortable, to not have to sort of think about numbers like that. And so I think that I'm not sure that I have much brilliant insight other than to say, it's a very, very playing field out there. And so you really want to ask as many questions as you can and talk to as many people as you can, looking at to what degree is that practice run like a business or like a medical practice that has a business behind it, because the culture of the place and look, business is not terrible. And there are some very successful, very busy places out there that run like a business and that patients are happy, and the doctors are happy. And you know, that's not necessarily always the worst thing. But I think different doctors have very different priorities of how they want to practice medicine, and what kind of lifestyle they're looking for. And it's going to be pretty different from one practice environment to another. And so just Just do as much investigation and homework as you can. Because it is going to be very different from one opportunity to another.


Griffin Jones  51:45

So that's for the homework, let's conclude with the introspection thing, because a lot of people listening are in the position of the 2012, Josh or Jean Klein. And maybe there's a couple different routes for that type of person, but some of them should stay at Columbia or wherever their academic center is, wherever they're doing fellowship, because they're going to be happy, they're at another one, some of them should go on to be should should just gobble and gobbling, gobbling till they're a bigger fish in the bigger pond that they end up with it someplace like an RMA or or an RMA or wherever they end up, some should go off on their own. And then there's other people still that it's like, oh, there's somebody that just started their own thing couple years ago, I don't totally want to start my own thing that I don't feel like starting from zero. But there's also a lot of opportunity for me to help make this bigger, I want to go join the Josh Klein's out there. So there's a couple of different options introspectively. And then this will this will be your final thought for the program? What How should people decide what's best for them?


Dr. Joshua Klein  52:58

That's a great question. I think that you can't have everything, I think that it's important to be realistic about the fact that if you're someone who is going to prioritize, you know, maximizing income, then you're probably not going to get that at a pure academic program. Because you're going to be salaried. And usually, that's not the culture. If you're someone who enjoys teaching who enjoys having some abstract today's stream every year going to conferences, then you're going to get that at a more academic program, it's gonna be much harder, you're gonna be sort of swimming upstream at at a pure private practice. If you're someone who has, you know, family, or hobbies or outside interests that are very important to them, that that, you know, you want to be out of the office by 5pm every every evening and not work weekends, you know, that that's going to be something that you want to take into account. And I think the bottom line is that there's no job, probably, that's gonna let you be like the division chief, and academically active going to conferences every couple of months. And you know, making a seven figure income, and not working weekends, and being out of the office by 5pm, every month, and every week, every day. So, so I think it's just a matter of, and again, no brilliant insight here, but you really just have to think about what are the things that are most important to you and your lifestyle and money is important, but it really is not necessarily the most important. And so, you know, make your list and then try to get as many of those things as as you can, because you're just it's like buying a house you're just not going to get everything unless unless something's you know, your I guess our unlimited budget, but most people are going to have to pick and choose. And so just think seriously about what's going to make you happy in five years and 10 years and then chase after those things. And maybe some of it will come along with it. You know, you can be in a private practice and still be the research person who does put together some research abstracts every year and like that's fantastic. But as long as you you know, are are comfortable the fact that that's kind of if you can, you'll do it but it may not happen then you're being being smart. So I think it's it's really a matter of triaging what what is going to be highest priority for you and your career and, you know, being honest with yourself about what's going to make you happy. And if you do that you should be landing in a good place. And there's lots of good places. That's another comment is that there's not like one right job, I think there's a lot of ways to be happy. So we're in a good time, there's a lot of good going on.


Griffin Jones  55:27

Well, if if one of those routes makes sense to talk to you, as you say, talk to everybody is that an offer you would extend are there that you would extend to the younger dogs that they can reach out to you on LinkedIn. So we will include that in the


Dr. Joshua Klein  55:45

video, I think my journey has been an interesting one and not the most common, you know, working and big place academic place, and then in New York, kind of CO founding my own place, and it's been a journey and it's been a learning journey. And so I do think that I can give people guidance, or at least my, my personal, you know, perspective, so I'd be happy to be available.


Griffin Jones  56:05

Dr. Josh Klein, thank you for coming on inside reproductive health.


Dr. Joshua Klein  56:09

Thank you for having me. It's been my pleasure.


56:12

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



153 Elizabeth Carr: What is U.S. IVF’s First Born Working For and What Is She Doing Now?

 This week on Inside Reproductive Health, Elizabeth Carr shares her experience from birth to where she is today, at TMRW, and everywhere in between. Born quite literally into the industry and its spotlight, Elizabeth has chosen to be an advocate for IVF, working to change public education, and further ‘industry’ advancements. 

Tune in to hear:

  • What Elizabeth Carr is doing to give back to the community that made her existence possible.

  • How her relationship with Dr. Jones and his family contributed to her life and ultimate career path.

  • What she wishes people in the industry would push harder for. 

Elizabeth’s information:

LinkedIn:https://www.linkedin.com/in/elizabethc

Twitter: @ejordancarr

Website: www.ejordancarr.com


Transcript

Elizabeth Carr  00:04

My speaking up and out has always been kind of my love letter to the industry as a thank you and to all the patients. As a thank you for saying thanks for not giving up and making sure that I got here.

Griffin Jones  00:17

unlimited human potential Do you ever think about the line of work that you're in, in those terms, unlimited human potential. That's what I think about when I think about the in finite or at least in depth finite number of IVF babies that can be born or babies born from art in general, my guest is Elizabeth Carr, you know who she is because she was the first baby born from in vitro fertilization in the United States, through Dr. Howard Jones and his Institute. And we talk about what that was like to always be in the limelight. But I think the reason why you'll get an interest in or you'll take an interest in this episode is because partly the relationship that she talks about with her family and Dr. Jones and, and then what the other IVF babies that she knows from the institute, what their relationship was like, and their fondness and even the way she thinks of Dr. Jones's colleagues, and that weren't there at the institute, but But everywhere. And so I think as you think about what kind of legacy that you're having, maybe we take a little break from the private equity and the hiring and the marketing and the business development and all of the this stuff, the important stuff that we do have to do we take a break for a second, so that you all can reflect on the legacy that you're leaving from someone who had one is very good about speaking about it, but to at least in this country, has been living it for the longest. So now she's with TMRW Life Sciences. And I get to talk a little bit about that, and a little bit about advocacy and an opening up. But think about this episode with regard to your legacy. And enjoy this interview with Elizabeth Carr. Ms. Carr. Elizabeth, welcome to Inside reproductive health.

Elizabeth Carr  02:23

Thank you so much for having me. It's great to be here.

Griffin Jones  02:26

You are the United States of America's first baby to be born through in vitro fertilization. So does Louise Brown, like ever? Just Does she ever throw some nationalistic crap at you that the UK beat us to it? Or does the stet you know, does that Steptoe Jones legacy does it? Does it manifest itself as a rivalry decades later, or was it the whole world collaborating to? To try to do the right thing?

Elizabeth Carr  02:57

Yeah, no, no shade, definitely no shade from Louise. And yeah, my doctors Jones actually worked with Steptoe and Edwards to kind of understand what they had success with, and then tried to replicate. In the US, of course, my distinction versus Louise, where maybe I'm throwing a little shade is that I'm really the first IVF baby, that, you know, when we think of modern IVF, I'm it so Louise was a natural cycle, whereas I was the first baby born using all of the, like, hormone protocols that we're also familiar with now.

Griffin Jones  03:35

Wow. So well, that's another reason why whenever somebody says, and normally there's playing around, but our country did this first or our team, our university, whatever did this versus like, but yeah, they did that one step first. And then because you did that one step and you help somebody out, they figured out another step. And then the other guys and gals over here figured out another step and as much better to think collegially Exactly. So. So when did that start to become a part of your life? Because it was always a part of your parents life, but But for you, it definitely wasn't, you know, in the first couple years of your life, in terms of like you knowing that, you know, at least age two and three

Elizabeth Carr  04:25

you Well, I mean, yes and no. So I let me put it this way. My first press conference ever was at three days old. So while I may not have had the cognitive realization of what was going on, I have always known that I was not like all of my other peers, you know, other kindergarteners weren't going on Good Morning America, but I was, you know, think things like that. So I may not have realized until I was older. What this meant: But, but I knew that my parents went through something different in order to get me here. That was kind of like my understanding when I was very young.

Griffin Jones  05:10

My assumption was no, it would have taken a few years before some of the to be able to explain it to you. But you were just never out of the limelight is what you're saying.

Elizabeth Carr  05:19

Correct? No. I mean, it was a media firestorm from the day that it was announced that there was a pregnancy even before I was born, just even a pregnancy there and woman impregnated was the headline that my father recalls reading. And he was like, yep, that's my wife. So yeah, it's always been a subject of media spotlight and scrutiny.

Griffin Jones  05:45

And so how long did that last for? You said you went to? You went to kindergarten, and then

Elizabeth Carr  05:54

I made its last my whole life. Yeah, it still happens. It's lasted my whole life. Basically, every reproductive milestone, somebody will want to talk to me about what this means, or you want to check in and make sure I was developmentally just like everybody else, because this was, you know, had never posted, by the way. Yeah, I mean, you know, mostly abnormal, I

Griffin Jones  06:19

think, crazy as everybody else.

Elizabeth Carr  06:22

Exactly. I don't think there's any real normal out there. But yeah, so I mean, it's been a constant. limelight. I mean, I had a camera crew here last week at my house, and I'm, you know, I'm just living my life. So

Griffin Jones  06:37

were there. Were there points in your life where people were less aware the media was less interested, like, oh, 13 year olds are gross. Let's bother again, when she's old enough to vote? Like, Were there ever lows in? Were there? And, or maybe at least lows compared to the peaks?

Elizabeth Carr  06:58

Yeah, I think, yeah, the ages that were less exciting, right. So like, nine was not a big deal. But 10 was a huge deal. Because it had been a decade since I had been born. You know, when I turned 16, it was like sweet 16. Right? When I turned 20, when I got married, when I had my son, when, you know, it's like, all of these kinds of life milestones that people go through. Mine had an additional level of media interest that I don't think many people realize until we start talking about it.

Griffin Jones  07:29

Hey, are you gunning for centenarian status? triple digits, because

Elizabeth Carr  07:35

I know that the running joke is, you know, this year, I turned 40. And I was like, you know, I can't lie about my age. Everybody knows when my birthday is exactly how old I am forever. Never. That's, you know, that's what I'm stuck with. So yeah, it's, it's crazy.

Griffin Jones  07:52

So when did this notoriety start to get you involved with the fertility field, like the fertility field had always known about you? The doctors knew who you were, and they certainly knew our Jones was. But at what point? Did it start to get you involved with them?

Elizabeth Carr  08:22

Yeah, so I mean, aside from the media attention, and all the interviews that I've had, over the course of my life growing up, I, I've always had an interest in science, I'm not good at math. But I've always liked to explain the science. So I've always, and I always, I think I was probably 10, when I started really paying attention to the industry and seeing what was going on and developing. So I've always paid attention to the reproductive field. But I also started realizing that because I had this weird platform in life, that I could use my voice for good and for change. And so I've really, from a pretty young age, started speaking up about different reproductive options out there, and became kind of like a junior advocate, you know, Junior age, probably 1011, I really started paying attention to what was going on with insurance. And I'm still actively fighting those insurance battles and testifying in front of various committees and on state by state basis and paying attention to all the laws and, you know, looking into just helping people understand their options. So I started really paying attention to that stuff, probably when I was 10. And then I went on to be a journalist and wrote, not surprising to many I don't think primarily about health and science and again, stayed up on everything going on. And then I've worked for a few fertility startups and done a bunch of free then to writing and social media for various companies. And now I'm at TMRW Life Sciences as director of marketing.

Griffin Jones  10:07

So you started off as a journalist, were you ever kind of covering just a regular beat? Or was it always Health and Science?

Elizabeth Carr  10:16

Yeah, so I did a range of things. When that you, when I started out, I worked from age 18, at the Boston Globe. And I actually started out as an obituary writer, because you can't label a dead person, believe it or not, so they let you start there. And then I did a lot of general assignment. And then I went into health and wellness was a writer, then I became a health and wellness editor. And so I've done you name that you name it, it runs the gamut in terms of journalism,

Griffin Jones  10:47

what made the switch or the transition from journalism to marketing.

Elizabeth Carr  10:53

So I spent 15 years of my career at the Boston Globe. And I actually jumped from the editorial side of the business to the marketing side of the business, because I wanted to learn, you know, the dirty little secret of newspapers is that you don't make money selling a newspaper, you make it doing events, and marketing, and in house advertising, and all these other kinds of modalities that a newspaper has available to them. So I just wanted to learn soup to nuts, the business. And so that's why I jumped to the marketing side. And then I figured out that, you know, this was an important skill in the fertility world for, you know, anyone looking to grow their practice or understand the business of infertility services or reproductive technologies as well. And, you know, it's hard, it's, it's complicated, right? If you don't understand the reproductive field, it's hard to translate it into plain English for people sometimes. And I that's, that's a skill that I wanted to learn and adopt very early, that I wanted to be able to explain something very complex in a way that people could understand it.

Griffin Jones  12:05

So what areas of marketing did you experience both at the Boston Globe and then afterward?

Elizabeth Carr  12:12

So I was one of the first digital reporters, you know, back before anybody knew what a blogger was, I was blogging, doing social media, tweeting, you know, doing kind of the early days of podcasting, where, you know, we did audio over stills, it wasn't really movies back then. But audio over stills kind of storytelling. You know, things like that, basically anything I could get my hands on and play around with I was experimenting with.

Griffin Jones  12:46

And then and then what happens after the Boston Globe.

Elizabeth Carr  12:51

Let me see, after the Boston Globe, I actually went to work for Runner's World Magazine, I was an editor there because in my free time, I am an endurance runner, and I run marathons. And so again, kind of still in that health and wellness bent, was a was a writer and editor there. Then I went to work for over science for a very short period of time, I then I worked for genomic prediction, I've done nonprofit fundraising, and leads kind of all the way up to today, TMRW.

Griffin Jones  13:27

All the while that you're doing like that you're at the globe that you're Runner's World. Are you? Are you involved in the advocacy? You said? Yeah, surance passion never left you. So what were you doing during that time?

Elizabeth Carr  13:42

Yeah. So it's all the stuff that nobody sees, right? It's all the stuff behind the scenes that we all know, hopefully we all know is going on, of, you know, fighting to get insurance mandates in various states where there aren't mandates and coverage, as well as making sure that bills that are being proposed have language that is protective of all, not just some seeking reproductive options. So all of the nitty gritty stuff that's behind the scenes that nobody really, you know, it's not visible, but it's critical work. So I've kind of always been doing that, since I was very young. It's just not something that people see.

Griffin Jones  14:23

So then how did you when did the logical or now seemingly logical conclusion of starting to work with startups in the IVF space? When did that happen? And how did it happen?

Elizabeth Carr  14:38

Probably. I don't I'm trying to think how many years ago probably 10 years ago, I think is when I started. Sorry, my dog is drinking water loudly off camera. Miracle. Thank you. So probably about 10 years ago, is when I started working in the infertility slash startup space in a in a professional capacity as opposed to just in a patient advocacy capacity? And how did it happen? You know, I'm not really sure I've just always kind of known a lot of people in the space. And I happen to have this like weird digital tool set to or skill set in my tool belt of various things I was good at. And I understood the needs of patients as well as the needs of clinics or providers as well. And so it was kind of marrying all of these various skills from journalism, marketing, patient advocacy, kind of all into one. You know, one multi tool, I guess you would call it,

Griffin Jones  15:47

as you've established, we all know how old you are. This took place about 30. Why not? Until then was was it? Was it just because you were just another person doing other things in your career? Or was it because there weren't as many startups in the fertility space at that? I think,

Elizabeth Carr  16:05

yeah, I think it was both to be honest with you, I think I was just kind of still, I felt like I still had a lot of growth to go at when i i left the globe, and I was 33. So I still kind of had this mini city of people to learn from and that was, I was really grateful that I spent a majority of my career there because I have learned so many different skills from so many different people. And then yeah, I think also, yes, we have seen more and more fertility startups survive those early days, to be honest with you. I think it's there's there's many, many out there, but not many of them become known until after they survived that first few bumpy like six months to a year. Right. And so that's kind of when I feel like people rise to bubble up to the surface.

Griffin Jones  17:02

What was it? What were people working on at that time that you found interesting in the fertility space?

Elizabeth Carr  17:09

I mean, back then, you know, it was a lot of the early days of pre Implantation Genetic testing, which is fascinating to me, because it was not even in the realm of possibility. And when I was born, I mean, this is really dating me, but they had a statement written, or my doctors had a statement written in their pocket about how it was a sad day for infertility that they had on backup, just because ultrasound was showing that I was really, really small and they were worried I was going to come out with birth defects because I was only five pounds 12 ounces. And ultrasound was so bad back then. Right. So people forget that, like the things that we take for granted now. vitrification I remember when vitrification became possible, and that was like, the catalyst and game changer in the field. You know, egg freezing was I remember being probably my late teens and touring a facility that had done the first egg freezing for fertility preservation for cancer patients, because that was it was very niche back then. And it was like groundbreaking that they figured out that, you know, we can freeze eggs and and they can still go on to become viable pregnancies. People didn't know that that was possible. So it's kind of like all of these milestone moments that I remember growing up with industry really in, in my view.

Griffin Jones  18:37

And then what, what landed you TMRW, and how long have you been there for?

Elizabeth Carr  18:44

So I'm trying to think I think I've been here six months now. I saw TMW at ASRM, actually. And I just thought, wow, this is the kind of safety and transparency that I hear from a daily basis that patients really are kind of clamoring for that they want, you know, they want more information. I know that we we all think it can be information overload because it can be right we didn't my my mother always jokes that she was kind of grateful that there was no Dr. Google back then when she was going through IVF. Because it is so overwhelming the amount of options and information out there. But I hear from people you know, I really wish there was a way I could just stay up to date on all of my eggs, embryos, health information, everything I needed to know and not wonder where things are or what the status of them is, in in the moment really, to know that everything is safe and I've worked so hard to you know, get these eggs or embryos that I want to protect them at all costs. And I think that you know, TMRW unique digital chain of custody and patented technology is just It's just, you know, so interesting in kind of leveling up that transparency and peace of mind for patients.

Griffin Jones  20:08

I don't know exactly when a startup becomes not a startup is.

Elizabeth Carr  20:13

I don't either.

Griffin Jones  20:16

Do we still call TMRW a startup?

Elizabeth Carr  20:18

I mean, I don't know. That's a very good question.

Griffin Jones  20:22

A lot of money, a lot of people.

Elizabeth Carr  20:25

We're all working very hard roster

Griffin Jones  20:27

at this point. So yeah. So in your director of marketing,

Elizabeth Carr  20:34

that's your director of product and clinic marketing,

Griffin Jones  20:37

clinic market? So do they pull you out like a dog and pony show? Yours? Which is, which is partly the role of marketing director anyway. But given your status, how was that used?

Elizabeth Carr  20:55

No, I mean, it's really kind of, I'm always the one saying like, Oh, I know them, or or, you know, like, let me I want to help or, you know, I'm really the one who kind of said, I want to help move the needle in whatever way I can for the industry. That is kind of my that is my, like, personal stake in the ground aside from TMRW, or any other company I've ever worked with? It's really how can I personally move the needle? For the better in the industry at for patients? That is, that is my end game. And so everything I do is kind of with that mindset, you know, moving forward? And no, it's really my job to kind of, again, translate all of the complex things about the about this technology that we have, and explain it to people in a way that makes sense. And let people know, you know, why it matters.

Griffin Jones  21:50

So our director of clinic and Product Marketing means of what TMRW is marketing to clinics, yeah, helping

Elizabeth Carr  21:59

helping clinics so that they can level up their practices in terms of having our cutting edge technology at their practice. And then as well as explaining the product itself, like soup to nuts, nuts and bolts in a very, you know, non technical way to understand.

Griffin Jones  22:16

So what are you doing to, to talk to practices now?

Elizabeth Carr  22:22

Yeah, so essentially, you know, my job now is to interface with all of our current partners, and help them explain to their patients, you know, this is the TMRW platform, this is why we're using it, this is what it means, you know, that kind of stuff. So I help them explain to their own patient populations, why this is important, and it matters as well. And then again, explaining the product to the clinic so that the clinic can then explain the product to their patients as well.

Griffin Jones  22:49

We're talking about lessons learned in owning a practice or owning a business in the fertility field and things that you may want to learn how to do or learn about before you go and start your own venture. Another thing is some of the systems that are used, and oh, people that can give really good recommendations on the different EMRs. They've shopped in the depth and scope of functions. But I would ask someone that you know, that uses engaged MD, if you're not already, if you don't use engage MD, and you're CISM, you're thinking I want to open my own office within my own group, or I want to open my own practice, I want to go join somebody else, and I want to be able to add something to it, engage them D is one of the surest bets that you can do, but you don't take my word for it. Ask someone that you know, because more than half of your colleagues are using engaged MD and more than half of your colleagues are extremely delighted with engaged and be because they got real informed consent. They don't have stacks of papers that people have to sign in then account for and then keep an eye out file cabinet somewhere. They have true informed consent from patients that have a module at their convenience, so that the staff isn't overburdened with questions that they don't need to be getting that they can help the patient with the attention that needs to be devoted to that patient's case. Because the elementary the rudimentary is covered, and now it's just what that patient is stuck on or what's unique to their case that the care team can focus their care on. That's what personalized care is. And more than half of your colleagues have seen the benefit from engaged MD that way so just reach out to any of them Hey, guys do use engage in the people you want to fellowship with people that you see it ASRM Hey, do you use engage them D What do you think I hear Griff talk about it. But he doesn't want to practice. What do you guys think? And see what they say but if you want At every workflow assessment want to see what other practices are doing, you want those insights that engage them D has, and you want to see how your practice stacks against that ideal workflow, then you go to engage them. the.com/griffin. And you mentioned that you heard them on the show, you mentioned that you heard them from me, and then you're gonna get that free workflow assessment. So ask somebody else, don't take my word for it, but go to engage md.com/griffin Or say you're on the show. So you heard from me, so that you can get that free work assessment for you. That's one of the biggest system wins that you could have right off the bat. And you can verify that just by asking people you already know, I hope you enjoy the rest of this episode about things you need to know for the fertility business you might start. When you're at SRM, especially like if you're either talking or you're involved with a session, or somebody invites you to be the guest. They're the guest of honor at their party, and you meet fertility doctors, what do they say to you?

Elizabeth Carr  26:05

Oh, it runs the gamut.

Griffin Jones  26:08

I want to hear the game I want to hear all the time, I want to hear

Elizabeth Carr  26:12

all of the games. I mean, I've heard everything from the very young embryologist who are like you're in all my textbooks, which makes me feel really old and weird, but in a good way. versus you know, some of the older physicians who remember by doctors, Dr. Howard and Dr. Georgiana Jones, and comparing notes to like, what it was like back then versus what it's like now. I've had people ask me really odd questions such as, Do I have a belly button? Spoiler? Yes, I do. I was born just like everybody else.

Griffin Jones  26:48

Doctors are asking that question. And doctors and patients have asked

Elizabeth Carr  26:51

me that question. I kid you not which it's always shocking when a clinician asks me that question. Mostly OBGYN so I have to be honest.

Griffin Jones  27:02

I wonder if there's what the reason that they're asking that question because

Elizabeth Carr  27:05

there's because in the early days of IVF, the slang term was test tube baby, right. And so the, the image in everybody's head was that I was grown in a test tube, which is just wildly inaccurate. Also, fertilization happened in a petri dish. And there were no test tubes involved in any way, shape, or form. So I always found that very amusing. And I've always hated that nickname.

Griffin Jones  27:30

But I thought there might have been like, but they didn't know that you that you went through gestation in utero, they didn't know that. They are a lot of people. A lot of people vitro fertilization also means grown

Elizabeth Carr  27:43

in a lab, like literally. Yeah. And I have to, I often have to remind people that that, honestly, the only difference was that fertilization happened in in a petri dish. And then I was placed back in my mother's womb. And nine months later, I came out just like everybody else does.

Griffin Jones  28:01

I mean, a lot of people think that, you know, like, Alaska is a country or that. Queen Elizabeth lives in Brazil. So like, it could, it could be, you know, I could see a lot of people thinking anything about that. But it surprise surprises me that OBGYN ins have

Elizabeth Carr  28:23

not awesome just to fit. You know, I'm just not I'm not saying everybody. But yeah, I mean, it's I think that's the one thing that surprises me still to this day, is that I have to do so much still basic education on what IVF? You know, I only primarily speak about IVF, because it's what what got me here, so I know it intimately well. But in terms of education on what exactly IVF is, there's still a lot of baseline education that needs to happen on a on a general level for a lot of people, many people have maybe heard about it, and think they understand what it is. But a lot of people there are still misconceptions about it. Yeah.

Griffin Jones  29:05

Unfortunately, it doesn't happen to me as much now that that generation is mostly gone. But I used to meet people that that knew my grandparents, I would meet older people that knew my grandparents, and they would talk about how they, how they knew my grandpa's. I guess that happens with my parents generation, too. But I guess I know more about my parents generation. So I'm just Yeah, a couple years ago, my brother and I were at a neighborhood bar in the neighborhood that were for the working class outside of Buffalo neighborhood for generation two, and we're at a neighborhood bar where like, all of the Irish working class stereotypes are coming together like our second cousin is our attending that we don't know that was oh, yeah, I know. And then there's this older couple there and that oh, and I know who your who your family where they were the Burns is and they were like telling me about my grant. parents and their family and great grandparents. I wonder, do you ever get that vibe from from older physicians like, who were maybe just behind the Steptoe Jones generation? And, like, do they want to tell you about Dr. Jones or duck, maybe even Dr. Steptoe, even though he wasn't in this country, like do they want to tell you about them in the same way that your grandparents friends would want to tell you about your grandparents?

Elizabeth Carr  30:33

Absolutely. And the grandparent analogy actually is a very good one, because that's how I've always referred to the Jones is my second set of grandparents. Our relationship for my whole life until they died was very, very close. Phone calls, emails, writing all sorts of correspondence. When I had my son, Dr. Howard wanted to make sure that I was going to a hospital with a level two NICU just in case, you know, all these kinds of things. So, yeah, people definitely want to share their stories with me of Oh, I was a fellow I was a Jones fellow or I went through the program, or, you know, I learned from so and so who was on the original team, or, you know, all those kinds of things, I actually really appreciate when people share those stories with me, because, you know, those were, those were kind of the Wild West days back then. Right? They were trying to figure out what was going to work, I don't think people realize that my parents you know, they didn't realize they were going to be the first until my mother got pregnant. And then the Jones were like, by the way, you're the first. And my parents, I think, naively assumed that there had been success, like it didn't dawn on them that there wasn't success. beforehand. And they weren't the only couple going through this. There were a group of other people going through this process at the same time, my parents were, but all the couples had a different protocol. And so none of the couples knew like, are we going to be the ones that the protocol works? Or is it going to be somebody else? And they weren't really allowed to share notes or talk about, you know, how their protocols were different. So it was kind of like, you'd pass in the hallway and wave and but you didn't know like, are they? Are they pregnant? Are we pregnant? What's going on? So yeah, it as I said, it was a wild west. So it's always interesting to hear those stories from from the very early group.

Griffin Jones  32:33

And so Dr. Jones passed away, like when I got into the fertility business, I started working with that, our first fertility client in 2014, but moved back to the US in June of 2015. And he passed away that summer. And how much correspondence did you have with Dr. Jones throughout your life?

Elizabeth Carr  33:00

Oh, as I said, so much correspondence. I mean, when I was little, we had a Mother's Day reunion every year at the Jones Institute in Norfolk, for the first 100 Babies essentially. And when it got to be 1000, and 1001 babies, that was our last reunion, because it just got to be too many people. And that was just from the one, you know, clinic. So throughout my life, you know, he would come to the airport and pick us up, or he would you know, I've got Birthday, birthday cards and phone calls every Christmas and on my birthday from them. I when I interned as a writer at The Virginian pilot newspaper, Dr. Howard actually helped me figure out my housing and I stayed with one of his fellows. And he and I had a standing lunch date every Wednesday. Well, I was there for the entire summer. He was one of the first people I told when I was pregnant with my son. He was invited to my wedding, you know, they were invited to my wedding. You know, anytime I had a newspaper article that made the front page or something like that, he would send me a note. So if people I think don't realize that we had such a close relationship, and they really were like a second set of grandparents, as I said,

Griffin Jones  34:23

so I just had a client asked me today, they were like, because we're doing a photo shoot for them. And we have a part of that where we we have just like an open period where people can come in and they can take their pick, they can bring their kids and they can take a picture and and they asked me what's the age limit because we just had someone in their early 20s who reached out to Dr. Toe and toe and said that they're now beginning medical school and as like there's no age like Yeah, that's great. That's incredible lady Yeah, like, that's it's not just a cute chubby cheeks that that is the whole story like, and you could argue that that's like, that's the story like, you know this, more broadly speaking this unlimited human potential you don't know what the human potential is, but we know that it wouldn't have existed if not for. Right. And so you like you were a part of of of that growing up. So I want to ask this question that has to do with the infertility community. If you think it's personal to me, I'll edit it out. I think it's, I think it's germane to the conversation. So sure. Did you go through infertility treatment

Elizabeth Carr  35:44

for everybody asks me that, no. So that was the other the other interesting thing about my mother's fertility journey to have me, she actually didn't have traditional infertility. She like where it was unexplained, or, you know, something was going on like that. It was scar tissue from a botched appendix surgery when she was in her teens. And she actually had three ectopic pregnancies before having me and so her fallopian tubes were removed, which, then that's where her fertility issues really came in. Because you, you know, back then you couldn't have a child unless you had fallopian tubes. So ironically, my mother could get could always get pregnant, she couldn't stay pregnant, the reason she couldn't stay pregnant was because of that scar tissue. So she was kind of the ideal candidate for this IVF program. And then No, I had no fertility issues at all. And I had my son at the same age actually, that my mother had me I was 28 when I had my son.

Griffin Jones  36:46

The reason why I asked is because I wonder what that's like the fertility community is such a tribe in many, in many cases, partly because they have at least some, some similar roots to draw upon. Like, even though the journeys are different, there's, there's some common threads, and sometimes those common threads are so distinct from the rest of society, that's where they form their bond. And, and you don't have that with them, you have a different kind of bond with them. It's like it's, it's as though they're, it's like their kids, you know, the the ones that have gone through treatment and been successful, are gone through time. Fast forward to be a grown up and now are with them in that community. So what what is that like, like to be to be not one of them at all, in one sense, and to them? And to be like, the most proud I know, there's so yeah, right, and product and and others? What's that? Like?

Elizabeth Carr  37:49

Yeah, so I mean, that's where, to me, I've always been very cognizant of that. There's like, I cannot speak to what it is like to exactly experience infertile infertility or trouble with your family building, right? I'm very aware of that. So I never speak to what that is like, what I can say is I can relate to what my, my parents went through, in their very unique situation. And that is where it has become my goal, that I am very humbled and privileged to be here. And I realized that I am very humbled and privileged to be here. And so my work as a patient advocate, or, as somebody who can be a resource or connector for somebody else going through this, my goal has always been for people to know what their options are before they need them. Because my parents really, you know, we're kind of given this option in a moment of crisis of like, Oh, my God, what do we do we have, we can have a child of her own, what are we going to do, and I never want anyone to feel like they don't know where to turn. And so my speaking up and out has always been kind of my love letter to the industry as a thank you and to all the patients. As a as a thank you for saying like, Thanks for not giving up and making sure that I got here. Because it took everybody it took all of my parents willpower of fighting. It took all of the scientists and lab technicians and embryologist and nurses, and even receptionists answering the phone and all the billing folks, it took so many people just for me to be here talking to you today. And so that's where I'm going to keep keep using my unique platform and voice to keep moving the needle ahead in this industry. And it's it's just it's it's honestly my only way of saying thank you because the words thank you seem wildly inadequate.

Griffin Jones  39:48

How old were you when you started meeting other adults that well, maybe now I won't even ask the question adults. How often How old were you? You when other people started introducing them to themselves, do you say I'm an IVF? Baby, too?

Elizabeth Carr  40:08

I mean, I think I'm a bad person to ask that question only because I have a magnet right at the end. And, you know, we had those reunions from from when I was very little with a Mother's Day stuff. So, so I always had other IVF babies around me, always. The only difference was, you know, when I was little, we would all introduce ourselves using our numbers. And so, you know, a friend of mine would be like, I'm never 10 and be like, I'm number one. You know, so nice to meet you. Where's number five? We don't know, like. So but then, you know, to have friends of mine. Now my age saying, Oh, I'm going through IVF or I'm having an IVF. Baby, myself. And they often say thank you. And I'm like, you know, I appreciate that sentiment so much. But like, honestly, I my, my joke is that I didn't really do anything I just showed up. It was really everybody else did the hard work, you know, I had no control. And whether I was here or not, it was everybody else.

Griffin Jones  41:06

Because you've got this passion, because you got this unique perspective. Are you ever asked to? Or do you take it upon yourself to be a public relations force when something bad happens, like when there is the the rare tank leak or embryo mix up? Or some sociopath in some, like OB GYN clinic from 30 years ago that fathers, how many embryos like when that stuff happens, and people are looking at the fertility field? Like, wait, what like, is that witchcraft? What's going on over there? And we know how rare that is, we know how much of a sliver it is to, in comparison to the good in the hundreds of 1000s of lives now over a million IVF babies that have been born from the treatment. But like, do you see yourself in in a unique position? Like do you feel an obligation to to be a counter voice when that stuff starts to get a larger share of voice in the public sphere?

Elizabeth Carr  42:23

I mean, yes and no. So obviously, especially with with my role TMRW, we're always trying to move the needle ahead for safety and you know, best practices and upping the standard of care, right? And so on, on that kind of mission level, I'm always saying like, this is why this technology is so desperately needed, so that in the rare circumstance or whatever that it happens, this is this is not a possibility, or the risk is mitigated to, you know, such a degree. On the other hand, I also know, because I grew up in this industry, how deeply IVF clinicians and lab techs and embryologist and everybody care about what they're doing. And, you know, I come at it from a very different lens of like, nobody would ever do anything on purpose, right? Like this is, as you said, like, these are catastrophic mix ups that I don't think anybody obviously ever wants to have happen. And so therefore, like, let's come together, link arms, let's talk about best practices, let's make sure that we're all doing everything in our power to make sure that this never happens, right, that this this is, this is the one thing we all collectively have agreed that we want to avoid from happening. So let's figure out how to do that together. And it is not from a place of, you know, fear mongering, it's, you know, we had a practice in place that was the best at the time. Now there's a new option, you know, let's let's go forward with the new option. Because it's new, it's a new standard. And it's just like, you know, kind of same thing with how the industry itself has grown up, right? We used to use certain hormones in the early days of IVF that now we don't really like my mom was on personnel, they don't make personnel anymore. There's now a new version out there. That's the next best, latest, greatest right? So we're always iterating we're always moving the needle. Again, even vitrification wasn't it was a moment in time where they were we were moving the needle, right? We went from fresh transfer to now we know we can vitrify and we can flash free. So what does that mean for moving the needle? And so that's where I always am kind of coming from like, what do we have to do now to move the needle? From an advocacy standpoint, from a safety and technology standpoint? What can we do together?

Griffin Jones  44:53

I'm curious a little bit while we're talking about that, I do want to conclude with you sharing what you think the field should be paying attention to. But I want to ask with regard to the extent that you're able to talk about what, what is TMRW’s vision or potential outside of just the IVF space? Like, I got to believe that this company is, is also going to do other things with this technology. So what's on the horizon?

Elizabeth Carr  45:25

Yeah. So I mean, I'm actually a terrible person to ask. Because I am so ingrained in this in this particular field and this particular dish that I'm like only, like a horse with blinders on that this is our goal right now, this is our mission, this is our drive. I'm, I'm the wrong person to talk about future looking, because at this point, it's we just want everybody to understand what we have going on. Right now. That's in the marketplace for patients and clinics to move forward. But I am excited about where where the potential of this could go. Although I don't necessarily I'm not the person that's necessarily involved in those discussions. But I am excited about yours, knowing about the person perceived benefits of this technology in, you know, potentially other fields. Who knows?

Griffin Jones  46:20

Well, let's talk then about what you think that the field should be paying attention to. And so let's maybe start this conclusion with what do you think that people aren't paying attention to enough of that, that you see, from your vantage point from having worked for all these different startups from our comfort mile from having talked to so many doctors and been involved in the institutional structure? What do you think that people just aren't paying attention to enough of right now?

Elizabeth Carr  46:55

I mean, that is such a hard question. For me, I think it's always the coverage and insurance landscape. We have known for many, many years that, you know, in many ways, reproductive technologies are cost prohibitive for so many people. And that continues to be a really tough nut to crack to make it more accessible to more people, and, and that is something that I know, we're all striving to change, but it's so hard, and it's so slow, that I think that that, you know, in this Roe v Wade overturned landscape, it's really come to the forefront even more, you know, as as a, as a worry that, you know, it will become less accessible, as opposed to more accessible. So I think, for me, personally, that's always one that I'm like, you know, if everybody can really pay attention, not just to the technology and best practices going on in the world, because we know that's going to continue to march forward. But really the landscape itself and, and making sure that everybody has access, and, and that is so key, and I don't think we can ever stop paying attention to it. Truthfully, like, if we take our eyes off that ball for one minute. I think it can be really harmful in the long run.

Griffin Jones  48:32

Well, then I'll let you conclude, however you want to clean our audience of practice owners and Doc's and fertility execs. Maybe it's it's a call for how you'd like them to get involved with that. But how would you like to conclude?

Elizabeth Carr  48:46

Yeah, I mean, I think, you know, for me, it's always, it always comes down to what do we think we need? And how do we think we need to get there. And I grew up in an industry where everything was highly collaborative, right? That was what everybody that talks about the Jones remarks how collegial and academic and collaborative they were, back then, that they, you know, wanted to share the latest and greatest research, they wanted to share best practices. And I think we all still need to kind of especially in this current landscape, continue to link arms and and kind of look around and say like, Yes, I know, we're competing, maybe for customer acquisition and those kinds of things. But let's make sure that we all agree that we want to provide the best care that we can to our ability, period, full stop, and whatever that looks like in the current day, landscape, technology, whatever it is, if we can all say that we're all driving towards the utmost best patient care. That's really all that matters to me. And I think that that's really all that matters to patients as well as they all want to know that we are marching in the same direction, you know, towards the best care and I think wholesale, you know, all of the practitioners that I've come into contact with, you know, embody that, which is a lovely thing. And it's very rare to have a whole industry care so deeply about, you know, their patients on it on a very human level. So I just hope that we continue that, and that we don't let any political landscapes or law changes kind of derail us from from really providing the best that we can.

Griffin Jones  50:34

And then we'll have a few more million Elizabeth cars. Oh, God. I'll be guests on the show. Maybe not me. But we'll, we'll do like every every million dollars or maybe 100,000. That can can be a guest.

Elizabeth Carr  50:50

That's that's the running joke of why my parents never had another they were like we were good with you. We decided to stop after you,

Griffin Jones  50:58

Elizabeth. Karen, thank you very much for coming on inside reproductive health.

Elizabeth Carr  51:02

Thanks so much for having me.

51:03

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

152 Pinnacle Fertility: Where’d They Come From?!

Inside Reproductive Health guest, Andrew Mintz, shares the evolution of Pinnacle Fertility on this week’s podcast episode with Griffin Jones. The fertility network which now owns ORM (Oregon Reproductive Medicine), SRM (Seattle Reproductive Medicine) and others, seemingly came out of nowhere. Is their model scalable? Will it stand the test of time?

Tune in to hear:

  • Andrew Mintz detail the Pinnacle Fertility model, including how they constructed their Medical Director and Lab Director Councils, and how they contribute to the overarching success and development of their network.

  • Griffin press Andrew on the efficacy of Pinnacle Fertility’s physician buy-in program, and how it could potentially implode.

  • Griffin question whether or not Pinnacle Fertility’s private equity backing equally beneficial to physicians across the board, or only those stepping into retirement.

  • Griffin ask how Andrew Mintz and his team approached the selection of the ever-challenging EMR system, and how they decided on just one. 

Andrew’s information:

LinkedIn: https://www.linkedin.com/in/andrew-mintz-712a999/

Instagram: https://www.instagram.com/pinnaclefertility

Facebook: https://www.facebook.com/PinnacleFertility

Website: https://www.pinnaclefertility.com/


Transcript



Griffin Jones  00:04

Nobody says we put the patient last, Andrew, and nobody says we're a bunch of dishonest dirtbags that are going to stab you later. So how were you able to actually demonstrate that almost every Fertility Center in North America is going to be owned by one of two companies in the coming years. It's one of the things that I talk about with our guest, Andrew Mintz. He's the CEO of Pinnacle fertility. If you're like me, you didn't know about Pinnacle fertility last year until he was ASRM last year, maybe even PSP CRS this year that that name really took off, they acquired six groups at the end of 2021. They have acquired more since including Seattle reproductive medicine. So they're quickly becoming a big group. And we talk about their model for making protocols uniform, raising the standard of care in their view, including having a council of lab directors, a council of medical directors, which I think that concept is interesting for you to listen to. I push Andrew on the criticisms that people have of private equity is it really just for the benefit of the retiring Doc's? I asked him that question of do we think that this is going to become a two horse race in the future? I talked about brands, that Kindbody style of brand versus this network style of brand and tell him which side I think is better, and ask him for his opinion. I also asked him to talk about choosing an EMR what goes into that process and should go into any that process and why they chose the EMR that they did. I asked about the model of doctors buying into the parent company and not into not not the equity coming from the at the practice local level. So we get some good answers in there. If you feel that I can go deeper on a specific set of questions, email me, let me know and our next guest will be the victim for that. In the meantime, enjoy this interview with the CEO of Pinnacle fertility, Andrew Mintz. Mr. Mintz, Andrew, welcome to Inside reproductive health.

Andrew Mintz  02:21

Thank you, nice to finally meet you in person.

Griffin Jones  02:25

I had never heard of Pinnacle fertility before the winter of 2022. And then by the time I got to PCRs, it was all the buzz, it was blue Pinnacle liquid pinnacle is doing now. And it's and so here's a company that, as far as I know, didn't exist a year ago, or a year and a half ago, maybe you'll correct me on the timeline. But then, in short order, started making a splash in the field. So why don't we start with the timeline of Pinnacle. And the the opening or need that you all saw in the marketplace to to state your own existence?

Andrew Mintz  03:05

Sure. So we actually started in December of 2019, with the acquisition of Santa Monica, fertility out in California, and then you know, COVID, hit kind of right away, and there wasn't a lot done for the year 2020. But come 2021 We started to reengage in the market. And we closed six practices in 2021. In the second half of 2021. We didn't actually create our name of Pinnacle fertility until like October, which is why no one's ever heard of Pinnacle before. But we brought on first RGA of Ohio, which is out of Akron and Westerville. And brought on a Dominion fertility and Virginia ihr. In Chicago. We brought on advanced Fertility Centers in Arizona, California fertility partners in in California, and ORM in Portland, so a really good group. And I think, you know, there were a couple of things that we saw as an opportunity to partner with groups, and that was that I had this conversation with Richard Morris, who runs our medical director Council, which I'll tell you about in a minute. But years ago, the way the fertility industry used to work is that doctors were very collaborative with each other not competitive. So they would go to their meetings, and they'd really start sharing all kinds of information about what they did in the lab, what their clinical protocols were, what they were seeing in terms of outcomes, how they're trying to improve outcomes. It was a very collaborative approach. I think that over time, as more clinics were created, especially as those that were created in the same markets, it became more competitive and The willingness to share the secret sauce started to whittle away. And so I think we had lots of people who were doing their own thing, and seeing what their outcomes were and, you know, comparing themselves against national benchmarks, as they saw in SART or the CDC database, we really wanted to bring back the concept of doctors working together, sharing what they're doing in the lab, reducing the variation in care, and to really improve the outcome. And we saw that as an opportunity that we didn't see happening in this marketplace as much as it could have.

Griffin Jones  05:42

Well, what do you feel that you can do to facilitate that happening that many of the existing networks aren't or can't?

Andrew Mintz  05:50

Yeah, so I mean, we've done a several things. So one, we started a couple of councils, which have real teeth behind them. So we have a medical director, Council and a lab director Council. And those councils have a representative from each one of our clinics. And more as we brought in this year, we brought on another few practices this year. And what we do is we talk about in the lab, for example, we talk about making sure embryologist are using same techniques and protocols, the media that we're using in the lab are the same, that the equipment that we're using are the same. And really just starting to compare the outcomes and talking about what people are doing. So we actually have lab directors that are going from one lab to the other, to look at what others are doing and then sharing that in in a forum under which they're making decisions about how to reduce that variation and improve the outcome. And I don't know that we see that in a lot of other clinics, I think there's a lot of talk about it. But we've done a lot of that and, and the other piece that we've had to do is come out of the lab director councils, the fact that as we continue to expand, some of the problems that we're facing in the lab have to do with just what you can fit through the lab from a volume perspective. And there just aren't enough embryologist. And so our lab director console, for example, started our own embryology school. We're looking now at a certification for the students in terms of how they become certified which doesn't really exist outside of ASHRAE. And really trying to get a lot more embryologist out into the marketplace. So we can they started the school, we do it in two places. One in Arizona, one in Ohio. We have four students at any one time, we get them trained in about 100 days. And we can train about 30 embryologists a year. And so we're really dedicated to one being able to have more embryologists available for the industry, and also specifically about making sure that we are teaching them the kinds of processes that we think lead to the best outcomes, and to ensure that in fact, we see that across our network.

Griffin Jones  08:18

Are you doing the same thing on the clinic side with a council of medical directors or practice directors?

Andrew Mintz  08:26

We are so we do have a medical director console as well. They making decisions in terms of you know, what kinds of genetic testing are we doing? Where do we send it? Who do we do it on? What kind of Mosaic embryos are we going to transfer? Which ones are we not? They're looking at safety protocols. They're looking at recruitment and retention issues. So there's a whole set of initiatives that our medical directors looking at as well, including clinical stimulation. So, you know, what are we doing to, you know, really reduce that variation, make sure that, in fact, we're doing the right thing for the patients and being able to maximize the, you know, their outcomes. And so there's a lot of sort of deep dive data that we pull and start sharing and discussing in those consults about the ways under which we're going to be practicing medicine within within pinnacle.

Griffin Jones  09:25

Is each practice represented by one medical director in the council?

Andrew Mintz  09:31

Yes. So we have one medical director regardless of size, so we brought on Seattle reproductive medicine just a few weeks ago. They have 14 rei physicians, but they only have one representative on the council, and then we've got Dominion fertility, which only has two physicians. And so they have one representative as well. It's a little bit like the Senate having two representative from each state. But But yeah, I mean, because the reality is, is that regardless of whether they're just talking to one other doctor or 12, they really need to make sure that that information is brought forward. It's discussed locally, and they are able to provide feedback in terms of what those what those protocols are.

Griffin Jones  10:12

Do they offer an equal vote and how the protocol comes to be?

Andrew Mintz  10:16

Yeah, so I think it's more of, you know, I think it's more of a discussion. And they come to consensus as opposed to voting things up or down. So you know, everyone recognizes that you can adopt a guideline that you think is going to be best for the organization, and then look at those outcomes. And if those outcomes aren't what you want, then you need to adapt your, your guidelines. So I'm not sure that we've actually taken a vote as much as there's been conversation and debate about the right thing to do. And, but everyone is dedicated to following the guidelines as they're created within the organization. So I don't think it's a majority rules type of, of atmosphere.

Griffin Jones  10:59

So that's my second question is, is how is the council governed, then, who makes the final decision who who releases the document, who drafts the document after, after the consensus is reached?

Andrew Mintz  11:16

Yeah, so we have the head of our medical director Council is Richard Mars, out of CFP. And he's the one that helps set the agenda. Um, he's collecting information from the clinics, and then coming up with recommendations to be discussed at the meetings. And so he is really kind of the driving force behind helping us prioritize what's important to the outcome, and the kinds of things that we're going to be addressing first, and how we're going to get there. So that's really how that's kind of organized, it's, it's a very, it's a free flowing set of conversation. So there's not a it's not a I wouldn't call it real formal, but they do come to decisions. And they do decide, you know which direction they want to go to. And we're just starting to scratch the surface. I mean, we're a new organizations, so they're addressing a handful of items, and they've got a handful or a long list of items that they really want to address going forward as well. You are

Griffin Jones  12:15

just scratching the surface, because now you've got a couple you your congratulations on that SRM acquisition, by the way, now you have a couple of dozen doctors across the, the the group thus far across the organization. Now, and, and, and people can come to consensus, but inevitably, people do not come to consensus every time in any organization. And we work with five Doctor clinics, and Dr. Nixon and I, I hear them not on the same page as each other. And very often, one doctor will be practicing a protocol in in office a and Dr. B is practicing a different protocol in office B. And and so when you inevitably run into, okay, there isn't a there isn't a complete consensus, maybe 70 or 80% are really on board and really feel strongly inevitably there's going to be a couple of people that feel strongly the other way. What do you do when you have established that protocol based on what the majority of the council sees it as best given the evidence? But there are a couple of people involved that don't want to practice that way.

Andrew Mintz  13:27

Yeah, so I mean, the first step is to create the protocol, the second step is to measure who's following it and who's not. And that's what we're in the process. So one of the things that we've also done is we've converted everybody to the same electronic record. So it makes it easier for us to be able to set things up within the system and for us to measure whether people are following the process as it's been decided. And so, you know, those are conversations, doctor to doctor, look, it's not a matter of whether they follow the protocol 100% of the time, there's no such thing as someone following the protocol 100% of the time, the issue is, are they documenting why they are not following the protocol, and there's going to be good reasons for it. So if there's a specific way under which we want to be stimulating a patient with a certain condition, and a doctor does not follow that protocol and does something else, if they're documenting why they're doing it, that allows us to be looking at that to understand how we need to expand our protocols to take care of different variables. So, again, being new, we have not yet I mean, we've created a handful of protocols and working on more. But really, these are long term studies for us to really determine whether in fact, they're giving us the outcomes we need, and who's following them. But we're really at the first step here of just making sure we create those protocols and and then we're going to start looking at who's following them and who's not and why.

Griffin Jones  14:50

And he talked about getting that measuring that as part of the EMR. You got everyone on the same EMR which is also not easy to do, which EMR did you choose? Did you make your own

Andrew Mintz  15:00

No, I mean, we don't start from scratch. So I mean, you know, there are, you know, everyone talks about using evidence based medicine. But the reality is that there's more than one protocol that's considered evidence based medicine. So I think there's not a lot of variation to begin with. And so I think

Griffin Jones  15:17

we're now referring to the protocol referring to the EMR that you chose your own proprietary, did you create your own proprietary EMR you chose another,

Andrew Mintz  15:26

we did not know, we, we moved to an assistant called Enable. And so we put everyone on enable, which we felt was has, right now the best capabilities to help us really connected with other technologies. So we've been really working hard on trying to use all the components of that system, to allow us to automate processes, and to really enhance the patient experience. So I've been talking a lot about, you know, creating and improving the clinical outcome. But the other piece of this is that we also really need to focus on the patient experience. And I think by having everyone on that same system and using technology to help us and the patient get through the process, I think that we're going to we're laser focused on that piece as well. So we need to make sure that patients are able to communicate to us effectively on time, we can be responsive to them, and there are the right people available to them. And the technologies are there to be able to interact with them appropriately get the information together and be able to present that to the patient, as well as recommendations and next steps. So we have not, at this point create our own electronic health record.

Griffin Jones  16:45

Well, let's talk about that shopping process. Because I think it'll be interesting to people. I'm not plugging one EMR over another. I am not I'm not qualified to do that we our clients use a number of them some of our clients use enable. But I think some people will be interested in to how you made that decision. I imagine there was a bit of a shopping or vetting process.

Andrew Mintz  17:06

Talk to us about that. Yeah, so we did that through all the IVF specific EHR systems out there. So we eliminated the ones that are more general electronic health records are used in the healthcare industry. And so there's a handful of ones in there. And we've actually done a review last year, and we recently did another one and just felt like it would meet our needs the best, especially in the way again, that it can integrate with technology, how some of the security issues that are, I think, available to it. And so really, we have a specific operational model that we have been employing in our practices. And we felt that this was just the best fit for that. And it's so far, it's, you know, it's worked for us because we're able to really collect the data. So at the end of the day, it's about how you use the electronic record system, as opposed to necessarily which ones you pick, this had features that we liked better that we think worked for us. And so that's how we made that decision. And that's what we're have moved are moving everyone onto that platform, what were those features that you liked? Oh, again, it was, you know, they have like two way texting with patients that gets embedded in the medical record and interfaces with the phone system, certainly in the way that it is built for the cloud. So it's not a server based system that was put in the cloud. It's a true cloud based system. So it has, we think some good security pieces in there. We felt that it was able to interface with vendors and and equipment more easily, giving us some good information, allowing us to bring it in and present it to the patient or want to, we'd like the patient portal, and the way that we could communicate to the patient. So there's just a bunch of things in there that sort of check the boxes for us. And, again, for the kind of operational model we use, I think that it just was a better fit. And so you know, the other ones have their I'm sure it have their advantages. We just felt like all the ability to use technology, all the think all of the capabilities that are built into the system that we are trying to take advantage of. We're just, you know, slightly ahead of, of where I think the other sports are there.

Griffin Jones  19:41

You mentioned wanting to improve the patient experience at a process level. What are some of the points in the process that you see is in need of fundamental repair?

Andrew Mintz  19:57

So there's there's a A fair amount, I think one is, you know, a number one has access. So, you know, being able to get patients in and get them through a IVF cycle that's efficient, that can make it efficient for the providers as well as the staff, I think is, is keep. So the biggest, I think hurdle in this industry for any practice is the fact that we still have a significant greater demand for services and supply of physicians and other providers to provide those services to them. And I believe that there is a room for innovation within practices that can allow for us to be able to service more patients in a very friendly way to get them through the system. And we can really sort of maximize the ability for patients to get in. So we still have clinics that have appointment, wait times that are three and four months out. It's too long, it's really unacceptable. And we need to solve that problem. So we think that the system will help us with automating processes and communicating to patients in a way that will make them more efficient. And so that's the first thing that I think needs to happen. The second thing is, is that I think we also need to meet the patients to where they are. So, you know, obviously, since COVID, you know, telemedicine has really caught on and it's here to stay. And I think patients like the convenience, I think a lot of them like the convenience, I think that they want to be communicated in a way other than a phone call, especially for the patients that we serve and the age group they're in. And so having the technologist that's allowed that we can text them to weigh that we can make sure that they're getting the information they need, we can embed the, the the videos that we have the educational materials that we have, and make sure they're getting through the process without someone having to call them and check in and we can sort of look at electronically will also help with that. So a lot of patients get lost through the process, they get lost at the beginning, because it's so overwhelming. And then they get lost through the process. And so to the extent that we can create processes, and have technologies that support getting these patients to understand what they're entering, and to help them get through the system efficiently, without being confused without being you know, without anyone falling through the cracks without missing something. Those are the things that I think are really key. And there's you know, story after story that I have seen where you know, patients, they get, you know, they get lost in this and they end up dropping out when they really need to continue through their IVF process or whatever fertility process. And

Griffin Jones  22:59

I have to say that I have to disclose that they're a sponsor before I ask the question, so it doesn't sound like a shameless plug, what are you using EngagedMD and all of your centers?

Andrew Mintz  23:10

Yeah. So I mean, we are rolling all these out and all of our practices. So they will all B have, they will have similar ways under which they are going to be processing patients. Obviously, there are differences from clinic to clinic, but we will be you know, we are continuing to roll out and refine our processes to make this efficient.

Griffin Jones  23:35

For those clients that are there, excuse me, those clinics that are three, four month out booking waitlist, and it's usually it's a couple physicians that are booking, it's often not the whole clinic unless it's a really small clinic in a really busy place. But for those that are booking out 12 plus weeks, is making that process more efficient include bringing some some of the testing that normally would happen after the first visit, and between the first visit and the follow up before the first visit.

Andrew Mintz  24:08

Yeah, so we are looking at the total process of care. And some of that is also, you know, some of the testing that we maybe can do in house to make that efficient as well. But we are looking at, you know, what's involved in a new patient visit what's involved in a follow up consult. And what information do they get between the first and the second and then before they start their cycle? What information do they get? And when do they get their medications and, and on and on. So we are looking at the whole process of care. We have mapped this out. And so we have a sort of a very specific philosophy about what should be happening at each step through the process. And the more consistent we can make that the better job we're going to do, of making sure that the patients aren't getting caught in the middle, you know, or Last,

Griffin Jones  25:00

can that also include some places the nurse does the follow up visit and the Ri does the initial visit, sometimes the REI does both. But some places the nurse does the first visit. And and so is that also part of this solution is a we? Well, maybe we used to do testing after the first visit. But now with this, with with booking this far out, that would mean that people can't get into the care system until that point. So we can we can do our testing before they come in for their visit we can we we can maybe have them meet with a nurse earlier so that that 12 week isn't isn't the first time they're seen. But it's the follow up with the RBI does does having either a nurse or an AP do the first visit is that in the playbook?

Andrew Mintz  25:50

Yeah. So I mean, we are invoking a type of license model. So we do not want physicians doing things that really only physicians can do we want advanced practice nurses to be able to do the things that they can do, we want RNs to do the things that they can do. And so we do have a general, a core set of services that we want each level to be to be doing. It depends on each mark, and, you know, each clinic. So in some clinics, we employ OB GYN who are doing some of that work as well. Some are have a really used nurse practitioners a lot others less so. But we do have a, a top a license philosophy. And so as we continue to integrate the practices, we will continue to be working on making sure that, you know, we're able to get doctors to do what doctors can do, which will help with the access issue. So if they're doing for example, you know, every single ultrasound, you know, that's not necessarily the most efficient use of physicians time.

Griffin Jones  26:57

I want to ask about the the inherent financing models of private equity, I'll let you know, Andrew, that I've been chewed out more than once by each side of being accused of being shill for private equity, that, you know, I'm in bed with these new private equity companies coming in and just using them to help buy clinics, which I'm not. And I've also been accused of being anti private equity and that, you know, I'm anti network and which I'm also not, I just I'm not qualified to evaluate the business models at that level, yet, I'm not strong enough in the finance piece of business in order to be able to say that maybe 510 plus years from now we'll be but right now, I'm very strong in the sales and marketing side. And I still feel like I have some pieces to shore up on that. And I and we are as a firm and so that's what I feel comfortable evaluating people on and I just ask people questions and I try to get them to respond to the counterpoints and, and so but I do hear a lot of the the model is inherently flawed, partly because of the debt that they have to service. And partly because I was stacked in favor of retiring doctors, and one of these folks that that mentioned, these boys is Dr. Ben White, he's a radiologist. And he's not in in Rei, but he writes about this a lot. And he says that the only doctors who can reliably benefit in private equity, are those senior partners close to retirement who can take their money and retire. So I'd like you to respond to that point.

Andrew Mintz  28:36

Yeah, I mean, to toe the truth grip, and I think it depends on who the private equity sponsor is, and what they are, you know, what are they trying to achieve? And what are they allowing the company to do? And so, so on one hand, I think there's two pieces to this one is, you know, and we see the stories is private equity, you know, destroying healthcare. And I can say that, in my experience working with Webster, which is the private equity, that company that controls, Pinnacle, is that they are very supportive of the strategies that that have been created. And that have been, you know, rolled out to the practices. And so we find a very, we have a board that is really pushing towards the successes of clinical outcomes, and patient experience, and caught and trying to find cost efficiencies for the patient. And I think that it creates a company that is sustainable strategy that's sustainable, that goes beyond who the private equity firm is. And so depending upon who it is, and I've worked with some that I think are very geared towards what's my return And I've quickly come to get it. And there are some that are really geared towards how can we build a great company? And what is it that we need to do to make that happen? I think we're gonna see more advances in healthcare is in fertility, particular, because of the investments being made. So I actually am very much in favor of allowing for investment in the industry, which I think it needs, when it comes to who does it benefit. I think it depends on how you define the benefit. But if you're talking about creating a company with with longevity, that is going to be competitive in the marketplace that has, you know, the latest technologies and equipment and provide the best outcome to the patient, I think that's a benefit to all physicians, whether they are near retirement age or not. And, in fact, those people who are younger will benefit from the investments that are being made now, that others may not in terms of the buyout that's going it goes out, you know, the buy up those towards the partners who own the clinic at the time. And so there is a one time, you know, financial gain to those positions. But I think if it's structured, right, you ensure that there, everyone's incentives are aligned. And that really, everyone's going to benefit from that. So we give, for example, we give equity to physicians that are, that did not own the practice, at the time of the sale, who have either we're either employed at the time or even employed after the transaction, we actually grant equity towards those associates. So they're tied into the whole value and, and the strategy, because the more successful the company, we want them to benefit from that as well. So

Griffin Jones  31:49

I think Woody in the private industry, me equity in the practice, or in the parent company, the parent company, for every associate or just for some associates that look like those are the ones that you want to stay on,

Andrew Mintz  32:02

for every Rei. So we give it to every REI has, is either been granted or is in the process of being granted equity in the parent company. And so they will own, you know, shares in the company, as does the private equity firm, as does the physicians who, you know, who bought who sold, you know, we're partnered with Pinnacle on that. So we find that an important aspect of tying everyone in. And for us, I think it helps with some of the some of the issues with turnover. So you know, the last thing that clinics can stand in this industry is to have physicians who are coming and going, it's disruptive, they're hard to find, access is already at a premium. So the better you can tie them into the success of the company, I think, the better chance you have of them staying and, and if you also create processes, and given technologies that make it easy for them to do their job, and they enjoy that and you create a culture of collaboration. And then they get to create a peer network of other physicians within pinnacle in this in this instance, I think it creates a winning strategy for doctors,

Griffin Jones  33:19

the investments that you talked about making it even if they all work, at the end of the day, it's about those investments are in service of getting our eyes to see more patients to be able to do more procedures. How much is there left to squeeze? Do you suppose before you're actually just squeezing?

Andrew Mintz  33:45

Yeah, it's not necessarily about the doctors working harder. Remember, we really want to move to a top a license model. So we really want them doing things that only physicians can do. So if they're working a 10 hour day, and, you know, they're doing, you know, consults for a few hours and and ultrasounds for another couple hours and then procedures for another couple of hours. The question is, what's the best use of their day? And how can that work? As opposed to how can we make you work harder, so that our support systems, more staff, more nurse practitioners, they may be able to assist and alleviate the work that are done by the doctors. And so the problem is still this imbalance between supply and demand. So the more that we can get people through the system, and the smarter we can work, the better we're going to be servicing the patient population.

Griffin Jones  34:41

I know a lot of doctors are seeing by 30 new patients a month it depends on how many partners they have and what kind of systems they have. But if we weren't to add hours into their week, and we were to do it with efficient processes, investment what What do you do? What do we suspect that that number is? Is it 50 new patients per month? Is it 60 new patients per month that we can, that we can get them to with pure efficiency and not hitting them with a, with a stick and dangling a carrot in front of their face?

Andrew Mintz  35:17

Yeah. First of all, I think that differs by doctor. So you know, they each process, you know, differently. I think we also need to be thinking about, you know, other ways to bring patients into the system. So, we talk about top of license, but the question is, can we train OBGYN is to do things that we aren't allowing OBGYN to generally do? Can we train nurse practitioners to do things like new patient intake, or to handle patients for cryopreservation, or for egg banking or some of those other things? So, again, I think we need to continue to innovate to make sure that people who want the service that they need can get it. But I'm not sure that that necessarily means that doctors have to see more patients in their day in order for us to significantly increase the ability for people to access and get through the process.

Griffin Jones  36:13

I want to shift gears for a second. Because I've had two different guests on with with different views on this. And I think it was back in episode 100. I had Mark Segal asked about he was asking about my opinion on what do I think about a network brand or partnership brand versus individual practice brands? And then I also had Gina bar tz on from kind body to talk about her brand, the global brand, that kind bodies building? In my opinion, Andrew is that I think that you all meaning that groups that have different brands from the parents organization and individual markets SRM in Seattle, or, or I'm in, in Portland. And I think that that I think that you all are at a disadvantage. It's like the IGA true value model where it's hard to scale brand to become a consumer brand. That is the pretty green lady from Starbucks that I think kind body has that advantage. Some people disagree with me, they think that it's better to have the local identity. Ultimately, I don't I don't think so in the in the longer run, I think you still have local reputation. Reputation is different from brand. But the whole point of brand is, is to be able to scale and identify. So you might think differently than I do. So I'd love to hear your side.

Andrew Mintz  37:44

Yeah, I mean, I think the branding strategy is to us not necessarily top of mind, in terms of some of the things that we're trying to accomplish. The reality is that these practices have local reputations, and the doctors themselves have local reputation. So there are some of our doctors who I think are known more so than for the name of the practice that they're in, let alone the national network that they're part of, I think that we will see over time that we'll be putting in some kind of tagline to our practices, such as, you know, a member of the pinnacle family, or something along those lines and create that, but I don't see the need for you know, the Starbucks of fertility, I just don't know that, that we need to create that kind of patient experience where they feel they can get the same thing when they go one to the other. If they're in Seattle, and they're going to go to LA and they want to go to Starbucks, they want they want to, they want to know that they're getting the same coffee made the same way. With the same process. I don't think that that's necessarily holds true in fertility, that what we do in Chicago, and what we do in Phoenix has to be exactly the same because we're not really servicing the same patient population, I think we will eliminate variations, but I'm not sure that that's going to be important to patients who are going to be accessing those services.

Griffin Jones  39:03

That's a good point from the repeat, you know, from the the repeat visitor, the repeat patient or in other fields, repeat customer side, it's not as necessary, which is part of what you want in a brand. You want people to just know what they're going to expect next, and they and they keep coming back. But in some areas like social media, especially, lots of people have lots of friends and they follow people in different markets. So to just being able to say I went to this place in New York, it was great. I went to this place in Chicago, and oh, there is one by me here in LA that that is useful. But also I think one thing that's just tremendously underused on the clinic side in our field is influencer marketing. We've seen the tip of it, but part of the reason why we haven't seen more is because up until very recently, there hasn't been somebody with one name that justifies a there a big price tag or a big Campaign for, you know these influencers to say, Yeah, we use x company.

Andrew Mintz  40:08

I just think that if we can provide the patient with the best possible outcome better than our competitors, and we can provide them with a good experience, I don't think that name is going to make a difference. And I think we're just going to stay focused on really those two aspects of the business and worry about the branding as time goes on. But at the end of the day, I'm on a much more sort of focused in on, how can we improve our outcomes? How can we improve our live birth rates? How can we make sure that patients are feeling like they were cared for through the process? And if that feels the same from clinic to clinic over time? That's great. If they're not called the same thing? I it, frankly, not that important to us.

Griffin Jones  40:51

You're doing something right, because you move very quickly, you said October of 2021 is I think, is when you decided on the pinnacle name, and it was in the second half of the 2021 that you closed on? Is it six practices. And and some of those are are ones that all of the other groups would have loved to have closed down. And so talk to us about your courtship process. Why was it successful in that short amount of time?

Andrew Mintz  41:22

I think that they buy into our strategy and our value. So our core values that we have around, you know, putting the patient first collaboration, integrity. These are I think, what speak to them. So we have

Griffin Jones  41:38

nobody says we put the patient last Andrew and nobody says we're a bunch of dishonest dirtbags that are gonna stab you later. So how were you able to actually demonstrate that?

Andrew Mintz  41:47

Yeah, I think that when we talk about not just that we have values, but that we live our values. So the creation of our lab director Council, and our medical director Council, for example, is a tangible thing that they can see that we're actually living our values. And so I think that's important when we go and have conversations with them about, we have these values, and this is how we live them. Here's our strategy, here's specifically how we are achieving these goals that we set up for themselves in terms of outcomes in terms of, you know, patient care, in terms of, you know, the patient experience in terms of all kinds of things. So we have some very specific goals for ourself. And, and we tell them specifically how we're going to get there, and what their and what their role is. And I think they get excited about it. Frankly, there's a there's more than one several practices that we had conversations that either we didn't think that they would fit well into our strategy in terms of them really participating it or they didn't like our strategy. And so from our perspective, that's okay, too. In that we think that we are partnering with those that are really dedicated to making that happen. And they have to take actions to make that happen. So the fact that they are participating on these committees, that they're adopting our protocols that they are, you know, we announced a partnership with genomics for our, our PGT testing, and everyone's now going to be sending to a genomic so that we can get consistency in terms of results. I mean, these are things that we are doing tangibly to make sure that we're getting the best outcomes. And I think that they see in the early days, they saw the vision and they bought into the vision. In the more recent days, they're seeing that we're actually executing on our strategy. And I think that speaking to who are partners in?

Griffin Jones  43:41

Yeah, so how did you how did you paint the vision? Because you, you did it before you even had a company name in many cases? So did you did you like bring a handful of people with you? Did you have Did you have some kind of storyboard? How did you you're successful in bringing some pretty big groups in before you even had like a cohesive exterior identity. So how did you How were you able to articulate the vision without that,

Andrew Mintz  44:12

so we set our we set a strategy and our strategy has some very specific goals. And so we were able to bring that out with us in terms of what we were going to do and how we were going to get there. Some of it is definitely leap of faith. So they looked at this and maybe they just saw something different than what others were doing. I can't speak to what the other networks are doing or what their strategies are other than what they share on your podcast or or on LinkedIn or something else. But I think that they really liked the concept and you know, selling the, you know, the whole collaboration piece you're going to work with other clinics are going to have peers, you're going to be sharing information and you're going to be making changes and making improvements and those be Pull to recognize that, in fact, that needs to happen. Even though some of our clinics have some of the best outcomes, I think in the country, the reality is that they all know that they can do better. And so the those that are more entrepreneurial, and spirit, those that are really understanding that, you know, change is not going to be avoided, that they have to embrace it. I think those are the ones that are really sort of gravitated to our strategy and our and our values, our mission, in terms of, you know, the thing that the steps that we're going to do to take to make some change now, you know, some of that is also, you know, comes with changes in process and changes and in partnerships and those kinds of things. And everyone recognizes that all that has to be reevaluated. So I think the clinics that we've been able to partner with have that same mindset, and those that have decided that we're not the best partner, maybe just have a different view or, or buying into, you know, the, you know, the mission of, you know, a competing platform, which is fine, too, there's plenty of that to go.

Griffin Jones  46:14

So you mentioned sometimes that it isn't a good fit, either. They don't think you're good for you don't think they're a good fit, what are some of the things that that tell you fairly early on or not even early on, at some point in the process, that it's not going to be a good fit.

Andrew Mintz  46:31

So two things are real red flags for us. One is, when they're only discussing money, then we know what the motivation is. And I'm not saying that money is not an important part of the conversation, but when they're fixated on the money and only the money, then then we know that they're really in it for the money. And that's not really the partner that we're looking for. The second thing is that we have a specific business model, you know, we when we ask them to roll equity, they roll it into the parent, not into the local. And so when they start when they start having conversations with you about changing the way and your philosophy about how you're approaching your partnership, then we recognize that maybe that's not there, too. And then, you know, we also do our own reviews of that as well. So, you know, we are looking at operations in the lab before we, you know, before we sign, you know, our definitive agreements, and we really need to make sure that, you know, they have a basis that we can build from, and not all clinics that we saw necessarily.

Griffin Jones  47:43

So they're getting equity in the new so part of you taking equity in their group is that they are doing that in exchange for equity, some partly, your cash is involved, too, but equity in the in the parent company, is that what you're

Andrew Mintz  47:59

talking about? Correct? That's correct.

Griffin Jones  48:03

What's the advantage of doing it that way?

Andrew Mintz  48:06

I think, you know, it allows them to buy into the full strategy of the organization. So if we are going to be building their own egg bank, for example, then they're going to be interested in figuring out how to make that as good as possible. And for them to be participating in the building and the use of an egg bank, as opposed to well, that's a separate financial, it doesn't really hit me. And therefore I'm sort of less invested in the outcome of how some of these, you know ventures are doing. So from our perspective, we like them to be supporting the strategy as a whole and them to be, again, part of that collaboration is that for all on the same page, so if it's good for, you know, if it's good for the organization, it's good for them, as well, as opposed to maybe advantage, one group over another for whatever reason. And, you know, we certainly don't want there to be competition within the organization, regarding who's getting more profits, we really want that ball to come into pinnacle. And for them to be incentivized to the pinnacle level.

Griffin Jones  49:19

I can see the upside of that. And sometimes there's a downside if people don't buy into the parent organization, and then it's just, it's just flipping the current. It's just flipping that the current practice, it's like, well, how much efficiency was really added and how much did we miss out on by not being a part of the network? So I can see the advantage of that does that put them at more of a risk for an Integra mat situation if my equity is here in this parent company now and then this parent company just took? Yeah, just bit the dust and, and now I don't have anything over there.

Andrew Mintz  49:53

Well, I think there's a lot of learnings from Integra med that I think everyone has taken with them Whether they were part of that network or not work, I mean, I think that because we have so many physicians involved at so many levels in the organization. So it's not just the medical director and the lab director concept, but we got someone who, you know, one of our physicians acts as a part time cmo for us. One of our physicians is leading a, our, our efforts on research and clinical trials, we have a physician who's leading our efforts on international marketing and other kinds of activities that sort of get them engaged and how it's going to work for the network as a whole, the more they participate in that, the more excited they are for it, and the more they're sort of willing to, to make it work. You know, I can see on the downside, which is, you know, what I do individually doesn't have as big of an impact to the whole organization as if it was just my clinic, but really don't have people thinking that way, at this time, at least. And so for us, it's been nothing but exciting to see the growth and the engagement that we're getting from our physicians and our practices to help Pinnacle be successful. And, and there were, they're starting to refer themselves as Pinnacle clinics, you know, over the name of their local brand. And, and, you know, internally, I mean, we don't clinical is not a patient facing brand, but it certainly is speaking to them in terms of what we're trying to do. So we're just loving the engagement that we're getting. And we're finding new ways to engage more and more physicians in the process.

Griffin Jones  51:45

For the audience that doesn't know Al Ries and Jack trout were two of the the like marketing thinkers of probably 80s, early 90s. I think Donny Deutsch, David Ogilvy, nowadays, Gary Vaynerchuk, they have that many books, they have a book called The 22 Immutable Laws of marketing, which I don't think is as relevant, I don't, I don't think they're I no longer think they're immutable, or at least many of them. I think some of them are mutable, but one of the rules that they have is the law of the category. And, and in that if you can't be the leader of a category, you create a new category of think of, well, you know, I'm not going to be the top personal injury attorney in my marketplace, but I can be the top personal injury attorney maybe for workplace accidents, and I'm going to own that category. And so, as long as we're speaking of just IVF centers, Fertility Centers is one category that hasn't fragmented in that way. Another one of their laws is that every in the end, every category becomes a two horse race. There's no RC Cola anymore. It's Coke and Pepsi. And, and I think there's, I don't know that that's true in every category. But do is that what we're going to see in the fertility field, is it so we've got pinnacle, we've got inception, Prelude we have. We've got us fertility, we've got the fertility partners, we've got IV somebody's gonna be really pissed at me for forgetting, you know, first facility, Boston, IVF, you know, somebody's gonna be mad at me. I'm going to forget somebody. But we have, you know, 678 network groups now. And is it inevitable that there's two of them and a number of years?

Andrew Mintz  53:33

Yeah, I mean, I think we'll see that we saw that with EDR. Ma. Right. So that was there an international play, and more so than, than local, but I would think that over time. The network's you know, there's only there's only 450 Some clinics in the United States. And, you know, some of them just are, you know, maybe investable. And so I think at some time, there will be conversations, if they're not already happening among the platforms to be combining their efforts into, you know, a single play, it would really, really have to show the advantages to making that happen. And I think that there, there is an could be. And so I would expect over the next few years, we may see that we may see platforms starting to come together. So if that's

Griffin Jones  54:25

the case, then it seems to me like some platforms would be incentivized to get gobbled up rather quickly. They they acquire a number of clinics, all of a sudden they are a company with a healthy balance sheets, they can get a multiple of the multiple that they purchased on which returns what their obligation to their limited partners. And so I could see some companies that may be where they were in business as a network partnership for a year or two. Become acquired by another one and And if that's the case, our practice owners not missing out on something because it's like, well, should, I should I could have just tried to build that multiple, that we ended up selling for more by myself.

Andrew Mintz  55:18

Welcoming, hindsight. 2020 So the reality is though, the woulda, coulda conversations I'm sure people have with themselves all the time, I think that we are going to see that. I think that in this industry, what we're going to find is that strategy, and and I think culture are going to win out. You know, we're, we're working in a very niche healthcare environment, right. And so certain, there are certain things that we don't see in fertility that you see in many other areas like, like burnout. Burnout is not nearly as prevalent in fertility as it is, let's say, an OB GYN. And so I think that we're going to find that people will continue to engage and stay engaged. And I think that these as these platforms come together, you'll find that you'll find a lot of interest from the partners to make it that much more successful. So if they have rolled equity or granted equity, I think that they will continue to want to have a stake in the game, and make sure that the kinds of collaboration and strategic initiatives that need to happen will happen. And I think we're going to continue to see that, at least in my lifetime.

Griffin Jones  56:46

I've, I've grilled Jaya, and you've been a great sport and and showed people what what they can consider with Pinnacle the our audiences, almost all practice owners, fertility execs, peers of yours, how would you want to younger Doc's? How would you want to conclude with them? Andrew?

Andrew Mintz  57:06

Well, I think what we really want is we want physicians to step up. So we are plagued infertility with a whole set of physicians that are called in or close to retirement. And what we need is we need future leaders. And I think the time is better now than ever. And so being able to go into a platform, such as pinnacle, or any of the others that you mentioned, and and be able to create opportunity for themselves in terms of leadership is never been stronger. And so I would really encourage physicians who are already in or about to enter the rd by field to really think about how to make it better. What can they do that their predecessors haven't? Haven't done? What kinds of ways can they take advantage of new technologies and investment that can take it to a whole different level, and I'm eager to see what some of these new strategies and some of these new adopters are going to come forward with and, and then see what happens. So I'm excited for the future and I can't wait for you know, seeing what's next, what new competitor comes in and what our existing competitors are doing to raise the bar.

Griffin Jones  58:33

We will link to Pentacles website in the show notes and as well to your LinkedIn profile for those that want to get in touch with you. Andrew Mintz, CEO of Pinnacle fertility, thank you very much for coming on inside reproductive health.

Andrew Mintz  58:48

Thank you, Griffin. Appreciate it.

58:50

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

151 3 REI Fellows Walk Into A Podcast…

What They Really Want Out of Their Future Permanent Position

This week on Inside Reproductive Health, Griffin Jones hashes out the goals, aspirations, and challenges of three prominent REI Fellows in their search for the right permanent placement.  Dr. Megan Sax, Dr. Victoria Jiang, and Dr. Zoran Pavlovic share their experiences on recruitment, what factors weigh in on their decisions on job selection, and how much they’re willing to put at stake for their professional (and personal) success. 

Tune in to hear:

  • What they are looking for in a partnership and/or position.

  • How factors such as location and politics have a huge impact on the appeal of job offers.

  • Griffin press all three and question how much accountability they are willing to take on in exchange for the autonomy they crave.

  • What you might say to a recruit to catch their interest.

Dr. Megan Sax Information:

Dr. Sax is a 2nd-year REI fellow at the University of Cincinnati. She has engaged in leadership roles as a women’s health advocate and medical educator. She previously served as the ACOG Junior Fellow Chair of Ohio and currently sits on the CREOG Council as the Junior Fellow liaison to ACOG. She has received recognition for exceptional teaching and humanism and intends to continue a career in medical education after her fellowship.

Twitter: @saxmeg8 



Dr. Zoran Pavlovic Information:

Dr. Zoran Pavlovic: Zoran Pavlovic is a second-year fellow at the University of South Florida Morsani College of Medicine and splits his fellowship training time between Shady Grove Fertility and Tampa General Hospital. His areas of interest include reproductive surgery, fertility preservation, third-party gestation, genetics, and IVF. Zoran loves meeting and conversing with great minds, innovators, and creators within the field of REI and is excited about the future of fertility care. He hopes to one day be an active contributor in the field of REI and a mentor to the next generation of physicians.

LinkedIn: https://www.linkedin.com/in/zoranpavlovic27/

Dr. Victoria Jiang Information:

Victoria S. Jiang, MD is an REI fellow at Massachusetts General Hospital. She is board eligible in Obstetrics and Gynecology and is currently completing her second year of fellowship in Reproductive Endocrinology and Infertility. She graduated from Emory University with a double major in Chemistry and Biology, with a focus in Organic Chemistry. She received her MD from Wake Forest School of Medicine in 2017 and completed her residency in OB/GYN at Emory University School of Medicine. She has received numerous awards for her teaching, research, and wellness efforts. Her interests include the integration of AI in medicine, genetic testing, and the ethical expansion of PGT, and PCOS.

Instagram handle: @vsjiangmd 



Transcript

Dr. Victoria Jiang  00:04

For people who want to have a seat at the table and make those decisions, I think for me that's at least where I'm seeing myself now. I want to be able to sit at that table and have a little bit more of a say in how these practices are developed. Because I think the biggest frustrations that I see in kind of these big, you know, corporates, like scenarios is that loss of autonomy

Griffin Jones  00:28

already everybody's trying to learn, you're probably trying to hire them. Everybody wants to get an associate doc or someone out of fellowship, and they're in short supply. So I talked to three of them today, and they're already in conversations with potential employers there. They've just started their second year. They come from different parts of the country. I'm gonna let them introduce themselves in terms of where they've studied. It's Dr. Victoria Jiang, Dr. Zoran Pavlovic, and Dr. Megan Sax. And we talk about how important being active as a fellow is and how important being active as a recruiting physician is, in order to tap into this person. We talked about how important partnership is to them or not, as long as we talk about how important academics are to them, or not as much as political advocacy, the things that they're paying attention to, when they are interested in partnership, I pressed them about okay, what are you expect you to put forth? What are you expecting to be accountable for in order to have that level of autonomy, and that level of share of the product, the company in the practice? So this is not meant to be confused with data. These are anecdotes, but I'm introducing you to three sharp fellows who are active who are plugged in. And knowing people like this helps you get in touch with more folks like them and knowing what they're paying attention to can give you a recruiting advantage. So hope you take advantage of that. And I hope you enjoy this conversation with three Rei fellows about what they want out of the practice that they ended up joining and what they want out of their careers in terms of partnering with other companies in the facility. To talk doctors Sax, Pavlovic, Jiang welcome all of you to the inside reproductive health show. Meg Zoran Victoria, it's good to have you. Thanks for having me. Great. So I did I just mess up your last name even though you told me right before we started recording is it Pavlovic?

Dr. Zoran Pavlovic  02:47

No of Pavlovich. Close you know

Griffin Jones  02:51

that that's a tough that's starting to make a little bit of a name for yourself, which is interesting. Meg was just mentioned in a podcast that I recorded earlier today. I'm on the board for the Association of reproductive managers a subgroup with in ASRM and there was some sort of programming that we're talking about for younger Doctor fellows. And the three of you were mentioned because of the role that you had at ASRM. So. But no, I mean, Rei fellows are coveted. And I don't like to do man on the street interviews meaning like I don't like to have anecdotes be representative of population, I don't have a ton of data necessarily, but it is kind of useful to at least it's at least somewhat, if taken with a grain of salt to go through some of your experiences and maybe your aspirations and what you want to accomplish because people want to recruit you, not just the three of you, but the 100 and however many 120 or so 130 140 fellows that are out there, and and that all listen to this show religiously. So we're going to do that. So each of you just want to give a little bit of background of where you are, what year you are, what were your fellowship and let's just start with that.

Dr. Victoria Jiang  04:33

Sure I can. I can go ahead. My name is Victoria Jiang. I am originally from Atlanta, Georgia. I went to Emory undergrad and majored in chemistry and biology with a focus on organic bio organic chemistry. Then I went to Wake Forest for medical school and marine for residency and now I am a second year Fellow at Massachusetts General Hospital.

Dr. Megan Sax  04:58

Meg Sounds good and happy to be here. Thanks for having us again Griffin classic 2024 coming around the bend. My name is Meg sacks. I grew up in Michigan, huge Michigan Wolverine fan went there for undergrad and yet somehow married a Buckeye against all of my family's wishes. That's gross. It is gross. Let me tell you. I studied neuroscience and then went to rush Medical College in Chicago for med school and then match at University of Cincinnati for OB GYN residency where I stayed on as an REI fellow and I'm currently a second year. I'm very interested in patient advocacy, Uncle fertility and education. I work both via different initiatives that ACOG and Korea ag and I'm hoping to continue a career in medical education.

Dr. Victoria Jiang  05:51

Yeah, Meg is our advocacy queen.

Dr. Megan Sax  05:54

You gotta be when you live in Ohio. Gotta be oh, we're

Griffin Jones  05:57

gonna have to talk about some of that. Then what about us on?

Dr. Zoran Pavlovic  06:01

Yeah, happy to be here, Griffin. Thanks for having me on the show as well. My name is Zoran Pavlovich. I'm a second year fellow at the University of South Florida in Tampa, where I split my training between surgery at Tampa General and also Shady Grove fertility for the IVF part. I'm originally from Chicago, and I went to residency in Chicago. And then college was at Creighton in Omaha, Nebraska. So kind of been a little bit of everywhere. And I came back here to Florida because I also did my medical school here at UCF. So you see up to USF enjoying the weather, and it's it's, you know, 90 degrees and super hot right now, but I'm glad to be here. And our focuses are down. Oh, sorry. Go ahead.

Griffin Jones  06:41

You all just started second year.

Dr. Zoran Pavlovic  06:43

I'll just start a second year.

Griffin Jones  06:46

Have any of you looked at employment agreements yet? Have any of you been in conversations with people about you know, I should say later conversations with people about where you're going to end up after fellowship?

Dr. Victoria Jiang  07:02

Well, I will say, Oh, go ahead.

Dr. Zoran Pavlovic  07:04

You go ahead. We go first.

Dr. Victoria Jiang  07:06

Oh, well, I guess I will say, you know, I think one thing that's been really terrifying is that the employment kind of timeline has very much moved so early in our fellowship. So as you're trying to grasp, like, how do I be a human? How do I be a physician? How do I be an REI, you're suddenly faced with finding this would be my first job since I was literally a waitress in high school. And so there's definitely been a bunch of really great like, podcast people to be able to lean on. I actually came back from an interview yesterday. And so this was definitely the first very early foray into the employment kind of piece. But it's exciting that the idea of gainful employment that our future.

Griffin Jones  07:44

Yeah. Yeah, like, Do you know any medical students? Let's interview them, because it's starting early. And earlier. Sorry, I interrupted us.

Dr. Zoran Pavlovic  07:55

Oh, no probs can see I agree with Victoria. And that I think I started having my first conversations back in the SRA retreat in Park City, which was November of my first year, just a few months in still trying to figure out my research project and already talking about places for to visit them to interview to send emails and have zooms and that's it started way earlier. So as Victoria said, when you're a resident, you're just thinking about how to be a doctor. Now, as a fellow, you're already thinking about, Oh, what's my career gonna look like? What job do I want? What environment do I want to be in? And that's definitely different. And I think, something tough to tackle for everyone.

Griffin Jones  08:30

What about you, Meg? Are you having these conversations yet? Or?

Dr. Megan Sax  08:33

Yeah, it's just wild. We had heard last fall at Esrei that they're going to start come in and you know, prepare yourselves, get in mind what kind of practice you're interested in what location and other kind of aspects of that. And I think historically, it was really the ASRM conference that people had their first interviews. And now that timeline has really scooched up. So we're having places reach out to us as soon as at the end of the first year, just like Soren and Victoria had said, and I'll be honest, these two have been my gurus in terms of what I'm looking for, and practices and things like that, and even what questions to ask from these employers.

Griffin Jones  09:17

I don't think that was the case a couple years ago, I think it was like, you know, you get towards the end of your third year and you start talking about it or that was before every last place was looking for an REI. I'm not saying that every practice is hiring for an REI, but I don't think any of them are not not hiring at the very least they're like, Yeah, we would hire somebody if, if if it was the right fit at the least. And then of course, many are really actively searching. So at this point, until we see a major reversal in supply and demand, at least which isn't on the immediate horizon. I think that at this point, first year, like once you're in fellowship, you're going to be an RA I therefore you are fair game for recruitment. It's like we might as well just try to beat everybody. Because if it's like college football, right, like it used to be, yeah, you just sign the people after they had a stellar senior year, then then the big sec, schools are recruiting for the most competitive players, and they start signing up, and then their junior year, and then sophomore year, etc. So, same thing has happened here. So I want to I want to go into some of these questions that you have, which by the way, when I have podcast, guests, I asked them for three to five questions ahead. And I would say, at least a quarter of them, give me nothing ahead of time. And by producers, bugging them for quiet, you guys gave me 30 questions. So we're not gonna get to all of your 30 classes a day. But I love that that that continuing education mind frame that three of you are still in, you're very welcome, way more prepared than the vast majority of podcast guests ever do. So let's talk about what are some of the key elements in your job search. And I'd want to just start with, like, I want to do a little bit of I mean, you can go into detail if you want to, but I want to do a little bit of a lightning round. Let's start with location. And Victoria, let's start with you. Do you have a location or a number of locations that you would like to be in? Yeah,

Dr. Victoria Jiang  11:24

great question. I originally was trying to go back down to the southeast because that's where my family was. And that's where I'm interested. Interestingly enough, with the dogs were stocks in rolling that has really put a wrench kind of in that big planning picture. My husband's a dermatologist, so we're looking at big cities with reproductive rights.

Griffin Jones  11:41

So you're now more flexible than you were? Is that what you're?

Dr. Victoria Jiang  11:46

Yeah, definitely more flexible than we were, I think there are gonna be big limitations as far as certain geographical regions, as far as just density of population need for an REI in that case, and, you know, competition and whatever those pieces are. But yeah, big kind of big cities kind of all around the US are kind of looking very broadly, and kind of seeing where we land.

Griffin Jones  12:09

So how, like, is it still? Is it a shortlist of cities that are on there? Or are you in on a scale of, of one being we're going to this exact city 10 being where we're open to Fairbanks, Alaska, we're open to anywhere? Where are you?

Dr. Victoria Jiang  12:26

You know, I have Fairbanks, Alaska is great for freezing eggs. Constantly. I would say on a scale of one to 10 we have definitely our top five favorite picks. And I'm definitely looking in those kind of top five cities. So like looking at places that have opportunities like the space for potentially my husband's a dermatologist, so he wants to open up a hair practice. So if you guys need any hair advice, I got the man for you.

Griffin Jones  12:52

Those all like top 20 cities, are they all more or less coastal? Like Are we more or less talking about? Is Boston New York's or Chicago LA? Like? Is that what we're talking about?

Dr. Victoria Jiang  13:03

Yeah, so I think we're looking at, you know, big cities. And so we had looked at like, you know, Nashville, Tennessee, we were looking at Northern Virginia, we're looking at, you know, Denver, Colorado, parts of Montana, and like, kind of that Montana, Wyoming area. And so a slightly, you know, second, like, we're not like top 10 biggest cities, but maybe areas that have a need that we can fill that kind of give us a nice, kind of I think one thing that's actually really interesting that we've been thinking about more than like the, the go getter academic, like you have to go from place to place to place is really starting to value quality of life, and seeing where we can raise a family. And so kind of see where that kind of falls into that has been a really interesting transition of goals for me, which I think isn't the most natural thing for really anybody in medicine, because that's not what we're used to.

Griffin Jones  13:49

No, I want to see more of that. Let's ask the go getter, academic mag, where do you want to end up location for Yeah, well,

Dr. Megan Sax  13:55

I love what Victoria is saying about transition into this new mentality. You know, our whole career thus far has been get into the next program match into the specialty match into the sub specialty, with a little less freedom of selecting your location or ideal city. For me, I'm also kind of that Doctor, Doctor couple, my husband's Arad ONC. So we'd be centering more along the bigger cities where we have opportunities for both of us. We are definitely born and raised Midwesterners, but just like Victoria said, you definitely need to consider this political climate change. But I will say you can be surprised by the institution you join by the kind of coalition network you can form again, I I love a cog staying involved in advocacy, you form your network and you you fight and stick it to the man the best that you can, but you also need to look at the long term and your future. So I would say for us, I'm very interested at staying at a academic institution or a practice that works closely with residents and fellows which can restrict the field a little better where you're applying to but I'm very open minded in terms of cities across the Midwest cities where we have family We're also very interested in Denver with most of my my big brothers are all moving out that way. So kind of keeping that eye on family where you're going to have that network where there's some academic opportunities.

Griffin Jones  15:23

Would you also do the Wyoming thing like Victoria is thinking about and have that focus on the quality of life? Are you looking for a big city partly because your spouse is also a specialist and you have to Yeah, you have to needs to fill

Dr. Megan Sax  15:38

right Victoria is way cooler than than I am I'm not sure I would do as well in Wyoming if

Griffin Jones  15:44

you want to be in a major city you want to be a bit more city

Dr. Megan Sax  15:47

I think having lived in places to me Ann Arbor, you know, the Midwest is a city so I think something like Ann Arbor, Chicago, Cincinnati, Denver would be more like ours. You

Griffin Jones  15:58

want you want to stay generally in the Midwest, though. Yeah. Are you like what about New York? What about LA? What?

Dr. Megan Sax  16:05

Yeah, that's a great question. I think with the right practice, if you find a good fit, that I'd be open opened anywhere I need to need to kind of keep the whole family in mind though, for sure.

Griffin Jones  16:15

What about us on?

Dr. Zoran Pavlovic  16:17

Like, yes, I'm also in a doctor, Doctor relationships. There's all three of us here. Well, my wife my wife's maternal fetal medicine fellow, second year Fellow at University of Cincinnati. So you know, her making friends, which is nice. For my situation is actually a little different. And that's because she or her father's private practice is in the Boca Raton Delray area. And so she's going to go join him after fellowship. And so I have to follow her, you know, we're going to stay together. So I got a winter follow her and down to Florida. And we're going to be in the southeast. So I'm looking basically between Jupiter to Miami, that south eastern seaboard of Florida. And so my practice locations were much more specific. I wasn't looking at different cities or even regions, but much more specific. And I think that's kind of one of the reasons why I may have started my job search earlier by asking questions, networking, asking some 30 year fellows if they knew anybody, or had any connections, because I knew where I wanted to go. So I didn't want to wait till the end of second year, beginning of third year where maybe the spots where I needed to go have to go, we're already filled up and taken by somebody else. So that's why I started my job search earlier. But I also was looking for not straight academics, but not small one to two person private practice, something in the middle, kind of private academic model, which REI has a great field for. We have a big enough practice, you can still do clinical research, or mentor residents and fellows, but not have to be part of an academic center or be too small to do anything like that.

Griffin Jones  17:48

This is also where the marketplace for REIs can be beneficial for someone like us. So you like Boca is not the biggest market, but you're kind of looking between Miami and Jupiter. And this is a time where a lot of those Miami groups, they'll be like, oh, yeah, yeah, yeah, we need a bulk office. We're just kind of sure, like you. And so that may not have been the case a few years back. But for the fellows listening, I think that, you know, like, a lot of Detroit people do have an office like or, you know, like might have offices elsewhere in Michigan and or like, so you want to be in Toledo, Ohio, you don't actually want to be in Detroit. Well talk to the Detroit people, talk to the Chicago people, even talk to the Cleveland people, like you want to be in you want to be in Bar Harbor, Maine, like, maybe there's not a big enough area for that, but talk to the people in Boston. And so that's something that I don't think was as feasible a couple years ago. I think that you'll have options talking to some of those groups. So how about so it's a May you straight up want to be in, in academics? How hard are we on that?

Dr. Megan Sax  19:05

Oh, yeah, no, that's a great question. I think just like Zoran said, that Rei is a really unique field and that these private practices still work with residents, do a lot of research, do data analysis within their own clinic and database. And honestly, some of the best data that we have in the field comes from those large private practices because they do so much more, so many more IVF cycles and other HRT. And so, again, I'm pretty open minded. I think as long as there are those opportunities to work with learners and continue research

Griffin Jones  19:44

are either a view or are either view really wanting to be in academics for Victorians are on or Do either of you really not want to be in academics?

Dr. Victoria Jiang  19:55

I will say one thing that really drew me to the field I sound like I'm about to interview for fellowship. Uh, I will say one thing that I do think is really unique about Rei, that is really special. It's kind of playing on what Baggins Warren was kind of saying, is that a lot of practices are still participating and have really robust research infrastructures. And I think being an academic for me means a lot of different things. It's not just working with learners. But it's also like staying up to date having Journal Club, like being able to stay involved with the most recent evidence that is being published and staying up to practice with X y&z And so I think for me, we're joining a kind of middle sized practice where I can get mentorship and making sure that I get like, you know, library access and have like a continual journal club or team review, like those kinds of academic pieces, I think, carry over to a lot of different types of private, domestic and private jobs. And I think that with a lot of the local hospital affiliations, you can a lot of the time still work within a private practice structure, and still have residents and fellows that you can mentor and kind of work with, which I think is really special. I know that one of my uncles, like my in law, is an REI in Chattanooga. And his practice partner is, for example, one of the MCS faculty at a local hospital and is able to work with all of the fellows in that capacity. Shout out to Tennessee reproductive medicine. And I think that's what's really great is because you can have a lot of opportunity, but not have to fit that like cookie cutter academics, because a lot of the challenges that I've seen with the academic programs is, is they're all being bought out by a lot of private equity firms. And so even if you join what is under the academic affiliation of you know, one program or another, you may not actually be buying into that true academic structure. And so I think finding the right program for me, is more important than really like whatever the definition of academic or private or private MX really is.

Griffin Jones  21:44

I think that's why you have answered that same questions. I want to talk about that point, Victoria, I think it's worth every fellow considering. This is, this is an actual data, this is just what I think it could be that the chance, whatever, of practicing ownership, you end up signing up for the chances of it actually being that ownership in three years time is less than 50%. Maybe it's 50%. Or no, it's fine. It's probably somewhere around there. And that's actually something to consider as you sign earlier and earlier, right? Because if you sign in at the end of your third year, then you can have a little bit more of a conversation with the ownership of what kind of direction you plan to go in. If you sign early on in the first year, a whole lot can happen in two years. And I've, I've I've seen this a bunch of times as far as like, and I'm going to join this practice right now can't wait to join this independent brand owned by Sierra. I'm gonna be an academic Sierra going to the Cleveland Clinic man, and they're owned by the Maven click. So zone, what about you? How hard or not hard? Are you wanting to be in the academic sphere?

Dr. Zoran Pavlovic  23:06

Pretty hard on not wanting to be at a straight University, academic situation more. So I think for me, I found that to be a little more, I guess the freedom of the clinical practice that I wanted to do in the private academic setting. I'm not a big person for grant writing, which I think there's a lot of that in academics. And I think there's people that do that and do it really well. And I'm really happy that they're in our field. And I respect them and love them a lot. But for me personally, that would be very difficult. And when I look at the clinical research that I would rather do you see all these biggest groups around the country, the CRMs, RMA, shady groves, US fertility is all that they have these huge clinical databases where you can have up to 100,000 patients and your sample sizes. And you can be really great robust clinical data. And like Megan said, you can drive the conversation, you can change practice patterns, you can help create committee opinions based off of that. And so that's why for me, I felt like I could find an impact within research and still be involved in that academic capacity without being an academic setting. And I personally also have more of an entrepreneurial business sites and one of my minors in college was was business. And so I do want to go to a place where there's that opportunity for either equity or partnership or growth or some kind of opportunity where I can help create and build something together with the practice that I'm at. And that would be hard to do at other other facilities in an academic centers would be more so moving up a professorship and becoming tenured. Whereas in a private practice, it's it's a kind of a different situation that just more so appeals to me. Well, I can still remain Tane some of that academic rigor.

Griffin Jones  24:44

So I'm just hearing that more from people in general, they still want a bit of the involvement with either research or teaching and this is probably something that some private practices need to figure out a lot of this a lot of the larger ones are already involved with at academic centers, but many of the smaller ones are not. So they have to figure out some way of scratching that itch, whether it's, you know, whether it's teaching the residents or whether it's sponsoring some type of research or going in and research with someone else or allowing time for their Doc's to submit an abstract answer. I think that that's something that private practices that aren't that don't have an academic relationship probably need to consider, because what the three of you just said, seems to be a recurring pattern from what I'm hearing from fellas. But now let's talk about partnership, which you started to talk about. so on. So I'll go back to you, which is on a scale of one to 10. How much do you want to be a partner meaning someone that owns a piece of the practice that they're working at?

Dr. Zoran Pavlovic  25:53

That's a tough question. I think it's anywhere from eight out of 10 to 10, out of 10. And the partnership can mean different things that can be either owning a piece of the practice and of the laboratory, or being able to bind to equity of the overall practice. So all of those options to me are appealing and things that I asked questions about and looked into. But some of the practices that have been talking to you to offer these more structured partnership tracks, and that have defined milestones of how you get there. And what that means. That appeals to me a lot, because then I know what I can do to work to get there. What that means when I get there, what does it mean to be a voting member of the facility to be able to help to drive the practice to improve the laboratory outcomes, and work with my colleagues and where we can actually be kind of a almost like a family unit in in making our practice as best as possible. Rather than either being a number in an Excel spreadsheet, or just like one person in a huge conglomerate, or even just in a one to two to three person practice where you make a partnership and that, but how much clinical decision making can an impactful decision making can you make when you're not involved as much in research or academics or mentoring others. So for me, it's an important I think the three things I would say, that I look for when I'm talking to all these practices are the culture, they really want to be surrounded by great people and great mentors that I can actually get along with and vibe with and feel like they're my friends and family, not just someone at work with the ability for opportunity for advancement, which is either partnership or equity or some kind of situation like that. And the ability to pursue some of the endeavors and passions that I have within the field of Rei. So I personally would like to have a day a week to do reproductive surgery, fibroids, endometriosis, laparoscopy robotics, and to be at a practice that will allow me to do that and schedule that into my clinic time instead of just making me do IVF all the time is really important to me as well. So those are kind of three categories that I look at when I talk to practices,

Griffin Jones  27:53

the millennial that wants it all right, well, let's, let's just talk about that, that that passion, and we're in regard to the criteria for advancement as you were talking about. So because what I see happening is a lot of associate Doc's getting to a point where they've been, it's almost always at the two year mark, it's somewhere around there, maybe a little bit shy, sometimes it goes up to three years, but it's almost always around a two year mark, where they feel like they can buy into the practice that they should be allowed to. And the partners don't see it that way. They don't think they're in a position to buy. And it's very often because it wasn't spelled out black and white, this is the volume we expect from you. This is the revenue we expect you to bring in. And or maybe here's some of the other business responsibilities that we expect you to take on. So I think it's a problem because people are hearing I can have my cake, I can do my reproductive surgery this time. And I want this partnership track and what they're telling me and that they're telling me I can buy into the partnership track, but that means that I do have to do as much IVF as possible. So let's talk about what first seconds are on of what like when they're giving you when when you're talking about a clear partnership track, like I they showing this is these are the volumes that you like these are this is the number of procedures that you'd have or the number, the amount of revenue that you would have to bring in. And is that commensurate with what you can do while still having a day for your passions.

Dr. Zoran Pavlovic  29:30

Yeah, some practices are more specific than others. And I think that that's something that every fellow if I have a bit of advice to give is to get really specific and what those details mean. And also have the contract lawyer review that with you and go over all those details. And don't be afraid to ask those questions. Because for some practices, they say it's a four year track mark, you meet the milestone of being board certified or board eligible and then board certified and that your volume is at least this much per year, you're reaching this productivity bonus. And then you become eligible to be considered for that partnership track. And then you can buy in for that. And this is what the buy in typically is, or this is what it was these past couple of years for our partners. And so they tell you this defined ways to do it and that I think I really appreciate so you can actually have a goal you can build a game plan in your mind going forward, as opposed to be more vague, saying, well, after the three to five year mark, we'll see where you're at or or or if the partners agreed, then yes, you can become eligible to maybe buy into something those the vague language I think is something that we should always look at and try to define as best as possible. Because the ones that are more structured I think are better for fellows and allows you to really kind of plan your time there. What

Griffin Jones  30:45

better for the practice so there's nothing to be gained from mutual mystification. It's why I sometimes think I'm a dick, my sales process because it's so specific, I create so much content about the sales process itself, and then the delivery process? Because it's like, no, no, like if we if I don't have partners, agreeing on what we're doing here and what it takes to do that. I'm not letting you engage in anything. I'm not letting you just create what my company does in your mind, and then still hold me accountable to that same result. I don't think the mutual mystification benefits everyone, that's what results in in the in the discrepancy, you can always still have discrepancy no matter how specific URL but the more specific you are, the less likely you are to have to enforce something later on or have to dispute something later on. Back. What about you for partnership one at a time?

Dr. Megan Sax  31:44

Yeah, that's a good question. For me, it's really more about the fit, I would say. And I love how Zoran kind of prioritized his 123 I think, honestly, it's so important to be transparent when on those interviews with that and vice versa, kind of turn the tables to what are you expecting out of me or out of a new hire? What role do you guys really need to be filled? And am I going to be the best fit for that because you both want this to be a relationship you might be moving across the country for and to make sure that this is going to be a long term sort of, you know, beautiful relationship here. So I would say for me having an opportunity to become a partner would be in more of a private Demick setting would be important and to have that outlined and have those goals set up. But I would say overall, you know, I'm kind of open to various models here, I can see. My note is not a deal breaker for you. Right, I think the most important thing is, you know that longevity, I want the security of having a job that I love. And if that means every day I go to work thinking you know, I get energy from teaching, I get energy from doing research, having colleagues who want to write papers, which Zorah and I know is so sick of fun. But I think being able to have that energy is the most important thing and really loving where you work. Having a partner opportunity, I think is only only a good thing and in the way that I view entering this process.

Griffin Jones  33:20

Fair. So you're, you're you're lower on the spectrum, then John, John is not going to work for anybody where he can end up owning a piece of it. And you're open to others, you're you're you're interested in it, but you're also weighing in other factors. Victoria, where do you fall on that spectrum?

Dr. Victoria Jiang  33:37

You know, I've thought about this a lot. And I would say I'm probably closer to where Zoran is like the seven to nine, eight to 10 kind of range. As far as partnership partnership means something that isn't just like, you know, buying into the company, it's like for me partnership is really more of like, do I have the autonomy to be able to do the things that I want to do? Can I contribute meaningfully to the way that this clinic is operated in practice? And can I be able to have a say in the really important decisions that are being made? And I think at the end of the day, I mean, you touched upon it like practices are being bought out so quickly, like the landscape of a lot of different areas are really changing very rapidly. And to be in a situation where you're an associate provider in like a scenario where you know, your value, you bring a lot of value to the clinic say it's reproductive surgery, and you're otherwise referring out all those cases, I think being really kind of straightforward about that and asking for it's going to be important, but I also don't want you know, the rug pulled from under me saying that like oh, by the way, surprise, you're we're actually getting bought out by XYZ company in the next six months. We're transitioning all of our leadership and we're all suddenly like an employee model. And I think that's what's really challenging for me is that you'll build a life you'll build a home, and you'll live somewhere for three to five years and if you don't have a clear plan of where that next step is going to mean for you. I think that's going to be really challenging for career longevity because I think a lot of the burnout that we see He is that, you know, KPI metrics, like you have to meet these certain, like UVF conversion criteria, and you have to do X amount retrievals a year, and it very much feels like the industrial IVF machine. And, you know, I think we, as physicians, should see that we bring a lot of value and being able to negotiate that earlier on, if that means less compensation, to be able to do the surgery that you want to do. If that means carving out like a stake in your contract to say, you know, I'm really interested in artificial intelligence. So I want to be able to have the opportunity to develop that kind of technology freely, and you know, thoughtfully, being able to negotiate that at the beginning is kind of like being able to have like a good practice partner is it's kind of like the philosophical idea, but then also like that whole legal idea. And I really just want to work with a group of people that understand where my mission is, we have a combined vision that we want to bring forward. And we want to be able to expand our influence in a more meaningful way. And I think that can be negotiated in a very unique manner, and whatever kind of job that you're going to be looking at,

Griffin Jones  36:04

might be worth examining autonomy and flexibility. Because they're not totally the same thing. Some of the things that you mentioned seemed to me like it would be more advantageous as an associate employee, like if, if, if I don't want to be a production machine, I feel like okay, this is what I'm willing to, like, this is what I'm willing to work, this is the scope that I also want to be able to do those things. And in, sign me up for that salary. Whereas if it's like, if you're, if you want to be a partner, somewhere, you're gonna be a production machine for a little bit. It's like it's better if it's something worth buying into. There's a reason why that is.

Dr. Victoria Jiang  36:42

Yeah, no, totally. And I think that, you know, it's all about I think, what I learned in residency, the most valuable lesson that I learned in residency is if you have a problem, being able to propose a solution to the person that needs to solve your problem is a much easier way of getting something done than to just like, be like, Oh, I don't like this structure, but I don't have an alternative, right. And so like, for example, if you're like about to start a start working for a practice and say, they're worried about your productivity, you want to start doing reproductive surgery, you go say to them, you know, I, you know, really love doing reproductive surgery, I know that as my clinic volume revs up, that may not be something that I can do once a week, but in the interim, could you just refer all of your patients, as I'm filling my schedule, we can kind of get that money back for our clinic, we can reclaim some of those reimbursements from the surgery that we otherwise would be referring out. And then we could come back and say, you know, as my clinic starts filling up, you're gonna get referrals, you're gonna get friends, you're gonna get all these different, you're gonna be drumming up more business, that I think that they weren't necessarily having seeing as an avenue of revenue, and being able to sell that value that is very uniquely you, I think it's not just being a fellow that can do IVF. But it's also like, I can, you know, represent us at local, you know, marketing events, I can do all of these little pieces that kind of build into that practice that I think also builds rapport with your practice partners. And I think part of the whole practice partner piece is is that your partner is trust you and do your partners, think of you as somebody that they can lean on to make decisions. And I think I want to be able to build that trust with my partners.

Griffin Jones  38:12

Boom, that's bringing a solution that's coming proactively to make that selling your case for what you want to do. You also made another point that I think we should talk about, which is because I think it can go either way, it's something for people to consider and that has to do with future risk. Are you better? Are you in a better position to to mitigate that as a partner as an associate, meaning like all the people that are selling their practices? And it's like, Wait, this isn't? This isn't what I signed up for? I could see it going either way, if you're a partner, you potentially have more you potentially have a lot more to benefit from. If they're flipping that and and the partners are, are part of who gets to make that and they're not always that's one of the things that they can get screwed over on they did they get to make that decision, they get to vote on that decision to begin with. You could also be, you could also straight up get screwed ie Integra mat, like the people that were partners that those practices got screwed there. They had to find new payroll company money they had to the people that had paid ahead of time that year, they had to make that up. And if you're associate that's not really like that's not coming out of your overall bank, and God forbid if it doesn't work out overall, you just go get a different job somewhere else. So I could see I could see that. Like you mitigating risk. Are you taking more risk on? I think it could be either one? Well, I think

Dr. Victoria Jiang  39:46

it's like what do you think is like risk first benefit, right? Like I think the associate model like if you're able to say you have a side hustle, something that you're into, like say you have a really popular fertility podcast, and you really want to like figure out How to really lean more into that like that may be better for you to be an associate more like an associate partner in that capacity because you can work on side hustles, you can have things carved out, have a little bit more time in that capacity. But I'm a strong believer that without risk, there is no reward. And it may be that you take on a big risk, and it doesn't necessarily play out and what you want it to be. But the alternative is that you're going to be putting in just as hard of work on a day to day clinical level. And whether or not you're going to be able to be the person that's at the, you know, helm of the ship. I think that's the phrase, I think that's going to be per person, I think that's going to be what people deciding, you know, I've met people who are saying, this second phase of my life, I'm done with training, I want to focus on my family, I want to pass my boards, I want to buy a house and I want to like, you know, snuggle at home, I think that's fantastic. And just as important as any of these other aspects of your job. But you know, for people who want to have a seat at the table and make those decisions. I think for me, that's at least where I'm seeing myself now is I want to be able to sit at that table and have a little bit more of a say in how these practices are developed. Because I think the biggest frustrations that I see in these big, you know, corporates, like scenarios is that loss of autonomy, you know.

Dr. Zoran Pavlovic  41:21

That's a return. I've talked about this so many times via text message and phone calls. And we talked about how being at that table being able to participate in that decision making is so much more, it's better than not being there at all. And I think that can even carry over into advocacy, which may you can speak about if you're not at the table making those decisions, and other people will be making those decisions for you. And that's doesn't work out well in politics and advocacy in medicine. I don't think it works out well. And the business aspect, either. And if we're physicians, and this is our field, we should be participating in this situation, not everyone will want to which is totally okay, as victorious. There are some of us that do. And I think that that's we may be some of the people that want to hear in this conversation. And I think that's important because I would rather be there and at least try to put my two cents or help make a decision or put a vote in versus not having that decision taken. For me, I would almost regret that saying like, Oh, I didn't actually do my utmost or my best to try to change this outcome or influence it in any way. And that's why that kind of decision making capacity is important to me.

Dr. Victoria Jiang  42:28

He is in fact, a millennial who wants it all.

Griffin Jones  42:31

So that's this is what I'm trying to think about. Because it's like, okay, there has to be something in exchange for the decision making authority. I've had, I had, I had a real struggle with my employees at one point in the past year, which is because one of the things that I do promise them is autonomy, they get to make decisions for their seat. That doesn't mean they get to make every decision about everything. And, and so I also learned that I need to be specific about what that means, like, No, I own this company 100%. And I am ultimately accountable for everything I am accountable for if I have to make payroll every single time I have, I have mouths to feed, lots of them. And I have an accountability to our clients that nobody has that level of accountability in our organization. And the more accountability you have, the more the more autonomy you have. So it's like, okay, we want to make these decisions. So what are you taking on? What are you being accountable for, you know, in a partnership agreement that that gives you that seat at the table?

Dr. Zoran Pavlovic  43:47

Yeah, absolutely. I don't think you can want to be involved or be a partner or in a decision making position or seat without taking on some of the responsibility and accountability and look into those details of that practice and diving into your your functions, your operations, how that could be better, where things could change, dealing with issues at the with, with employees, or between patients or bad reviews, I think you have to you do have to take on some of that administrative work. And I'm not much not a big fan of administrative work, but I know I would have to have it, it's going to be part of my life. If those are the kinds of decisions, if that's the kind of position I want to be in one day, and you're right, you have to it's going to be some it's going to be additional responsibility. And so you decide for yourself, is that a responsibility that's worth it to you to have that partnership or decision making process or is it not? I think that can change throughout your life as well.

Griffin Jones  44:38

We're talking about lessons learned in owning a practice or owning a business in the fertility field and things that you may want to learn how to do or learn about before you go and start your own venture. Another thing is some of the systems that are used and help people that can give really good recommendations on the different EMRs they've shopped in that depth and scope. Both functions. But I would ask someone that you know, that uses engaged MD, if you're not already, if you don't use engage them D in your system, you're thinking, I want to open my own office within my own group or I want to open my own practice, I want to go join somebody else, and I want to be able to add something to it, engage them D is one of the surest bets that you can do. But you don't take my word for it. Ask someone that, you know, because more than half of your colleagues are using EngagedMD and more than half of your colleagues are extremely delighted with EngagedMD, because they've got real informed consent. They don't have stacks of papers that people have to sign and then account for and then keep an eye out for a file cabinet somewhere. They have true informed consent from patients that have a module at their convenience, so that the staff isn't overburdened with questions that they don't need to be getting that they can help the patient with the attention that needs to be devoted to that patient's case. Because the elementary the rudimentary is covered, and now it's just what that patient is stuck on or what's unique to their case that the care team can focus their care on. That's what personalized care is. And more than half of your colleagues have seen the benefit from engaged MD that way, so just reach out to any of them. Hey, guys, do you use EngagedMD in the people you want to fellowship with people that you see it ASRM? Hey, do you use EngagedMD? What do you think I hear Griff, talk about it. But he doesn't own a practice. What do you guys think, and see what they say. But if you want that free workflow assessment, you want to see what other practices are doing, you want those insights that EngagedMD has, and you want to see how your practice stacks against that ideal workflow, then you go to engage them the.com/griffin. And he mentioned that you heard them on the show, you mentioned that you heard them for me, and then you're gonna get that free workflow assessment. So ask somebody else, don't take my word for it, but go to engagedmd.com/griffin, or say you're on the show. So you heard from me, so you can get that free work assessment for you. That's one of the biggest system wins that you can have right off the bat. And you can verify that just by asking people you already know, I hope you enjoy the rest of this episode about things you need to know for the fertility business, you might start, I think there's there's a couple of different ways that you all can look at your careers, which is everybody talks about being an entrepreneur, like it's the greatest thing, it's not the greatest thing, there are advantages to it, one of the advantages is leveraging systems and capital so that you're not just trading time for money, and that so you potentially have the freedom to do a lot of other things. But it comes with a ton of risk, a ton of spotlight, a lot of obligation. And then another way of looking at your career is is you're a craftsman and and craftsmen can also have really great lives because they have a trade that is so in demand that they can call a lot of shots, then they don't have to have a whole system to they don't have to leverage a whole system. They can say this is what I charge like I'm this good at it. And make it seems a little bit more interested in I mean that you're still interested in the entrepreneurial route too. But but you're also open to this this craftsman, right? So what like, what is it that you also want to be able to do and advocacy is one of those things. So why is that important?

Dr. Megan Sax  48:44

Yeah, for me, it was really just being in medical school in Chicago, I did a lot of work with a program called the Midwest access project that did some elective termination training. We spent a lot of time at Planned Parenthood. And then coming to Ohio for residency was almost like a culture shock for women's health. But I will say in Cincinnati, it was really incredible place to do residency because it's, for those of you who don't know, the Ohio geography, it's on the river, and the other side is Kentucky. So it's really the first safe haven for most women seeking abortions from the south. So you got this incredible training at Planned Parenthood, which was five minutes from our hospital. And you just heard all of the stories saw incredible experiences and women going through just about everything to get there. And I can we have this Fetal Care Center and all these other you know, everything that you hear about in terms of fetal anomalies, medically indicated abortions. And so the dog's decision has just been tragic for the woman of Ohio. We overnight really went from 20 weeks, six days elective termination now down to six weeks. And like I said, this was the first is a place for a lot of the South to come to. And so I think not only do you have to Did it teach me coming here that you need to be familiar with the legislation in your state surrounding women's health, but you also have to be a fighter and you have to be vocal on behalf of your patients and share those stories with legislators, obviously, in a HIPAA compliant fashion. Because nobody else is going to speak the scientific truth if you don't. And so to me, you know, hearing Victoria mention this risk benefit and, and that I'm really thinking of it more from a perspective of, I want to be in a leadership position, I do want to make these decisions for my practice, whether I'm at an academic institution, but whether that's as a medical school clerkship director or fellowship program director, or division director, you know, to be in the room, where it happens, is definitely very important to me. But whether I take that risk financially to have that possible financial gain, I would say, you know, it's definitely very appealing and interesting, but I would be seeking, you know, consult from these two on that, as I typically do with with anything business oriented.

Dr. Victoria Jiang  51:15

I mean, for what it's worth, I think Meg is a great testament to the whole idea of finding that passion and learn, like feeling that spark for something and then chasing right after it like she has, we always say she's our advocacy queen, because she always has like, gonna sign this petition and like, we have this thing going on, like, oh, my gosh, we're trying to fly it in protests and do all these things. But I think that for me is like, that's the autonomy, right? It's like finding that passion, doing that passion, and then making something out of it. And I think that's the true spirit of entrepreneurship, right? It's like, finding something that you can have like a very specific niche and focus and being the best in that field and doing that. And I think if you bring those skills in that focus, then you can really like one of the biggest things I learned in fellowship is that you can't say yes to everything, and you shouldn't say yes to everything. And it's okay to not have your like eggs and every baskets, even though we like a lot of eggs hashtag. But it's like, you know, you can't say yes, everything, you can't do everything, you've got to focus what you're gonna do and market yourself from that perspective. And, you know, being partner for Meg, maybe being clerkship director or fellowship director, and that in and of itself would bring value and joy in that long, like career longevity. And I think for us, as at least for me, up to this point in training, it's been blinders on just clinical practice patients above everything, you know, you're in this hyper competitive academic environment is all about publishing papers. And then realizing and this last year doing research, there's so much more to the field that you can bring, that isn't necessarily the most traditional medical aspect, because the traditional medical aspect is becoming something so much more different than what it was 15 years ago, and being able to navigate that in stock to job search, but also like, life goal searching, I think, is been the most kind of interesting revelations, at least for me when thinking about that philosophical kind of partnership role, like what do you want out of your job? What do you want the freedom to be able to do?

Dr. Zoran Pavlovic  53:13

And other career I would say, the more the more philosophical, global aspect medicine, I think if you become complacent, right, medicine becomes run by someone or something else. And as physician burnout increases, I think a lot of that burnout comes from just us becoming complacent or being forced to be complacent. And so other people are making decisions for us. Other people are dictating our time, where we do anything from reimbursements to how much advocacy to do to what the laws are. And if we want to make medicine, you know, health care oriented, you know, physician and provider run system, we got to be a little bit less complacent at the least, that's what I feel like I want to be involved and that's what drives me. And I get the passion from that to be part of it. To help make it our own again, instead of just letting either businesses or politics or other other outside forces drive health care and medicine, if we can make any

Griffin Jones  54:09

change. Well, that can quickly become that can quickly become perverted, though candidate like corrupted that because like, it's like, then the business person really could just like the doctor can become the business person like and it's, it's, it's not immediately obvious where it's like, okay, that's the clinician, that's the business person over there. And, and especially when you can also as we see in marketing all the damn time, you can use ethics, you can even use or what's perceived as ethics to drive a marketing message. It reminds me of the Simpsons episode where Mr. Burns. He gets involved in recycling for some reason and like he's just using it to dry up the oceans or something and Lisa says, Eat you You're so evil and when you're trying not to be evil, you're even more evil. I saw this all over the place in business. Some of them the marketing messaging is, it is like just totally dishonored. It's perverse. And I don't think we're immune to that in the REI field. So I want to go down that rabbit hole, I want to ask you like, one other question, going back to the basket is Victoria talked about the basket, and maybe that will bring us back to this, of like, like this mission and message? Because I've asked you one question out of your 30 questions. And looking at this sheet, it's not just 30 questions, because each of them are like five quiz all like, all the things that we talked about were from one question, although we probably we did cover a lot that we covered what I wanted. But I want to ask you, well, there is another question that I'm glad you all put on here, which is do your do you see yourself in any role outside of medicine? So maybe that ties back to what we were talking about, like of keeping the mission Hall. And Meg was talking about advocacy. But that can really mean anything? Like what roles? It can mean anything? I mean, sitting on a board that has nothing to do with reproductive medicine? I could it could be not actually practicing medicine, but sitting on advisory forum for for a Silicon Valley company. What roles do you all see yourselves outside of medicine?

Dr. Victoria Jiang  56:30

Meg Sax for President 2036 Go.

Dr. Megan Sax  56:36

up right here. You got it.

Dr. Victoria Jiang  56:38

I'll be revised. I mean, all jokes aside, I guess for me, oh, gosh, I think that for me, I've always had this this is like totally. So like thinking totally outside of medicine, I've always wanted to learn how to bake like really fancy French pastries. So I feel like in the second life that I'll have, I'll probably go to like chef school and learn how to be like a patisserie, like person like pastry chef. And like the more realistic kind of like logical, field oriented way, I kind of imagined myself pivoting into more of a data science space, I think that one of the biggest untapped, you know, really untapped and truly understood like power of big datasets and clinical processing is going to be thoughtful developments of artificial intelligence and data processing, to be able to better diagnostics to be able to better die, like better, like genetic information processing. And I think it's going to be revolutionary towards the ability for us to have image processing. And so I imagined myself either doing my own kind of startup in that capacity, or potentially like joining a advisory board or serving in that capacity, kind of feeling how I can disrupt the field in a different way that is going to be bigger than me seeing patients myself, I think that is what I imagined my long term legacy to be and what I hope it to be because I think we have this one short life on the world, and I want to be able to make the biggest impact and get the most people pregnant as I can.

Dr. Zoran Pavlovic  58:06

Yeah, I agree with Victoria in the sense that there was a question on there that I think we pull it what do you think was the biggest things coming up in infertility and REO the next biggest innovation or what that and I think artificial intelligence and genetics are those two sectors that are really booming in our field, ai ai being closer to and like genetic engineering, all that being a little further away. But both of those are have such powerful capacities to make a lot of change in people's lives. But also, like you were saying, Griffin, there could be a double edged sword, you know, things different technologies may not be may be marketed as being great, but they may not actually be as great. Or we may be talking about when we get to the point of actually AI dictating care or genetics being able to be modified and embryo like what does that mean ethically? And I think there's these crazy ethical questions and business questions and medical questions that need answering. And I see myself as hopefully one day becoming knowledgeable enough and enough of an expert in my field, that someone would trust me to be part of a consulting group or a CMO of our company, or an advisory board or somebody people to sit down to help make these difficult decisions and have these difficult discussions. And I would like to train myself and gain my knowledge to get to that point one day, that would be really amazing, because I do feel like we have these epic situations and questions that we need to answer coming up. And if I can be a part of that and at least contribute in a positive way that I would look back at my life when I'm retired or just sitting on a beach somewhere in Bali, hopefully, like I did something, you know, beyond just like tutorial was saying, being in my clinic and taking care of patients, which is extremely important and the utmost importance of medicine, but that's how I would want to try to see if I can add to the field.

Griffin Jones  59:54

Yeah, I want to maybe just remark on that because it's amazing how It subspecialist physicians you're so you're so educated, you're so trained, you're so freakin smart. And, and, and truly are exceptional in many extra ordinary in many senses. And then in other senses, it's like, just as human as everybody else. And it's amazing. When I'm in a room of a very eyes, it's, it's a natural human tendency that likely comes from evolutionary biology that when you see someone getting more, you really want more, and because so much is coming into our field right now. It's, it's, it's very easy for me to say like, I want that, and I would just caution people a little bit yet you've worked really hard, where you're gonna be okay, no matter what you do, you're gonna, you're gonna be all right. Remember that the vast majority of human life up to this point throughout history, and even in great many parts of the world today is extreme poverty. And, and even by the standards of our country, you're going to be you're going to be doing well, no matter what. So I think it's just something to keep in in mind. As for all the the, for all the artists was for all of us, that it is our tendency to look at people and be like, they gave him what he's getting what for being on that board. He sold his practice for what? And it's like, you know, focus on some of the other things as well. And maybe you compare yourself to your ancestors, as opposed to the other colleague all of the time. I know, and just your competitive rate, especially REIs. So you're going to do it some of the time. But

Dr. Megan Sax  1:01:48

Matt, towards our patients for a second, too. Yeah. Yeah. I mean, you're so right. I think, unfortunately, that is kind of the human nature. But we feel that for our patients, too. And I know I've talked to these two about it. And one of the most frustrating things about our field is the accessibility and really lack thereof for such a huge proportion of the population. And I mentioned earlier onco fertility, huge passion of mine, as well as just fertility preservation for transgender population among other kind of medically induced infertility. Right. eugenic infertility. And so I mean, to kind of swing together the two questions of what's your passion outside of your clinical practice? And Zoran bringing in the where's this field going in the next decade or so I would say increasing access, I'm gonna make it back to advocacy for a second just say, you know, currently, we have 12 states that have fertility preservation laws, or in other words, mandating insurance coverage for that I intragenic. Infertility. And to me, this is this is not enough. And I can tell you, Ohio is not one of them. But, you know, we're seeing the state mandates increase now with 20 states, and we're seeing IVF coverage in 14 of those states. And I think that's going to go up. And I think in the next decade or two, maybe even sooner, we'll see a much larger patient population, I think that's part of the reason why they're coming for the REI fellows earlier in earlier is anticipating this huge increase, but I know the three of us will, will be fighting for our patients and increasing that accessibility and, and that's going to be hopefully part of something that I do outside of my clinical practice,

Dr. Victoria Jiang  1:03:35

I think that's really important to always like think of is that as you accumulate more resources, you also get to be the person who delegates the utilization of those resources. And I think what's what, you know, Meg was really thoughtful about kind of touching upon is even being able to practice right now, as a fellow in a mandated state, you know, even the state mandates aren't perfect, and there's a lot of insurance hoops, you have to jump through each case, you're you're spending a lot of time with patient, you know, authorizations and pieces like that. And so there's a lot of work to be done in the field that, you know, disrupting the field isn't just like, you know, the big bucks and making millions of dollars, it's like, allowing, it's like starting a genetics company and allowing people to have cheaper, more affordable carrier screening, so that they can actually know what carrier screening is, and being able to offer that at a price point that they can afford, instead of $1,000 a panel, it's increasing access to patients who otherwise would be afflicted with genetic diseases and offering genetic testing from that capacity and like being able to really utilize the resources information in the best, most thoughtful way. And I think that, you know, any physician that I have ever met always, you know, is thinking, what about my patient? How can I get the best care for this person? How can I get around these hurdles? And I think that that's something that uniquely positions, you know, physicians to be leaders and ethical development of the fields because we're always having that patient in mind and that may not necessarily be as easy to see, for, you know, politicians. I know, it's been a huge challenge with being able to bridge that gap of politicians being able to see like, what does it actually mean to have a six week abortion ban? And how is that going to actually impact the patients that you're seeing on a daily basis. And so I think having a bigger voice, and being able to be at that position is going to be hard work, you know, it's going to be seeing 1000s of patients and having good reporting good outcomes and doing the best for them. Because at the end of the day, that's what we do. We are craftsman, a craftsman with an idea for bigger.

Dr. Zoran Pavlovic  1:05:33

It's our job to kind of sift through all these things to these different technologies. You know, you go to ASRM every year and there's all these new booths or this brand new technology coming out. But how much of it is actually helping patients? How much is more marketing and a marketing gimmick? And what does it actually mean? And sometimes it's years of using that device or that idea before people are looking at the outcomes and say, this actually didn't help anybody. And so that's where we need physicians that are patient, mind and patient focus to be there at these advisory boards at these tables and to discuss these things to see what will actually be beneficial, what won't be beneficial, what is the research back what's evidence base, what might not be evidence based, but we don't have any other treatments for it. So maybe we should go down that avenue, and be able to make those decisions for patients so they get the best possible care and the best possible access is big in Victoria, we're staying.

Dr. Victoria Jiang  1:06:20

Clearly I've been doing these conferences wrong, I thought the best technologies were the ones that gave out the best sperm pens,

Griffin Jones  1:06:26

are getting the swag is something to be said for that. Well, one of the things I say frequently is that it's hard to provide, it's hard to to have a valuable business mean, it is hard to have something so valuable, that it is worth getting more money than then what you're what you're giving away, it's so hard to be able to do are you meaning actually, the opposite, I think I'm trying to say is that you have to give away so much value that it's it's worth more than the money being received for it. And in order to to actually like deliver something so high in value, all of the systems and people that need to be it's hard to do. And, and I take that obligation so seriously, as a business owner that when we're not doing our best, as a firm, we're just taking people's money, we're just I hear I say they all say they're going to add to the pie, but we just feel like, they're they're just taking away a piece of our pie. And when you fail a business, that's what you're doing, you're just taking away a piece of the pie. When you succeed a business you are adding to the pie. And it's so much harder to do than to say. But I want to conclude with let's just say each of you have interviewed at this point, each of you are talking to people, names, specifics. And I know you're not going to give those but give us some insights or just what are you paying attention to like as you're we've talked about the like what's important to you, but I'm talking about when you're interviewing with people, like what are the impressions that you're getting from interactions? What is it that you're paying attention to? Let's conclude with that? Dr. Sachs? We'll start with you.

Dr. Megan Sax  1:08:10

Sure, I think something that has really stood out to me and kind of gives you that that nice feeling like oh, wow, this could be a really good fit, is when they say we want to make sure that this is where you're going to be happy. You know, when you start to get into well, which clinics would it be? Or which you know, other kinds of details? Like Zoran would say, really that importance of the details. They'd say, you know, this is we want you to be happy. And that really stood out because I feel like as as a resident as a fellow, maybe it was more like No, no, I want you to want me What can I do? And it's really nice to kind of have this table flipped this time. And I think it feels a lot more comfortable than those kinds of stage we did. We were the first rate I think we were the first COVID interviews for fellowships. And we were so used to the zooms on zooms and those kind of, you know which answer which story am I am I tell him for this question, which just feels silly after a while. But these interviews, it's like, Who do I want to be my partner? This could be for 2030 years. So I think that's important. And I did also want to include that. I don't want any fellows out there feeling like Why haven't I heard anything yet? I think the three of us have, you know, gone to conferences,

Griffin Jones  1:09:28

I'd be thinking that I would think of that. You're gonna suck you suck if nobody's called. Nobody's college by the end of the second is something to be said for that make which is Be active. The more active you are, the more opportunities you have. And that isn't just there. It's not just for fellows to i, there's been a couple of people that I know are trying to hire fellows, and I've invited them on this show. And, and there's like they just don't It's like this, this fellows are listening to the show you're trying to I'm giving you free advertising to talk about whatever. I, the people that are really good at recruiting fellows, I'll just make up I don't want to say any doctor. So I'll just make one up Dr. Angeline. bolsos is so good at recruiting fella is because she's all over the place. And she's super generous. And, and there are other people like that. And it's tougher for some of the smaller people to do that. But the more active they can be, the more likely they are to be able to be connected with people like you. And and the same thing is true for you guys that opportunity begets opportunity. You are active at Mrs. Ai, you ended up on this show that's going to result in a couple of phone call or an email from somebody here there. Yeah, it was you met somebody from the armed group, which is going to lead to another opportunity. So no, I wouldn't be a little concerned. Like if you haven't gotten a call. Maybe I should start being a little bit more active.

Dr. Victoria Jiang  1:10:59

I will say I think a lot of people wait until ASRM of their second year. And I think that's a really great touchdown point for a lot of people because it's really easy to connect with people. So if any fellows out there I knew for me, like thinking of ASRM as like kind of a deadline or kind of like a touch base point of like putting out feelers and networking, I think was a good place to start. And I definitely think that we're really early in kind of looking at the field. But soon, you know, time flies, and you're going to be graduating sooner than we I mean, hopefully,

Griffin Jones  1:11:33

you're early and this is the least busy time of your lives for the at least the five years on either side of it. Right? Like you were busy as hell and residency and yeah, this is a brief window, you're gonna be busy as hell again. And so yeah, it's not like you're it's not like you're behind the eight ball if you are if you haven't talked to anybody by by second year, but but the more you put yourself out there, the more opportunities you get. There's one: What are you paying attention to?

Dr. Zoran Pavlovic  1:12:05

Yeah, pay attention again, but big for me is culture, how the different partners talk to you know, interact with one another, how they say the practice runs together, how they say the console. It's a big deal for me, when I talk to someone at the actual practice, and they say things like, Oh, I'm gonna have an issue, I just walked down the hall and my partner, I call this person or if I have a tough surgical case, this person is there to help and backing me up just just shows me that strong culture of collegiality and togetherness and collaboration, which collaboration is a big word for me, Megan will here has heard me say it a million times. And back when we met in the NIH, that's like all we did was collaborate on a bunch of things, and now Victorian and also doing some stuff. So that's that collaborative togetherness environment is big for me, because I think as a team of physicians, we can do so much more as a team of physicians and of course, other practice providers together, we can do so much more than an individual. And so it's important for me to be part of a great team. And so I pay attention to that team environment, how are they within one another? How did it happen? How does the practice run together? How cohesive are they to help each other out? And I get that from actually having personal conversations, not just from the interview? But I'll find people at the practice and email say, Hey, do you have time for a phone call half an hour here? Half an hour there and just speak to me one on one so that I can get them one on one? And really hear from them? What they think, what are their thoughts? What are some of the pros, what are some of the cons and that goes back to what you said Griffin about being active. If I had advice for residents, incoming fellows, new fellows or current fellows, now it's that don't be afraid to just kind of put yourself out there to network to have conversations with everybody around you even even if you're introverted, which may be harder to do that. Just put yourself out there, we have such a great field of so many people that want to help and there'll be excited if you're excited about the field and passionate. So walk up to that person after the presentation or go to the poster presentations or when some guy that you recognize from podcast walks up to you to pull up PCRs, you know, talk to that person. I think that was huge. When I met you for the first time, I was like, wait, I know your podcast. And that's our first conversation started, but just be active in those conversations, because that will continuously lead to more and more connections and doors and situations. And we can help each other that way. I mean, that's what makes them united. She asked me for some help with connections in Chicago people that I did research with, and I was just like, yes, let me text that person right now about you how awesome you are. And that's how it worked out. And so keep having those conversations and just be active. We're here to help.

Griffin Jones  1:14:33

Victoria, did I ask you what you're paying attention to or to interrupt you with calling people losers?

Dr. Victoria Jiang  1:14:39

Maybe a little bit of both. I will say the things that I'm looking out for definitely the same layer of collegiality. I definitely want to be practicing with people that I just love working with. But I think for me, it's going to be the little details of clinical care that I think are going to be the make or break it or you know, I want to be in like a medium sized practice. I don't want to be by myself. I want to have a little bit of mentorship. I don't want to be driving to 55 Different satellite clinics, you know. And I think what's really important for me is Journal Club and team review and being able to like lean on my practice partners to learn and get better. Because I think the great thing is, is that you're going to pull together people that have been trained in all different places in different times. And I think that you can learn a lot and make your practice like your own. And I think for me staying ahead on the literature on the new findings, the new technology is going to be something that's going to be more challenging as we get into the nitty gritty and I want to be in a like environment that pushes me forward and allows me for like professional development in whatever capacity that they may mean and being able to be around the right people to do that. And be able to have good mentors in that capacity I think is going to be what's the most important

Griffin Jones  1:15:52

if you go to Montana or Wyoming you're absolutely driving to six different satellite your your driving hours to go to the gym. Doctors Jiang Pavlovic, Sachs, Megan, zone, Victoria in reverse order. Thank you so much for coming on inside reproductive health. It's been a pleasure talking with you all. Yeah, thanks so much.

1:16:16

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

150 EngagedMD’s Prescription For Reducing Fertility Center Pain Points, Featuring Co-Founder Jeff Issner

In this sponsored episode, Griffin Jones and co-founder of EngagedMD Jeff Issner discuss the unique ways the company provides added value for practice owners, employees, and their patients. How informed is your informed consent? Does your practice unknowingly carry added risk? EngagedMD’s education and informed consent solutions help to increase provable informed consent, reduce practice risk, increase and personalize provider-to-patient face time, increase patient education, save time, add to practices’ bottom lines, and ultimately increase access to care.

Tune in to hear:

  •  Jeff and Griffin discuss ever-present nurse burnout, and what EngagedMD does to take some of the weight off of nurses’ shoulders.

  • Griffin question how EngagedMD’s program roll-out can be successful with varying practice size and demographics.

  • Griffin question how business advantage and patient standard of care can both be bolstered by partnering with EngagedMD.

  • Staggering statistics on the EngagedMD analysis of ROI on just a two-practitioner clinic, and how these results increase patient access to care.

Jeff’s information:

LinkedIn profile: https://www.linkedin.com/in/jeff-issner-0620a912/

Website:  https://engaged-md.com/

Facebook: https://www.facebook.com/engagedmd


Jeff Issner  00:04

If somebody blindly signs off on something, and then an issue happens, if you can't demonstrate that the informed part of informed consent occurred, it's not helpful. It's not very valid. So all of these things are, of course, litigated through the courts. And but it's very clear that just signing a piece of paper is not informed consent, you need to ensure that patients are informed and actually understand before consenting, fertility, nursing, burnout, Rei, productivity, fertility, patient satisfaction, the standard of care, revenue, these are just a couple of things that I talked about with my guest, Jeff Fisher, he's the co founder of  EngagedMD, and you've heard of them, because they're a sponsor of this show. And you've heard of them. This happens, all fertility clinics in North America are using them. And you've heard of them, because so many people have come on the show and at conferences and other places and been talking about how amazing they are. It is a sponsored episode. And so you'll hear me sing their praises, because I legitimately don't. I don't have anything to counter with, it's been the most lopsidedly Positive reported company that I know of, in the fertility field. And

Griffin Jones  01:14

but I still tried to make it more about things than EngagedMD in the scene. So that's what Jeff talks about. On the show, he talks about areas of nursing burnout, and what clinics are doing to solve that. He talks about areas where physician productivity is limiting or, or the hindrances to it are limiting access to care what they did to improve access to care, we talked about what the bridge is between business, like a business advantage versus now is integral for the patient experience and for the standard of care that patients receive. And we talk about the risk that practices face in informed consents, and the hindrances, that that can lead to people moving on to treatment and practices being liable. So all of these things we cover in this episode today. And if you want to engage MD to take a look at your workflows, if the examples that Jeff talks about in this episode are interesting to you, he is somebody who will look at your work and they'll do a free assessment. If you go to engage them d.com/grip. And they'll do that assessment for you for free. They'll point some of these things out to you. It's a free eye opener for you from a third party that works with more than 200 fertility clinics. And if for no other reason, it is nice to say that you heard about them on the show that you heard about them from me, because that helps us create more free content for you. So I really enjoyed this conversation with Jeff, I liked hearing about what  EngagedMD is going to do next. And the case studies that Jeff refers to and the problems that clinics are facing, I think will be of interest to you too. So please enjoy this episode with Jeff Isner, co-founder of engaging Mr. Listener. Jeff, Welcome back to Inside reproductive health. Yeah, thanks, Griff. Glad to be here. You're the first person to ever do a sponsored episode of  EngagedMD and I get a lot of messages from companies, what can we sponsor the show? Can we be a sponsor? And I'm gonna work it out, you know, we're gonna work out inside reproductive health, eventually to where I would say eventually, because I'm still working on this, you know, fertility bridge Client Services stuff. But inside reproductive health is getting big enough to the point where we can start to work out things that aren't an endorsement, but because right now, it's been the podcast, it's been my voice. It's almost like there's no way there hasn't been a way for me to do a sponsorship, that isn't an endorsement. And I have to be really careful about what that is, like when people say, You're a shill for this company or a show for that. It's like, the only sponsor that I have is EngagedMD and I tell all of you that and it's because I've known Jeff and Taylor since 2015. And more than half of our clients have used it and all of the things that people tell me about EnagedMD so I've only even had the sponsorship conversation like the opportunity to be a sponsor with like three companies. And ultimately, so far you are only the only one there was a good fit for at this like endorsement type level. And it is because you hear me on the show Jeff puts out a challenge every week where I'm like, Okay, if if you're the person that's gonna tell me the for There's a bad thing about EngagedMD, send me the email. I'm not saying the email will never come. I suspect that one day it has to write like one day it has to come where somebody's like EngagedMD do. No one ever has no one ever has up to this point. It's all been like glowing reviews. And so I just like for the three people that are living under a rock, what is the  EngagedMD from the owners perspective? And what's the value that you sought to bring in the marketplace to begin with? 

Jeff Issner  05:31

Sure, sure. First of all, thanks again, for having me. We appreciate what you do, in terms of the podcasts and all this amazing information that you share with this community. And we're not perfect, enga EgagedMD is not perfect, but we work really hard to create amazing experiences for our users and ultimately for patients. 

Griffin Jones  05:47


Jeff Issner  05:48

So to answer your question, now, the way I like to explain engaged MD is through the story of how we actually got started. And about in 2015, when we met, our medical director really felt this problem day in and day out and his practice. And he was explaining the same things over and over and over and over again to patients and their partners. And making sure people understood what the process looks like for fertility, treatment, the risks, the alternatives, and medications, all these really important things that patients need to understand in order to make good informed decisions. And he realized, well, I'm repeating myself over and over again, and I'm probably only covering maybe 60, or 70%, of what I ideally like to and I've got all these kind of external factors that are pressuring what I can cover, whether it's the time I have for the appointments, or what else is going on in my life, or in my day. And he realized, well, I'm doing it this way. And every provider in my clinic is doing it a little bit differently. And ultimately, the patients are on the other side of my desk trying to just drink from the fire hose and absorb all of this very complex medical information for the first time. And so when patients go home, they try and remember everything that they had just been told, whether it be from their doctor or their nurse, or medical assistants or any other staff, it's too much. It's just too much. It's a ton of information that we're jamming into these appointments. And so they go online, they look for answers, they end up calling their nurses and their medical teams to try and get those answers. The nurses are picking up the brunt of this. They're doing IVF classes, med teach classes, really trying to fill in the gaps again, so that patients can make those good informed decisions. And they make those decisions historically on pen and paper. So documents are being printed, they're being given to patients, they've got to take them home, they're getting notarized, they're getting filled out incorrectly, and they're getting lost before, hopefully they get scanned back. And so we looked at this problem and said, Wow, it's so much time and energy that everybody is putting into this. And it's a suboptimal patient experience, clinic experience. There are all sorts of risks that are introduced. And so there's just got to be a better way to go about what we viewed originally as just informed consent, making sure that people are educated and consent to the right things in the way that aligns with their behaviors and what they want to do with their treatment and their goals. So we EnagedMD. And that was kind of the impetus for the platform and the company. And we have two primary product lines. The first one is Elon, so a library of educational modules that we've developed, that cover everything from COVID-19 protocols and fertility one on one, all the way through all the different types of treatment that patients may be pursuing, through the very end of the patient journey, what to do with extra gametes or embryos that you may have that OurCrowd preserved that. And these modules can be pushed to patients so that they can watch this content on their own time. They can rewatch it as many times as they want answer questions, demonstrating that they actually understood everything and then come back into their next appointment, and have a much more effective, much more efficient discussion with their medical team that's focused on the nuances of their care. Let's talk a little bit about that informed consent part for a little bit. Because anytime you talk about informed consent, you have to say, I'm not a lawyer, talk to a lawyer, get legal advice. Don't get it from me, because I'm not giving it to you because I'm not qualified to give it to you. But when I ask attorneys in our field, and

Griffin Jones  09:18

I'm chairing this session that you're actually speaking at SRM and I asked people about like, just like, what's the standard for informed consent? They'll just engage them D A N, like, What do you mean by and so what do they mean by that?

Jeff Issner  09:36

 Yeah, well, ultimately, it's a non delegable duty for the provider to provide informed consent and it's making sure that patients understand everything that they need to know all of the process the risks, the alternatives, in order to and also they comprehend everything, not just or being told everything but they actually understand everything that they need to know in order to make a good decision a shared this vision with their medical team about their care.

Griffin Jones  10:03

So I didn't really think of it in this way until I was on one of Dr. Katz's webinars and the viewer, you may have also been speaking on it. And and, and this may have been in the beginning of the pandemic, when people like the people that hadn't figured it out already kind of like had to figure out their the E signature, and people were asking about informed consent. And it and Dr. Katz said, What what's, what's greater evidence of informed consent, a stack of papers, that it's that like, there's a signature and at the end, and a couple initials throughout that, like 10 point font of language that people have never heard before, or a series of videos where they have to sign off at where they have to complete each module where they have to take a quiz, demonstrating that they that they did and then a a trackable digital signature at the end. So Ken, like you talk about that level of informed consent.

Jeff Issner  11:16

Yeah. And it's the way that you're talking about it. It's kind of how we break up our product lines, I've always related the informed part to our elearning product line and the consent part to our esign product line. But consenting is much more than just signatures on paper, if somebody blindly signs off on something, and then an issue happens, if you can't demonstrate that the informed part of informed consent occurred, it's not helpful, it's not very valid. So all of these things are, of course, litigated through the courts. And but it's very clear that just signing a piece of paper is not informed consent, you need to ensure that patients are informed and actually understand before consenting,

Griffin Jones  11:55

and it's pretty easy to me, it happens a lot you can ask your turn, how often is somebody able to argue that they weren't informed and in cuts out just went through, you know, just got married not too long ago, and then, you know, talking about just family law and in figuring things out like that, and, and they don't even let people do pretty, you know, they don't even honor prenups that are within like, oh, let's say a week or two, because or I should say many courts, many courts will not honor that prenup set or within like a week or two because it's like, well, it can't really be informed consent, many courts will throw out prenups that don't have where the other person isn't represented by counsel. Many courts will throw out them where they were represented by counsel, but there isn't the documentation that they were properly informed. I think that's how Eduardo Saverne successfully sued Facebook to get back his stake. And that, I think it is because he signed everything. But he said that he wasn't properly informed. And I think he won't, and that's why his name is back on the Facebook mass that is co founder. So is that like,

Jeff Issner  13:09

it's all of these components. And Dr. Letteri from Seattle reproductive, wrote a great paper a few years back about the primary components of various litigation that has occurred over a certain period. And even if informed consent, isn't the primary reason for the case, is very often a supporting issue around the case

Griffin Jones  13:29

that it was that Was that intentional from the beginning? Or was that just kind of like a happy byproduct? Like originally, you're trying to inform patients to help with client workflow or just help with clinic workflow to help with the patient experience so that they're better informed? And oh, yeah, well, we'll include the e-signing. At the end was, was it a byproduct of this being used for informed consent in this way? Or like, like, which came first? Was it the patient experience focus, kind of workflow experience? Or was it the informed consent?

Jeff Issner  14:09

Yeah, so it was very purposeful about informed consent at the beginning. But that's not our primary value proposition anymore in terms of how we talk about the product. So when we originally developed EngagedMD, we started with the elearning modules, and really started with IVF and IUI. And it was all about ensuring that every single time people were consistently and comprehensively informed and understood what they were just being informed about. And we realized we had that informed part. And we needed the, what I'm calling the consent part, the digital signing part. So we built out our esign engine that helps digitize all of the consenting signature workflows. And it was only once we really started getting traction in the market. And one of our primary demos is to listen really closely to our customers to determine what we develop next. And what we're hearing is informed consent is super important. This is great. It's very helpful. Bye To the real benefits that we try and the real problems that we try and create benefits around our saving time, improving patient experience, reducing risk where we can, and going paperless. So it was only after we launched it, we realized, wow, this is much bigger than we originally thought. It's not just legal informed consent. This is creating these other benefits that are much bigger than what we had originally intended.

Griffin Jones  15:23

I want to talk about that, because I saw the benefit immediately, like as soon as I figured out what you guys did, and it probably took me a little bit to be fair that I probably don't know what half of the people in ASM do. But it didn't take me too long. Like as soon as I met you guys, and we talked and I was probably 2015. And I thought, Oh, these guys are nice. I kind of, you know, I have an idea of what they're doing. But it wasn't probably until I started people, I started hearing people say, this is what we're using. This is how we're using it. I'm like, oh, light bulb, I need to pay attention to what this is. And very early on, I saw the I saw the value and but I could also see what the potential objection would be. And I could almost immediately also know how to address that objection. And that objection was, well, you know, people expect personal care from us, they want to be able to talk to a nurse, and they want to be able to talk to a provider and you know, they're paying all this money for care, they shouldn't be at home and, and watch a video and and I just immediately thought like, yeah, they're paying all this money for care. And is this stressful to go through this process? They shouldn't, they shouldn't get the least amount of value out of their time with you that they can, they should be getting the most amount of value with you that they possibly can. And if they can only remember 30% of what you told them. If they're asking you questions that are completely generalized questions as opposed to specific to their case, then that is not the highest amount of value. So did you all have to work on that positioning it for? How do you help clinics position it the right way.

Jeff Issner  17:20

And it was my biggest concern, when we launched to, quite honestly, was this just going to be homework for patients when they're paying 10s of 1000s of dollars for care, and a few things to know. One is what you call about, we are trying to make that in person time more valuable, so that patients can come in with that baseline knowledge and actually have a good interaction. That's two ways that really focus to their personalized care, not the basics of how the menstrual cycle works. And what stimulation is, we want to focus on your specific issue when we've got that really valuable in time, that time together in person. So that's kind of like the core reason why this improves those interactions is you're giving that baseline info at home. But we study this obsessively. We are extremely data oriented at our company. And we measure every single step along the way, both from the patient experience and the clinical experience where I'm just wrapping up a case study right now with Seattle reproductive medicine. And this aligns with the rest of our data points where we surveyed patients and clinics but 98% of patients that the videos were helpful addition to their consultations with their medical team, and 89% agreed or strongly agreed that engage them D actually made them more satisfied with their care. So we've got to meet patients where they are, I know personally and patients who would agree based on our survey results, that people want to do things on their own time at their convenience, and they want to use that time together with their care team as effectively as possible.

Griffin Jones  18:55

That's, that's, that's huge buddy. If anybody had a nine or a close to a 10 on a net promoter score, that would be through the roof, you know, almost almost unheard of, and and SRM is not a little practice. I don't know how many Doc's they're up to now at least 12. Maybe they might even have more than that at this point. They at least two abs and they're really great group that serves a diverse patient population from all over the Northwest. So to have something like to have people say that I'm jealous of you. And and if I can go on a little tangent of why I'm jealous as a business owner of  EngagedMD. I was watching I was on LinkedIn and one of my favorite marketers was talking about he was making fun of a lot of b2b marketing companies and he was saying we make blank easy. And he's and then he's like this is this is the value prop that most b2b marketers put forth, he's like, how about you just take blank off my plate entirely. And there's so much that you guys are able to take off the plate that as a client services firm, it's like I am always trying to develop to develop further develop what we can take off people's plate, but you guys just you take off so much of people's plate that they can actually provide that level of care that the patient needs.

Jeff Issner  20:29

Yeah, we're, again, we're obsessive about the data. But we're really, really obsessive about listening to our market and listening to our customers. And every single new interaction that we have with a fertility clinic, we start with a needs analysis, we really want to listen, what is your current workflow? What is the current patient journey? Where are you spending time that is manual redundant, that you don't need to be spending so that you can operate at the top of your license. So we're just absolutely obsessive about finding those pain points and helping support clinics to get better about them and to improve on upon them, whether it's using engaging DEA or not, but we're trying to develop all of our products around those issues that we hear directly from our market and our customer base,

Griffin Jones  21:13

I want to talk about those pain points, because they're not getting less painful. There's a lot of things that people could or, or more might do to improve their business that would be beneficial for their best business. But it's not necessarily. It's not painful enough. It's the adage of the old man on the porch with the dog and the motorist stops by and he's visiting the old man. And while he's having the conversation with the old man, that dog keeps whining. And finally, he asks the old man, what what is he whining about? And the old man says he's sitting on a tech, is it? Why doesn't he just get out? Why isn't it quiet? Why isn't he get up, and he has heard some bad enough to whine it doesn't hurt him bad enough to get on. And, and, and in your space? I think that there's it with the pain that your company is addressing. There's a lot where it's the point where the dog has to get up and maybe even, you know, prior to two years ago, maybe they could have sat on the tack longer. But nurses are so burnt out and embryologists are burnt out if people can't get enough staff, but you can't get an even get enough people to answer the phone. And so you need to make what you have with people, the time that you have with people as productive as possible. So we've talked about a couple of these problems, like I want to talk about the nurse time savings. I know, like there's examples of people everywhere, but they just talked to me about you know, what nurses, you know, like the time savings, and and yet, otherwise having to deal with appointments, that has been a pain for them and and how you've helped to solve that.

Jeff Issner  23:01

Yeah, to your point, the pandemic definitely accelerated a lot of these problems. And the the nursing shortage that we're facing right now is certainly exacerbating the issues that we're trying to help support. So I think it's it's pretty well agreed upon that nurses take on a huge brands of patient education and patient support throughout the entire patient journey. And that forms in IVF consults or IUI costs, whatever treatment starts before that, honestly, even through diagnostic testing, and talking through all the different things that you may want to consider prior to starting treatment and determining your treatment plan. And then throughout treatment, as well. As you're getting ready, you've got your Med teach. So I think that's a great example of an area where we heard that things we actually partnered with SNP pharmacy on this. Together, we heard that this issue of really non personalized injection, teach classes where everyone is coming in sometimes one on one, spending an hour with a nurse learning how to inject themselves through with all these different types of medications. And you've got to go home and you've got you know, videos that you can find on YouTube that you can try and search down that aren't particular to how your clinic does it or particular to your plan. So we built med ready together, which is a very personalized approach to injection training. So together with SMP, we built all this content, it's all done through motion graphics so that we can keep it up to date. And we can keep on modifying it and customizing it so that it makes sense for the clinic's protocols and their approach and how they use their medications. And when you assign these modules, you're assigning a module that is specific to the medications that the patient will be using. And this really engaging 3d Motion Graphics manners, that patients can go back and watch it over and over again, and not only understand how to use the medications, but understand why they're using each medication as it relates to the protocol. So I'll use an example from our friends at RTI, Ohio. and they were having 45 to an hour minute or 45 to 60 minute long consultations with patients just for injection training, and those were with every single patient and couple. And they adopted our med Ready program. And you know, I think, as most people are a little bit hesitant to reduce the time with patients, but they realize that this was actually able to completely replace their injection training classes for the majority of their patients. So the patients who didn't need that extra time, again, very specific questions about their injections, the majority of things are answered through the module. So they're saving four to five hours per day of nursing time by just using one of our module components. So you can apply that kind of math and apply that logic to all these different stages where you have the redundant conversation happening again and again. So that you're focusing keep on saying this nursing time, physician time, and that's provider time, they're operating at the top of their license really focused on the personalized issues, not the general things that can be repeated through a video series.

Griffin Jones  26:05

I'm just picturing the nursing managers that listen to this show here that like four to five hours per day of nursing time. And if they're one of the few clinics that aren't working with engagement, busting into the practice owners door right now with their iPhone in their hand playing this piece of the podcast, we get what for? And a lot of people can think that are listening, but what would you do if you had four to five hours of nursing time? Back like, you know what, that four to five hours is being wasted on right now that you're not getting to where your where your nurses are burnt out where they're where they're saving calls for the next day, because they just can't get to any more else, they're never going to leave the office, and then the patient's pissed off about that, because they aren't getting the answer back that day that they they were hoping to because the nurse is answering some other question or doing something else. So I think that's it. I think that's incredibly useful, no matter what employment market we're in. But especially with people being so short on nurses, it's just like a necessity now.

Jeff Issner  27:22

Yeah. And you know, you're looking at that. And so we're, we're starting with this kind of base level, ensuring comprehensive, consistent education occurs. And then it builds on that and you're actually improving the patient experience and the clinical the nursing provider experience. But when you start taking that problem a level higher, from a business perspective, you have more time to see more patients. So ultimately, you're generating more revenue, you're helping more patients access better care, and you're able to generate more revenue as a business. So it's really a win win win. And that those layers of value proposition continue to build on each other.

Griffin Jones  28:00

Let's talk about maybe the consent side, too. And at some point, I want to talk about of just like, of like how this impacts of weightless or rather what you can do during long wait periods, because that I would say the average is eight weeks now and some are 1216. And so but let's talk about consent for a little bit like what of the the issues been for clinics pre gauge MD? What are they struggling with?

Jeff Issner  28:37

Yeah, so it goes back to just the issues of paper. And, you know, it's 2022, and things have gone completely digital. But in the fertility world, this paper is really important, you've got to make sure that the right person is signing the right thing at the right time, you're authentic, getting all of that in song, the right workflows. And with paper, you're not really fully sure what's going on outside of the office. So you give people this information, they have to read it. It's an incredibly complex medical legal format, they've got to make their decisions on it. Oftentimes, they need to go to a notary to get that authentication done. And then they have to bring it back in or ship it back in or scan it back in. And if anything goes wrong along the way, you got to redo that whole process, right. So if somebody fills out the wrong thing or signs in the wrong place, notaries aren't trained to fertility treatment and what people should be doing with their decisions. You've got to go back and do that whole process again. And then if it comes back and you actually do collect it correctly, it's got to get back into the medical record so it can get lost, they can get caught up on a doctor's desk or somebody's desk, ultimately needs to get scanned and to have that proof that you've got the official informed consent. And so there's a lot of costs and a lot of time and a lot of again, suboptimal experiences in corporate added in that workflow. So with our esign engine, we're really just trying to make sure that all of that can be handled through your inbox. So you can digitize all of your documents we'll work through with our customers, for anything, not just consent, anything from patient intake through financial documents to test requisition forms, we have the ability to create those workflows digitally. Ensure you can track all the education and all the documentation in one place. So things are never getting lost. They're following these digital workflows that make it really hard to choose the wrong thing or to make errors on the consent, you're never going to miss a signature and nobody's ever going to get skipped in the signature process. And you can always go back to engage them data, see that digital copy are never going to be searching for the paper version that might have gotten shuffled somewhere.

Griffin Jones  30:48

Which that in and of itself of how long that can take people and like the anxiety when you can't find it because it is in that one file that it's supposed to be in. Yeah, it's just amazing how people use paper for for anything, at this point,

Jeff Issner  31:07

nothing worse than somebody getting ready to start their cycle or even worse, somebody's getting ready for retrieval and say, Oh, no. Where's that consent? That's the that anxiety that we're trying to completely eliminate?

Griffin Jones  31:20

Well, it was. It's funny, you should say that, because when I did my talk at PCRs, it was originally supposed to be about like, like bizdev. And then they gave me the talk to the nurses, the nursing track, they gave me the the last talk of the of the week, it was like the 11am Saturday talk. And he gave it to it was to the nurses. I was like, great, like the people who couldn't give two craps about business development. And this is what I do. So how am I going to make my talk relevant to them. And it was it had to do with branding, it had to do with creative and I had to tailor it to how to get patients to want to engage with your practices, processes. And I was just asking nurses ahead of time. Like, like, what's the biggest thing that when you tell like, you could tell patients 100 times, but you still feel like you're struggling with this problem with them. And consent was at the top of the list, like having their consents ready having their paperwork done ready to go before it started protocol?

Jeff Issner  32:30

Yeah, it's, um, nobody likes paperwork, right? I think we can say unanimously, nobody likes chasing down paperwork. But it's critical. It's really important. And so what we're trying to do is build that into the workflow, throw that in as part of, you know, these engaging videos that you're watching, tie it into a bigger part of the journey, make it digital, make it engaging, exciting, make it so that people want to do it, at least more than they would want to do it. If it was just trying to go find a notary and sign some things on paper.

Griffin Jones  32:59

You guys are right at this junction point of something that I've wrestled with since I've been in the field, which is I could just tell it like that eventually, something that might be a business plus, it first, eventually becomes part of the standard of care or elevating the standard of care. And, you know, 10 years ago, probably having a digital module would have been a business plus, it would have been Yeah, a nice little advantage to have. But now, it's like, man, you're dealing with the biggest stress in your life as a patient and a top five, and you're usually spending a lot of money. And you're, you're doing this all at a time when you like, you have to keep track of all these different things that add all this different times. And you guys are kind of like almost a little. I'm not saying the same way. But like how when you sign up for Airbnb, like it's a lot to list a property on Airbnb like to go through everything, but they break it up. So you know, you're not filling out 100 question form. It's like, what kind of house do you have? And then next, and I'm not saying that everything that you do is like that is like that, but you break things up in a way for the patient that I do feel that it is the state like that's the standard of care that's necessary for improving the standard of care now, it's not just a business plus anymore.

Jeff Issner  34:38

Yeah, I think there's a few things that you just call out there. We'll start with the standard of care. You know, we're, we're operating with about 60% of the US fertility market. We've got a very large market share and Canada, UK and Europe as well. And so, I would say that it's becoming the standard of care, especially in terms of informed consent. We're really proud of how widely adopted, this has become, and it's really become the way to educate and to consent. So really proud of those statistics. But the the other thing that you called out is the way that we're breaking things up. And we're taking experts and adult learning and elearning. And we're taking all of the best practices that are constantly evolving. I mean, we're in the world of Instagram, and Tiktok, and video, education and video. You know, absorption is definitely the standard. And we're taking all those best practices, and applying them within our platform, so that people are getting the right information at the right time, that is unique to their journey. So we're really, really focused on making sure that that overall journey, we're pushing the right information and nice chunk size bits, so that people get the right amount at the right time to properly absorb it properly make the right next decision.

Griffin Jones  35:58

For the listener, just imagine, imagine going through something as legally intense, and as outside of your expertise that requires deep expertise that you can think of like you're going through a, you know, some some very detailed estate planning. Or even more, maybe you're going through, like the you're building your dream house, and you've never built a house before you just you've been a good Rei. And now you can afford it. Now you're building your dream house, do you want to get it all in one huge sum? Like, here's the dot, like, here's the here's this stack of papers, and you got this limited amount of time to talk to me? Or do you want to have an extremely thorough module that you can go through piece by piece on your time, go back and make sure that you understand, and then use your time with the expert to be able to ask any any question I, I think if people think about it, if if they had that same opportunity, in other realms, it becomes even more heir apparent of of how useful it is. Yeah, it's

Jeff Issner  37:12

hard. And you know, we're all biased because we live in this industry. And so some of it is it becomes second nature to us. But it's so hard learning about fertility. For the first time, I remember when I first started working in the industry, all the acronyms of the, you know, different ideologies of infertility, all the different treatments and medications, there's just so much to comprehend. So I think we take that for granted sometimes that this is second nature to us. And people who are exploring treatment for the first time, it's all completely brand new, down to the vocabulary,

Griffin Jones  37:49

we're talking about improving workflow, which means improving productivity, which means potentially improving revenue, and that is flush with the topic that we cover on the show a lot. It is a business show. And we talk about private equity, we talk about venture capital, and one of the one of the claims that private equity has, and one of the gripes against them has to do with increasing productivity. And so I say on every episode that I talk about private equity, I don't have a dog in that fight. I don't I don't know I don't feel qualified to analyze the standard of care that private equity either improves or, or worsens. I just bring people on and I try to challenge them. But the the argument for private equity is that they increase efficiencies. And the argument against private equity is that ultimately, whatever those efficiencies are just means like squeezing more cases out of the provider. And so it's like, okay, we could squeeze more cases out of the provider by making them work more by packing in patients by by taking away time that they actually need to see the patient. Or we could do things that legitimately improve the experience for the patient and allow the provider to not do things that are redundant or lost, because the patient is a deer in headlights. So can you talk about? I mean, have you done any kind of analysis for return on investment?

Jeff Issner  39:35

Yeah, definitely. And just to kind of address the goals of private equity. I mean, I think process optimization is clearly one of those in order to generate a more efficient business. And if you can do that, while creating better care, that's amazing. And if you can do that, creating better care and also improve access to care by creating more time and more efficiencies in that whole process, you're helping more people ultimately have a child. So I think that's a really positive thing I know there's many different angles to private equity and with all things, there's pros and cons. But to take it this on a much smaller scale of how we look at ROI, again, going back to that initial needs analysis and workflow analysis that we do with every clinic, every clinic has unique problems, they all kind of revolve around the value propositions that we talk about. But one example that I'll give them a needs analysis that we recently completed and completed the ROI analysis for this company, they were to provider clinic. And they had 45 minute new patient consults, and 45 minute IVF consults. And we did all the math with them in terms of how much time you had save, what you could be doing with that time, how many more patients you'd be able to see with that time your margins on that. And we came out with an ROI of over $100,000 per year just on a to provider clinic, saving those 15 minutes on each of those consults, where you're able to accomplish by just spending your time more effectively, more efficiently, ultimately helping more patients access care.

Griffin Jones  41:12

That, to me, seems huge for the places that just can't get another Rei. And in a two provider clinic, there's a lot of those in your smaller cities. And, and it's the smaller cities that really struggle to get new Docs, it seems to me like 80% of the docs go to 20 cities in the US. And it seems to me, I still don't have any data. But it just seems that every anecdote that I can think of supports that that the only time that you see someone from an REI go to a Buffalo, New York, where I'm from, or a Youngstown, Ohio or Lincoln, Nebraska, is when they are their spouse are from within a few hours of their it's just so hard to get Doc's and so the alternatives like what we're just not going to, we're just not going to provide care to these people that are here. And so I often think of like EngagedMD, like being useful for ROI for for for bigger groups, because you know, they're the ones that kind of have their their eye on the p&l, but more but is there's not really separating the Pro and revenue from the from the increase in access to care is there.

Jeff Issner  42:37

Yeah, I think so. I think so. And people who really embrace that are where we see the most success. And even with, you know, the smaller local clinics, you can still make this your own right. And I think the fear sometimes as well, I don't want to be like everybody else. The people that really embrace this and start customizing the video modules and produce their own content to have as part of the patient journey and make it branded and talk about their practice and talk about their locations. That's that just warms my heart to see because they're really taking this technology and making it their clinics and making it using all those kind of efficiencies of what's being built as a baseline, but really customizing it so that it meets their needs. It really does give that boutique feel to each of their patients that come through the door.

Griffin Jones  43:32

How have you seen engage them the influence patient behavior, have you?

Jeff Issner  43:39

Yeah, that's a great, really great question. We've been doing a lot of research on EngagedMD. So we've been very fortunate to have third parties say, Oh, this is interesting. Let me get a study going. And we've had a couple of papers published. And we've got a great one that Dr. Meg sacks from University of Cincinnati. She's an REI fellow there is presenting at ASRM. So this is an example of how we've seen patient behaviors and outcomes change. And we're just starting to explore this because I think, anecdotally, it makes sense, and it happens, but we want to prove it with data. So let me give the example that she's been studying. We've been really focused on carrier screening. So just to give some background on what carrier screening is and why it's so important, from my perspective, we can prevent genetic conditions from being passed down if patients do pursue carrier screening. And it's one of a bajillion different things that has to be explained to patients as part of that initial console diagnostic testing phase. So like everything else that can be kind of shortcut, and patients may not have the right information in order to make an informed decision about actually pursuing or declining carrier screening. And not only is that kind of a workflow issue, but it's also a risk issue. We've seen massive lawsuits in the space of a patient's who feel that they weren't properly informed and ultimately had a child and Fortunately, that was affected by a genetic condition, because they declined

Griffin Jones  45:03

carrier screening because they didn't. And they didn't feel they were informed

Jeff Issner  45:08

correctly, they didn't understand the impacts of not pursuing carrier screening, informed declination is what we would call it, and didn't realize that they could go through PG TM and prevent this genetic condition from being passed down. So that information is important from, you know, population health perspective, it's important from a risk mitigation perspective. And also, it's just one of the like I said, bajillion things that has to be covered with every patient. So we developed a module on carrier screening in a workflow to allow patients to learn about what carrier screening is at home, just like the rest of our elearning modules. And then they can flow directly into making their decision about either moving forward or not moving forward. And what we saw when comparing the patient cohort that went through the  EngagedMD workflow, versus the cohort that went through the traditional provider console, is nearly double the amount of patients who went through  EngagedMD in deep decided to pursue carrier screening, which is just gonna let that sit for a second, that's massive, that's a huge impact that we can create.

Griffin Jones  46:09

Do you know the sample size off the top of your head, I don't know

Jeff Issner  46:13

off the top of my head, but we replicated it at a completely different clinic with a completely different group and completely different researchers kind of creating the study and is nearly identical results. And that was at a very large group that we had a ton of volume going through, but Dr. Sacks will be presenting SRM quick plug for her. She's got the poster is gonna be

Griffin Jones  46:34

on this podcast. I'm actually recording recording that episode with her and two other Rei fellows later today. So I don't know if their episode will come out before yours or yours will come out before there's I don't know how we have it scheduled right now. But yeah, little little shout out to her.

Jeff Issner  46:50

Yeah. And I think this is just the tip of the iceberg. We're really motivated to figure out what drives these patient behaviors? And how can we create really positive outcomes and health outcomes, not just patient behaviors, like positive health outcomes from using this tool, and providing great education and great patient journey management? Every single step along the way?

Griffin Jones  47:12

So yeah, maybe people should let that there's a couple of things that need to sink in people's minds from from this conversation so far. One is four to five extra nursing hours per day, what would you do if you had four to five extra hours for your nurses per day? Another one is, what would the quality of care be like for your patients? If double the normal number were going through carrier screening? But how do you make sure that engagement is actually rolled out successfully, because people have asked me to build software before and the first reason I declined is because I'm not a build. It's just not my core competency. I'm a creative I'm a salesman and building out that is what I'm good at. And, and even a CRM is too far away from that, that core competency, but the other thing is just like until it until it talks to everything. In many cases of software, it's just one more damn thing for for staffs. And, and people very often aren't even using the same EMR for scheduling as they are for billing as they are for the actual medical records. And, and then much more like, yeah, there's some people that use HubSpot and and Salesforce, I've never seen somebody like really use it like really, really, at best. I've seen a sort of rudimentary use of, of CRMs. And that's true for Yeah, like project management software that I've seen workflow software, I've seen kind of shoes. So how the hell have you been able to be like, how do you actually get people to, to roll it out? Because it's obviously being rolled out? You're at least half of clinics are using it. Everybody's telling me they like it. And and you have these surveys from both patients and staff that give you the glowing reviews. But how do you actually make sure that the rollout gets you to that place?

Jeff Issner  49:18

Yeah, well, no one likes change, right. I think that's people humans in general don't like change so that the

Griffin Jones  49:25

it's because it comes at a cost, right? It's because there's Eduardo Harrington, Dr. Harrington sent me a book. Oh, and the name is escaping me. So I'll put it in the in the show notes. But he was a Harvard professor. And and he talked about this very dynamic of like, of why companies especially don't change because the cost to change can be so disruptive to what it is that they're working on that very often when there is a disruptor in the marketplace. It is the new To company because they don't have the current obligations that the established companies have to serve us. So it's hard to implement change.

Jeff Issner  50:12

Yeah. And I think it goes back to having a big enough pen, the problem has got to be big enough, and we have to understand it well enough. So the that needs analysis that we start with, that turns into a workflow analysis, and really understanding the problems that we are trying to solve together, that are big enough to introduce this change. That's where it all begins. So we are, while there's best practices that we've learned with the about 200 clinics that we've launched at, each one uses it slightly uniquely, to solve their specific problems. So we need to understand we need to really intimately understand those problems, so that we can introduce a workflow and associated training for staff that aligns to solve their problems so that they're able to feel those efficiencies. With this has been a, an area that I've focused on from day one in town, I've really made a priority. The first person we hired as a customer as a Customer Success lead, we want to make sure that people are supported through that onboarding, that implementation, so that they start to feel and see that value. And then on top of that, we going back to being obsessive about data, we create dashboards, we're monitoring every step along the way to make sure that people are being successful. And we provide that data and those dashboards back to our clinics so that they can see which of my staff members are being compliant, which are not being compliant. How are things being received by patients? Where can we tweak and modify the workflows. So a really great example that the customer success team shared with me SEMA over at SCRC, has created a dashboard that we provide all the data into, and she actually creates competitions about who can send the most modules and forms and who can follow these workflows, the best to really encourage that compliance. So I thought that was a fun way to kind of leverage that data to make sure you're creating that optimal outcome. So it starts with really understanding the problems we're trying to solve. It ends with really closely monitoring and supporting our clinics to ensure that that change curve is overcome so that people can really see and feel the value. Talk to me a little bit

Griffin Jones  52:19

more about what your customer success leads do, like how do they help people implement? Yeah, so

Jeff Issner  52:26

we've got a number of people who are focused on this, the customer journey, I'll call off the customer buying journey. So starting with our sales team, who's really kind of understanding the problems that we're trying to solve. We have a professional services team, who's doing all of the digitization, helping with the workflow analysis, and ensuring that the right training takes place. So really making sure that the the workflow and the needs that we understand are translated appropriately into solutions within  EngagedMD. And then as we launch, our customer success team is there on an ongoing basis to check in to make sure that things are going successfully to compare across benchmarks, and to listen to things that change because we all are clinics or businesses are going to evolve, whether it be through legislation or through growth, or whatever it might be. So we're here to listen and to introduce other ways that you can keep on tweaking your workflows, tweaking the platform, growing within introducing other modules, customizing your modules, changing your consent, workflows, whatever it might be to ensure that ongoing success.

Griffin Jones  53:31

What about at the financial piece of the journey in the fertility bridge, fertility patient marketing journey, it appears in the third column, there's four columns, the third is conversion from a pointment to treatment. So they become they be they've gone through their first konsult They have not yet gone on to treatment there's some drop off their finances one of those pieces so we we like to make videos about finance, we like to we like to create more content ahead of time we'd like to insert some of the content that people get before they meet with the financial counselor so that again, it's not a deer in the headlights thing and that they just it's not like their Sally down the hall go talk to her now like they they have a little bit of familiarity with with Sally there, if not looking forward to seeing Sally that they know who Sally is what they're going to talk about with her in a way that doesn't try to answer their questions that can't be answered before. It's actually one to one specific to that person. So what do you all do you all help with that? That part of the journey at all and how?

Jeff Issner  54:53

Yeah, we're really starting to make great headway just recently in this area of the patient journey and So the way that the majority of our products have been developed is by hearing our customers say, Yeah, we started using engaging D to do this. And it was like, Whoa, I hadn't even thought about that. How did we not? How do we not think of that, let's try and develop more of a productize solution for that issue. So Shady Grove, as a great example of the financial area, their financial counselor started using our esign engine to get financial documents squared away. And as we dug in a little bit deeper to that, we started learning about all the things that people are saying over and over again, very similar to a US an IVF patient as an example, the way that nurses and providers are explaining the medical process to financial counselors, we're explaining the same financial programs, how to navigate your insurance, what to be looking for what to be thinking about. And so we've just started building modules, that helps support that financial decision making just like the medical decision making. So this is allowed Shady Grove to help support their financial concepts, they've got a massive financial counseling team to help ensure that patients can make those good financial decisions. And this allows their team to not have to repeat things about their payment programs and their financial programs, instead have a much more impactful, much more efficient discussion with patients about what their options are and how to move forward. So we're starting to, you know, as  EngagedMD continues to grow and to look to other areas, we want to be exploring other places the patient journey, other places of the clinic journey, and other types of users within the clinic who are looking to save time looking to improve the patient experience looking to reduce risk, we're looking to go paperless, that's how we want to keep on growing is finding ways that we can help support them best those issues best, so that the practices can keep growing and seeing more patients and we can keep growing as business as well.

Griffin Jones  56:57

I think that people often just stop at the financial challenge and think like, well, either patients can afford it or not. It's like, that's that that's not as far too simplistic of a conclusion. There is a range within there. And sometimes that there's no financial option to where a patient could feasibly pay for treatment. And that's, that's very sad. There's often a range of people that if they could, if they understood what the options were for them, then that's what household budgeting is. It's all a calculus, and the things that win are the things that one seems higher priority, but to that you understand that you understand how you're going to, you're going to pay for something and it isn't just simply a question of, well, they can afford it or they can't.

Jeff Issner  57:51

Totally totally. And it's that kind of plethora of topics that need to be explained. And as a staff member at a clinic, you have to prioritize your time and what's going to help people the most to make decisions, and it's impossible to cover everything. As you know, a consumer of healthcare is I think all humans will be at some point, navigating insurance is super hard. It's really complicated. And I work in healthcare, and I understand the space very well. And it is so complex to navigate insurance. It is so complex to navigate out, taking out loans to look through these different types of shared risk type programs. There's a lot to comprehend there. So we're trying to serve hacking away at that. Everything down to what is the deductible and what does that mean? And what does it copay through loan terms? And how do you actually navigate these different financial programs many clinics offer,

Griffin Jones  58:48

I want to ask you about the future of EngagedMD, but I want you to give me something that I can like, talk crap on you at because yeah, it's a sponsored episode and you guys pay me but you don't pay me well enough that I wouldn't bring that I wouldn't jab you with a thorn. If I had it. I just kind of love doing that. And like I do it with every guy I tried to. But I also hate it when I watch the news. And I feel like they're trying to get somebody to a specific conclusion. I just like playing with each side of an argument. And I just don't have anything for the argument against you and I don't have anything. I appreciate

Jeff Issner  59:33

that. But we are not perfect and we are trying to become more and more perfect every day our team is growing. Our processes are growing. Our product is growing. It's evolving, because you have to keep on evolving. And we do run into issues with any technology as any business does. And we're really just trying to be the best selling cannon. Our ultimate mission is to make life easier for everybody so that we can improve patient access to care. And so we're trying to center on that. And we're trying to be really thoughtful about the solutions that we bring to market and the way that we support our customers. As with any company, there's growing pains that come along with that. But we're working really hard to add value to the industry to really be a positive light as an industry player who can help support clinicians, staff, members, embryologist, patients, their partners, really all the players that take part in an episode of care,

Griffin Jones  1:00:31

will tell me a little bit about some of those things like, give me some of the earnest struggle that you're having and one of ours has been in that, like that third phase of the patient, or because we're never going to be pure operations consultants, that's not us. But you get to a point where sales and marketing can say, well, it's out of our hands, now it's in it's in our hands. And to me, that just always seemed like a dereliction of responsibility. Like, at the end of the day, someone is hiring a marketer because they want more revenue, they're not, there are some other things that they hire that person for, but a marketer needs to be able to set up the sale. And, you also should be able to set up a sale, that is delighted. And so I've had challenges with my team. And if you've made some personnel changes in the last year, because we couldn't get on the same page of what that is. But an example is, you know, we're talking about reputation management, like we help with reputation management, like the online reviews, and, and we know how to get people more positive reviews to a point. And then we might reach a point where it's like, okay, they're still getting these types of complaints. And, and what I want to be able to do is give people clients, the procedure of this is exactly what's broken. This is how you fix or this is exactly how you implement this into your EMR, I don't want to just give people something that could have been written in a blog post. And because I agree with Rita Gruber, when she says marketing throws the ball, it's the practice's job to catch it. But the practice doesn't care if you're Tom Brady, and you throw the perfect spiral. If they can't catch it, I want to make the ball land into their hands. That's the idea. And so, and that takes a ton of work. It takes discipline. And you have to be able to say like we don't, we don't totally have this yet. Because every marketer just wants to say they're the, they're the cat's pajamas. And the only reason why other people suck is because they're not as good as it No, it's it, it is connecting all of these dots, that's what it is, you're supposed to connect all of the dots. And, and so that's what, you know, that Fertility Bridges are in a struggle, what's EngagedMD?

Jeff Issner  1:03:00

Yeah, you know, I kind of go back to all the ways that people have stretched the platform in ways that we didn't fully expect. And it's great. They've created these workarounds. And sometimes there's things that people want to stretch the platform and do things that intuitively make sense in the vein of education and documentation and patient journey management, that when they even on the expense, it's like, oh, yeah, I wish we could do that today. But we, you know, we're building out a platform that needs to be scalable, it needs to be secure, it needs to be well managed, it can't break down. So we were just constantly trying to build out things in a very thoughtful way to meet these kinds of workaround methods and workflows that people have put together on our platform. And I wish we could do it as fast as possible because what it ultimately creates is people might run into a bug or they might run into an issue where they can't complete the workflow. And that's not the experience that we want people to have and our support team has helped people through that come up with other workarounds. So we're constantly trying to build the platform out again, in that scalable, secure way. So that your data is safe, your patients are safe, you're safe. And we're working really hard on that we've got a give a little bit of teaser to the next generation of  EngagedMD they're getting ready to launch that will help ensure that scalability and more flexibility so that all those crazy use cases that our customers come up with will be able to better support them and continue to build upon at a faster clip to help make sure that we're supporting people even better so. It's not perfect, I think we're doing a really good job of creating as many workarounds as possible and supporting people but that would that would be the area that kind of keeps me hungry and keeps me you know, Taylor and me working really hard and growing the team and growing our resources so that we can support more of these things that really should feel fall within our wheelhouse education documentation patient journey manage met, we want to keep on growing the functionality so that there's nothing this will never be the case, of course, but we want it to be as close as nothing that we can't help solve for.

Griffin Jones  1:05:10

As the challenge with the business owner, right, you're, you're steering the ship. And it's either the iceberg that you want to avoid, or the part of the water that you want to turn towards. You can see it like you can see, it's like, can you turn fast enough for that is the challenge of a business owner. When Marc Andreessen says that software is going to eat the world? One, I believe him too. I think he's talking about  EngagedMD, as you're as you're just is, as you're competently absorbing each of these spheres as you expand. So let's conclude with what do you, what can you tell us about your your roadmap, where, where, as specific as you feel comfortable going on public record, what can you share with the audience?

Jeff Issner  1:05:58

Yeah, so I mentioned we have a new version of our platform coming out, that's going to continue to expand upon the ways that we help support patients through their ultimate journey. So while some aspects of our platform right now are very much like, here's where you are, here's what you get, we're trying to create a more cohesive patient journey that's easier to manage, from soup to nuts to create a very consistent, comprehensive experience for all of the different patient journeys that you can have, and then track and manage. We're also to that point, expanding into other areas of the patient journey. So like the financial counseling journey, we'll call it, we want to keep on building out products, content, things that can help support patients through all those different stages, and we don't currently do right now. And then the last thing is just introducing more industry partners and working with more industry partners that can benefit from having this interaction with both patients and clinics to help, you know, support through things like the medication management processes, or the genetic testing processes or whatever it might be, we want to make sure that we're plugging everybody together to create, again, a great patient journey. So software contents, the people to help support it. That's where we're growing so that we can keep on helping more and more people access that amazing care.

Griffin Jones  1:07:21

Yeah, fastener it has been a pleasure having you on we're going to link to engage MD obviously, in the show notes and tag you in social but people can actually go to engage md.com/grip, and they can get a workflow assessment where EngagedMD looks at a lot of the things that Jeff talked about today. So if you want to see how your clinic stacks up, they will look at that for you. And they'll do it for free if you go to engage md.com/griffin first sponsor I ever had, because of how many people have just been blown away by your company. And I know that my own company isn't at that same echelon. Yeah, I can, I can save that. And so I admire that you've been able to do that because I'm really really trying and I know how hard it is. So thanks for sharing that on the show.

Jeff Issner  1:08:18

I really appreciate the kind words, appreciate your support and really excited to continue growing with you and growing with the industry. And so thanks again for having me. Can't wait for the next one.

1:08:30

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

148 "Physicians Are Bad Business People" And The MedikalPreneur Author Who Says That’s A Lie

This week on Inside Reproductive Health, Griffin hosts MedikalPreneur author, board-certified REI and OBGYN, and Inside Reproductive Health fan-favorite, Dr. Francisco (Paco) Arredondo to discuss the misguided concepts of physicians as business owners and operators, and what it takes to make it as both a healthcare provider as well as a successful proprietor. https://medikalpreneur.com/product/medikalpreneur/

Listen to hear:

  • Dr. Arredondo’s 5 H’s for hiring success.

  • Griffin point out that doctors can get away with bad business techniques because their trade is so high in demand.

  • Griffin press on the tension between employee satisfaction and client retention, and question who really comes first, and why it matters.

  • How much culture influences business success, and what to ask yourself about your own clinic operations.

  • Dr. Arredondo’s crash course in business success as a practicing physician.

147 The Fertility Private Equity Playbook: The Players And The Payors. As Analyzed by David Stern, CEO of Boston IVF

Boston IVF CEO David Stern describes some of the challenges of private equity backed businesses. Griffin grills David on the models of Boston IVF and their parent companies.

Listen to the latest episode of Inside Reproductive Health to hear

  • David Stern talk about how little of their own money private equity firms typically use

  • Griffin press David Stern on whether business decisions and clinical decisions are always separated

  • David Stern and Griffin discuss the meaning of “trapped equity”

  • What happens when Private Equity doesn’t flip at the right time, who pays for claw back provisions, and what about those hidden fees?

  • David Stern talk about Boston IVF’s model for partnership

146 Held Over The Coals: Fertility Insurance Not Created Equal

This week on Inside Reproductive Health, Griffin gets to the root of the insurance debacle in the fertility industry with Holly Hutchison, managing partner of Reproductive Health Center in Tucson, Arizona. Are cash pay patients subsidizing insurance companies’ poor coverage? How can practice owners survive when insurance authorizations are exceedingly slow, reimbursements are laughable, time to pay is unpredictable, and patients don’t understand their own coverage- or lack thereof? Who is left holding the bag when insurance doesn’t cover what it claims to, and can anything be done about it?

Listen to hear:

  • The evolution of insurance in the fertility space: how it began, when it was successful for a hot second, and where it is today.

  • Griffin question which is more beneficial to the provider- employer benefit groups or insurance companies- and why.

  • Griffin question why fertility clinics haven’t cut out the insurance companies who are draining their bottom line.

  • Griffin discuss the cost-benefit analysis: (Reimbursement, time to authorization, time to payment, volume to practice, patient cost sharing) and how to bring more leverage back to the provider.

145 Two Founders Trying to Flip The Script in The Challenging Fertility Start-up Space: Abby Mercado and Kristyn Hodgdon

On Inside Reproductive Health this week, Griffin Jones chats with Rescripted founders, Abby Mercado and Kristyn Hodgdon about their business model, how it came to be, and what risks they have in this space. How has Rescripted’s capital been invested? How do they keep content fresh? Will they survive and thrive in this space, even though so many others before them have failed- despite having massive capital? Listen now and join the conversation, with Griffin Jones on Inside Reproductive Health.

Listen to hear:

  • Griffin point out that pharmacies missed the boat- they could’ve seized the direct to consumer route, but did not.

  • Abby and Kristyn break down their business model, why it works, and what they won’t allow in their space.

  • Griffin discuss raisers of capital who had the cash, but ultimately failed, and question whether or not Rescripted has what it takes to beat the odds.

  • Abby and Kristyn explain why, and how, Rescripted was founded, and where it hopes to go in the future.

144 More Dangerous Than Overturning Roe? The IVF Legislation You Really Need to Watch, According to Atty. Igor Brusil

Griffin hosts embryologist-turned-attorney, Igor Brusil, to discuss what he, as an attorney, believes is a bigger threat to the fertility space than the overturn of Roe v. Wade, and why. What implications could changing donor privacy laws have on your practice-even if you don’t practice in the state that overturns them? Could they extend beyond donor rights and result in an inspection of your business? Listen to hear one specialist’s opinion on Inside Reproductive Health with Griffin Jones.

Listen to hear:

  • Who is advocating for the release of donor information, including medical history.

  • What laws, changing in states like Colorado, could impact your practice (even if it is not in the same state).

  • Griffin press on whether Roe v. Wade has a larger potential to damage the fertility space than changing donor privacy laws.

  • Griffin question why no one is protecting the rights of the donors.

  • Igor’s opinion on what you, as a practitioner, can do to protect yourself and your business.

Ep. 142 When the pretty lady in green comes to the fertility field: 4 Competitive Disadvantages for Fertility Business Owners

This week on Inside Reproductive Health, Griffin Jones explains how reputation and brand overlap, how they are both born of positioning and culture, but are not equally synonymous. “Brand is about relevance and differentiation. Reputation is about legitimacy”.

In this week’s podcast, Griffin shares four competitive disadvantages for fertility business owners.

Listen to hear:

  • What four things brand can do that reputation cannot.

  • How impactful recognition is in your brand, and how to improve it.

  • How your brand can align with peoples’ individual expression of self.

136: 6 Pillars for your IVF Center’s Killer First Impression

Episode 136 IRH cover photo

This week on Inside Reproductive Health, Griffin shares the 6 pillars to generating the best first impression for new patients, and how that can directly impact both your bottom line, and the patient experience. Listen to hear how you can build a successful New Fertility Patient Concierge Team. 

Listen to hear:

  •  How (and why) to put the right people in charge of your patient’s first impression 

  • Griffin explain how to emotionally incentivize your Concierge team.

  • How to measure the Team’s impact on your practice’s bottom line.

134: What the Heck is Kindbody Up to Next? with Gina Bartasi

Gina Bartasi on Inside Reproductive Health

This week, Griffin chats with Gina Bartasi, founder and chair of Kindbody about the development and success of the first-ever consumer fertility services brand. Griffin posits that their latest acquisition of Vios will not be their last, Bartasi disagrees and instead has her sights on global scaling. Bartasi believes that the end-to-end care model of Kindbody is most beneficial to the patient, and everything is better, and more efficient, under one umbrella.

Listen to hear:

  • How Kindbody developed their brand, and how it influences their culture for employees and patients alike.

  • Griffin press Bartasi on future multi-site multi-practice acquisitions, and how that may influence global growth.

  • Where Kindbody stands on utilizing extended care practitioners for retrievals and transfers.

  • Bartasi argue that Kindbody’s end-to-end business model improves (and controls) the patient care experience.

  • Bartasi use stats to back the clinical success of the Kindbody model, despite the 25-30% price cut.


Gina’s information:

LinkedIn:https://www.linkedin.com/in/gina-bartasi/

Twitter:https://twitter.com/WeAreKindbody

Facebook:https://www.facebook.com/kindbody/

Website:https://kindbody.com/


[00:01:08] Griffin Jones: The first global brand in the reproductive health space. And if you think there's been global brands before listen to this episode, because I'm talking about consumer brand, this is the first global consumer brand in the reproductive health space. It's Kindbody. I've got CEO, Gina Bartasi back on.

After a couple of years, we talk about what Kindbody has been up to in all the markets they're in and where they're going, talking about the history of their acquisition with Vios, they've raised tens of millions of dollars in venture capital funding. There's a couple of things that I pushed back on Gina about talking about this concept of this Jeff Bezos, Amazon Sam Walton, Walmart type of end to end channel domination. They Kindbody is going after. There's a lot that I'm not qualified to examine. I'm not qualified to examine on a lot of their business model and certainly not the clinical side. And I know that a couple of you are going to think that I'm kissing rear end when I'm, when I talk about brand, when I go into that part of the I will fight you. I am not kissing any, but I am telling you the things that I've been telling you for years, and I'm seeing somebody do in practice and now people are starting to feel, oh, this isn't just about bringing new patients in the door. This is what it means. To have a brand that is not window dressing.

If you think that Kindbody’s brand is, oh, that's just good marketing. That's just pretty stuff. It isn't, it's the foundation of everything that they've been able to put together. And it is an extreme, competitive advantage in recruitment and retention of employees among other things. So if you'd like some help with that guest who does that for us?

The firm that sponsors this podcast, of course, Fertility Bridge. And we are helping a lot of different practices across the country to up their brand, regardless of whether they have a patient acquisition challenge or not many of you don't, but there are reasons why this branding and creative messaging really, really benefits groups.

And we talk about that today. So you can tell me if you feel that I was kissing her. If you feel that I was too tough, you let me know, enjoy this episode with Gina Bartasi.

Ms. Bartasi Gina, welcome back to Inside Reproductive Health. 

[00:03:40] Gina Bartasi: Thank you. Thanks Griffin. Nice to be with you. 

[00:03:43] Griffin Jones: What is it Kindbody been up to in the last two and a half years since we spoke, nothing right?

[00:03:48] Gina Bartasi: Nothing, not anything at all. 

[00:03:50] Griffin Jones: Not a damn thing. 

[00:03:52] Gina Bartasi: Sitting, twiddling our thumbs, trying to figure out what we're going to do next.

You know, I've always said the success of any businesses, only about its people. And so we have an extraordinary team. The team has parlayed their knowledge and experience into a tremendous amount of growth. Right? So today we have 26 locations not the least of which is the new virus clinics that will pull into the Kindbody network that acquisition closed February 1st.

And then those Vios locations will be rebranded Kindbody. But Angie Beltsos is one of a kind you know, I know that the audience is aware of all the PE money rolling up practices in the industry. We are not a roll up firm. We have preferred to build de novo, but Angie is unique. She is extraordinarily talented as a physician and she is even more talented as a clinical leader, just as a leader in general, she knows a tremendous amount about business, about productivity, about margin.

And so, yeah, we have 26 locations. We'll be adding another 10 this year for 36 locations by the end of the year. And then we're back in the employer business. So we see quite a bit of interest from the employer business. Certainly our consumer audience that we started with is still a big part of our revenue.

And then we see quite a bit of payments come from the managed care industry.

[00:05:15] Griffin Jones: She  knows the answer to this, but I don't, is Vios the first acquisition that kind of body is done in terms of presence?

[00:05:21] Gina Bartasi: I noticed the first acquisition, I've done quite a few acquisitions in my career, but it may be the first one at Kindbody.

I shouldn't, it should be an easy answer. We haven't bought any other clinics. I'm trying to think if we've bought anything else, I guess not. So Vios is the first, it will be the last multi-site multi-physician practice we acquire again, we prefer to build de novo. We wouldn't rule out some of.

[00:05:45] Griffin Jones: This podcast lives forever Gina, do really want to say that it will be the last. 

[00:05:49] Gina Bartasi: No Griffin, it'll be the last multi-physician multi-site acquisition we make, we may make some tuck-in acquisitions. Right. 

[00:05:58] Griffin Jones: But even that, why rule that out?

[00:06:00] Gina Bartasi: Because I know the multi-site physician groups and they are already owned by one of our peers that are not a lot of multi-physician groups, still standing that are independent, there's probably less than 10 in the entire country and the 10. 

[00:06:16] Griffin Jones: All multi-position and multi-site meaning multi-site meaning more than one lab. Is that what you mean?

[00:06:22] Gina Bartasi: That is exactly right. That is exactly right, because we wouldn't be interested and it's too easy. Thanks to our extraordinary real estate team for us to stand up a clinic with the lab. They've gotten very proficient at it in the last 12 months. So the reason we would make a multi physician, multi location acquisition is to get scale. There is not, again, there's probably less than 10 of those.

So yes, there are multi-physician, but maybe they only have one lab and then one satellite office, which would rule them out. So that's the reason it's an emphatic statement. I think, you know, we're getting a lot of requests now. From the employer market to think about international expansion and so potentially internationally, we wouldn't rule it out, but in the United States you know, and Angie knows everybody as well.

We are looking for physicians that are like-minded, you know, Angie, she's wildly unique. And so she's amazing, and we have so many other amazing physicians, but there's a culture at Kindbody and Angie believes in that culture, the culture was almost identical to what Vios culture wise. I mean, we prioritize patient care.

The patient always comes first. Our employees come first, you know? And so there was this, this real foundation and we are here to serve others. And so that's what makes, it's one of the things that makes Angie and Vios so unique. And it's also the reason. I think we're limited in terms of other potential acquisition targets is rare to.

So, seamlessly be able to put two companies together that agree on so many things. Usually when you're rolling up things or you're putting two things together, there's a lot of friction. The integration is hard. There's a lot of disagreement. There's a lot of debate about, oh, and you just don't have any of that.

You just don't have any of that. We are incredibly like-minded now we've known each other a decade and that probably helps as well. 

[00:08:19] Griffin Jones: Well, I want to ask about how you did that vetting because it sounds, it reminds me a little bit of like the Facebook, Instagram, sorry, where Zuckerberg said you, most of the time, we're not going to do.

Acquisitions most of the time we're going to be building out Facebook property now, meta properties. But at the time they saw something that was perfectly in line with what they were trying to do. They stole Instagram at the time for $2 billion and it totally fit. And so that's what you were describing with the Vios acquisition, but how did you vet it to that point?

[00:08:51] Gina Bartasi: Yeah, again I think knowing Angie and Greg for more than 10 years was extraordinarily beneficial. We had talked on and off for the last several years. Again I've thought Angie was just as unique as I think she is today. I thought that the first time I met her at 10 years ago, I met her at PCRs and she's so articulate.

She listens first, most leaders talk first and listen, second, Angie listens first and talk second. And that's a rare characteristic to be both a leader and an extraordinary listener. A lot of leaders are not as humble as Angie is. Angie is extraordinarily humble. And so I would watch her in meetings.

I would watch her interact. I was like, wow. She is a total bad-ass and I always wanted to work with her. I did work with her. I worked with her at Fertility Authority. I worked with her progeny and as time grew on, the affinity grew more like she, she continued to impress me. And she continued to raise the bar.

I knew her when she was at FCI, I watched her grow Vios she does everything with a tremendous amount of elegance to and class. And that's hard to do. It is really, really hard to scale a business and grow a company that fast and keep your cool and take the high road and work hard and not lose it while you're trying to juggle all these things.

And she just did it, you know, and I watched her. And so anyway. 

[00:10:18] Griffin Jones: She does do that by the way. No, I don't talk about things that happen in business meetings on the air, but Dennis, at a super high level, I think Dr. Beltsos is comfortable with me saying she does that. We'll be quiet and let everybody talk and then she's, and then it's like, all right.

And then she's honest, like she lets people say it and you get to see your processing and then boom she's she's got it. So you described her well, so that got you into the Midwest. So you, you found this really good culture fit for you all you acquiring Vios and then, and now you're in the Midwest.

What cities are on the, the docket that you can tell us about now?

[00:10:54] Gina Bartasi: Yeah. Well we want to be completely transparent, so we don't mind sharing with the audience, but we're opening Seattle. We're opening Dallas, Houston, orange county Miami, Charlotte we're opening in Washington DC next week. Two weeks.

May 4th. Whenever that is. Oh, maybe it's in more than two weeks. Maybe it's in three or four weeks. What am I missing? Should be like, we've opened two already. We opened Denver two weeks ago. We'll open Dallas in three weeks. Excuse me, Denver. What did I say? DC? Dallas. Houston. I'm missing some, but anyway, that's kind of the footprint.

Oh, we're opening Brooklyn, a third location in New York. I should have the map in front of me, but that gives you a general idea. 

[00:11:35] Griffin Jones: It gives me an idea of the near term is, I mean, in a few years time, are we talking about everywhere? Gina? Is that the play? Like, are we going to see Kindbody Cleveland? Are we gonna see Kindbody Buffalo?

Are we going to see? 

[00:11:46] Gina Bartasi: Columbus, we're actually coming to Columbus before we're coming to Cleveland. We are, we're taking and we're adding a location in the east bay. So both New York, San Francisco and LA we'll all have three locations, but I think that's right. Our plan calls for 50 locations within the next two years.

We want to be where our patient population lives and works. The majority of those locations will be retail in nature. We, you know, believe in the consumerism of healthcare and really building a global brand. We talk about a national brand, so our eyes are set on the US over the next 24 months.

But in three to five years, I think you would see con body locations internationally as well. 

[00:12:25] Griffin Jones: I want to talk about that global brand and what Kindbody is done to get to what you have now. I am jotting that down because I want to ask you a little bit more, but I don't know if the employer benefits side was part when we spoke a few years back on this show.

And so what has changed in, in employer benefits from, from when you started Fertility Authority and then, and then progeny that or whatever, what was that? Seven years ago or? 

[00:12:53] Gina Bartasi: Yeah, seven years ago. 

Yeah. 

[00:12:55] Griffin Jones: So what has changed since then that you feel like, okay, we need to be a part of this? 

[00:13:01] Gina Bartasi: Yeah, I think the biggest thing that's changed is employers now recognize that having a fertility benefit has gone from a nice to have to a must have today there is a robust RFP process.

There wasn't any RFP process. There wasn't anybody to RFP the business too. It was kind of progeny. And then I think you had some legacy players whether that was when or arc, but they really weren't in the employer business like project. You had no competition the first four or five years, and then they've got their hands full.

Now in the last couple of years, there are several kinds of other Progeny me toos, whether you, whether you, you know, again, you see Carey C store club, you see Maven coming in and there they do care navigation. We sit independent from those folks because we're in the provision of care. So we can also do care navigation, which we would argue as table stakes, but really only three things matter in healthcare.

Any kind of healthcare, but specifically fertility patient experience, patient outcome, and cost. It's the only thing that matters to the patient,patient experience, patient outcome and cost. And by the way, it's the only thing that matters to the employer. And what I have found after building and running the largest care navigation firm as a care navigation or middleman or an insurance company, you cannot effectuate change in those three areas, an insurance company, or a care navigation firm cannot affect member experience.

They cannot affect outcomes and they cannot affect costs. Only the doctor's going to set his reimbursement rate. He's only going to decide how many embryos to transfer only. He can decide how to give that patient bad news, whether that's a diminished ovarian reserve diagnosis or a failed IVF cycle, but in order to really effectuate change, And really change kind of how patients go through the process.

You have to be in the doctor business. So today the employers are issuing RFPs. I think in the beginning large tech companies on both coasts are really in the valley, kind of started this fertility benefit. But today you see requests coming in from very, very large employers in retail and manufacturing and automotive.

Like it again, it's moved from kind of a nice to have to a must have benefit.

[00:15:13] Griffin Jones: For that reason though. Wouldn't those other companies say that Kindbody is not independent, that they're independent because they're not in the provision of care and that you're able to manipulate the market. If you end up becoming the Jeff Bezos or the Sam Walton. out there. 

[00:15:32] Gina Bartasi: Yeah, well, so we have partner clinics who are very like-minded. We have other clinics that are not like-minded and they don't join our network, but there's a bunch of clinics that prioritize patient care and are very genuine about patient care. And they see a lot of volume from us now, a lot of volume from us.

So I think that concern of okay, if Kindbody sells and directly to the employers, they're going to keep all the business. We have too many other partner clinics willing to attest that that's just not the case. I think in the beginning there was worried, but we've been at this, you know, a year and a half, almost two years now.

And we have clinics again, that would attest to Kindbody treats is fairly, they pay well, they pay on time. Like there's just too many people out there advocating exactly the opposite. Now our job is to continue to improve member experience every step of the way. And so you know, we prioritize patient experience and we do think we hear from patients the way patients experience and go through that Kindbody journey is very different than many of the other primarily legacy practices.

There are some new clinics, again, that I think are again very like-minded in our peer group that we have a lot of respect for it's mutual, but going through. Kindbody utilizing our proprietary technology is a very different process than a legacy clinic where you fill out a paper chart, the nurse calls, you get your voicemail, you get to call them back.

They get to call you back. They get like all of that waste and inefficiency and telephone tag. That's endemic in the legacy fertility programs, as well as the legacy care navigation from secure navigate. The challenge with the care navigation firms is, you know, once you refer that patient to another clinic, you lose sight of them.

You don't even know if the patient showed for their appointment, much less, whether they had an ultrasound scan and for the employer that they don't even know if they're being double billed, they may have major medical and you could build that for them. You could build the ultrasound scan through major medical.

You could also build the ultrasound scan through your fertility care navigation firm, but there's a lot of waste in healthcare and in the fertility industry that we seek to continue to get rid of and, and operate more efficiently. And I think the employers, and I know the patients see that today, the member experience is significantly different and I use member and patient as the same thing.

Patients are the consumer terminology member is what employers call their consumers or their employees are called members. 

[00:18:02] Griffin Jones: So how do you scale this out at a, at a time when REI is, are a bottleneck with 1100 of them in the entire country, we have far more people that need treatment than we have an infrastructure to be able to treat them.

And so how. Are you able to expand how many people are able to be treated? What's the role of OB GYN is, or physician extenders in your model? 

[00:18:30] Gina Bartasi: Yeah. You know, I think everybody acknowledges today. You have to have a physician extenders. You just do there's, more than demand than supply.

And the number one thing that hurts a patient is having to wait 3, 6, 9 months for treatment. I would tell you that again, Angie Beltsos says, your question is about scale and how we serve up enough REI is to handle all of the demand that is Angie Beltsos's wheelhouse. You look at the physician productivity of her doctors and it's extraordinary.

One of her lead physicians did more than 1000 cases last year. That's extraordinary. Now you have to have the mindset. You have to have the support around you. You have to have the APP's around you. You know, again, I've spent 12 years in the industry and most doctors, not most, a lot of doctors I've talked to are very comfortable doing 150 cases.

And they say that, listen, I do 12 to 10 to 12 cases a month. I sell an IVF cycle for $25,000. And that's my model. I'm like, okay, well here, our success rates and heres, yours, and I just don't think patients, we have one mission and that is to increase accessibility for all. Fertility treatment has been reserved for rich white people on the upper east side of Manhattan.

 And the Bay Area and Beverly Hills, and we think there is something tragically wrong with charging $25,000 for an IVF cycle and insisting on cash pay. We think the model has to change. You have to bring down the cost of care. You can have a premium experience without a premium price tag. Griffin.

The question is, how do you do that? Well, you utilize technology and you use technology to replace everything that's transactional and healthcare scheduling appointment. We are the only fertility clinic that I'm aware of that allows you to schedule an appointment, move an appointment, cancel an appointment.

You can pay your copay. Like everything. That's transactional should not be done by an REI. It should not be done by your front desk manager. It should not be done by your RN. It should not be done by any of those people. It should be done by technology. How do you pay for everything else? You do it online.

Like this industry is incredibly archaic that there's all this telephone tag in doing simple things like paying copays and scheduling an appointment, or even hearing your medication. Like you're walking down the street, you're driving and a nurse calls and says, turn up or down your FSH drug. And you're trying to write and drive and you're, you know, it's incredibly emotional, like all that's bad.

So we own our own patient portal in our EMR. So everything's incredibly transparent. You can pick it up. And by the way, if you forget what the doctor said, you can go right back to your patient portal and remember what the doctor said. So we believe that we can get to scale and extraordinary physician capacity, but we have to have like-minded physicians, the physician that says to us.

I only want to do 10 to 12 cases a month is not the right fit for Kindbody. And if Dr Beltsos says we're on this call, she would say the same thing. And that doesn't mean that we want the physicians working harder. It does simply mean we just want them more efficient instead of taking down the patient's credit card or calling the patient's insurance company to help them understand why same-sex male couple cannot conceive and, and meet the 12 month threshold that your legacy benefits provider has in place.

Like all of that needs to go away so that the REI is doing things only the REI is capable of doing. 

[00:22:05] Griffin Jones: So I've got to decide because I'm not Joe Rogan with a three and a half hour format that I've got to decide, which of these four or five sub topics that I want to go down that you talked about. Let's start with the, you know, talk about like, we agree that we're at a point where we have to use advanced providers.

The debate is to what extent. And I just had the CEO of Mate fertility on debating this topic with Dr. John Storment and I don't know if that episode will drop before or after yours, but th but it's very much a debate of to what extent. And so what is the limit of, in your view of where advanced providers can be used or where trained non REI, OB GYN?

[00:22:50] Gina Bartasi: So you should know that I do not make any clinical decisions. I have never made any clinical decisions. I don't make clinical decisions today. Dr. Angie Beltsos our CEO of clinical. We'll make all of those decisions today. We use REI to do all retrievals in all transfers exclusively. Okay. Now we people know Kindbody and the knock is, oh, you guys have OB GYN.

Well, 20% of our revenue is GYN. We do complex GYN, right? I mean, again, what, what, what we don't-we prioritize the patient. Okay. We just do, and we think when you have an ectopic, the worst thing we can do is send you back to a primary care. Or if you have a miscarriage, the worst thing we can do is send you back to some doctor that doesn't have your medical record to go back and do a surgery that can be done by our OB GYN onsite.

You build an affinity with this brand and this REI doctor, you hear patients talk about autonomy. My fertility doctor, now I have to go back to my primary care doctor to get a D&C, like something's wrong with that? That's archaic healthcare that has all these silos and bifurcation. And no one cares about the patient.

Do my medical records follow me from my primary care, from my OB GYN, to my REI, to my mental health specialists, to my nutrition coach. The answer is no, unless you're at con body at Kindbody. We built the entire company around the patient and we said, okay, we're going to blow everything up. We agree that the current model is broken.

It's not anybody's fault. It's just history, right? That's how it was created. The REI set over here and the primary care it's because of how insurance pays for historically didn't cover fertility, but yes, covered major medical and maternity. But today, again, if you prioritizing the patient, the patient doesn't want to be shuffled to all of these different providers.

They just want a baby. They want it as affordably and as nicely and as kindly and as easily and conveniently as possible. And it's not that hard, but it does mean like breaking some traditional rules that says, okay, your OB GYN and your REI cannot be under the same roof together. We think that's silly and not patient friendly.

[00:25:11] Griffin Jones: Well, you talked about as part of that, that you're not going to make these clinical decisions. That's why Dr. Beltsos says she CEO of clinical. And I have to say I'm incredulous when CEOs say this a bit, because to me, it's not like there's not a perfect divide in everything. There's things overlap a bit.

And an example that I was challenging Dr. Andrew Meikle, on this from the Fertility Partners and how he gave an example of client is kind of like one that you talked about that happy doing 150, 200 cycles, the sweetest, sweetest people that really love their patients are definitely not charging them a lot.

Definitely they are below market rates. This individual sees all of their own you know they eat this individual does the ultrasounds for all of the patients. And like to me, that's where, you know, when you're saying like, you know, we'd get rid of these transactional things that the REI does not need to be doing.

That's something that the REI does not need to be doing in my view business guy, Grif that owns no part of his business, but if I own part of someone's business, I think that I would be making that call. And that's an overlap where the standard of care matches with or overlaps with the transactional, isn't it?

 Is a light bulb starting to go off about what branding really is, what its power is that it's not just a marketing tactic done by your marketing director. It's not just done for patient acquisition.

It involves the binding of the culture of what you're able to do, of how patients perceive you and how they want to come along and how your peers and prospective employees and prospective providers. See you, and are you the one that is in line with the current generation? Can you at least communicate to them or are you seeing as something less relevant, something less?

To want to be a part of, if that's the case, did you know that we have a full creative team? We have a creative director, we have an account manager, we have an operational marketing strategy. We have a digital strategy, all full-time people. Plus our production, people that know the fertility, patient marketing journey of not just the creative messages.

But where it goes and have a system, a fertility brand scale that makes it easy for you to not see, okay. It's just us trying to say we should become more current or more hip, more new, but that can actually say, okay, this is where we are at a 1.75. And this is where we want to be at a three point six. We have that all, we have that all Fertility Bridge and to start with us, we're not going to do everything for you at once, but just to look at what you've got and at least tell you what to do.

That's less than $600. It's the goal diagnostic. It's 90 minutes with myself, us giving you this framework and going through what you have and applying that discussion of positioning and branding with you and your partners go to fertilitybridge.com. Sign up for the goal diagnostic and represent your group in a way that is fitting with the practice that you're really trying to build, because I think you might be starting to see that all this brand thing it goes beyond just getting people in the door.

It's who you are. And if you want some help, we're happy to help you with it fertilitybridge.com goal diagnostic. Meanwhile, enjoy this conversation about branding with Gina Bartasi.

[00:28:46] Gina Bartasi: Well, so again, this has to go, this goes back to why Vios and Kindbody were so meant to be like the way that we were practicing medicine. And we thought about ultra sonographers doing ultrasound scans was that's how we were practicing medicine with Vios and Angie, and decided to come together, like how we practice medicine and how we prioritize the patient, how we have phlebotomist draw blood sonographers, do ultrasound scans.

You know, like what nurses do we was just together. Now I will tell you, Angie has upped the game. She's refined the process and we follow her lead. There is no, like, again, an Angie will be the first to say that. And the business people take a back seat and Angie is a business person, but she is our clinical leader.

So she decides patient flow, a number of nurses to REI. She decides all of that. Now, again, the reason that these companies came together so easily, We believe so many things. We were already practicing medicine. It's not like you had to take the client that you just mentioned that was comfortable doing 150 cases a year.

And you had to put that culture with this culture. The cultures went together just like this easily and seamlessly because we already agreed that truthfully, the REI is a subspecialist. This is a well-educated they've been in medical school a very long time. I have a hard time asking any of our REI's ,can you do an ultrasound scan? They'll they will do it. They're happy to do it. They've done it before. It's just, you know sonographers doing 20 ultrasounds a day and REI might, you know, do two a week to help one out. So it goes back to, you know, again, patient how the what's in the best interest of the patient.

Do you want somebody doing this twice a week or 20 times a day? 

[00:30:43] Griffin Jones: Well, let's talk about the best interest of the patient with regard to what you were talking about. Like you said, you know, what Dr. Beltsos has been able to do with physician productivity is incredible. I was just talking with just recorded a different episode, different topic.

We're talking about embryologist and it was like, these embryologists are burnt out. Like they can't do any more because, but the demand is that, like, we were trying to get everything we possibly can out of these embryologists. And so there is a tension between what the market needs, the patients need that you're trying to address and what the capacity of the workforce is able to deliver.

You said in the very beginning, something that I don't like when CEOs say Gina and I, cause I try to make myself choose, which is employees come first patients come first, which is declines come first or new employees come first. Do the managers come first? Or the customers come first. And so what, what, like when you're trying to meet a demand and meet the market, and we know that the market demands five times more than what the field's putting out, you're trying to meet that.

How do employees possibly come from first? 

[00:31:53] Gina Bartasi: And employees always come first. They have to, because the employees will take care. If you take care of your employees first, they will take care of your customer. They will take care of your patients. And that's when we're talking to doctors, you know, doctors say, well, I used to do that.

You know, we want the doctors to know that we can train and teach nurses and front desk managers and practice managers to be just as kind and just as empathetic to that patient that the doctor can. So again, employees always come first as it relates to the lab. Listen, there's a shortage of labor everywhere.

It's the embryologist, there's a shortage. We know there's a shortage in our eyes. We have to do a better job of training. We've been fortunate, you know, we pay competitively our team members get equity. That's not true for 90% plus of the fertility clinics. And so I do think it was really, really difficult for us to hire the first 12 months, but in the last 12 months there's quite a bit of incoming interest in I've got career opportunities at Kindbody.

[00:33:00] Griffin Jones: So then how, but I used to agree with the employees always come first and I'm trying to like, like actually live that out now. But I used to believe that Mark Spolestra said that we have it wrong, that we put shareholders first, then customer second and employees last, and it should be employees, customers, shareholders, because if you take care of the employees, they'll take care of the customers and now it'll make the shareholders happy.

 And I always did believe that until like, but what about when you get to this point that we're at, which is a bit historic, like this labor shortage that we're seeing, not just in the IVF, like every place in the market, but it's like, all right, I can take care of employees till the cows come home.

Anybody's employees can go someplace else. Right now. You're trying to, you're trying to keep them up. And meanwhile, there's so much money in the marketplace that people are coming to you and there's so much demand. And you're trying to like, how do you do that now? 

[00:33:54] Gina Bartasi: Yeah. I think again, you have to utilize technology, so you have to go through the lab.

Certainly. That's what we're doing in practice management. So our product people, shadow doctors and nurses to see what they do on a daily basis. That's repeated. Okay. What do you do every single day? That's repetitive. That should be moved to our EMR patient portal or somebody else now what needs to happen that we're probably not doing as good.

A job of Griffin is having our product. People shadow the people in the lab and it has to do with the sterile nature of the lab it has to do with I'm not even sure what it has to do with you know, Dr. Beltsos could tell us, or even Dr. Morbeck Dean Morbeck as our chief scientific officer. But we have to get arduous task and any task that can be moved to technology, to technology, and then you free up human labor.

We've been able to do that on the practice side. We have not spent as much time refining that on the lab and embryology side. I'm optimistic that more economies of scale can come. If you just spend time in the lab and say, what are you doing? That's repetitive. That should be moved to technology.

I do know now we've rolled out some new technology platforms to help kind of ease the burden. And then there's this, like, there's a, there's a training and an input of data and an expert and an export of data that is more time consuming for our embryologist than we would like. But you get through this kind of crunch time of about three months, anytime you roll out new technology or implement a new SAS solution, but we are constantly thinking about.

How we can use technology, whether it's our own or whether it's a third-party vendor to free up humans in this case, embryologist. But right now, embryologists are doing a lot of repetitive things that we think that can be moved to technology. Now, right now they're still biopsying, trifecta, derms, like a lot of their stuff.

They're still you know, cryopreserving oh, sites, they're still doing a lot of things that require extraordinary hand-eye coordination. And those things are, are not close to being automated. But there's still a lot of other things on their plate that can be automated. 

[00:36:07] Griffin Jones: Well, let's shift gears a bit and talk about what I really want to talk about, which is this global brand, cause this is the type of stuff that I am interested.

I am interested in brand. I'm interested in creative messaging and I think it is a huge mistake for anybody who thinks is window dressing. That is not looking at it at all correctly. And I want to know if you think that. Maybe exaggerating with this, but I don't think that kind of body could have gone into all of these different angles to the depth that you have without the foundation of the brand that you had built.

Am I overstating it? 

[00:36:48] Gina Bartasi: No, but you're a marketer and a brand guy. You sound like me. Like again, we knew it's not fertility, it's not IVF. It was intentional Kindbody wants us as humans to be kind to our body. It also does not uniquely say IVF. It could be egg freezing. It could be same sex. Like there's a lot of things that go into this name and this brand.

And it doesn't say Seattle, it doesn't say Charlotte, it doesn't say any particular city can be a global brand. But we thought about that from the very beginning, because I felt like healthcare was missing a room. Global brand. It's not blue. It's not pink. It's, you know, yellow, we call it optimistic, yellow, yellow is intentionally gender neutral.

A lot of people, if you do all of these customer surveys, which marketing people do a lot of people, don't they just say, here's what I believe. And I'm like, whoa, did you do any research or did you do any customer surveys? But if you do customer surveys on your thoughts about yellow, lots of people associate yellow with happiness, right?

Hope like there's a lot that goes into this yellow and this name and it's intentional. All of our locations is intentional. Do we don't have any hard edges in any of our clinics? There are no 90 degree desk. Everything is round there's again, a lot of thought that goes around this round desk, softening the edges.

There are no medical degrees on the walls. Our REI are highly educated. We don't need degrees from Brown University or Stanford on the wall. You'd probably as an educated patient, know that I went to Stanford or to I didn't. But so we do, we believe there there's huge power in brand and now, you know, We've been fortunate.

There's a lot of affinity for the brand. And so now we try to, we're always working to extend the brand. And so now we are, you know, we spray paint chalk every time we open a location, it's cool to be kind. Right. ‘Cause we have to remember in this busy world, and this is before the war and now there's a war and there's, you know, there's just a lot of challenge.

And so we have to remind people because it's cool to be kind like lead with kindness because kindness is contagious. It's like our yellow happiness, like, you know, just be kind you know.

[00:39:01] Griffin Jones: Brand driven CEOs have such an advantage that you being a brand driven. Like when you look at like, I think Sara Blakely, Spanx, Walt Disney Richard Branson, like these are brand driven CEOs and to you are Kindbody is the furthest end of the spectrum.

I actually have that spectrum, but the other end of the spectrum is people who think nothing about brand whatsoever and say, oh, we have to, oh, that's like a logo, a yeah. Like colors. Yeah. Like have our marketing director just, just do something like that. And it is everything that you do, and it's enabled you to go to, to all of these different places.

 And so I want to talk a little bit about like, how that. Moving along with the generations, because, so we made a scale, we made a four point spectrum of the fertility brand and decide on a one. This is your advanced reproductive surgical associates of Smithfield like that, the ones. And then the twos is like Patel, Fertility or, you know I'm trying to make up a Smithfield IVF, very on center.

And then a three is like the nicest of your healthcare brands got a familiar messaging and, and kind of body is the, is one of the only, so we ranked every center in the entire us and Canada kind of body is one of maybe like the only force they one or like one to three fours. And so that, like, you're the first kind of consumer brand in this space.

Talk a little bit about. 

[00:40:42] Gina Bartasi: Well, that's intentional. Right? First of all, thank you, Griffin. Second of all, it's intentional. It didn't come after the fact it was we wanted to create a consumer brand, by the way. You know, we also think now, like, and I know Peloton has been beaten up in the public markets, but we think about Peloton instead of soul cycle.

Like, we've talked about how magical Dr. Angie Beltsos says like, how can, how can we get Dr. Angie Beltsos to be Ally Love or Robin Arzon Jess King? Like, how can you, how can you make Dr. Angie Beltsos global, right? And so we are constantly thinking about the brand and about how we protect the brand and how we continue to do right by the brand.

How even in the most difficult, challenging situations, we're kind to each other kind to competitors. We call them peers. Peers is a more friendly term than competitors. So it's in our language, it's in our culture like how we protect each other, how we protect this brand, how we cultivate the brand.

But again, it was very intentional from the beginning when you come to any of our clinics, or even if you go to the patient portal, most patient portals are ugly. Most EMR is, are ugly. Everything when we should, at some point give you a product demo. When you come in to our product through the technology, everything is very elegant.

Everything is yellow. It's on, not everything is yellow because we have neutrals and other colors, but it is aesthetically pleasing, right? And so you can see all these touch points along the way. We predict your likelihood of success. We predict how many eggs we think you're going to get. We predict fertilization rates.

We show your embryos growing. We are completely transparent. And again, when you go into the clinics it's not white, right? There are no white coats. There are no white walls. There's no white paper. 50% of our REI's are BIPOC. I am incredibly proud of that because guess what? Our patients are 43%.

But it goes back between 43 and 50%, but it's intentional. If you really create a mission that says, we want to increase accessibility for all, then you have to have a brand. You have to have visual elements. You have to have clinics that look and speak to accessibility for all. And that's not white walls or white coats or white paper. 

[00:43:08] Griffin Jones: It of corresponds with the generations too.

So on our scale, we laid it across the generation. Like, so you picture the generations is like a news ticker, and it's not that a one was, was like one equals baby boomer. It's just that like the overlay of a one is that it was designed or, or lack of design for the baby boom generation. And a two was that baby boomer bit X and three was mostly acts a little bit millennial. And so the fours, which you're one of very few as is the the first brand that's for millennials and gen Z 

[00:43:49] Gina Bartasi: Yeah. Yeah. Again, a large portion of our new patients come from Instagram, look at Dr. Beltsos or Ruby Jelani or any of our doctors. And, and we encourage them to do that.

Like we are kind, but we're also fun and competitive and we're like, okay, who can, you know, create our competitions? Like could be great. The funniest Tiktok video, like, I don't know, we're having fun, practicing medicine, helping our patients build the families of their dreams and that doesn't have to be white and sterile and old, right.

It can be fresh and it can be fun. And so, you know, when we think about brand, we have competitions of who can create the most fun tick-tock video. The majority of REI is that got your one, two, and maybe even some of your threes are like Tiktok, like, is that tic-tac-toe what is Tiktok? You know? And so, but we are constantly thinking we want to be better than we are today.

All of us do. That's the competition in us. Okay. We have an extraordinary brand today. Like how do we take it up a notch? And we're trying to think about what's happening new on, on Instagram. And do we call our locations like as a con body ATL, is, is it Kindbody Bay Area? Do you start then to segment these markets or is it just one brand?

But we think about brand every single day. We think about culture every single day. 

[00:45:14] Griffin Jones: Talk about how those two are, are together, because I'm trying, I'm just finishing an article called the difference between Brandon and called where they, where they converge and where they diverged. And so I think like so many, I'm finally starting to get people interested in branding and creative messaging for like how they set expectations with their patients and how they get their team to be cohesive around something, as opposed to, they don't care about patient acquisition right now, because everybody's slammed.

That's how I started in this marketing field was marketing patient acquisition, but it's like, no, this is how you get people and like it as a part of something. So I want you to talk about the culture, cause I'm thinking like Gina, before I look at somebody's LinkedIn profile to like, see what they're, I know that they went to work for cause it seemed in the yellow, in the background.

And so talk a bit about how you use the brand for culture. 

[00:46:12] Gina Bartasi: Yeah, I think a lot of it starts with humility, right? The brand is humble. It's not, anybody's last name. It's not, you know and our culture really starts with this humility. Right? So those two things are ingrained. I think that's not just humility too.

It's a vulnerability to it. You know, it's also our brand and our culture. We do embrace risk. You know, we tell our doctors so I can brace risks, do something crazy on TikTok. And you tell a doctor or a scientist embrace risks. They're like, whoa, whoa, whoa, whoa, whoa. I'm a doctor. I don't embrace risk, except that if you teach them, we're not talking about embracing risks.

When it comes to a prognosis of an onco patient, we're talking about taking risks as it relates to the brand, as it relates to culture, allow yourself to have fun. Allow yourself to smile, giving devastating news, another failed pregnancy test is hard. It's hard. And we're so glad you're empathetic to your patient.

But outside of that, how can we make you smile? How can you be cheery and yellow and optimistic? And so we believe that there's a lot of similarities that brand and culture do go together. And I don't think our brand would be as successful if our culture wasn't so strong. And I don't think our culture would be so strong if our brand wasn't so strong.

And I think the other thing that I would say about culture and brand is team, right? I think too often, you know, healthcare, people and doctors in particular may think solo first, like I'm a doctor and at hierarchical and solo, and those are not things that belong in our brand or our culture.

We don't do anything singularly. Not any of us. And Dr. Beltsos would say the same thing and Beth Eschbach Greg Poulos, none of us do anything by ourselves. And that's intentional. We make group collaborative decisions and same thing with our brand. It's we invite feedback. We invite constructive feedback, constructive criticism, because we want to get better every day.

And again, that goes back to our brand and our culture. 

[00:48:15] Griffin Jones: And with recruitment too, I have to believe that that's giving you an edge because just look at, you, look at a one baby boomers. Who's answering your phones. Who's not even the answer who are the docs now who's buying in. And so I have to believe that, you know, it's like in these places that are like, oh, you know, we're busy as can be with.

New patients, but what is it like with people that like, do they want to come work for you? Like are they excited about, are they behind a mission together that they will go and express to their friends of like, this is who IVF and worked for and you better know about them. 

[00:48:53] Gina Bartasi: They are. And they do.

That's recent though. It's just in the last 12 to 18 months. You know, Dr. Lynn Westphal was our first REI and our chief medical officer. And it was hard even with Lynn's reputation and, and she has an extraordinary reputation and is a member of SARC, a legacy member of A\SRM and starting a phenomenal reputation.

But remember doctors I said are notoriously risk-averse. You encourage them to take risks and not like, whoa. And so in the beginning they Kindbody was, you know, another startup and, you know we started in a mobile clinic that was oriented towards the brand and service. We're going to bring care, whoa, Griffin, we're going to bring care to the.

You don't have to come to me. I'm going to come to you and the doctors like, whoa, whoa, whoa, whoa. You have a mobile clinic. You're going to the patient. We don't do that. Patients come see me. They wait months to see me. And I'm like, why are you bragging about patients waiting to see you? Like something's unconscionable, but a doctor would brag that you're you have these long wait lists.

Don't stop bragging, stop bragging. It's not good for the patients so. 

[00:50:01] Griffin Jones: That's thinking like an individual contributor as opposed to an entrepreneur though, because the entrepreneur wants to scale the individual contributor wants. Yeah. It's like, oh, sweet. I'm the best. 

[00:50:12] Gina Bartasi: Yeah, well, and again, I think now we have, if you count all of our providers, the APPS, the REI's the OB GYN, there's 65 or 70 of them.

Now, maybe it's 75 or 80, I'm losing, but there's enough now in the industry that they do call, you know, they do call and say, Hey, it'sKindbody hiring. We have in our slack channel, we have a new hire and there's a big referral network through the doctors in the embryologist. So it's gotten significantly easier in the last 12 to 18 months.

And then again, you look at these extraordinary leaders on the clinical side and again, both our scientific lab site, as well as our practicing. 

[00:50:53] Griffin Jones: I know the criticism that I'm going to get after this episode, which is I've been blowing sunshine for Kindbody for the last 15 minutes. And so no, I'm not because one, I can't evaluate you on a clinical level.

I'm not qualified to do that ever. And and even I'm not qualified to evaluate you all on many of the areas of, of your business model. I don't know. I don't know if they're a good or bad what my wheelhouse is brand and creative messaging. And for those of everybody listening knows that that's what I care about most.

And I'm not making this up, you could look at our scale. If you want, you can look at our spectrum. It's empirical kind of body is a four on that. And I think it is a huge advantage that the other networks don't have. Again, oh, you're blowing sunshine. No, I'm not. This is an advantage.

The other networks have a disadvantage of your there IGA. If anybody remembers the IGA soup or like a True Value, they bought hardware stores. Where kind buddy has the Starbucks advantage. I think it's such a disadvantage for these networks that are, that are going for scale to not have any of the advantages of scale that come from brand, which is not window dressing for all of the reasons that we just talked about the instead of it's we're Joe's coffee in Seattle brought to you by we're we're coffee roasters of Denver brought to you by so-and-so over here versus Starbucks where Starbucks, where Starbucks and that there's something about that, that, that pretty lady in green that you invites the customer to be able to recognize something that unites them, to be able to express it themselves, as opposed to just someplace else and the employees that want to and do work for there.

It's like, this is what we're about. And so when did that, when did you know that that was going to be a thing? Like when did you think about doing it the other way at first? Like, oh, well maybe we'll be a network. 

[00:52:50] Gina Bartasi: No, we were always going to establish a brand. We were always going to have these warm colors.

We had three focus groups, three dinners and three focus groups. So six meetings and we would pull the audience. Do you like yellow? Do you like purple? Do you like warm? Do you like hard edges? Do you like blue? Like. And this brand is where it is because we gave the brand to consumers, to future patients, to existing patients and future patients.

And this was before COVID, you know, we had in-person meetings, we sent out surveys. We still survey patients. We want to know, because I think if you, you establish a brand three and a half years ago, you ought to check in on it every four to six months to say, Hey, am I on the right track?

We do. We measure NPS. We are maniacal. We have a 90 NPS, which is unheard of in the healthcare field. It's definitely unheard of in the fertility field, but we measure every single we want to know from patients how we're doing. We want to know that patients have this affinity for the brand. Doctors and nurses and our front desk team to fill an affinity and a protector of this brand.

So, you know, thank you for the accolades and the kudos. If you were able to measure our clinical success rates, like we have a responsibility to report to the CDC and SART you will see that they are above the national average. Now they're above the national average because we're big proponents of GPTA, but they are in line with our peer group.

And I think that was, you know, everybody said, okay, you can build a brand, but maybe your clinical quality would have to sacrifice, oh, well, you know, how are you able to offer an IVF cycle at 25 to 30% less than everybody else? Like you use technology, you know, Dr. Nicole Noyes just joined Kindbody and New York and you and patients are now going to be able to see Dr. Noyes at 30% less than they were paying at Northwell at NYU. Okay. I am ecstatic about that. I am so happy for a patient because many patients that 30% additional charge would have been out of reach, much less patients that have to go through two or three or four cycles. So we continue to be on a mission to provide more accessibility for all a premium experience, without a premium price tag.

[00:55:15] Griffin Jones: I want to say something about somebody that I've been reluctant to say that about two other companies too. And the reason I haven't said this is either in an article or on the show is because I think that people will either think that I'm insulting them or that I'm propagating them. And I'm really not doing either.

I'm really just saying mucho ojo pay attention, like really pay attention to what they're doing. That I don't feel get enough respect and what, so I've made, like I'm saying, I don't feel like they get enough respect. What I mean is pay attention. And that's you all it's Fertility IQ at CNY Fertility. And and so like where you are in this journey.

I don't remember if it was Nelson Mandela or Desmond Tutu, who that says, you know, first they ignore you, then they laugh at you, who then they fight you, then they join it. Where do you feel you are on that trajectory? 

[00:56:05] Gina Bartasi: It's hard to group everybody in the same bucket, because I think, you know, the end, I think some are still fighting.

Some have already joined and then some are still making fun of us. Despite our clinical success rates. Despite we have 84 clients, they're fortune 50 customers. They're big blue chip customers. You know, we have a sign in every single Kindbody location. And as we have lots of art, because we think art goes back to the quality of the brand, but there's a sign that says underestimate me.

That will be fun. And so, listen, we don't mind, like I I've had a lot of criticism throughout my career. You get tougher at it. You get accustomed to the criticism because you're doing something new. So underestimate me. That'll be fun. 

[00:56:59] Griffin Jones: What is on the horizon for you all? What is Kindbody need to accomplish in the next year or, and more interesting like what's going to happen next with the brand?

[00:57:13] Gina Bartasi: You know, again, we've talked a little bit about it, but I think you'll see the brand globally. And I think you're going to see the brand more and anything Griffin, where we let go of the patient, if you prioritize the patient, but then you send the patient out for genetic testing, or you send the patient out for carrier screening, or you send the patient out for donor egg or donor sperm or surrogacy.

When we let go of our patient, that makes us nervous because we are maniacal about patient care. And we're not sure that all of the other people that we're referring the business to are as patient-centered as we are. Yes. We trust them, are they're our partner today, but I do think you'll see us extend the brand to other ancillary businesses where we may be outsourcing.

Now we're going to pull those services in house. You know, I want us to be a leading brand amongst same-sex men, amongst single moms by choice. We've done a really great job. I was going to say same-sex women, but we have a lot of same-sex women, men that trust this brand, but I just want it. I, again, we're, we're so oriented towards this mission to increase accessibility for all.

[00:58:21] Griffin Jones: Why didn't venture come into this before? So when I have David Sable on this show, we talk about private equity. They're buying clinics, it's their model to buy a clinic. Venture capital is looking for something that will scale. So they're normally looking at like AI or software, you know, other, other kinds of tech because they want that scale.

And many of them don't feel like, oh yeah, clinic model is something that we can scale. What how were you able to pitch this to venture to say, oh yeah, this isn't a private equity play. This is actually something that we can scale. 

[00:58:54] Gina Bartasi: You know, it probably goes back to track record.

I think venture capital people are fearful of CapEx, heavy businesses, like standing up for wall clinics, you know, before we hired a single doctor or stood up a clinic, we own our own technology. We invest in it. We have 55 engineers and engineering and it and dev ops. So there is definitely a tech play.

It's one of the reasons our doctors can be more efficient. They can see more cases because we're not doing all the menial work. I know the VC community, you know, and, and so it was significantly easier this time to raise money than it was five years ago or 10 years ago. So, you know, venture investors, all institutional investors, like pattern recognition and they say, oh, you know, gene has been able to do this before genus, you know, this is Kindbody is my third company and women's health.

It's my fifth startup, which just means I'm crazy. But you know, crazy fun. Like , it does get easier. You're able to build teams easier. You're able to raise money easier. You know, Kindbody has challenges like every other business that's growing has challenges. But today, when we see a challenge versus 10 years ago, in many cases, I know the answer, or I know the person who knows the answer versus when you're just younger or you're a newer entrepreneur.

You spend a lot of time evaluating the answer to that question that was just posed today. Questions and problems come up, but I'm like, oh, I've seen this one before. Here's what we should do. You know, and same thing with Dr. Beltsos and Beth Eschbach or Greg or Lynn or any of our team, like you have an incredibly experienced team with a long depth of knowledge and scaling other organizations.

And that's one of the things that's allowed us to execute this quickly in the short amount of time. This well is a Testament to the experience to this team. If Dr. Beltsos and I tried to do this 12 years ago, when we first met at PCRs and she had all these Christian Louboutin on, like, I am in love with this woman, I don't think we would have been as successful 12 years.

It'd be interesting to ask her that, but 12 years ago, we just didn't have that same level of knowledge of experience. 

[01:00:59] Griffin Jones: That's why my client services firm is completely cash growth because this is my learning speed. Yeah, no like it's my learning speed. I will probably do faster things in the future, but I'm really trying to nail the fundamentals right now.

And cash growth has allowed me to do that. So for those that raise so much money and do it so quickly, it's a. 

[01:01:25] Gina Bartasi: Well, I don't know how old you are Griffin, but let's assume that Dr. Beltsos, so are at least a decade older than you. And that's the experience I'm talking about. So does that help. 

[01:01:36] Griffin Jones: Help there's hope for the rest of us?

I will let you conclude, you know, our audience is REI, is its fellows. It's practice owners. There are a lot of PE and venture people that pop into this podcast when they're doing their, all of their due diligence and studying of the field. So how do you want to conclude to that audit?

[01:01:58] Gina Bartasi: Yeah. We've been incredibly blessed and I just want to thank I think the criticism makes us stronger and makes us better. And then those that have been huge, enormous cheerleaders. Thank you. Thank you, Griffin. It's been great for you to come to the industry as well and really elevate marketing.

I was a marketing CEO, a brand CEO, and so it's good to have other cheerleaders that talk about marketing and brand in the field. So thank you. Thank you. We've been blessed and. 

[01:02:25] Griffin Jones: With the field was crying out for a D student to come in and build a client services firm slowly. 

[01:02:32] Gina Bartasi: Love it. Thank you, Griffin.

[01:02:34]Griffin Jones: Thanks for coming on. I appreciate it. Take care. Bye.

The Fertility Website Rip Off: 6 Tips to Protect Doctors

By Shaina Vojtko and Griffin Jones

Let’s just hope fertility doctors aren’t paying attention

Most fertility practice owners redesigned or built a new website in the last decade, and they might be getting hosed.

The website development-marketing problem isn’t unique to fertility doctors. If you’re the executive of a fertility company or any business for that matter, these tips are equally relevant to you. There’s just an established category of marketing companies that takes advantage of physicians and some of them have concentrations of fertility doctors.

The problem: paying for website maintenance with a big marketing markup

Your new website project is finally complete and search engines are starting to reap the fruits of your labor.

Now, regular updates and maintenance are crucial to keeping your site running at full capacity. In most cases, the first touchpoint a prospective fertility patient has with their provider is their website.

Security is the primary reason that website maintenance is so important. When you don’t make website maintenance a priority, it’s easy for hackers to find vulnerabilities. With a few clicks, they can easily target an outdated site.

As a marketing tool, your website was designed to provide information and turn visitors into new fertility patient inquiries. An up-to-date site and content management system (CMS) demonstrates credibility and communicates that it is safe for visitors to submit their information to you.

And because security and maintenance are such a need, some marketing companies take advantage. They bundle in low return marketing services and mark up what should be a low cost expense.

We’re not talking about small firms with good hearts that struggle with keeping the mission (scope) from drifting, while not being so rigid that they fail to help the client when they could meaningfully do so. That’s a natural tension that all client services firms face.

No, we’re talking about large medical marketing agencies whose business model is undeserving doctors by scaling their overpriced packages, including arbitrary blog and social posts, or ambiguous ongoing Search Engine Optimization (SEO).

Make investments, pay expenses, and know which is which.

Remember a $10,000 expense that generates nothing is more expensive than a $2 million investment that generates $5 million. Return is more important than cost, though the higher cost the bigger the problem if there’s no return.

The best way to keep your fertility company’s website updated and protected from hackers, while not overpaying for it, is to have a website maintenance package that is separate from hosting and from your marketing investment.

Here are six tips to help you:

1. Your marketing agency can hire a developer, but don’t hire a development agency to do your marketing

Digital marketing agencies and website development agencies were usually one in the same in the early days of the internet. Because each has become so specialized, it’s far more effective for them to partner than to try to do it all.

Fertility Bridge, for example, has done, and will do, plenty of website builds and redesigns…but we are not a dev firm.

For the convenience of our clients and for the continuity of branding and messaging, we have preferred developers on our contract team with whom we’ve partnered on many successful fertility websites. We can use them and include the cost of development in a one time project. Or we can use the client’s developer while we provide project management and design.

2. Quote maintenance separate from build

Ask for the cost of ongoing website maintenance, including security and routine updates to be quoted separately from the site build.

You may need continuous improvement in marketing and business development but keep those separate from the maintenance of a new site. Again using Fertility Bridge as an example, after we redesign or build a new website, the minimal maintenance agreement is between the developer and the client, completely untethered from the client’s engagement with us.

3. Budget for both website hosting and website maintenance

While both have associated costs, web hosting and web maintenance are two separate functions. Both are necessary for the health and existence of your website. The main purpose of web hosting is to get your website live on the internet so people can access it.

4. Keep the hosting cost the smallest

When budgeting annually for maintenance fees, don’t forget to budget for hosting costs, too. You can expect to pay anywhere from $25-75 per month for hosting with an annual contract from WP Engine.

In order to keep your website online, you’ll need a reliable web host. While there are plenty of options for hosting providers, make sure to pick one that is designed for speed. A fast loading website is key to a strong user experience and good Google rankings. We recommend WP Engine or DreamHost but strongly encourage you to take the advice of your developer as they are well versed in the specific needs of your website.

5. Use this checklist to select a good maintenance plan

A good maintenance plan covers security but should also take into consideration routine content updates and changes to website pages.

  • WordPress Core Updates

  • Theme and Plugin Updates

  • Security, Uptime Monitoring, and Hack Clean-up

  • Regular Back-ups

  • Access to Support Resources

  • Content Management*

  • Performance Optimizations

While package costs can vary significantly based on the level of customization and care needed to handle your individual site, it is reasonable and typical to see costs that range from $500 annually for lean updates to $5,000 or more annually for robust updates.

6. *Have someone on your team that can update content

Minor content updates are a tension point between fertility companies and their agencies. Minor updates are those like

  • Adding office hours for satellite office on location page

  • Removing staff member from about us page

  • Changing PGD to PGT-M on old blog post

  • Deleting Zika pregnancy warning from home page

Sporadic requests like these are not a good use of the developer’s time to receive, nor yours to send.

You don’t need an employee to create major pieces of content, a marketing agency can do that. You need someone inside your organization who can make content updates to your website. If you’re a giant fertility company you may have a whole team, but even a small REI practice needs at least one person who can access your website’s CMS.

*Being able to make content updates is not the same as having the relevant skills to properly maintain a website. If your team member causes an error while updating a page, you need to have someone retained that can fix it.

INVEST FOR RETURN, KEEP FEES SEPARATE

Sometimes fertility companies have to invest a lot in marketing, but it should be for the return of future value. Don’t buy services you don’t need because they’re bundled with something you do need. Keep website maintenance separate from build, hosting, and marketing. Train someone in your organization to make minor updates to your website. Follow these six tips instead.

If you think your fertility website is preventing you from reaching your business goals, consider Fertility Bridge’s strategic guidance to determine how it plays into a greater market or brand strategy.

Start your business assessment with our Goal and Competitive Diagnostic for just $597 here.

126: Increasing REI Productivity with Balance with Dr. Kutluk Oktay

Dr. Kutluk Oktay on Inside Reproductive Health

This week on Inside Reproductive Health, Griffin Jones and Dr. Kutluk Oktay go down the rabbit hole on the meaning of work-life balance. They discuss Dr. Oktay’s approach to limiting his patient load to spend more time on research and how that affects his motivation and quality of life. This conversation culminates in tips on how to be more productive and comments on developing leaders in your organization so you can get the balance you deserve. 

Listen to the full episode to hear our perspective on: 

  • How to fill your schedule

  • What makes good leadership

  • How does social media fit into ‘self-care’

  • How to approach work-life balance

Dr. Kutluk’s Information: 

Linkedin: https://www.linkedin.com/in/kutluk-oktay-md-phd-909b656a

Website: https://www.fertilitypreservation.org/


Sponsored by: 


Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.

Mentioned in the Episode: 

Profit First by Mike Michalowicz: https://profitfirstbook.com/

Need help attracting the right people to make your practice great? Connect with us at fertilitybridge.com


Transcript

[00:00:00] Dr. Kutluk Oktay: I always think that our colleagues thought they were doing the best 25 years ago, but we look at what they've done.

We kind of roll our eyes, right, if we thought that it was today. So I always imagined myself looking at myself 20 years from now.

 

[00:01:01] Griffin Jones: The episode, I just recorded one a little bit differently than I thought it was going to go. I thought it was going to be about pursuing a career track in academic medicine. And it's a bit of that, but it talk more about what it means to have a meaningful and well-balanced career. My guest for today was Dr. Kutluk Oktay. He's at Yale. He's a professor of OB GYN and reproductive sciences. There is the director of the laboratory of fertility. The preservation and molecular reproduction there, he has published over 200 manuscripts and book chapters. His research has been funded by the NIH for almost 20 years.

And we talk about what it means to have a meaningful career for someone. Not that there's one path for anyone, but giving the listener an idea of what it's like to balance this and how you incorporate different interests, not just in the work part, but all of the things that happen when you're not working, you know, like your family, your health, your fitness, your hobbies, if you have those.

And that's what this episode explores in a way that's a bit more meaningful than just talking about self-care as a platitude, which I can't stand. And then talk a little bit about that in the conversation, but I'll let you decide. So I hope you enjoy.

Dr. Kutluk Oktay, welcome to Inside Reproductive Health. 

[00:02:22] Dr. Kutluk Oktay: Thank you. Thanks for having me. 

[00:02:25] Griffin Jones: I'm interested in the topic that you and I were snowballing, the idea that you had about the ability to have it all as an REI practitioner and specifically with regard to working in an academic setting.

And so before we go into how one is able to have it all, I believe that that the topic you had phrased as was having your cake and eating it too. So let's start before we talk about how to eat the cake, tell us what the cake looks like. 

[00:02:59] Dr. Kutluk Oktay: I'm not sure if there's a cake in this instance, but well, cake is I think hobby, the first trick is that, you know, you need to love what you're doing and if you're doing what you're doing as a job, you know, it's not a cake, right? So it's a cake because it tastes good, then you enjoy it. But even having too much of your favorite food would not be good for you even eventually get sick and tired of it.

So I think to me, cake is what you love doing. And the cake is one that's made with balanced ingredients and not one flavor's overpowering the others and a healthy cake a healthy cake. So you have to bake your own cake. You have to come up with your own recipe. If you have the wrong recipe for your cake you know, you may so soon throw up everything you had eaten so the speak.

[00:03:55] Griffin Jones: We talked about a balance of ingredients. What are some of those ingredients look like? 

[00:04:00] Dr. Kutluk Oktay: Well, you know, a little bit of flour and I'm just getting. 

[00:04:03] Griffin Jones: That's a different show. That's Inside Reproductive cooking. 

[00:04:07] Dr. Kutluk Oktay: I know I just want to make stuff, you know. During the time of COVID we are always disoriented and the wrong show. Okay. Because I do some cooking and that's part of the ingredients, right.

You need to balance your life as much as your work life. And you, we cannot be a single channel or a single ingredient cake. You know, if you just made it the flour, no sugar who's going to eat that cake. Number one is to have their idea of ingredients and not to build on one ingredients.

So maybe if you want to start diverging from the cooking analogy right. In my case, I'm curious, right, because I'm both a scientist and clinician, and I always question, I always question and say, there must be a better way of doing this. And I always think that our colleagues thought they were doing the best 25 years ago, but we look at what they've done.

We kind of roll our eyes, right, if we thought that it was today. So I always imagined myself looking at myself 20 years from now. And first of all, try to always improve things. And so that kind of makes it fun because to me, nothing is routine. Everything is a challenge, the challenge to do better, do better for your patients and do better for the field.

 Never stagnate. And so the ingredients for that reason is of course it's a good patient care, but innovation and always asking, you know, what can I do? What question can I ask? And how do I study that to take this current approach to the next level? 

[00:05:59] Griffin Jones: When you talk about a balance in work life, do you mean balancing life within work with life outside of work, you know, family and hobby balance?

Or do you mean balancing what you do within work? 

[00:06:14] Dr. Kutluk Oktay: Right. So in your life different index funds. One is the work index funds that you want to track the optimum rate of increase in your quality with balancing components of your work. And then you have your family life. Then you have your hobbies and then you have, you know, another balancing there.

And then together you balance all of these together. So you have balancing the compartments, but then you are so the life balance. So when I say work life, not work life, but your life at work. I'm talking about, I personally, if I just saw patients seven days a week, I would probably burn out in two weeks.

And because that's not how my brain functions. Right. And as I said, that, pausing and asking questions, how can I do better? And if you just constantly see patients, you cannot pause and ask that question. So for me action versus introspection in our case, introspection is we could say research because research is introspection to me, you know, asking questions about what you're doing, whether it's right or not.

And how can I just like, how can I be a better person? So for me, there has to be a balance between actually seeing patients doing surgery, administration research teaching, and doing yoga and during your breaks, whatever. If you're doing that to work you have to find the right balance for yourself.

You might be a warrior you know you see patients, seven days a week, I admire you. But I don't have that skill. I personally my approach is I focus on one patient at a time and I put a lot of energy and time in one case. And I probably can do, I don't know, certain number of cases like that in a given time.

And then I turned my energy to more academic questions who would, which would, I answered correctly, benefit those patients or the patients in the next generation. So I have to balance the work like that. And then, and then leave time for things that make you relax outside of the work and that's going to be different for everybody.

But to me family is important. Hobbies are very important, exercise, you know, well, if I don't exercise properly, I could be staring at my screen for five hours and producing nothing. But sometimes you take part in a health to hit that, you know, hard tennis session. And when you come back in three hours, you do work that you would normally do in three days in two to three hours.

So, I mean, time is a very expandable thing. Reality, we think five hours equals five hours. Now, you know, five hours could be 72 hours, or it could be three minutes depending on your mindset productivity energy level. So you have to do things to expand those three hours. Again, to buy your times for other things.

[00:09:22] Griffin Jones: So let's see how many different metaphors we can use on today's episode. I like the index fund. Let's stick with that because you have your total resource allocation in your portfolio. In this case portfolio is the total amount of time and you have a number of different index funds within that portfolio and then with in at specific index fund, you have allocations of shares to different different companies in one index under, or perhaps even across different fields. So let's stick with the work index fund and then we'll, and then we'll move on to the rest of the portfolio. You talked about saying, you know, seeing patients every day, you would burn out within two weeks.

So research helps you be introspective at all. Teaching helps you to improve. Why do you feel that the academic route has been best for you in, in, in serving those different areas? 

[00:10:23] Dr. Kutluk Oktay: Right? I think I have to think about, you know, an artist. Right. You know, why did being a you know, impressionist help me kind of why, you know it's just, I think part of it is you have certain tendencies, 

[00:10:35] Griffin Jones: Let me rephrase that because rather you have your tendencies, why do you feel that working at Yale was more accommodating to your tendencies than maybe if you had gone and worked for a private practice or a network, or maybe if you'd gone somewhere else in the country, why do you feel that working at an academic division suited your tendency better?

[00:10:56] Dr. Kutluk Oktay: I'm not necessarily advocating for or against any company or any setup or private practice and all that. I think you could have a private setting but you could affiliate yourself with an academic Institute and you could still follow by the same index fund so for me. 

[00:11:13] Griffin Jones: Would it be the exact same index fund though?

Or would it be like Fidelity's version of what Vanguard did? Well, you know, it's pretty much the same thing, but the expense ratio is different and there might be some fees that I don't know about. And can you do it the same way? 

[00:11:30] Dr. Kutluk Oktay: I dunno. Yeah, you're right. Their management fees could be different.

And so I, maybe there are different, you know, they may not be as broad based. But I think the key is to think creatively. I think we see examples of these major private enterprises. You know, turning starting fellowships doing you know, academic investments with their private money, et cetera.

So within that, somebody who's interested in boats can also find home. So it's not necessarily, you know, Yale versus some major and right for the private practice, but I think the formula, so in the end, yes, you are right. That not every enterprise would be accommodating right. To somebody who wants to spend time on research.

So first of all, you have to find that study for yourself. But second thing is you may have to create that same for yourself. And you know, if you're attracting research funding one more or the other, or you have some you know, you have some charity or something that's you can attract money and other different ways than you can set up your lab, even in a major commercial enterprise nevertheless in academics it's easier, but it used to be easier. Let's say because academic centers are also facing a lot of financial pressures. So I don't think there's one perfect solution in that sense.

[00:12:53] Griffin Jones: Why do you say used to be easier?

[00:12:56] Dr. Kutluk Oktay: Well, I think if you listen to people for before us and when NIH funding rate was something like 50%, every other grant submitted would be funded and the universities received a lot more government funding, state funding, they had more money to throw around for research and free up there faculty. So those resources have been over time restricted. So with the managed care managed care squeeze as well. So a lot of academic centers you know, they're pushing their faculty to work, you know, similar hours to sometimes, you know, privates centers. And I think in our field it has become a problem and a lot of good any centers have lost their REI divisions and because financially it didn't make sense to a lot of them.

 Must create it Yale in one sense that Yale department of OB GYN and reproductive sciences as always being a pro translational research always support it clinicians with scientific interests and always created time as much as possible or supported them so that they can get funding.

So there's still departments like that somehow, but not as mad as many of those. So I'm lucky to be where I am right now. 

[00:14:16] Griffin Jones: Yeah. Well that changes things for the people that go into work for those places. Don't they, if what they wanted out of an REI division was to spend perhaps less clinical office hours, more research hours if they are starting to see more of the push that, well, we need you at this clinical capacity, no matter what do they lose some of their recruiting edge? 

[00:14:45] Dr. Kutluk Oktay: I think so. I think academic centers especially at the more advanced level you know, junior colleagues, they still, I think are attracted academic centers because they need to pass their boards. Maybe build a little bit of name for themselves, but I think there's a difficulty in recruiting, more senior people and and losing a junior people when eventually they have acquired, you know, certain credentials and skills.

So yes, I think there's a brain drain in academia, especially in our specialty. You know, there are still mechanisms of supporting these like your productive scientist development program wore her, like Yale has this. So we have number of faculty who are on these tracks with protected time.

 And then we see that there are some, you know, rising stars because of that. You had one of our colleagues on your show and there is still opportunities, but you know, if you compare, academia in terms of salaries to a private practice you know, we are all aware of the differences but, you know, I think the medicine, or especially our subspecialty is not something that you want to pursue because you're only interested in the financial aspects.

I think in that case risk benefit ratio is not that great. You really have to love that the path you have chosen. So as I say, somebody who's likes to do a lot of introspection through research will not be happy in that continuous flow of academic clinical practice. 

[00:16:16] Griffin Jones: What advice would you give?

Because a lot of the people that listen to this show are fellows, and some of them might even want to come work for you. So the advice you give could be used against you, you got to remember that, but people are listening across the country. And in other places too, for that matter. And so what, what advice would you give them to investigate if the program they're interested in potentially working for really does meet. What they want in terms of research in terms of protected faculty time, or if it's just kind of a smoke screen, for lack of a better word though. I'd certainly don't mean to say it's so sinister for you're just going to be a workhorse clinician, like you would anywhere else.

What advice would you give fellows for sniffing that out as they determine what program they want to work for? 

[00:17:11] Dr. Kutluk Oktay: So going back to financial and knowledge, I would say invest early, you know, start putting in your 401k. Well, they were early, right? I think that should start when your residents, because if you are number one, you think you are interested in research.

I usually don't like to use term research to speak on cliche whether what it means, I mean so that's why I used introspection analogy, but you're more introspective, inquisitive. You want to approach more creative side of what we do. I mean, clinical creation is also important.

I think I have to start as a resident, maybe even a medical student building that those research skills. And so that, you know, when you hit fellowship, you are maybe a few steps ahead and you can do things and enduring fellowship that could prepare you to be more competitive for an academic job, which would enable you to, you know, get funding early.

And once you secure some funding, then you have more support from these institutions to have more time. So it's a self-fulfilling prophecy, you know, like you start with know to write, to propose, to think eventually you're not going to produce anything. So you have to preempt, I would say, you know, just decide on your career path, not first year of fellowship book.

Oh boy. Maybe when medical school or first year of residency and build those skills and portfolio. If you're interested in clinical research, start working with somebody to build have publications and understand the skills. If you're interested in basic research, same thing and hit the ground running.

And so that's number one. Number two is, you know, there may not be a lot of academic jobs that you can negotiate necessarily about. If the other alternative is working for an academic center and like working for a private practice, but every reduced salary, you may. If they give me this I'll work for academics.

If they don't, then I'll just stick with private practice. I think they need to have a good negotiation. Maybe allow them themselves three years of maybe protected research time in which time they can apply for various mechanisms for junior faculties. As I said, there's a productive scientist development program.

There's the Warhol from NIH and there could be other mechanisms. Most likely they get that on board and then they can build on that. Then start getting, you know, bigger grants, et cetera, if that's what they're interested in. So that would be my general guidance. 

[00:19:51] Griffin Jones: So that negotiation happens for the employment agreement.

This is the amount of protected time. You have this when you're negotiating the employment agreement? 

[00:20:01] Dr. Kutluk Oktay: Right, I mean, you know, some institutions are like, Very rigid, right. And say, okay, you're coming as an assistant professor, unless you get a grant, we'll give you, or, you know, .5 FTE for you to do whatever you want with that time.

Some institutions are more rigid. Some institutions maybe looking for they're missing that we've been talking about portfolios, et cetera. Maybe now let's go more towards smaller. I mean, building a department is like building a national soccer team, you know, like you have to put the people with different skills in different positions to lead, and maybe they have a lot of strong clinicians, but they need somebody who's promising who's going to move the field.

So if you can show them the portfolio like you've done in your residency, you published three key papers. It shows that you are a promising person. Okay. Going back to the investment. So this is a low risk investment for us looks like, but he or she has done during residency. Imagine if you give her time during as an attending faculty, what she could do.

I mean, it's going to depend on the job, but if you have already built some portfolio, it will be easier for you to negotiate.

[00:21:13] Griffin Jones: Okay. So let's move on to a couple of the other index funds in our portfolio. We've talked about what would the actual work-life the allocation of work.

Let's talk about the rest of the allocation of life. You could family as its own index fund. Hobbies would be its own index fund. Health and fitness would probably be its own index fund. And so of those other three things, which, which do you find sharpens the saw most for you? And by that, I mean, gets you back.

You mentioned if you play around a tennis that you can be exceptionally productive afterwards. So which do you find reenergizes you the most quickly?

[00:21:59] Dr. Kutluk Oktay: I don't think anyone matters individually because in the end this is the total amount of assets you retire with. Right. So I don't care which one built that fund.

I think it, again, it's balanced and it's also depends on the day. Right. But you know, I can have the same pleasure as going, picking up my daughter from school, let's say, during the lunchtime and bring her home and chatting whatever, as a you know playing a tennis match and kicking the rear end of a right.

You know, long-time rival in tennis or something like that. I think it also depends on your chemistry that day, too. Right. So so I don't think that there's a formula for one person, but whatever keeps you balanced. But I tried to keep these things going. I agree with you that exercise a regular exercise is important.

I also personally do yoga regularly. I've discovered this maybe three, four years ago. And it's a really, it balances you in some things. Some days you have 10 minutes, you do 10 minutes, some days you have more, you do more. So not only exercising of body at the same time, you're exercising your mind in a different way than when you're reading or doing experiments or seeing patients trying to solve a clinical dilemma.

I think your mind, your brain also needs stretching. So if you only stretch it in one direction, it's deformed. So you know, like seeing patients at stretch stretches this way, we will research stretches this way, but if I do yoga this way, you know, exercise this way, family that way. So you're going to have more space.

So for me, you know, it depending on how things are one may do better on day am. I may do better the other way. 

[00:23:43] Griffin Jones: I didn't think that I would do an Engaged MD sponsorship read for an episode on work-life balance. And then I got to the end of the episode and I'm like, no, this is the meat and potatoes of what you want from someone like Engaged MD. One of my guests and I are talking about the junk bonds of work that go into the work life allocation, the junk bonds are those things that are monotonous tasks that should be done at scale, should be done with software, should be done ahead of time, should be done at the convenience of the user, but aren't. Things like repeating the same information to patients to teach them things that are coming in their protocol.

The same legal forms, except you're tracking down one for this patient. And your staff is basically law clerks because they're tracking it down for another patient. All of these things that should be done at scale, that should be organized in a platform. And that's Engaged MD. That way you're spending your time with the most valuable minutes possible tailoring the experience to the patient's needs.

They know what you're talking about because they're well-educated and you're not acting like a darn paralegal go to engagedmd.com/irh, but only if you want 25% off the implementation fee, if you do, if you go to engagemd.com/irh and you select. You heard them on the show or you heard them from me, you'll get a few bucks off of your implementation fee and it helps us to create more content and give you more resources like this, but you'll also be getting time back to make life better for you, for your staff, for your patients, because that allocation is not infinite.

The junk bonds have to go. And the meaningful work and the meaningful things that we get out of life have to stay, go to engagedmd.com/irh and get some of your time back.

 When you said at the end of the day, it's the fund that helped get you rich was the most important. And in this context where we're talking about rich in life, as opposed to material wealth, but that can be a part of it.

And I think that the question people need to get to this allocation answer is what does it look like at the end of your life? And what, what do you think you'll regret? And I do believe that there are people like Jeff Bezos and like Elon Musk that I don't think they're going to regret, not spending time with their loved ones that much.

 I really believe that those are people that will regret if they haven't gotten to the absolute limit of their pursuit. So I do think that is possible for most of us though. I don't think we're going to look back and say, I wish I worked one more day. I wished that I had taken that meeting.

I wished that I had done that for most of us. I believe that we're going to either regret not having pursued something else that was meaningful or spending more time with our loved ones. But what we will regret if we just sit on the couch and do nothing and we don't, and we don't become better at our craft.

And so now you have more things competing for time. Potentially what I think has to go is the things that don't lead to any one of those things that have been decided as meaningful, meaning candy crush, video games and not to say that all of those things can never be meaningful, but I I'm talking about the things that don't fulfill our, our biggest interest in the form of hobbies that don't make us closer to our family.

That don't make us better at our craft. You know, the YouTube videos that I think those things are the things that have to go and if you want to have a balanced life, you really have to, you have to protect even more. Don't you, in terms of your time allocation. 

[00:27:44] Dr. Kutluk Oktay: Absolutely. You've got to get rid of the junk bonds, you know so penny stocks, whatever exactly.

I mean, I'm not saying I have an ideal situation here. Yeah. As you said, you know, watching TV, you know, Fantastic movies that you can watch and great sports events you can watch. But if you can, if you're consuming a TV three, four hours a day, the social media Instagrams and things like that you know, you're already, what is that time coming from a lot of those other components, right?

As you said if you think that you fulfilled everything else and you still have free time, congratulations to you and you must be in a different dimension, but go ahead and invest your time into other things. Perhaps one of the things that I do is, yeah, I rarely watch TV, for example, I'm never on social media.

I'm very selective. For example, I mainly use LinkedIn, but that's select, maybe I will post once a month. Maybe we'll our operation we'll do an Instagram post once a month. As you said that the social media could be poisonous in that sense. You know, obviously if you have a professional operation, I think this is more for private practices.

 They do all that stuff for you that can spare you, right. In terms of business marketing. 

[00:29:11] Griffin Jones: Well, a lot of people think that I am just ubiquitously pro social media and I approach life as a consumer and a business owner. Not always through the same exact lens. It's important to look through both lenses, but sometimes they are different as a business owner.

I can't get romantic about where my client's attention is. My perspective client's attention, or in the case of providers where their patient's attention is, I have to go where that attention is, and I have to speak to people where they are. But as a consumer, I don't need to be watching what my friends are having for breakfast or some political debate between two people that have no business commenting on policy one way or the other. And I think that has to do with the junk bonds that you were referencing. It's not for me to say this. This is exactly a junk bonds. Although I think generally I could speak to it and generally be right, but it's going to be different for people's allocation, but people do need to get rid of that first, because there's never going to be enough time for all of the other. 

[00:30:19] Dr. Kutluk Oktay: Right, I mean a social media. You're right. There's a business function of it. As I said, you know, you can use that, but otherwise it's designed to be addictive. I mean, it's a drug, so we just, the more we take it, the more you'll be evicted and it's a war text. You'll be socked in there. So, you know I was always scared of that.

[00:30:38] Griffin Jones: Did you think in these terms, when you were building your career outlook, what did you think as you took your first real job? Or did you think, well, this is how I want to build my life. Or did you start thinking about terms like work-life balance after, after your kids started growing up after millennials started talking about it all over the place?

Is this something that a focus that came to you later on? Or did youset out to build your career in a certain way?

[00:31:08] Dr. Kutluk Oktay: I think cliche, right, that's what they say life is what happens to you when you're busy planning. And so obviously, no, but I mean, my goal was always to have fun and that if something is not giving me fun, I'm not saying, you know, fun, meaning you know, I'm going to be playing cards all day or something, but there has to be fun.

Right? So when I followed my own principal, it just naturally happens. I try to do my allocation based on that, but of course, you know, the the more you live and see the more wrong steps and missteps you take, you realize that, oh, you know, I shouldn't have gotten that waste your next time. You're better trained the mouse.

You don't get into that trap. Yeah, I don't think that you can do that allocation at birth. 

[00:31:58] Griffin Jones: Well, maybe that's what we're starting to see more of maybe not at birth, but starting to see it younger and younger. And I wonder if that's the difference when we talk about millennials wanting work-life balance, one of the responses has been, well, all the generations have wanted work-life balance.

It would have been great to have, and surely millennials are not exceptional as humans in the sense that they are the only ones that want balance between their work and their hobbies and their health and their fitness.

[00:32:28] Dr. Kutluk Oktay: Well, I think there expectional, I admire millennials you know, like they're the homodeus.

[00:32:33] Griffin Jones: What's exceptional about them? 

[00:32:36] Dr. Kutluk Oktay: They've got all the skills, you know, like we didn't grow up with a giant life pop med, you know, the internet, right. We came into that. So they have this huge life, bob mitt on internet. They can, they can get their answers to everything. I mean, one question is now, how necessary is the classical schooling system?

And you know, you can get all the information. Of course, the skill we need to teach them is to objectively analyze what they see on the internet to scrutinize it. But my 15 year old has more wisdom than I had when I was at 35, because of all the giant global library that they have at their disposal.

 So they figure it out. When I figured it out at 35, they figured out that 15, of course they don't, you know, like, why am I going to be a doctor? I want something that offers me more balanced. I'm going to plan something so I can work from home or, you know I'm going to boost start-up I don't want to work for anybody else.

So I think that's where I'm saying that they have that kind of long view. They don't have the classic on the standing of her going to working for somebody it's still the right. Of course that's going to create some kind of anxiety in that generation because you know, there's so much competition for the independent space.

So it's an interesting experiment and I'm waiting to see how it's going to end. You know, like I lived there 15, 20 years, we'll figure it out. 

[00:33:57] Griffin Jones: So I think that's what makes them accept. It's not the desire to, because you yourself have talked about that desire, but it is exceptional that they are coming into the work force with a picture in mind of what work-life balance looks like.

And they are willing to prioritize it in terms of walking away from offers or quitting jobs or who they go to work for. And your point is interesting about how the accelerated learning from the digital age has been a part of the accelerated expectations, right. You hit on the accelerated learning what you knew at 35, your 15 year old knows.

I think that's all also true for expectations of, oh, if this is what a 35 year-old drives and what a 35 year old makes in salary. And this is what I want coming out of college too. 

[00:34:53] Dr. Kutluk Oktay: You know, I don't know if it's some kind of enumeration issue, but definitely they have I think you know, more global view on things and the priorities.

And so, you know, maybe you know, maybe they don't think that you need to sacrifice your life because life is the most, you know, most valuable commodity. To you know, have a luxury car, right. And I think they're so globally connected. They experienced the word globally and you know, they have other ways of enjoying life rather than traveling on a private jet.

So you know, it's not a hippie generation, right. But I look at it as you know, differently, less militaristic male generation. I don't know how I put it, but that they're less regimented to me more broad minded. And they don't want to be you know, put into cubicles to achieve what they want to achieve.

And I don't think there's any amount of money that can force them into the lifestyle that they detests. They think they have options, let's say.

[00:35:54] Griffin Jones: Well, I think one wrench in the works is that having junk bonds in the portfolio, I think they want the yield of the portfolio. And that is, it is possible to get a high yield from portfolio.

But I think that there's a lot of junk bonds in there. And that's one of the concerns that I have when I hear the word self-care and I hear it's, I am more than open to the idea of self-care it is necessary for being productive. If it's something that, that actually helps rejuvenate you, that if it actually helps you pursue a larger goal, but if it's just increasing media consumption or if it's just an excuse to differ from an obligation, then I don't see how we get to a place where we have 30 hour productive work weeks. If there are marbled with escapism. 

[00:36:54] Dr. Kutluk Oktay: Right. Escapism it's the right word. I mean, that's why it's a drug, right, alcohol, drugs, social media. You're constantly escaping from what you have to do or what you should really be thinking.

 That's kind of what the quick send for the next generation. So that's going to engulf some, some talents and bog them down but others will learn how to dance around it and hopefully do great things. And I think also being aware of what we are doing to environment is also very a lot of young generations are aware of that. And a lot of them are more worried about that then you know, filling up their coffers because you know what good it does if you don't have a good healthy planet to live with, what are you going to do with all that money? So I think that's the other reason, I think this generation will have a long view because they need to think about the entire planet with what they do. 

[00:37:54] Griffin Jones: Well, \ they do have a lot more to think about in terms of, you know, having to have a response for other things that are, that are happening. And so let's pretend that we, we have solved for the junk bond issue for the moment that we've gotten all the junk bonds out of our allocation.

We are left with high yield, low cost index funds that lead us to a good outcome. At the end of all this. But then there is this pestering concept that I hear from, and about physicians who look and I don't know that it's erroneous. It could very well be valid, but the, but the idea is that, well, physicians can never really be off.

They can never be totally unplugged because what if our patients need something from us.

[00:38:45] Dr. Kutluk Oktay: Well, I have to take a break now, so I'll see you in five minutes just getting right. I get to a point physicians can be off on the paper, but they can never be off here. Because I mean, at least personally, but I know a lot of other people, you know, and if we wouldn't, if I go away.

 I think about my patients. What happened to this? What happened to that? What happened to that? That's the nature of it. That's why you don't pick this field. If you're really not, you know, you don't like to have that kind of lifestyle. Right. But not necessarily your uncle, every movement of today, but when we are caring for people's future it's hard to completely detach yourself from that.

But if you're working in a good team situation and you have colleagues that you can trust maybe you can disconnect nicely when you're off, when you're doing your yoga, when you're like a week away with you know, doing the things you like. But if you're a one man show, yeah, that's very hard.

Maybe one of the advantages of being an academic sort of larger practice is that you can have other people take the burden off of you sometimes. 

[00:39:53] Griffin Jones: Can you do that if you're taking a two week vacation with your family and you just want to be alone with your family and a cabin in Europe, can you say I'm not taking any calls?

I trust my partners to be able to handle the case. Can a physician do that? 

[00:40:12] Dr. Kutluk Oktay: I can imagine a physician can do that. So I'm I can imagine that it happens in other practices. All I could say that, you know, academics and other places, I've been to several places and I've seen that happen. I don't necessarily see anything wrong.

That's an individual personality issue, I think And you can also set limits. I mean, I don't need to know these, but if something like this happened, yes, you can contact me. You know, we have patients that we make very personal personal relationships in terms of patient doctor relationships and that sometimes they just want to hear from you.

And so yeah, there will be situations, well you could be in on vacation, but there's some emergency, we'll have to answer that. But the key to that is to be able to switch on and switch off you make a phone call, you know, give instructions, and now you're back to as if it's never happened so it's matter of a.

[00:41:05] Griffin Jones: What about the doctors that say, I trust my partners, they're perfectly qualified, but my patients expect me and they have to be able to reach me. And I can never have a window where I'm unreachable. 

[00:41:20] Dr. Kutluk Oktay: Right. If you're complaining about that, that means that you need to change it. So you cannot say that I don't trust my colleagues.

I need to be reachable, but I'm never off. So that's like trying to have the cake and eat it right. Going back to that. But when it comes to patient care and when you're trying to be personal with your patient, provide personal, there's no formula for that other than cloning yourself. So either you trust your team or be available.

So I don't know if there's a formula for that. So I, for me, I set sort of criteria. Okay. You know, XYZ happens. Perfect. Good. Go ahead and map. But it hits, I dunno, let me cry. Then you have to call me and you know, that way, if you get a call, you know, that it was absolutely necessary or, you know, you clone yourself, there's exactly a personal like you and a fine great, go away to Mars on a mission or whatever.

Nobody can reach you. 

[00:42:21] Griffin Jones: I have somewhat of a formula. It doesn't totally address the limits that you would set in terms of, of what you can use of what people can contact you for or not. But it does give a formula for how much time one might want to protect. Have you ever heard of the book profit first? 

[00:42:41] Dr. Kutluk Oktay: Maybe I'm not sure.

[00:42:42] Griffin Jones: Well, link to it in the show notes. The author's last name. I can't pronounce, even if I remembered it, but it's the concept is a bit contrary to gap, generally accepted accounting principles, where revenue minus operating expenses equals profit and profit. First, it simply is revenue minus profit equals operating expenses.

So you're always allocating for profit, even from the infancy of a business. And if you're an infant business, you, you have almost nothing to allocate anyway. So, but you start with that current allocation percentage, and then you have a target allocation percentage. And so in the beginning, you might be saving a dollar, but the point is that you reserve profit from the very beginning and learn to manage operating expenses accordingly, as opposed to the reverse. And when I think of the needs that we have to have loving relationships with our families to have mental health and clarity breaks, there has to be some time and I'm not going to tell people how much time it is.

 But when I'm with my loved ones, that there's nothing that's going to interrupt that unless it is a grave emergency. And so I'm going to write this book someday, Kutluk called time first, where it, you start off with a current allocation percentage and maybe it's just, you know what, every Sunday evening, I'm gonna I'm tucking my daughter in, and I'm going to read her a book and nothing will threaten that.

And then a year from now, I want to be able to do this and five years from now, I want to be able to take three weeks in Europe. I believe that that has to happen. People have to have some allocation of percentage of uninterruptible time and then based on how that goes and how much they want, then they can have a different target to augment for the future.

[00:44:32] Dr. Kutluk Oktay: Right, I mean, you know, the vacation break, whatever is break, but I also think about you may have that time, but there is a situation. If you didn't respond that would create consequences that cost you more time in the future, which would come out of your family time. So even when you're on your off time, you have to be able to recognize the situation.

If you didn't respond at that time. That will cost you a lot more time in the future. So you can think about scenarios of, you know, the complication happens and you, you don't give the right instructions or whatever that, you know, them medications may take more time. So it's a bit tricky. We say that, but you know, as a physician as I said, you need to be able to have some kind of artificial intelligence in your system that will read that out.

Do that calculation for you before you're interrupted. It doesn't happen a lot if you have a good team. So that comes to building good teams. You good leaders are the ones who develop other leaders. Your leadership is measured by the index. Of how many leaders you can develop or how many people who would lead others.

But when you're building your team, you need to build people who can also independently think and function with you. Again, if you don't have a good team it's hard to have time off. 

[00:45:57] Griffin Jones: Well, in order to have an independent team, though, you also have to take some time off because how do you know if they're really independent or not?

If you're constantly there, they will ask you and you will stick your finger in the pudding jar. If, if that temptation is offered, I took two weeks last year in 2021. And my team didn't make every decision that I would have agreed with. It revealed to me. Oh, there's, there's one to three things here that are clearly missing from our core processes that I need to fix.

And I only knew that because I went away and they made a different decision that I wouldn't have made. and because of that, it's like, okay, well, I was gone for two weeks that the farm isn't going to burn down the practice, isn't going to burn down during a two-week period. But then I can make the, it could, I guess it could. 

Well, that's a good, that is a good point though, because I couldn't have done that six years ago, so that is a good point.

 But that's why you start with a day and then maybe it's a couple of days and then it's two weeks. And eventually I'd like to be able to go for big blocks at a time. So we've talked a lot about the different balances of work, not just what goes into work, but also the things that accompany it like health and fitness, family and hobby.

We're going to conclude the show and a lot of private practice owners listen, but there are a lot of division chiefs that listen to this show. And one of our biggest segments is fellows and it's younger associates that are thinking about what the next move next move is. So how would you want to conclude with them, Dr. Oktay? 

[00:47:34] Dr. Kutluk Oktay: Well, to fellows are the biggest, you know, very important part of the team, whether they're clinical fellows, research fellows, you know, observers, whatnot. And in my career, I always worked with fellows of again, either clinical fellows or fellows from various parts of the world.

 And their contributions are tremendous. So they are important part of the. And that's, you know, by working with a mentor prepares them well for the future. So my advice to them again, I said, you're a fellow now, but if you are planning to be a fellow, you're going to start early bit, but also find yourself a good mentor and which could help you with whatever you want to accomplish in your career and work with them. 

[00:48:18] Griffin Jones: And you said that you are active on LinkedIn, so that may have been a little subliminal nod if somebody can people reach out to you on LinkedIn, if they're interested in it.. 

[00:48:27] Dr. Kutluk Oktay: Oh yeah, absolutely.

All the time. So, you know, I decided to focus on one social media gadget. And I think LinkedIn works well because it's nicely filtered and more focused on professional topics and I think it's pretty efficient.

You know, I have through LinkedIn may have formed many alliances, solved many issues reached out to executives of insurance companies when we had problems with the patients, reimbursements, things like that. So I think LinkedIn is a really a good way to expand your network. 

[00:49:02] Griffin Jones: Well, before I let you go, I know that everybody listening to the audio and not watching the video is picturing you as a millennial with your artists in coffee and your beanie and a flannel, but Dr. Oktay is in a suit and tie today, and it's been a pleasure having you on Inside Reproductive Health. Thank you Dr. Kutluk Oktay for coming to IRH. 

[00:49:22] Dr. Kutluk Oktay: Thank you. Thank you. Next time, I'll put that digital outfit on. 

[00:49:27] Griffin Jones: Sounds great. 

115: Exploring the Role of Obesity in Fertility Medicine with Evan Richardson

Evan Richardson on Inside Reproductive Health.png

Obesity plays an important role in the worlds of many struggling with conception, and in recent years the field of Obesity Medicine has grown substantially. Weight loss makes the fertility journey so much easier while increasing the quality of life for the patient.

Today’s episode features Evan Richardson, CEO and Founder of Form Health, a modern obesity practice that remotely connects their patients to dieticians. He speaks with Griffin Jones about a wide range of topics relating to obesity and fertility, from their complicated connection all the way to the future of subspecialties and medical health as a whole.

You can find the episode anywhere you stream podcasts or at our website.

Today’s Episode Focuses On:

  • The role Of BMI in fertility

  • The importance of medical subspecialties

  • The difficulties behind sustained weight loss

  • The future of subspecialty practices

  • The relationship between obesity medicine and fertility medicine

Social Links:

Evan’s Linkedin: https://www.linkedin.com/in/evrichardson/

Form Health Website: https://www.formhealth.co

FH Facebook: https://www.facebook.com/formhealthofficial

FH Instagram: https://www.facebook.com/formhealthofficial


To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

[00:00:00] Evan Richardson: We're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice.

 

[00:00:55] Griffin Jones: Today on Inside Reproductive Health. I hosted Evan Richardson, who is the CEO and founder of a new tech health startup called FormHealth. Before I get into my show with Evan today, my shoutout goes to doctors, Adam Griffin, and Mike Sullivan from Buffalo IVF, who are the reasons that I got into this field more than seven years ago now, starting from a small rural village in Bolivia for $500 a month, doing organic social media to now something that is unrecognizable to that venture. And so a shout out to those guys. I don't know if they listened to the show, but you have been telling people have been getting the shout outs because you've been texting them.

So if you call on those guys or if you're friends with them. Please text them, let them know that they were in this shout out today show with Evan. I know some people are going to be grumpy with me because they want to come on the show. I've got to be real protective of who I have on the show, because this is the media platform for REI and business people in the field and practice owners.

So I've got to be really careful most of the time, I don't let industry, side folks on, although sponsorship is a different option available, but I thought it was important to talk about the ways that tech can help us. If not triaged patients, at least help you treat the patients that you need to be treating, doing the things that you need and want to be doing.

And then letting more efficient solutions help with that, which you don't. So if I sound incredulous in this interview with Evan, just because I was trying to be a good steward of how you might be combing through their value proposition. I'm not a clinician. I did my best. So you can take a listen to this show with Evan.

He's been in the tech space for a while. The health tech space for awhile. He was an early employee at Castlight health. He's a member of the board of directors of bicycle health. He was part of the founding management team at grand rounds, which is also a telemedical concierge. And so he is now in this VC startup world very much.

And I hope you enjoy the show.

 Mr. Richardson, Evan. Welcome to Inside Reproductive Health. 

[00:03:25] Evan Richardson: Very happy to be here. Thanks for thanks for making time here. 

[00:03:28] Griffin Jones: I've got to tell you that I'm a little bit not looking forward to when this episode comes out for a reason that we've gotten, I've gotten very protective of the audience of this show in the last couple years, because now we're sort of the only media outlet for the business side of fertility, which has a lot of people asking me like, hey, can I come on the show?

Can I pitch this, or can we talk about this topic? And now, like, I also want to get to the point where we're in sponsorship mode. Didn't think that was the realm that you were in, but I just know that people that have asked me to come on are going to be like, what the heck why'd you let that guy on you didn't let us, I do have an explanation, but I, and I want to go back into the I want to start backwards a little bit before.

We'd talk about what form health is, but if we could start. Why fertility, what is the relationship to fertility? Then I'll get my answer and then we'll work back and then forth again. 

[00:04:29] Evan Richardson: That makes, that makes a lot of sense. So I feel like that, to answer that question, I can tell a little bit about form, which is that we are a concierge telemedical weight loss services.

So we work within the realm of medical support. We are we are a medical practice. We treat patients and we work with those individuals to meet their broader healthcare goals within the context of helping them to lose weight. And it turns out that weight loss can be really important for fertility for a number of reasons for a number of practices folks have a BMI cutoff and patients would come in above that cutoff can't receive certain services because risks because risks around sedation for other folks, there's a, you know, a real demand for surrogates. Sometimes the surrogates don't meet a BMI threshold that's required.

And then for the broad population you know, risks around risks around becoming pregnant and then carrying a child to term all go up as BMI goes up from from the sort of obesity level, which is a BMI of 30. We've worked with fertility practices now for for quite awhile to help them to bring patients into the realm of being treatable from a fertility perspective, BMI down below any sort of hard ceilings, they may have to increase. The number of surrogates that they have available. And then also just to improve sort of all of the outcomes related to fertility all by helping their patients reduce their body mass index. And it turns out that, you know, the relation between the relationship between fertility.

And BMI is fairly clear, right? All risks to becoming pregnant or to carrying a child would turn to come down as a patient brings their BMI back towards the sort of clinically normal threshold below a BMI of 30. And that's really where we help. That's where we work with fertility providers to help, to improve not all of their outcomes and broaden the base of patients and surrogates they can work 

with.

[00:06:29] Griffin Jones: What other subspecialties of healthcare, if any, are you working with? 

[00:06:34] Evan Richardson: Yeah, well, so that's a really great question. The answer is is all so, you know, we work with primary care providers. , we work with folks in the orthopedic space and then, you know, kind of everybody else, I would say those are the big the big four with fertility kind of leading the way for the sub-specialties that we work with today.

But we do have referring providers that come from, you know, the broad. Medical subspecialties, because there really is no area of care that at wherein outcomes and patient outcomes are not improved by helping those individuals with a BMI over 30, to bring that BMI down below the obesity. 

[00:07:15] Griffin Jones: Well, I don't really give a crap about those other subspecialties, but what I am interested is a little bit more on how you partner with clinics, but the reason why I was okay with having you on the show is because there a tremendous bottleneck in fertility right now there's simply more patient demand than there are providers to be able to treat them.

And we need other means to help. I dunno if triaged is the right word, but to help with some of the treatment that doesn't need to be going on at a fertility specialist so that the fertility specialist can do what only the fertility specialists can do. And so talk a little bit, but I also brought John because it didn't seem like, you know, you were necessarily.

That you had like this really, oh, I don't know deep monetized partnership with fertility centers. Maybe I'm wrong. How do you partner with fertility center? Yeah. 

[00:08:12] Evan Richardson: So great question. Yeah. And I think, look, you're right. The challenge for fertility centers in a lot of cases is how to be as efficient as possible at delivering the care that they deliver to as many patients possible.

When you have somebody coming in, who doesn't meet one of your sort of basic requirements around care. That's a challenge to you know, to sort of work with that person, especially over a period of time. If they continue to not sort of be within that BMI limited require. What we do in partnering with fertility centers is we try to work as closely as possible with them in support of the patient's goal of fertility.

That means that we try to make the burden. In terms of getting patients to us as light as possible for those referring fertility clinics. And then we try to make sure that when that patient is ready to come back we make that process of coming back to the fertility center as easy as possible. So I would broadly kind of group our partnership into two kinds of patients.

The first one is patients whose BMI precludes them from one kind of treatment or another. So we'll hear frequently that, you know, a center has a BMI cutoff of 35 or 40 or so around IVF as a broad category. And the reasons for that, I have a lot to do risks from sedation and risk of airway collapse.

It's certain a higher BMI and the threshold depends a lot on the facilities that are available and just the, the policies that practitioners are put in place for those patients who have who have a BMI that precludes them from receiving care. We partner with the facility.

Take that patient understand their fertility goals, understand the fertility path forward for them understand the weight target that they need to achieve in order to receive in order to receive fertility treatment and work with that patient over the course of weeks and months, independent from the fertility practice.

And about the only thing that happens during that process is we update the fertility center on a regular basis and that. Frequency depends really on the fertility centers preference for those updates. Usually it's about once a month, we give them an update on sort of the patients that we're working with for them.

And then when that patient hits that BMI threshold, we then with the right amount of notice, cause then in many cases, you know, it takes you know, four to six weeks to get an appointment with a treating provider. We'll say to those patients who were ready, Hey, you hit your threshold or you're about to hit that threshold.

You're ready to go back. Let's get you set up with that care. We a ll work with the fertility, the referring fertility practice to make sure that person who previously was just not eligible for care and previously could not have received treatment. Now it gets back into their practice in a pretty seamless way.

And, and is able to get care. Typically we continue to work with those patients because now they're in the second category of care, which is patients who are eligible for fertility services, but who would but, and who are already sort of receiving those, but who would like to continue to lose weight.

And for those folks, typically we are treating alongside the referring provider. And again, you know, we make that pretty, pretty seamless to the referring provider. There is no change. 

[00:11:25] Griffin Jones: Referring provider in this case, being the REI? 

[00:11:28] Evan Richardson: That's correct. Right. Isn't the fertility is the fertility specialist. It's pretty seamless to their fertility specialists.

They don't have to do anything to change their path of treatment because is actively losing weight. We always are making sure that we're up to date on the path of treatment forward patient, and that we're practicing in line with those care needs. And the patient often, you know, continues to lose a meaningful amount of weight as they go through treatment.

We will stick with those patients oftentimes through pregnancy and then afterwards continue to help them to lose weight when it's appropriate to lose weight again, which of course it's not appropriate during break. 

[00:11:58] Griffin Jones: So while we're on the topic of referring providers. When we say referring providers, we typically talk about OB GYN, sometimes PCPs.

And one thing that I've heard from REIs for as long as I've been in the field is there's often a trepidation of disrupting their referral patterns. They don't want to they don't wanna, they don't want OB-GYNs to perceive that they're taking their patients who have always send them. So that they'll keep getting referrals.

Some, there's probably some threads of this concern that are valid often. I think it's probably not valid. OB-GYNs are just as busy if not busier than REIs. And so our PCPs and very often we're talking about low margin insurance patients which is why I'm interested in exploring this telehealth idea, but I can hear a couple people, a couple REI's in the back of my head saying, well, why would we refer these patients out to a platform like this and piss off the, you know, the, when we could be sending them back to their PCP? Sure. That's a 

[00:13:04] Evan Richardson: great question. Look, I think, you know, For some patients the PCP is a perfectly appropriate place to treat their obesity.

And in many cases, the PCP has already been a part of the discussion, right? So most patients that have obesity are counseled by their PCP, that they should be losing weight. They'll ask that BCP, hey, what should I do? And that BCP will have sort of, you know, taken them through their, their frontline treatment.

I think the reality is. In the vast majority of cases, those that mode of treatment doesn't work. And so just like we work with BCPS and, you know, different side of our business, we work with PCPs is the referring provider, as opposed to fertility as the referring provider. And we do that because the PCP say, all right, I understand that there is this new area of medicine called obesity medicine and that's our subspecialty. That's a specialty in which form health practices, our physicians, our obesity medicines board, they have they typically come from an endocrinology or primary care background, but they've all passed their ABOM. The American board obesity medicine boards.

And they just have a, just like, you know, , cardiologist has advanced experience within their area of specialty. Our physicians have advanced experience for these harder cases in the field of obesity. So while an REI might say, gee, why wouldn't I just send this back to the PCP?

Who by the way, sent me the patient the first place. I think the, the short answer is. Oftentimes those PCPs have already done the work that they're able to do and haven't gotten effective results. And in many cases, when it comes to actively treating these patients for for obesity many PCPs don't feel that they're sort of the right set of folks to deliver that care, which is why we work them as referrals as well.

[00:14:44] Griffin Jones: What evidence supports your idea that the treatment is very often unsuccessful. Obesity treatment is very often unsuccessful with the primary care. 

[00:14:54] Evan Richardson: Well, so, I think the biggest piece of evidence would simply be the continued upward climb of the rates of obesity in the United States.

Even though everybody's PCP who has a BMI over 30, we'll sit them down. You really need to change? 

[00:15:10] Griffin Jones: What are we talking? Numbers wise. And I know that you probably have this like memorize for VCs. So like numbers wise, what are we talking about obesity and that you're 

[00:15:20] Evan Richardson: discussing today, the obesity rate for adults in the U S as close to 45%.

And it depends on what what statistic you want to look at. There's a few, they're not suggesting. The pandemic and the folks that being home there've been some pretty substantial increases in that number, but, you know, here, as recently as 1982, the rates in the us were 10%, right?

This is a this is a health challenge that up until January of 2020, along with opioids was, you know, one of the two major problems at the US phase. And I think, you know, we haven't seen sort of any change there that is despite a lot of healthcare focus in the area and a lot of counseling from BCPS.

I think the challenges that for for many doctors you know, that there is a there's a sense of, Hey, know, what to deliver the right care for obesity medicine to deliver, you know, the right kind of accurate around weight loss. We need to have a very active set of interactions with a patient.

Perform health, for example, meets with our patients once a month with their physician twice a month with a dietician so they're seeing somebody from form health almost every week, and then we're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice. In addition to that for some patients, and then there's an asterisk here because for patients who are maybe pregnant or working to get pregnant, many of the medications in the space, aren't always appropriate.

But for many physicians there's a world of medications that are helpful to. And they're not comfortable in prescribing those for a variety of reasons that have to do with training and history and all this stuff. And so, that's why you know, a lot of physicians today are excited to refer out to specialty focused obesity medicine.

[00:17:13] Griffin Jones: What kind of results are you seeing now? And if you're still in forecast mode, how will you be measuring the results? 

[00:17:19] Evan Richardson: Yeah, that's a great question. So, so, you know, we've seen results that are best in class for obesity clinics. You know, we have our specialty, as I mentioned is obesity medicine.

And so there's a fair amount of research that looks at. The rate at which folks are able to lose weight, you know, for us patients that are doing great can lose up to 25% of their body weight over the course of six months those are the results that we have seen. So very very substantial weight loss.

Typically a patient is losing about a pound a week and, you know, for some patients they'll stop and they'll say, hold on a pound a week. You know, I shouldn't, I be able to lose it faster with a medically engaged program. And the answer is. No, and you're losing weight much faster than that then it's not sustainable weight loss, and you're much more likely to stop.

And you're much more likely to see rebound after that. And so lots of studies today show that you know, about a pound a week is sort of the upper threshold for how fast somebody it's a little, it's a little faster than that when you start weight models. But the sustain rate is about a pound a week and we see that.

And I think the thing that's really important for our field is how long does somebody stay in. This kind of program. So for a lot of more traditional weight loss either self guided or guided through a program, like a weight Watchers, et cetera, people retain on those programs for a very short period of time.

Right? We're talking 20 days, right? 22, 23 days, and sort of average retention there. And if anybody's tried it themselves, you've probably had a similar experience. The first two weeks you're really motivated. Third week you started adding up. I want to keep doing this. By the end of the third, we get a couple of reasons not doing he.

Didn't what we see is that about 75% of our patients are still with us at 6, 7, 8 months. That's a lot. Right. And when somebody sticks around with you for that time, you're really able to help them make material changes in their life, lifestyle, and health. And you're really able to see those folks go from you know, from a very high BMI down to something that's more you know, more clinically help them.

[00:19:10] Griffin Jones: Have you done any abstracts yet? 

[00:19:11] Evan Richardson: We've done a couple of posters. We did a poster at the at the obesity society here last year. And we did one at ASPM, American Society of Pediatric Surgeons here this year.

[00:19:22] Griffin Jones: Summarize a couple of those findings for us. 

[00:19:25] Evan Richardson: Yeah. I think, you know, in line with what we just talked through.

So, you know, typically patients are losing about a pound, right? and that we see that retention that is, you know, very substantial during the forecast period, I think, you know, the results that we're the most proud of you know, are actually coming out of some of our work with fertility centers where, you know, we had just this month two patients who became pregnant who had been having, you know, real challenges or.

Eligible to be getting fertility services because of their weight. And after working with form, went back to their REI and are now working on building a family. So that's the kind of thing that we get really charged up about. 

[00:20:02] Griffin Jones: That's what the audience gets charged up about too. A pound a week and a longer enrollment in the program for the intervention.

What compared to baseline, I guess, what is the average intervention yield? 

[00:20:22] Evan Richardson: The average intervention, self-guided intervention doesn't yield anything. And so I think that's a really important thing to think about. So, you know, the alternative to referring to obesity medicine provider is the tele patient, hey, you know, you should maybe join a weight watchers. You should you know, you should work on this yourself self guided interventions because they don't last long. Don't tend to show great results, you know, weight watchers and others have some good clinical studies where they will show that their population is able to lose weight.

But the live reality of somebody on Weight Watchers is very different from a lot of those studies. And the reality is most patients don't stick around on those studies for very long. And so, I would suggest to folks that are listening to think about their patient population and think about those people who they've said, Hey, you know, if you want to have better outcomes on agent lose and weight and think about sort of what percentage of those folks were actually able to achieve that weight loss in our experience and, you know, sort of more broadly looking at the broader population data, it's very unusual for someone to be able to under sort of self-guidance or under.

A purely behavioral program to lose a significant amount of weight. We're not talking about 10 pounds, you know, but lose 30 plus pounds. And keep that off that's fairly rare. 

[00:21:32] Griffin Jones: Yeah. Well that was going to ask how do you stratify that a little bit more? Because I imagine some people will say, well, these programs work excellently?

And so to say like self intervention doesn't work, it could be, right, but how do you, what are some of the parameters that, show us that's true? 

[00:21:53] Evan Richardson: Yeah. So I think, you know, one of the biggest one is just the overall gain in BMI, across population. And again, that's been, you know, that the rate of obesity has been taking up you know, very substantially over the course of the last decades was really no pause right there, there is not a year in the last in the last 20 where the obesity rate in the country in the U S has gone down and that's generally the case globally. And so, you know, I think that again, if a person is not able to stay on a plan for more than a handful of weeks, they will not be able to achieve results. You know, you can think about a weight gain, typically takes a while. So for many patients, they're, you know, gaining a, you know, a couple of pounds a year on.

And they may have a year or two when they gained a substantial amount of weight. But if you asked them kind of, what was the trajectory of your weight gain over time? Typically it's, you know, it's a couple of pounds a year and just like weight gain can take a while. You know, that weight loss often can take awhile, even when it's medically assisted, right?

The fastest that you can go is about an hour a week. And so, for a lot of patients, what they find is, you know, gosh, if you're staying on that program for 14 days or 20 days, that might be fine. If you want to lose five pounds to go to the beach or for an event or something like. But when you're talking about sustained weight loss, most patients, the vast majority of patients benefit from that intervention. 

 

[00:25:38] Griffin Jones: How does the formhealth get paid? Is there a partnership from the fertility? Is there a referring fee?

[00:25:46] Evan Richardson: It's a great question. And the answer is no. So no cost to the referring provider and, you know, we look at this partnership as working to help the we're gonna help the individuals, our mutual patient to achieve their broader health goals in the context of fertility, the number one goal at the top of the list is I want to have a baby. And that's the goal that we are working towards together, but just like the fertility, especially just like the REI is not is not paying and is not able to pay. their referring provider. Fee to the provider who refers patients to form.

And you know, we think of this in terms of, you know, what value can we provide to that provider? So that's why we are keeping them updated in an effective and pretty efficient way for their time in terms of how these patients are working. That's why we're making sure that we're treating inline with that provider sort of needs for that patient when we work with them.

And really at the end of the day, this is just about us helping these patients. Together to achieve that fertility goal. 

[00:26:42] Griffin Jones: So is it a monthly subscription from 

[00:26:46] Evan Richardson: the great question? How do we get paid for? So, so, so there's two parts to how how our economics work. We are a we are a reimbursed.

Service. So when a patient sees their physician that service is submitted to their insurance, just like any other physician interaction would be. And then and then that sort of adjudicated through their insurance coverage, et cetera any cost to the patient for labs, any costs, the patients for medication all of that sort of runs through the insurance just like it would for any other medical interaction. And then in addition to that, we have a monthly fee that's $99. And that really covers the cost of the dieticians that patient works with. So there's two parts to that team. One is the physician two is the dietician. And so those dietetic services are covered by the $99 a month fee, which is paid for by the patient.

[00:27:34] Griffin Jones: I want to talk a little bit about the insurance and telemedicine, and that will make this tangent make sense because in February, 2020, I was at a small fertility conference. Very cool. Intimate fertility conference in Colorado. And we were starting to talk about this novel virus that was developing in the east, but.

[00:27:56] Evan Richardson: I haven't heard of it. 

[00:27:57] Griffin Jones: When people didn't really know what was going to happen yet so this is like the first week of February. And at that conference separately. We were also talking about the future of telemedicine, but also kind of how it was a pain in the neck because if you practiced it, if you hadn't, let's say you're in oh, Erie, Pennsylvania, and you're seeing patients.

Just across the border in New York state that you would have to have a law in some states. I don't know if this is true for Pennsylvania, New York, but at least in some states you'd have to have a license to practice in multiple states and. 

[00:28:28] Evan Richardson: That's the case in the majority of states. 

[00:28:30] Griffin Jones: Okay. And so, and then all of a sudden a month later, a lot of these regulations were put on hold and health and human services and office of civil rights I believe is, are the two agencies that that enforce HIPAA. And so they said, you know, you can use zoom, you can use FaceTime, you can use Skype. And so how did that affect or not affect you all at that time? 

[00:28:54] Evan Richardson: Really good question. You know, we have been a purely telemedical business since we got started and so we have been working within the sort of fairly complicated telemedical regulatory regime that exists. And so for us, in some ways, you know, we were already really prepared for everybody to get pretty excited about telemedicine. We didn't change the way that we work with patients.

We already had tools that were HIPAA compliant that were in place. I think some of the benefit to some providers was that, you know, some of the interstate licensing requirements or were waived or otherwise loosened for a period of time. I think, you know, for us that didn't have a big impact either because our providers, you know, were already sort of licensed in these states where they practice, you know, for us as a growing business, our perspective was we never know how long these waivers are going to last.

And they are really important for some of the emergency or near emergency medical treatment that had to happen around around COVID. But we didn't want to build our business on some of those sands that could shift pretty quickly. And so by and large, you know, everything that we did was highly compliant with the pre waiver world of telemedicine. 

[00:30:09] Griffin Jones: Your explanation of how you get paid from patients and from insurance companies and not from centers is part of the reason why I had you on the show. People sell to centers, then they're going to be more likely in that sponsorship category. I know that some other people are still going to say to me, oh, that's me too.

Why can't I come on show? Listen, sometimes I'm in a good mood, keep trying me. And but I am really interested in the idea that we just have to be doing, we have to be getting people to other solutions that are found in tech and do you think that we need to be propagating that for the triage aspect?

One concern that I've seen is, we've seen people come in and there's been a couple of them that thought, oh yeah, they're going to be great. They're going to stick around. And then it's like what? They burnt through that money pretty quickly. I didn't know you could burn through $60 million that quickly, but apparently you can and  VC is a cutthroat world. 

[00:31:07] Evan Richardson: Great parties. 

[00:31:08] Griffin Jones: So what challenges are you on the lookout for? 

[00:31:13] Evan Richardson: Yeah, look, I think, you know, we think that not surprising the world of obesity medicine, the specialty of treating treating folks in BMI north of 30 or in some cases be north of 27 with certain comorbidities. We think that is a big growth area in healthcare broadly today only about 1% of individuals with a BMI north of 30 are receiving medical treatment for their weight.

If you look at any other major medical condition type two diabetes, high blood pressure depression. Typically treatment rates settle out for reimburse services at about two thirds. And and I think, you know, we are entering a world with AMA recognizing here about seven years ago, that obesity was a medical condition with the creation of the American board of obesity medicine in a world where treatment of obesity will be more the norm. It is the exception today. It's absolutely the exception and, and I think, that's part of why, fertility, for example, has been a big growth area for us because patients weight so directly impacts their ability to to, to conceive and to carry a child.

And so I think, you know, we are headed over the next 10 years towards a world where treatment is more than normal, where we start to see treatment rates north of 50. For individuals with a BMI of 30. And that doesn't mean that all those people go to obesity sessions, right? Primary care will start to treat this more frequently, et cetera, et cetera.

But you know, in that world, what we are really looking at over the next 10 years is an incredible period of growth. And I think, you know, for us as a result, some of the biggest areas of concern are really just, you know, how do we grow effectively? How do we support that? In a way that matches with our very high level of standards for the care that our patients receive.

And how do we continue to do that as we scale out larger and across more states. So I think, you know, the the question for folks in our space is you know, as awareness grows, as referrals grow, as practitioners start to say, well, I'd refer out. If I saw high sugars, I'd refer, you know, for treatment, for what looks like it might be, know, a case diabetes.

If I saw high blood pressure, I'd probably refer out for that for treatment as well. I'm seeing somebody coming in with a BMI of 30, that is a medical condition. Of course, I'm going to refer out for that. But then as that becomes more of a norm of thinking, you know, I think the real questions are, you know, how do we as a.

As a specialty of medicine, how do we make sure that we support that growth in a way that's going to be effective and high quality for all of our patients?

[00:33:47] Griffin Jones: So what are some of the obstacles look like? Like you as the visionary of this burgeoning company, when you are thinking that six months to a year, what are the things that you're saying, this is what we're getting over as a company in the next half a year so? 

[00:34:01] Evan Richardson: Yeah, well, look, I think you know, I think supporting demand is always a big challenge as a growing company, right? So, you know what we have seen in working with and working with fertility providers and other physicians more broadly is the impact we've been able to have not really has been positive for their patients and as a result we, you know, we'll often with a as an example with a fertility provider and they'll say, great, I'm going to refer you. The folks that come in and their BMI is over 45. I can't do anything with them unless we bring that BMI down. And within a couple of months, we're seeing everybody with a BMI. 30. And they're actively treating those patients between 30 and 45, but they've seen such great results with the patients that have a very high BMI that may start to say to everybody else along the path, Hey, let me just toss these folks over to form because they know the support is there and they know the results are going to be there.

And this is something that the patients want to achieve along with their fertility. And so I think, you know, for us, we look to growth and we look to making sure that we continue to support those patients in the best darn way that we possibly can. I think, you know, the world of COVID is an interesting challenge for us as well.

Are, as I mentioned, purely tele medical patients never come into an office. That's really comfortable for patients because now they don't have to leave their home. And even as they go back to work, they don't have to leave the office. They can sit in a conference room like I am now and have that conversation with their with their practitioner receive treatment and go on about it per day.

But I think that, you know, we're going to see what changes in people's expectations, you know, w what we've seen across our business is a lot of folks have had some pretty material unplanned weight gain during COVID. And so I think that is you know, an opportunity and a challenge, because there's more folks that need help, but at the same time there's a lot more obstacles in their way that are causing the gateway to.

So I think, you know, there's some challenges from the medical side there's some challenges.

[00:35:51] Griffin Jones: I thought of two more questions that the audience will be grumpy with me. If I let you off the hook, then I've got it right. Then I've got a selfish question for myself that is of zero value to the audience.

And then lastly you can conclude with however you want. So, but I know that some people. There is sometimes a referral paranoia in this. And again I think most of it is unwarranted most of the time because of how busy we all are, but some people may see you've had luck, at least building the beginnings of relationships with a couple of groups.

They see another group on they're like, well, yeah, Person is two miles away from me. If I refer patients to form health, they're going to refer them back to this other group. 

[00:36:35] Evan Richardson: That's interesting. So, so, you know, I think all of these are things that we work really hard to just make sure for our referring physicians, when we receive a referral from a from a physician, you know, we mark that down.

 And we are working with that physician at the very least, keeping them updated on their patient's progress. And then sometimes if that patient's actively receiving treatment, then we'll kind of get the the note from the from the referring provider to make sure that our treatment path is still in line with their path of care for that same patient.

And when it comes time to send that person. We are already queued up with that. with that the referring physician, the one that sent us the patient in the first place, and we just sort of naturally send them right back and we keep we keep pretty good records on that internally, mostly. So that weekends stay in line with that physician's path of treatment.

But this isn't something where, you know somebody sends a patient. And we said, okay, well, who do we like in, you know, in the city of Boston to that referring provider? I do think, you know, we, we do have growing relationships with a number of providers nationwide and you know, we have been excited to support our relationship with those providers.

So, you know, we have a bunch of providers and say, great, know, we, help generate some content with you. We're always happy to, you know, lend or medical experts out to a little bit of content with them. We've got, you know, mutual, a webpage that we stand up. There's the opportunity to do you know, some, some joint work in building sort of practice volume.

And we're always supportive of that you know, I think we want to do whatever we can to help differentiate our practice partners, our referring partners, and help make it clear to patients that, you know, incoming to this specific REI. It's not just, Hey, you're here for one thing and one thing only, but it's a holistic solution that can include weight loss that can include all the things that patient needs to make sure that they can have the best chance possible of fertility 

[00:38:26] Griffin Jones: Hopefully, that's the more superficial concern, the more sincere concern that they will not let me off for letting you off is what are you doing with the data and what are you going to do with the data? 

[00:38:38] Evan Richardson: Good question. What we do with the data now is make sure that we're treating our patients appropriately and effectively.

I don't think that we have any plans around you know, looking at referral patterns or selling that data to other to other, you know, sort of like larger data entities or anything like that. I think, you know, there are opportunities, the things that we are really interested in with that data is publishing and making sure that the ways in which we are working with patients and the centers that we are working with you know, are really able to show the difference between those patients that, you know, that they worked with and help bring the BMI down. Some success rates they had there versus those patients who, for whatever reason were appropriate to referral or what there asking.

So we are actively working on a couple of paths now to start to publish with some of these larger opportunity groups. And if any of your viewers out there want to be part of something like that, where we can really take a look at the impact of of weight management around fertility treatment, you know, that's something where we're looking to add additional practitioners in groups into some of that work that we're doing.

[00:39:38] Griffin Jones: Okay. I think I've poked you to the extent that most of them would I think most has been filled. This is totally just for me. My two favorite influencer docks outside of the fertility field everybody's this is outside of the fertility field. My two favorite influencer docs outside the field are Jason Fung and Peter Attia and for their research and work on longevity.

And specifically with fasting protocols. This is just me. This is just me really curious how much of your protocols involve fasting or is that in your purview at all? 

[00:40:15] Evan Richardson: So not really. And I guess the first, the first thing that I'd put next to that, I think Fung and Attia are often working with folks that have very different health challenges than those people who are dealing with obesity.

Right. You know, to the extent that I've read some of their stuff. And I think they're pretty interesting, but they're really working on folks that are, you know, kind of already, you know, pretty far down the road of hitting all of the basics of helpfulness and are trying to kind of tweak and do a little bit of biohacking and really make sure that they're squeezing the most they can out of their know, out of their lives and their physical bodies.

And I think that's pretty interesting. We certainly do work with patients on multiple different protocols that help them to control calorie intake. And so, know, there's two big pieces of our care one is working with that physician. Two is working with a dietician intermittent fasting is absolutely one of the tools that our dieticians use, not so much for, you know, some of the outcomes that Attia and Fung might be you know, really focused on, but just because there's a lot of data around IF that suggests that for some people it's really helpful with controlling caloric intake. I think we're a little bit more skeptical on data suggesting that your body is burning more calories when you're doing intermittent fasting or that you have sort of increased metabolic activity when you're on IF.

But we absolutely see that it's super effective for a lot of people and helping them to control which helps them to control calorie intake. So given that, the reason I said that it's not really part of our program, this is not a required part. What we do is we try to work pretty pretty carefully with each patient to make sure that the dietetic approach we take with them is built for them.

And for some people IF just as ineffective for other folks. You know, they want to try, they want to try a different kind of restriction and I want to try, you know, meal replacement, or we may believe that's going to be highest impact for them. And so we work within those within those protocols, but there are a number of our patients that do IF and many of them find it to be pretty, pretty impactful, but they apply it and it is applied a little bit differently than what Attia and Fung are typically doing up.

[00:42:22] Griffin Jones: Well, we got to do is get you a show so that you can have those guys on your show and then they can see if they see it the same way. But that's just for me, this audience is mostly REI is mostly execs in the fertility field, a lot of practice owners. So how would you like to conclude with, to that audience Evan?

[00:42:41] Evan Richardson: Yeah, I think, you know, first it's been fun to have the opportunity just to chat with you. I think to those folks that are listening form is a practice that is really built to support your patient's outcome. And we work today with with dozens of practices across the country to help their patients to achieve better fertility outcomes, to achieve more pregnancies and carry more pregnancies to term.

And we strive to do that in a way that has as little friction to their practices as possible. What helps them to work with more patients and deliver better outcomes. And so I think, you know, to the extent that is something that folks are are excited about, and at least in our experience, a lot of practitioners are excited about working with more patients and improving outcomes for all their patients.

We're ready. And, and we'd love to hear from you and you can track us formhealth.co 

[00:43:36] Griffin Jones: I mean, I think this is the trajectory that we need to. At the very least look a lot more into, in the field to help expand text's use of applying the rest of the health treatment that we might not do. And thank you very much for coming on Inside Reproductive Health.

Thank you.

Why Fertility Businesses are Positioned as Commodities

 The shift in buying behavior that has discounted many to vendor status

WHO PAYS FOR DINNER?

Do your fertility clients reach for the bill when your check arrives after dinner? Or is it a forgone conclusion that you’re picking up the tab?

My Account Manager told me this was one of the aspects of working for Fertility Bridge that was most unusual to her. She had previously worked on the “industry side” of the fertility field where vendors are often viewed as food and beverage procurement.

I don’t necessarily want my clients to pay for my food and drinks. Sometimes I just want to treat them because I like to. Still, I really appreciate that our clients always want to pay because it’s one subtle indicator of who they view as a vendor and who they view as an advisor. 

And that got me thinking about you. 

JUST ANOTHER FERTILITY VENDOR

How is it that a tiny firm like mine has been able to move from vendor to advisor in just a couple of years, when established or well-funded groups are being discounted as a commodity? It wasn’t capital or medical or scientific expertise, that’s for sure.

As far as I can tell, the shift from vendor to advisor is correlated with the shift from sales to marketing. Many fertility companies are viewed as commodities and vendors because they are still trying to fulfill positioning needs in the sales process that now take place in the marketing process.

Every time I skip steps and try to accomplish positioning requirements in the sales process that should have been established in the marketing stages, I regret it. Comparing the results of an outbound campaign at the end of 2020, vs the effectiveness of publishing a clear and firm point of view on every segment of our sales and delivery process, (I hope) I’ve learned my lesson for the final time. When I over-invested in the sales process, I often made our firm appear as a vendor. When I do the positioning work ahead of time, we are viewed as advisors and the sales process is easier and more genuine.

POSITION AS VENDOR OR ADVISOR~POSITION IN MARKETING OR SALES

Consider the shift in the sales and marketing funnel as illustrated by Steve Patrizi. 

fertility marketing funnel

Representatives and indeed entire fertility companies are positioned as vendors by practice owners and executives because the companies are doing too much in the sales stages and too little in the marketing stages, to position their value. They are mixing tactics and skipping steps.

The result is being overinvested in the awareness stage and undifferentiated in the sale. If you’re not following the concept, a couple of examples may be familiar enough to click.

  1. Massive industry sponsored parties at fertility conferences~overinvestment in brand awareness

  2. Expensive dinner bills and overpriced field reps~undifferentiated in sale

Neither are categorical mistakes. Large events and expensive salespeople can be a tremendous competitive advantage. Still, even when they are strategically sound, there are concerns about each. 

Conference parties need careful positioning in and of themselves because they are a major public relations (if not legal) liability. Yes, you could tone it down, but conference parties are typically a zero-sum game. They’re either a grandiose affair where everyone shows up, or they get little traffic because everyone’s at the big party.  


The best reps are worth their weight in crypto, but many of the others do nothing to drive sales. Too many payroll, travel, and entertainment expenditures are wasted because reps are doing the job that well produced content is supposed to do. Furthermore, the best reps are drawn to and enhanced by good positioning. 

HOW TO POSITION FOR EXPERTISE AND VALUE

If over and underinvestment in certain stages of the sales and marketing process cause fertility businesses to be positioned as dispensable commodities, how do they position their value or expertise so that they are not easily substituted? 

Consider the Business to Business Fertility Marketing funnel here.

It’s a mistake to treat the funnel merely as a checklist. You may do webinars, have client testimonials, and even a brand video. If they’re the same as everyone else’s and if they don’t fluidly set up the sale, it doesn’t matter. The telos of a salesperson is to sell. A salesperson that cannot sell is not a good salesperson. The telos of a marketing system is to set up the sale. If a marketing system cannot set up the sale, it doesn’t matter how much you spent or what title you gave it.

NO, I SAID DIFFERENTIATION.

What differentiates your fertility company from the others? If you said, personalized customer service, we’re off to a bad start for two reasons. First, the delta between companies’ opinion of their experience and the customer’s perception is tenfold. According to research by Bain, 80% of companies say they provide a superior experience but only 8% of customers say so. 

The cause of the delivery gap has been summarized by Dr. Francisco Arredondo and others as 

Satisfaction=Perception-Expectation.

The cause for the high expectations that drive the delivery gap is the second reason that attempting to use superior customer experience as a differentiator is a bad idea: it’s undefined so no one knows what it means.

Here’s the litmus test: If I read your differentiation statement in a room of your competitors and ask who can say the same about themselves, how many will raise their hands? If you put me in a room with all of the agency owners and marketing and business development advisors in the world, how many would say they get results for their clients? Millions.  How many would say they “really get to know you” or they have an “arsenal of resources”? Most. How many could say they have served more than a dozen fertility companies? Four or five. How many raise their hand when asked if they are exclusively devoted to bridging sales and marketing for fertility companies and have a published point of view on every segment of the fertility patient marketing journey? 

One.

REARRANGE SALES AND MARKETING, GRADUATE FROM VENDOR STATUS

Failing to adapt to the shift in buying behavior from sales to marketing has left many fertility companies undifferentiated in the sale. When one corrects too many expectations in the sales process, they’re viewed as a pain in the rear. When one corrects expectations in marketing, they position themselves for an advisory role in the sale. By not differentiating their positioning early on and throughout the marketing journey, fertility companies are frequently positioned as vendors or commodities by fertility practice owners and executives. Marketing isn’t just the promotion of your company’s position, it's the continual reinforcement. You need a clear and firm point of view about everything you do, and that point of view needs to be reinforced and distributed by content before your sales reps ever have to repeat them. Who knows, maybe your customers will even buy your next dinner.

Read about how we help B2B fertility companies differentiate themselves and increase sales here.