Brand vs Reputation: 4 Competitive Disadvantages for Fertility Business Owners

By Griffin Jones

“Our reputation speaks for itself,”

Does it?

Young, massively funded companies are entering the reproductive health space and developing widely recognizable brands to a population that had been generally unfamiliar with the field.

Established fertility companies often attempt to counter these branding advantages with their reputation. 

Reputation is extremely valuable for all of us business owners in the reproductive health space, but especially for fertility specialists. Even when process complaints and negative outcomes make an REI’s rating less than five stars, you still have a proud reputation. You’ve dedicated your career--one which very few other people can do--to help people have families. Your reputation deserves respect.

Still, reproductive health companies that make little distinction between brand and reputation are at a competitive disadvantage.

Brand and reputation overlap. They can work with or against each other. But they are not the same.

In the absence of the intentional formula ‘reputation plus brand’, a fertility business suffers from the default equations of ‘reputation minus brand’ or ‘brand minus reputation’.

“Brand is about relevance and differentiation. Reputation is about legitimacy” 

“A strong brand helps communicate that the company and its offerings are relevant and uniquely able to meet customer needs. A solid reputation is desirable because all businesses ultimately depend (either directly or indirectly) on the goodwill of the governments and communities in which they operate”. From 'Don’t Confuse Reputation With Brand' by Richard Ettenson and Jonathan Knowles

In the case of your fertility practice or reproductive health company, your reputation amounts to what is said about you by these five groups

1. Patients/clients

2. Peers

3. Employees

4. People you do business with

5. Media
   

Patients

On social media, on online review sites like Google and FertilityIQ, in patient support groups like RESOLVE and Fertility Matters. Through patient satisfaction feedback platforms like Press Gainey or Net Promoter Score.

Peers

If you are a physician this includes colleagues in the field, but also includes aspiring providers, referring providers, and competitors. At ASRM and other conferences. In private conversation

Employees: 

On LinkedIn and sites like Glassdoor. At networking events and your own office.

People you do business with: Your vendors, expert advisors. How you treat them and pay them gets around, too.

Media: 

The coverage that you do or don’t have from reporting outlets.

Reputation isn’t always fair. It is what it is. It doesn’t matter if one negative story in the press is a stain on your search results. It doesn’t matter if competitors drag your name through the mud, if a few former employees have an ax to grind, or if some former IVF patients take a negative outcome out on you. A sterling reputation is hard to come by.

A strong reputation is not necessarily equatable to a strong brand, either. And vise versa.

BRAND IS WHAT YOU SHOW OF YOURSELF

While reputation is what your five constituencies perceive and say about you, brand is what you give them to recognize you and associate with you (or not). Reputation is sometimes reactive. Brand is meant to be proactive.

Brand does at least four things that reputation does not do. It 

1. Multiplies 

2. Differentiates

3. Expresses, and

4. Promises
   

1. Multiplies
   The simplest definition of brand is simply, a mark. No; logos, slogans, taglines, and ambassadors are not in and of themselves, a brand. Nowhere close. Still, these symbols allow companies to scale their message and perception to a magnitude and readiness that reputation cannot.
   “Brand functions as a multiplier” -Mark Di Somma, Brand Strategy Insider.
   

2. Differentiates
   The purest form of differentiation is recognition. A successful brand allows each of the aforementioned groups  to recognize an organization’s position and differentiate it from its competitors instantly. An artisan coffee shop may have a wonderful reputation, but you recall Starbucks’ mocha lattes, the way they name the sizes of their drinks, and how they write your name on the cup just by seeing their logo.
   

3. Expresses
   We’ve chosen to split the concept of brand identification into the two concepts of differentiation and expression because differentiation allows consumers to identify you out of a crowd, while expression allows them to use you as part of how they identify themselves.
   
   There is an abundance of research, including this study from Elsevier, that shows how “consumers seek new ways in which they can express their personal identity through brands”. The more our field serves and works with newer generations, the more they use brands to express themselves. 
   
   “The core of Gen Z is the idea of manifesting individual identity. Consumption therefore becomes a means of self-expression.” - (From McKinsey & Company,  ‘True Gen’: Generation Z and its implications for companies’  byTracy Francis and Fernanda Hoefel
   

4. Promises
   Reputation is the judgment of your promise. Brand is the promise. Patients and clients set their own expectations in the absence, and sometimes in spite, of a clear promise. The more strongly your brand reinforces your promise, the more you are able to impact the measure by which you are judged.

REPUTATION PLUS BRAND

When fertility companies fail to distinguish the difference between brand and reputation, they are at a competitive disadvantage because of how reputation and brand bolster or undermine one another. 

Reputation and brand overlap because they are both born of positioning and culture, but they are not equally synonymous.

In the absence of the intentional formula ‘reputation plus brand’, fertility business owners are left with the results of ‘reputation minus brand’ or ‘brand minus reputation’.

Consider the four advantages that a robust brand is meant to secure for your company. The last two, expression and promise, are particular vulnerabilities for reproductive health companies.

If you would like to further explore the brand and reputation potential of your fertility business, we address that in our Goal and Competitive Diagnostic.

125: How to Attract Per Diem Embryologists

On this episode, Griffin Jones and Giles Palmer, the executive director of a group called the International IVF Initiative, discuss  what’s happening in the lab and why clinicians, managers, and other folks should pay attention. Giles holds webinars for embryologists and other fertility professionals, attracting over 800 people each session. Tune in to this episode to hear more on the shortage of embryologists and how automation could be one key to increasing your embryologists’ capacity and quality of life. 

Listen to the full episode to hear: 

• Giles perspective on hiring young embryologists

• How automation will affect lab efficiency

• Giles viewpoint on corporate IVF

• How Giles is able to attract large crowds of embryologists 

Giles Palmer: 

Company name: International IVF Initiative

LinkedIn Handle: https://www.linkedin.com/in/giles-palmer-52461531/ 

Twitter Handle: @IVFLIFE

Facebook: https://www.facebook.com/giles.a.palmer 

Website URL: https://www.kosmogonia.net/ 

Want to make your company irresistible to new talent? Let’s start the conversation at fertilitybridge.com

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Transcript

[00:00:00] Griffin Jones: So I think what I'm saying is the cycle of life is continuing, but yes, it seems to me that the trajectory of most things is consolidation and fragmentation happens with countries, happens with businesses. And so we're seeing consolidation right now, but I also think we're seeing fragmentation and, and niching as well. 

[00:01:00] Griffin Jones: On today's episode and back in the lab and I'm across the pond. I haven't had too many guests from the UK or from Europe and on today's show, I have an embryologist, someone with lab experience, someone running an initiative, that they'll talk about from the UK who has also worked many years in Europe.

This is Giles Palmer. He is based in Cardiff Wales at the moment. And now he's the executive director of a group called the International IVF Initiative that he formed with some other lab folks in the start of the pandemic. And now they have audience. Like several hundred people, not just embryologist and lab staff, but also clinicians.

And in this episode, we talk about what clinicians, managers and other folks who aren't in the lab have to worry about what's happening in the lab because it's coming for them so enjoy this show with Giles.

Mr. Palmer Giles. Welcome the Insider Reproductive Health. 

[00:01:57] Giles Palmer: Thank you very much. We meet at last, I think we occupied the same you know, virtual university, if you like, but it's good to see you, you know, So it's great to be on the show. Thank you very much.

[00:02:09] Griffin Jones: Well, I like to give you the ability to decipher some of my audience. I'd like some exposure to yours because I got to confess. I have not had too many guests from the UK on the show of 125. You might be number three, maybe number four. And so that's fine. We are having to recruit a, too many guests. And so I felt we need more representation across the Anglosphere and here you are. 

[00:02:37] Giles Palmer: Well, thank you very much. I shouldn't be offended at all. I mean, I only moved to the UK only about six years ago. Yes. I was born in Britain, but I've worked most of my life in Europe. Okay. And I came back to the UK, you know, only a short time ago, so although we're out of your work. I still like to think of myself as European. But certainly from across the pond. So yeah, perhaps I can give a different perspective in things in the IVF world, in that respect. 

[00:03:02] Griffin Jones: So having worked in Europe for a number of years now, working in the UK and the initiative that you're involved in that we'll talk about.

That sounds like you have a good exposure to both the UK and Europe. And I want you to give us just a little bit of state of the union of what's happening over there. So here in the US and Canada last year and a half is you're probably aware most centers have just been slammed. Some have not. If they're in competitive markets or they haven't updated their business in a long time, but I would say 75% centers have been slammed.

I might be starting to change now. We'll talk about that in a little bit, if that might be the case, but what's been happening in Europe and the UK post covid.

[00:03:43] Giles Palmer: Oh sure but what's the word you use slammed was that? 

[00:03:47] Griffin Jones: Very busy. It means very busy. 

[00:03:49] Giles Palmer: Very busy. Okay. 

[00:03:49] Griffin Jones: To be at or exceeding capacity. 

[00:03:52] Giles Palmer: Well, thank you very much to clarify that marvelous. Yes. It is incredibly busy.

Both in Europe and in the UK. And you can see this from the posts, you know, everyone is hiring, and that's from the countries that I've worked for and in the UK. But yeah. But why is that? It's not just that there's been like a bottleneck, you know, and people haven't been treated over there pandemic.

First of all from the patient point of view, I think that people have thought, you know, they're like reassess their live and they say, yes, I want to have IVF. So yes, there's been a small amount of people that couldn't be treated and now they're being treated, but there's a lot of people that are thinking, yes, you know, I want to start a family.

So I think there's been an increased demand. Also, you know, the life of the embryologist has changed dramatically over the past few years. I mean there's more free cycles. Okay. Which means you have to have a devoted person to do that in the lab, it's not so much, you know, like full rounded, like, in the IVF lab, you'll have an egg collection, you'll fertilize, and some days later you'll then have the transfer, you know a lot of people are freezing the embryos and transferring them in a further cycle.

So that means that there's a lot of you know, force to be done as well. Which means as well for like the dynamics of a clinic as well. And I don't know if you've touched on this in some of your programs, but you get a higher throughput through your theater. If people are just having egg collections, when people are having egg collections you know, egg retrievals, but also embryo transfers, then there's going to be some time that you've got to sort of a lot for that, but I think the dynamics have changed in the clinic. And even within the inner workings, people are working a lot more and continuing on for that, of course you know, PGT and biopsy. You know, other techniques are being used as well. So I just think in a way it's a great time to be an embryologist, but it's a very tiring time to be an embryologist. 

[00:05:45] Griffin Jones: Is batching common in the UK and in Europe?

[00:05:51] Giles Palmer: Not so much, no in your Europe and especially where I was like in the Mediterranean which is quite shocking for people in the states. I know that like using summer, we wind down and there's a reason for that. Like, you know, for example, I was in Greece and there was no treatments in August, okay,, but that meant that, you know, the whole staff could be taken you know, could take a holiday.

You know, the clinic could be shut down. It could be just, you know, like maintenance done on that period of time. And then, you know, back up again after August or so that was like in that sense, patching, but in the UK, you know, there's no distinction between, you know, summer and winter there, mainly because of the weather, I think, but there's none of that that goes on, obviously in large air, you know, larger countries like India, there is a lot of batching just because it's such a wide expanse and the such a demand for embryologists that they cannot be treated in that sense.

So there'll be a clinic which will open in like a remote area for, you know, for a certain amount of weeks, but I wouldn't say batching has done. No, no. The only time it may be done, I think is in clinics that treat HIV patients. And then we sort of have a certain time where they'll treat HIV patients you know, for risk of contamination and whatever they like bachelor in that sense. But now it's, work all around the year. I think a few days of in holidays, but it's busier than ever. 

[00:07:09] Griffin Jones: So what are people doing to meet the increased volume? You said everybody's hiring, which means that there are not enough people coming in and filling those positions as quickly as possible as it is here. And so what are people doing?

[00:07:23] Giles Palmer: I mean, the desperately trying to find staff, and it's not always the solution that you can find a trained staff, okay, there was effect, I was giving a talk in Arizona, that was the start of January this year. And I've talked about mental health, which was a study we did which was the international study. We did actually with the group that I worked with and we looked at burnout. So ita lot of embryologist who are suffering or on the verge of burnout.

There's so much work that's going on. But that said it's very difficult to recruit younger people that have the skills, now it takes investment to train people. And the ideal thing is of course, to find someone who's like pretty well-trained or at least knows the basics. Now there's a lot of masters courses all around the world going on teaching at various stages, some are treating practical aspects.

Some are treating just theoretical. So there is quite a large pool of young embryologists, but it's being accepted to sort of join a team because as I said, there is an investment that needs to be done plus, and we're sort of changing tack a little bit. There's a growing workforce, especially in the states.

There's a lot of embryologists who have worked in clinics for over 20 years or more. This again was a finding from our study and these people will be retiring soon. Okay. And leaving the workforce. So there is I think a crisis coming perhaps when we have to find the men, you know, the members of staff to actually fill in this space.

Again, you mentioned, what are people doing to alleviate this? Two things I'd like to mention one is that there seems to be more and more what I called locum, but you call per diem embryologist,. okay. And it's a supply in need. I mean there are many more that are coming out and they can actually move from clinic to clinic and give their skills to a clinic who for many reasons needs to have more staff.

Okay. They have to be mobile. They have to be very well trained to sort of go to another lab. In fact cook in another kitchen, if you like, okay. They have to know all the equipment, they have to know all the protocols and they have to assimilate very quickly into a lab. So there's many more per diems coming into the fray, if you like.

And one thing which is changing is that now that the clinics are sometimes in chains, you know, the corporate companies which are coming out the advantage of those is that they can in fact relocate or they can move around their staff. So now I'm terrible at the geography of the states.

But you know, let's say that it's spread across the nation. If there's a shortcoming in one of the clinics, okay. In some kind of conglomerate, then they can effect, you know, move around people to sort of care for that. So that I think answers, that's my long answer to your, the question, but there are ways around everything again it's a good time to be an embryologist because there are many jobs out there.

[00:10:15] Griffin Jones: That's right. It's a seller's market at the embryologist, the seller in this context, though, people are, they're recruiting, they're using per diem folks. Is there any acquiescence to the burnout in, from the side of the clinic and the lab in that? Okay. Well, we just can't hire enough per diem folks, or we can't replace the folks that are being burnt out.

Our current staff are telling us they're burns out and we're so afraid of we lose even one that will, our problem will be compounded that much more. Is anyone saying, okay, well, our waitlist for patients might be two months to start IVF. Well, sorry. We're going to have to make it three or two and a half because otherwise we're going to burn out our embryologist.

Is anyone acquiescing as far as you? 

[00:11:02] Giles Palmer: I know of one example that slowed down there are treatments and that's a clinic in the UK actually who through staffing reasons they just had to. Okay. And. It's all power to them to be able to do that because you kind of went to clinic, you know, on a shoe string and you kind of when a clinic, you know if there's not an adequate number of staff.

So I think that has been the case. But it has been the case, even with the pandemic. If you think about it, the way that they've had to slow down in the UK, they couldn't have had to stop completely. I know in the states that wasn't the case. In every single state in North America. But you know, there has been this like management of staff just sort of keeps them furloughed if you like.

Okay. And sort of like gear them up again to be done. What has happened in the pandemic is that there's been a lot of like a, transfer's a bit like football. There's been a lot of you know, key players that have moved from clinic to clinic. And that's been the case, not just in the IVF world, but also in any kind of industry.

We've found people have reevaluated their values and their job. And if they haven't happened, if they haven't been happy in their in a particular job and feel a bit disgruntled with that company, then they had a great opportunity to change. We see a lot of fluidity over the last few months.

But then if you've noticed as well, there's been a lot of changes going on. And of course that goes fuels. Why people have been advertising so much. So there has been more change going on in that market, you said it's a sellers market. Well, I kind of took about salaries. You know there are clinics which are offering, like sign up bonuses for that, which I think is a great incentive.

But salary isn't everything and that's very easy for me to say, but you know, there are various things in your working life, you can look at as opposed to just salary being the reason why you leave. We know the embryologist are, are the greatest asset to a clinic, but if they're so good then you always have the danger that they're going to leave.

Now I was in lab management, I'm an embryologist, but I've been in lab management for, many years over 30 years. And some of your staff maybe like headhunted, you know, maybe taken away. Well, that's Inevitable, you have to be gracious when that happens. There are wheels within wheels.

We're still a very small community embryologist. I don't know how many thousands we are worldwide, but we are quite sociable and we all meet up, you know, even more so virtually, so is to be gracious. And if they have to go, they have to go. But there are many ways that you can keep an embryologist and it can be an, and you refer to burnout.

It can be just a flat fact that you, you give more amicable working hours or flexible hours. 

[00:13:36] Griffin Jones: I was having this conversation with Dr. Tony Anderson from Texas, and he was saying the exact same. You said, but I pushed back and said, well, how do you give people better working hours or fewer hours? When the queue of patients is figuratively around the corner and if you do that, then you're either pushing back treatment for people or you are putting the workload onto another embryologist. Say how do you do that when the demand is so high? 

[00:14:09] Giles Palmer: Well, I'm sure there's no company that's going to give someone, you know, extra time off if that's at the detriment of their lab staff.

Okay. But it's all part of management, you know, it's all part of lab manager. You have to have redundancy anyway. Okay. that is a day-to-day thing that a lab manager has to cope with. There's always going to be, there's always going to be someone in your large chain of clinics that, you know, you're going to be ill for one day. I'm going to have to take time off for like personal reasons. So you should always find that you can fit people to their abilities. You have to have younger staff. I'm not saying you can't and you have to train them and you have to train them on the job. Like I said, there are many training colleges around.

Okay. Especially in North America that, you have someone who has the competencies to sort of start with a less learning curve. Okay. When they join the lab, it is a commitment to the lab manager to actually see that everyone is competent and everyone starts off. But you know, it has to be done in the UK in fact, there's a new sort of subset of embryologists. Think they're called lab practitioners. I could be wrong, but they just do egg collections and semen analysis. So they do, let's say You know, limited workload, but it can be like a job which would take an embryologist, you know, hours away from doing other work while the other more experienced people will do.

You know, the embryo biopsies, the ICSI, makeup the culture medium. So, you know, there are ways around that.

[00:15:33] Griffin Jones: What do you think should be eliminated Giles and in any workloads, there's priority is eliminate, automate, delegate. And when you're getting so busy, you have to be extra scrutinous. What do you think could be eliminated or automated readily that you still see many labs not doing?

[00:15:56] Giles Palmer: I think you know, a lot of it is the paperwork. Okay. Now you don't have to be paper free, but you can be paper light in a lot of the clinics. A cornerstone of clinical embryology is of course quality control. Okay. But you still see people walking around the lab with, you know, pieces of paper you know, with a little tick box.

 Okay. There are now electronic means reflections where it's an outweighed and just electronically typing all these numbers you have to do. And they're forgotten about in a way until you want to actually retrieve them and reflect on them for any number of reasons. Okay. There's lots of things that can be done around the lab, which again, can be automated.

You do in fact, have these alarm systems on most of the critical pieces of equipment, but you still have to visually check them every day. Okay. I'm not saying that you shouldn't. But there's a lot of paperwork that goes on now, embryology as well. And we've spoken about this many times between the peers is there's a lot of admin work that is done with embryology.

Now that is a root of great concern because when an embryologist is trained, he doesn't realize that he's got to do another quality control assessments and he's got to do stocktaking and the, and the inventory to look after the, you know, quiet back. Okay. Even speak to patients. A lot of people are unaware that they have to do that when they train to be an embryologist.

And it could be that the embryologist wants to spend time on the bench work. So, you know, automating all this interaction with the patients, if you don't want to, or the admin, it could be done and there's not an efficient EMR at the moment, which can help with that. You've got to take yourself out of your working routine and type things in.

But you know, that will change. We often speak on our initiative about, you know, like smart devices now in the future, there'll be, you know, like perhaps smart dishes where you haven't got to use a sticky labels and there'll be voice to action certain ways that you can witness things in that sense.

But technology is coming just to take all the admin away from the embryologist. So that will be a good thing. 

[00:18:01] Griffin Jones: Well, there are some life sciences companies out there now. With replace a lot of the manual systems and both with storage and managing if they're not cleaning up right now on the heels of labs needing to become more efficient because they can't fill enough embryologists, then they don't have a very good sales platform.

I think there are some solutions out there I'm not qualified necessarily to speak right now. The pros and cons of each, but are these, some of the things that you talk about in your initiative that you call Ifree, which is the international IVF initiative. Tell us more about that. What do you do there?

[00:18:41] Giles Palmer: Sure. Well to answer your question about, does it, does it fill the void? Well, it's certainly a space which has been filled up by many companies. So, obviously you know, there is work for everyone to do making things automated and one is with the, you know, like quite a storage. It's a no brainer just because why should we have to check ourselves visually every year that we've put something in the right place, if it can be done automatically, then it should be done. You know, once AI of course has perhaps been overused these past few years. I mean, you know, everything is AI at the moment. But it's like tangible benchtop AI, which is going to come out and actually help us.

It'll rank things first it'll help us choose embryos a little bit better, but we'll still have to have embryologists that will actually look over the results. You know, it's like, a driverless car, will we allow complete control over it? You know, like a driverless car, we'll still have to look at this you know, this data to help us. That will be an improvement because now, you know, you'll know about time-lapse and time-lapse imaging, which is a fantastic way forward is a better way to incubate, it's undisturbed, but to choose an embryo, an embryologist may spend, you know, a much longer time if they have time looking over these images and trying to choose, which is the best embryo, it may call over one of his colleagues and have a debate purely because you have the luxury of seeing the video of that sense. So all these new technologies we talk about in our initiative. But it, talks about so much more it's really addressed to clinic staff We have a slight majority of embryologists, but also clinicians and lab managers follow this initiative.

We usually have them once a week. It's become very popular, but we do the whole gamma of the IVF industry. So we do like the cutting science. Okay. What's happening with new articles and practices. We can then do about new innovations. So again, we do about what's new on the market, but we've also touched on the field of embryology and looked at things that concern them, like quiet governance which is of course affecting everyone with a recent or failures, which are happening, everyone's paranoid to say the least about getting things right. We've looked at staffing levels. We've done a survey which was awarded which has been awarded at the fertility 2022 for its work.

We looked at mental health in an international survey, which I think I sort of touched on beforehand, but there's a lot of data in there. There's a lot of data that we know now about the psyche of the clinical embryologist. And then of course we've done a few webinars as well, which have looked at animal reproduction.

Okay, cloning stuff, which you know, is interested people. I think they do our job, which can, if can add that to your daily speaking with the patient, giving you a weird and wonderful, explanations from nature, then that's quite good, really. And we've even gone off piece and had people from NASA that had spoken to us because as you know, every five minutes people are popping into space nowadays and there will be productive houses with that.

There's micro gravity. There's a radiation problems and it's not been discussed. So people are doing experiments on sperm and embryogenesis in space which I think are interesting, not just as an embryologist, but the lessons they learn can she help some of the medicine here on earth as well.

 So we've done about everything cause you can see.

[00:22:02] Griffin Jones: When did you start? 

[00:22:04] Giles Palmer: We started just as the pandemic hit, actually the start of 2020. And it was Dr. JacquesCohen who got us all together. He felt, you know, and is a great visionary. So he thought that embryologist would need someone to talk and and to discuss things, especially as you know, there were like furloughed in, at home and in this uncertainty.

And he got together with Thomas Elliot of ivf.net. Who's a bit of a it wizard and he set up a website and they had the idea to have these like webinars. And of course, everyone has been doing webinars, but I think we've done something a little bit special. They've been very popular and to go with those two, Dr. Zsolt Peter Nagy.

Okay. And they look at like the scientific content of everything. And then we've had Mary Ann who's been with us in the IVF industry for a long time. Shaista Sadruddin as well. She helps out and Colin Howles, of course, who's quite a well-known figure in the pharmacy world.

So that's the core band, if you like, but we've been helped with, you know, so many people in the IVF industry, so many people have wanted to help us.Dr. Liesl Nel-Themaat has helped us out, Dara Berger, Alison Campbell, another person from the UK. And two others, Alison Bartolucci and Kelly Ketterson have all sort of helped behind the scenes to make these things a success.

[00:23:24] Griffin Jones: You mentioned that you have it's embryologist heavy, but you have a number of clinicians and physicians and lab managers, what kind of crowds are you? Are you getting now that the pandemic is now that people are on zoom every second of the day, like they were in March and April of 2020 about what's a average crowd for you?

[00:23:45] Giles Palmer: Well, we got about an average 600 to 800 people, every webinar I'm told is pretty good, especially as like companies that hold webinars you know, don't do very well at all, but it's because it's because it entertaining, you know, yourself and then your interview skills are fantastic.

You have to make people buy into the time that you want to give them, you know, they're working hard, it's their own personal time. Okay. You know, it's gotta be something that they want to listen to. And you know, and we have topics where I think people want to listen to, you know it's got the scientific core but it's also entertaining as well.

You know, no one wants to finish you know, like a long day and listen to like a commercial yeah. You know, on a certain project, you know at the start of the pandemic, of course it wasn't much higher. We were having over a thousand people attend but it's like leveled off to the numbers, which I've said.

And then of course it's put on the website afterwards and then many thousands watch it on demand as they say. Yeah. 

[00:24:40] Griffin Jones: Are they mostly coming from the UK and Europe? What's your distribution? 

[00:24:45] Giles Palmer: I'd say it's over half from North America. Okay. And then after that it sort of pretty similar numbers, but I wouldn't say that you know, too many people from the UK, watch it shame on them, but I say it's like north America and then the rest are all very similar.

You know, we've got UK as well, obviously. We've got a great following from. And now in India, usually the tone that we show these webinars, it's like 11, 12 o'clock at night, but thankfully that, you know, they stay up to listen to it as well. We do have them on other times if you never time to time, but the time we usually have them, which is 3:00 PM Eastern it's sort of our slot.

So we're quite pleased that we've got, you know, like a global following. 

[00:25:24] Griffin Jones: So, what are some of the insights that you've gleaned in the last few months? Because on this show, I talk about the business side of the field. And when I have lab folks on and talk about the business side of the lab, but I'm not having any sort of topics on about the latest techniques on ongoing to date by her beyond glasses.

And I'm not, you know, I'm not covering hatching. 

[00:25:47] Giles Palmer: Yeah, I'm not sure, but you know what it is though, but you know what it is you see, and that's the thing. And we'd still have people who own a clinic who we may want to dip into you know, webinars, just because it's much more practical experience. So you'd have someone talking perhaps about hatching blastocysts isn't it, you know, as you said, but it will say, it may be in a. terrible discussion where you've got people from, you know, leading clinics all over the world and they're talking about, well, I do like this and I do like that. So it'll perhaps, you know, help them sort of manage either their workload or their sort of plan about how they want their clinic to go.

 So that's what they gleaned from it, you know, that, you know and we have a large, we have a very large, let's say following, we have over 18,000 members, but that doesn't mean that they watch it every week. Of course, you're going to have like a subset of people that are going to be interested in, you know sperm and similarities.

Now, even if. 20% of those watching it, then that's a very, that's a really big number. You know, other people who are interested in like the tech side of it are going to be that and other people, which are medicine are going to fall from that field. So, you know, by having a large net, if you like and being global, we can get the numbers, which are quite envious in anyone's book I think.

[00:27:00] Griffin Jones: Especially for people that want to talk to embryologists right now. So who can join? Is this, is this a membership that people have to sign up for?

[00:27:08] Giles Palmer: Anyone can join. It's completely free and heal and it will always be free. We have an electronic membership card, which is quite good that you can put it on your phone.

So we've noticed that you know, that Evan has email overload and sometimes, especially with webinars. So we have a lucky little app if you like, but it's, but it's a membership card which will tell you where the next session is coming up and there'll be various offers on. And you'll be first to know about certain things.

So that's what we do and that's how they hear about it. We've got the website, which is IVFmeeting.com, which has the back lobby of all the talks. And we don't just have the, like the whole webinar. We also have them sort of cut up into each single lecture. So we're finding that even like master's students or I should say in a master's course, the teachers is telling the master's students to actually, you know, go and watch session 66 or go and watch you know, the topic on this.

So, you know, it's quite an archive of like, current topics there. And we do delve into, you know, the, you know, the business side of things sometimes, you know, the management side, as you said, within a very successful. 

[00:28:14] Griffin Jones: Yeah, but session coming up it by the time this episode is out, your session may have aren't fast, but I see you have a session coming up on corporate IVF.

[00:28:23] Giles Palmer: Yeah, I think it's very exciting. It's a very exciting time that we live in and you know, the clinics are just the preserve of like a single doctor or a group of doctors anymore. You know, these, you know, this is big business and to be quite honest, I think it does need to go into the biotech arena.

So we're getting these large companies more so in North America, but most centers in the UK now are, there's only about three or four, you know, like groups, if you like small in comparison, perhaps to ones in the states. 

[00:28:52] Griffin Jones: Is that across the board of Giles? Now there's three or four major groups, but are there still boutique centers in different markets or it's almost everyone owned by those three or four groups?

[00:29:04] Giles Palmer: There's still a boutique. There's still boutique in Europe. There are very much boutique markets now. Okay. Save a few, you know, like IVI, and Eugin still, they are the, you know, the end of the preserve of like a group of doctors. But I think the writing on the wall, you know, I think it's a good model.

It's a good business model. It's good for quality. It's good for results. It's also good because you know, all the research nowadays is going to come from private companies in the states. There's no money, which is given to embryo research at all. Okay. Although there is funding, you know, for other forms of medicine.

So it's going to be the antidote is going to be the conglomerates that are going to have the mic to do this, you know, and that again is going to be like a coward that is going to attract, you know, like embryologists that want to do that work, big data, large number of patients. That's where the, you know, that's where the research is going to come from now a days.

[00:30:03] Griffin Jones: That's the argument for corporate IVF. There's also arguments against it. And I have both perspectives come on my show. are you going to have a debate in your topic on corporate IVF or what are you going to cover? 

[00:30:18] Giles Palmer: We don't usually have the format of a debate now, you know, there were many other webinars and even, you know, the courses conferences, which do have like a debate.

[00:30:28] Griffin Jones: Neither do I, by the way sorry to interrupt because I want to sidetrack on this because so many, I would love to have a debate on my show because so many people will email me after a certain topic. And they'll say, I can't believe so-and-so said that when I think they're full of it. And I said, well, why don't you come on and share your perspective. No, you know, I can't, well, it would be great if people would.

[00:30:55] Giles Palmer: Well, I mean, I want to hear the, what are the arguments against it now? I'm sure they are, and I can guess that, you know, people think it's not gonna be personalized and whatever. But I just see the writings on the wall, you know, That's the way it's going to be.

[00:31:09] Griffin Jones: So this is the way it's happening over here. And I actually don't know if these metaphors work. Europe or the UK, but in the United States for a hundred years ago, you have a brewery in every city, in town, in America. There was Goebbels in Detroit, there's Genesee and Rochester. There's old style in Chicago and, and some of them are still around and some of them aren't, but every city had its own brewery or a couple.

And then as the century progressed, you had MillerCoors Anheuser-Busch merges the three conglomerates. Then you had south African brewing by Miller and then they walked coolers together. And then, so then you have SAB MillerCoors. Actually, I do think this analogy works in Europe because InBev comes from Europe and then merged with Anheuser-Busch. So now you've really just got two conglomerates that control most of the group, but what did we start seeing in the mid two thousands? The emergence of craft breweries, again in just about every city in America, and then some of them grow and they get bought by the bigger guys and then the middle of the new middle guys are buying the smaller guy.

And then people are starting brand new breweries. And it happens with breweries that happens with local and regional banks. And we also see some of it with fertility centers that this doc was a partner over here, or they worked in an REI division and they got bought and then they went off and they started their own thing.

And now they're growing again. It gobbled up.

[00:32:33] Giles Palmer: So what's the answer. Yeah. So, yeah. So what's the answer, no, I mean you know, you could say if there are these conglomerates. And with your beer analogy, you know, is their choice. But of course there's choice because there's market forces. That's what I think.

And you know, someone's going to offer these things. And you mentioned about like the emergence of these microbreweries. Well, you know, that'll happen again, maybe with IVF, so, you know, all that we are seeing.

[00:32:57] Griffin Jones: We are seeingg it. So I think what I'm saying is the cycle of life is continuing, but yes, it seems to me that the trajectory of most things is consolidation and fragmentation happens with countries, happens with businesses. And so we're seeing consolidation right now, but I also think we're seeing fragmentation and, and niching as well. 

[00:33:18] Giles Palmer: Yeah. But like, while these companies are big, then they get super efficient and they get this big data and that can help the smaller ones in the long run afterwards, you know, it gives them the opportunity to faction out if you like.

[00:33:29] Griffin Jones: If they provide efficiencies. And so come on my show and say, they're not so good at biting efficiency. I've gotten accused of being both. I'm neither. I do think there are pros and cons and I let people say which they think is.

So we've covered a lot. How would you like to conclude most of our audience right now comes from North America, about 75%. But there are some folks outside, I think after the US and Canada, India is our biggest listenership, but we've had listeners from Australia and central Europe.

You speak far more to the lab side, whereas our audience has some lab folks reach out I, how we got connected. But a lot more on the clinician side and the business side. How would you want to conclude with our audience either about what you see happening in the field and what like see, or what you'd like people to know about?

[00:34:22] Giles Palmer: I have to take a moment to think about that. I would just think about saying that what you've said to me now is you know, that you think that you are catering for an audience, which is just mainly north America, perhaps, and many conditions. And I think that we cater for people from the lab side of things, but as our hashtag is, it's like hashtag share the knowledge.

And that's what we did. You know, first of all, and people are watching it because whether it's legal aspects or it's business aspects, as you mentioned yourself, it is coming their way. And you know, we've got 180 countries that follow us and I'm sure you have as well, because they're going to learn something from what you're saying, and they're going to learn something from what we say as well now, maybe they've got different laws and a thing that we have seen. Not just with my, with my day juggles with is that every clinic works differently. Okay. They may have similar protocols, but every clinic works slightly differently, but they have these common problems in each country and each region has a way to solve that.

But you know, the issue of, you know, quiet governance. So what are you going to do with your non-compliant embryos, for example, what are you gonna do about safety? What you know about quality control, what are the legal aspects? What are you going to do about staffing levels? As we mentioned whatever it is, it's coming their way.

We've had some sessions on Treatment of same-sex couples. We've had successes on trans folk, which applies to perhaps my country, UK and yours, more where it is more open and it's more accepted, but as a service towards that many other countries in the world that's an opportunity for many of these people, but it's coming their way.

You know, this globalization is happening and they can learn from you know, like reaching out and having programs like yours, like mine and like others, where they can just see the writing that is on the wall and what is coming up in the future. 

[00:36:11] Griffin Jones: Well, I thank you for coming on to share some of that with this audience.

I hope our audience will come and check out your initiative the international IVF initiative at IVFmeeting.com and we'll link to that in the show notes and hope that they benefit from the insights of the things that are coming their way. Thank you very much for coming on  the show, Giles. 

[00:36:35] Giles Palmer: Thank you very much.

124: How to Increase Patient Satisfaction & Online Reputation with Rony Elias

This week on Inside Reproductive Health, Griffin Jones is joined by Dr. Rony Elias. They discuss how Dr. Elias is able to attain hundreds of positive reviews online by deliberately putting service first and friendship second. Contrary to many popular social media doctors, he believes in firm social boundaries with patients because ultimately, patients are there for a service, not a relationship.

Listen to the Full Episode to learn:

• How to set social boundaries with patients

• When you should or should not reach out to your patients

• How to talk to patients about sensitive topics like weight and age

• How to increase patient satisfaction whether treatment was successful or not

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.

Want to put a strategy in place to improve your reputation both online and offline? Visit us at fertilitybridge.com.

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Transcript

[00:00:00] Dr. Rony Elias: They can maybe relate to more on a personal level or so, by the end of the day, they're coming to receive a service. They're not coming to make a friend. They can't, they have a lot of friends. 

[00:00:49] Griffin Jones: Today's show I've got Dr. Rony Elias. We talk about patient satisfaction and reputation management. If you just took a sound bite from either side, you might think that Dr. Elias is all about being a warm and fuzzy doc. And on the other side, you might think this is a stone cold rules physician, is likely the balance between those two that has allowed Dr. Elias to be a very highly rated physician. Having hundreds of positive online reviews in several different platforms. I first noticed it in 2015, when he had only been in REI at Weill Cornell for four years after finishing his fellowship in 2011 and that trend continues today.

So we talk about the success that he's had in patient satisfaction and developing so many positive online reviews. And you might take note of the balance that he strikes in this conversation.

 Dr. Elias, Rony. Welcome to Inside Reproductive Health. 

[00:01:50] Dr. Rony Elias: Thank you so much for having me. I'm very much looking foward for this Griffin. 

[00:01:54] Griffin Jones: The nature of today's episode is the nature of the same way you and I met. I don't know, but you were one of the earlier docs that I met in the fertility field had moved back to the United States in 2015.

And that was probably the year that we met and I came to see you in your office and I was trying to think of how well, how did we connect in the first place? And I'm pretty sure it's this topic of patient satisfaction. And online reputation, which dovetails where more of my space. And, and you had won a good one back then, and then I just checked up on you again this morning.

I was like, oh, darn Rony is doing really well. And so let's start really broadly. Because there's some thing that causes patients to say that they love you and not just do that, but do so in mass. And there was a difference there because there's a lot of people whose patients love them, but they don't always say so publicly in mass.

So let's start with what you believe the tenets of patient satisfaction are. What do you think it critically boils down to? 

[00:02:59] Dr. Rony Elias: Again, thank you for having me. Actually, I remember when we first actually met, you had to reach out to me and I find the model to be like amazing. I didn't know that there's anybody like it was out there, like looking to just focus on fertility social media, marketing, all of this other stuff.

I think we contacted when I had first started that point out. Actually I never moved outside the country. I was always here, but I was just starting my practice consignors later. And that's when you contacted them the same thing you asked me, like. I don't want to be too foot philosophical, but I think to simplify it, Since when I was a med student, I always felt that it's kind of a matter of pure luck that I'm on this idol, this side of the bed, meaning any day I could be the patient any day, I could be the one struggling for infertility men, women, whatever.

So I just try as much as possible to put myself in their shoes. What do they expect from that provider or from that healthcare provider? Whatever. What do they expect? What would I have these. And I think even when the fail over and unfortunate negative cycle, are there just being, putting yourself for two seconds only?

Like what would you want the other person to tell you when there is that bad news? And obviously when there is a good deal, it's easy. I think that's what made me make the patient more. Being more grateful whenever I tell them about the first negative cycle. And obviously whenever they have the positive results and they can even advertise it more, but what keeps them and the practice and they feel like they just did not just another, , like another number, essentially.

Like what everybody's saying. I think it's being in their shoes is very like simple, but at the same time, it's very hard to do, especially when you have a lot of people that you be in that you have to be in their shoes everyday. 

[00:04:44] Griffin Jones: So you're trying to be empathetic to what they expect and expectations can be divided into circumstantial.

There are people that have different expectations based on their personality types. And then maybe there are some things that are universal. Do you see some universal expectations that fertility patients expect that it doesn't really depend on personality type? These one or three things are what every fertility, patient expects from you?

[00:05:13] Dr. Rony Elias: I think every patient in general, they're coming for you the same way you go to, I mean any other, you go to a plumber, you want them to fix your, your toilet. You're going to fix your, your bathroom. You're not looking to become friends with them. So they're coming to you to help them with their care. Once you provide this help, as much as you can.

I think from this point on that they can maybe relate to more on a personal level or so, by the end of the day, they're coming to receive a service. They're not coming to make a friend. They can't, they have a lot of friends they're not. So I tend to always focus on. Many of them who we have to do share I'm in the age group where many of them are similar to my age or a little bit younger that we happen to have common friends they're sent to me by friends or something.

I type to always avoid to interact with them socially, till when their kid is over, although many of them would say, well, how about we do something together with your wife with this, especially the one that even have kids before they come in for a second. If I tried to avoid that because why they here is for this and that's universal. Every patient is coming to receive certain care and you have to provide that. Then you go to the next level. Then you can try to be funny, can fact associate interact with them, whatever, once you give them what they can do for that's. I think the common denominator for all patient, not patients coming to make a friend, you know, they would like to have a friend as a buck.

They're coming to get the care. 

[00:06:39] Griffin Jones: I want to talk about that a little bit, because I've always felt that way. Even when I was earlier on in business, I could feel someone was too interested in what I was selling or offering because of my personality, because they got along with me, they thought I was funny.

They thought it was a good guy. Yeah. And I really try to not lead with that. And because I found problems when I did that earlier on, you know, people were buying Griffin Jones, Fertility Bridge for the guy with beard and the haircut and the cool ideas and the red pants. And, you know, they just had this idea of whatever it was that I did.

But then when it came time to servicing them, they weren't buying into a process. They had some idea in their mind and, and it wasn't an into a process. And so I then sometimes aired the other way, Rony where people are like, you know, you're almost like a ** in the sales process.  I try not to be so strict, but I do. If we're not getting to business first, then I worry that we're not going to be able to have a good social relationship later. And so I just want to make sure that I can serve people and if not, we can be friends outside. But so talk to me about how you don't go too far to where you're just it's all business or do not try to mitigate that.

[00:07:55] Dr. Rony Elias: No, I mean I am hundred percent agree with you. I think that the personal parts was the cherry on top. Like I tried it, it is hard, especially like I said, because socially I'm at the age, but still some of them are coming friends to somebody else. Anyway, I actually prefer not to see those patient essentially.

You know, if I feel like if it's gonna become like, you know, my sister-in-law or something, I definitely want to see you. I was not somebody else, but a friend of a friend, you know, I try to, they try subconsciously to, to divert you into somewhere else. Like for example, I can give you an example of a patient of mine.

She had failed multiple times after the first cycle. After the second cycle she became pregnant with us and it happened that they have a very close friend. It's a friend of mine. We have been to spend a year with together. We were, this is like four or five years ago. We spentthe years and we share a phone number and I have to give them my phone number.

We share phone number. Now I show they've done with their family you know, having children a year and a half later the hospital each out for me has my phone number. I have my Facebook on my Facebook then, hey, how are you? We want to go? I didn't respond to that. It's a message on Facebook. I didn't respond to that.

And then finally he emailed me. I just am sure I CC somebody in the office. So I just, patients subconsciously are going to want to go there because they also want a friend, especially when something's stressful and all of that. And they felt like, but now that they become back a patient, I had to shift my mindset to back to being you deal with my office, you come in there and then sure. I asked her about how they're doing socially. I may ask this for everybody, especially now with COVID how you guys knowing how you're coping all of that. So you have to show some empathy, but you know, the interactions shouldn't be through those other platforms or through personal connection.

Like, you know, especially that this is very private, what we do. I mean, you know, it's very private, like, you know, for them, for me, for everybody, I mean, so many times some patients. This is an or close friend to my wife. That's how they came to me. I don't even tell them, I don't even mention it to my wife that, you know, and you have to really make that mental switch that this is one thing and that's something very different.

 And then regroup at the end. If the outcome was successful if they stopped here. I mean, some of them do stuff. They don't push it, not successful, but I think they appreciate that. They appreciate that. 

[00:10:13] Griffin Jones: Is this contrary to conventional wisdom or is it conventional wisdom?

And it's contrary to maybe what's popular about the idea of bedside manner right now. I think there's some people listening and they think, yeah, well, I tried to do that. I tried to, to address the issues first and to. To make sure that we understand everything and to show how we can help. And then I'm more personable because that's what I understand to be professional, but then I'm getting lit up on reviews because people are saying that my bedside manner is cold.

And meanwhile, there's all of these physicians on social media specialties that seem like influencers, they're like people you want to hang out with and that's part of their personal brand. So is what you're talking about is it contrary to what people are consuming of?

[00:10:59] Dr. Rony Elias: We do not need to cut into practice across the board.

I think not just infertility, but so many other different thing. I think it is contrary to that, but maybe this is the, maybe that's how a fortunate in my reviews, maybe I see all my patient that they saw that I'm kind of like different with that now by no means you should be. Not like not showing empathy, don't care for patient because not just because I personally care, but again, I remember what I said earlier.

I keep it up other patients just before we spoke today, there's a patient of mine who had a successful outcome. She's pregnant. She's with her OB she's four months pregnant. I'm not allowed to see her medical now because we don't carry him out of practice past 12 weeks. She's 13 weeks. I got a message today at an email that's a 40, she was Adobe and there was no heartbeat. I grabbed the phone and I call her, see how she's doing. I told her what I advise next, not to be discouraged because I mean it, you know, like I, like, I mean it, and also it's fair for her to hear. She reach out to me. I didn't look around. If she had told me if it was social media or whatever, I mean that wouldn't be the way to go, you know, but back to your point, I don't want to kind of like diverse too much, but yes. That's how many practitioners or in any industry, not just in medicine, you just follow the trend, the social media they're friendly. He's funny. They do all of that like there is a reality shows about this, it just, I don't think that's fair for the patient and it's definitely not my personality, but you mentioned also something about the code. I just recently heard of, I have a group of patient that are actually from overseas, that they come here just for their care because they had failed multiple times in their own country or in Europe.

And I just have a certain buildup of those patients that come in here and they happen to reside in one building because the company who sponsors their stay has a building that they put them in it. So they all talk essentially. And I heard from a nurse, the nurse that go provide their care. They said, they all love me.

That's why they even sent their relatives and whatever, but they don't like that. I don't socialize with them because we have the same culture, the same background, this from the middle east, et cetera. And I think if I did that, if I did the opposite. You know, like I wouldn't have had the same quote-unquote success or following up because they didn't come here to make.

It will be nice, but I didn't. So, but she mentioned something which I'm starting to work on, is that when I'm seeing them, you tend to be a little bit quicker to visit. They would want to spend more time now, now it's COVID I cannot spend a lot of time inside the patient inside with the patient inside the room, but that's something that I start to say, maybe I should, you know, I tend to feel like, Hey, you're here for this care.

I'm addressing it, et cetera. Once they start to do go about other stuff, maybe I should take a little bit more time to address that not to feel that quote person, but I'm not going to be their friend at least for the time being until they finish there care.

[00:13:55] Griffin Jones: So you're appreciating the perspective of the patient is that they're coming to you for a problem. They could do a number of different things to make other friends. Most of them have plenty of friends and they're coming to you to solve a very serious problem. And it's your job to address the case at hand and to explain how you're going to solve that problem. So how do you do that? The first time that you meet someone? How do you set the stage of this is how this relationship is founded?

[00:14:24] Dr. Rony Elias: I mean, first I heard that directly and indirectly from any patient, I take a lot of number 50 with all of the records aspects.

Sometimes more than like if there's 200 pages and I go over every single thing, the relevant stuff and the kind of not relevant stuff. And I make sure that they know that I went through that. Many of them went to multiple cycles before, no matter where those were done. They're very valuable. You cannot just say, because we're Cornell. We're a big center.

We're not going to look at what other people did, especially if they had partial success or maybe some of them didn't have children so that I make sure that I review it and I mentioned it to them and they know that the ambiguity, so I am thought they could be from my home country, from my town, from other, I don't go over like which school you went to, what did you hang out with? And like I said, many of them are more or less than my age or a little bit younger. I leave this at the end of the discussion so that they know that, you know, and I actually, I speak to other languages very comfortably. I speak French and Arabic, and if they are French or Arabic, I just say the hi and bye.

And those things, which is the whole care, the whole medical discussion is done in English basically, you know, assuming they speak English, of course. And then after that, If they start to ask me for occasionally some of the, okay, we get your number, except that I'd like to kind of, you know, just, I was like the best way to reach me, which is to get my email and my assistant email.

Because now I'm talking to you. If somebody has bleeding something urgent, they reach out to me. I'm not going to disrupt this, and it's, and I mentioned it to now, it's like, if I'm doing surgery on you, I'm not going to stop that in order to address somebody who could have something urgent need to be addressed.

So I make sure they understand that the way of communicating is my direct email, you know, as well as always to see my, somebody in my office, the nurse, as well as the medical secretary, Japanese therapist, and et cetera. And I think then they start to feel like this is not like we chose him maybe because of his background, maybe because of he's review, but he's not just focused on that.

He's focused on my care, what I did before and where are we going to go move forward. And lastly, I always make sure to tell him. Which is I believe it, I don't just say I'm very fortunate that I've practiced in this area. We all actually get very fortunate in those where fertility centers are present, that there are like, for example, New York city.

We're fortunate that I think we live here because there are amazing restaurants, amazing hotels and amazing fertility doctor. Many of them, you can just walk across the street. So by me reviewing another, another practice protocol, it's just a different point of view. It's never like, I can't believe they did that. and most of them, they were not happy with the care there.

So you could kind of build on that if you wish. I tried to avoid doing that because I'm sure that other, he or she doctor who took care of them, one of their best interests in mind, it's just that we're not successful. And the opposite is true. And I make sure they know that from the first visit, whenever I'm seeing somebody who did care before, I was like, I'm going to tell you my point of view.

And this is by no means a reflection back on the other places because they should, who are not successful with us or with me, they're going to go there because they're very good and vice versa. And then they feel like I really focused on them. I'm not focused on making myself look better. Of my center or my statistics for the better and et cetera and all of that. 

[00:17:46] Griffin Jones: One of the things you talked about was the delineation of communication. It's not the best place to text you very often. There are some people that are just on every single text, email, phone call. That's how their brain wires, they can respond instantly. Many of us aren't that I'm not one of those people either.

 And if they're asking you some questions, it's lost outside of the chain of communication of the people that can respond to it. If my clients text me and ask me what's going on, it's like, I don't know, let the project manager knows what's going on. The account manager, the project manager knows what's going on with the work that we're doing.

The account manager knows what's going on with you are needs what you're doing. The strategists know what's going on with what they're helping with. They can still text me. Hey, Griff. I just want your advice on this, but even then I have a different phone number to my same phone.

When clients see, I have an iPhone, they're like, why do you show up is green? Because they're going to a separate work phone number so that I can keep that. Because if it's mixed up with group threads of my cousins about the Buffalo bills or to my fiance, then, talk a little bit more about that delineation of communication.

How do you formalize that? 

[00:18:55] Dr. Rony Elias: You do the exact same thing that I do, like, you know, I tend to, however, I respond to email by the end of the day, every single day, I have an OCD seen Red and if you look now at my phone, like on the Gmail or whatever, the email tab you're going to see.

 Like now I just, because we start to talk, I have 14. I can assure you by three, 4:00 PM. They're all gone. They're not basically. So I do respond by that way. If they put something on WhatsApp, I have international patient that I don't know how some of them would able to find my number. And sometimes it's like 9:00 AM and Dubai, it's 2:00 AM here.

 So my phone, I actually sign the Whatsapp communication completely. I only see it whenever I look at. And whenever they like, typically we do the consult, especially in our virtually and I, as of any records that you haven't. I'm going to send you an email, please reply all to CC everybody.

Because if you sent me your blood count, just to me, there is a very good chance. We're going to have to repeat it when you come in. Because I mean, you got like 30, 40 emails sometimes. So they always ask and if they, especially the international ones, they tend to still, despite that reply, just to be reply back to them.

And I put everybody else from your team, like similar to your team, your project manager, et cetera. It's a training exercise and now initially I would miss it sometime. Now. I became allergic to the fact that that's not done. You know, I just like tell the nurse, please make sure you spoke to Mrs so-and-so because she emailed me as supposed to email you or something before I forget. And it is honesty for their best interests. If they, I have occasionally for example, the patient that come in and they want to, I'm part of a group I'm part of we're like 14 different fertility doctor and some patient wants to everything to be done by one person. And I explained for them why that's not for their best interest when it's a big room. It's like, you don't want me to be doing an ectopic pregnancy at 6:00 AM in the morning and come to your retrieval at nine, you know, and I think that's also something that you have to train the patient to understand that, it's for your own interests to have things divided appropriately.

And whenever you have a problem for somebody to focus on it, obviously it's going to be me in your day to day activity. But if something urgent, don't just reach out to me. Especially not like on social media or anything like that. Most of them don't actually I have to say. 

[00:21:25] Griffin Jones: So you are setting the stage for how the process of communication is going to go.

Do you set the stage of your personal philosophy, meaning in the very first minutes of your first consult with a patient, do you say, look, I understand a lot of people like to be friends. I really enjoy my patients and I do like getting to know them, but I'm very focused on getting to business first because I want to make sure that I serve.

Do you do take like a minute or two to set the stage? 

[00:21:55] Dr. Rony Elias: I don't directly like that, but I think indirectly, they probably understand that early on, most people don't want that. They want it, like you will attract them if you do that. But I don't think they expected early on. They might expect it that later on and the middle of the care or something.

Now the one that are, this is at the 90% of the patient. The one that are really like came to you through a personal contact, I tried to ask them to the least amount of like, for example, somebody who just came to me because they want a doctor and a little bit, and they find me, I asked them, where do they live?

 When they come to the visit, I ask them if they have children or whether they shouldn't go to school, et cetera, the one that they came personally because I kind of know that I don't really pretend to ask them those questions. I try not to ask them to social question, to let them mindset focused, you're here just for that, you know, essentially, but I never do it like directly like that. Cause I think there might many of them, I mean, also they might feel like that's kind of a little bit too aggressive and I have to also actually forgot to mention something many of the patient I became very close friends with afterwards.

One of them is actually my very good friends. Some of them became friends with my wife. Like they're very close, but once they finished their care. So I enjoyed was the interaction I have with the patient split, but I don't want this to change why they have to see me. That's the priority. 

[00:23:17] Griffin Jones: So I wouldn't necessarily recommend setting the stage in that way for you because you're doing really well across platforms.

You have a really high rating and coming from dozens, if not hundreds of reviews and that isn't the case for everyone. So if someone is listening and they're thinking everything that Dr. Elias has said so far, I'm doing, and people come on and they say, I'm cold. They say I'm a jerk. And I would say, if that's the case, if that's the type of your response, That you're getting then setting the stage can really be useful and you just end it with, is that okay?

And you pause and you let people digest it even if for a second. And I've seen a lot of success with physicians doing that. Even if they change nothing about their personality, sometimes people can say, listen, I'm not a warm and fuzzy type of doctor. I just want to put that out there. Your care is extremely important to me.

I tend to deliver facts without a lot of social softening. And I tend to be very direct. Is that okay? And people, even if they are not okay with that, at least they know what to expect. 

[00:24:25] Dr. Rony Elias: Yeah. I mean, for those cases. I agree with you. I think setting the tone early on, but also saying why you're not doing it.

It's not that you're not doing it because, I am focused on your care. I think actually, since you mentioned it again, I mean, I haven't checked recently, but I think one of the. And I loaded this actually indirectly. Interesting for you, basically. I never know, because when you mentioned about, I never really looked mad if you, because I know that people are going to be, I have five stars and little Starbucks, but whenever you told me, many years ago, I actually went through a few websites and I did not look at the five stars one.

One I looked at, like, for example, I had one, I forgot what it was 7 out of 10 and I so why now that patient, I remember her very well because she so far had two children with us. When the first child is when she had an ectopic pregnancy and I operated on her and when I finished the surgery, I went, spoke to her husband and her family explained everything. There on she came back into the cycle and she got pregnant before the pregnancy though, she, the one who wrote the seven, she was not happy that I didn't call her the next day. Now in my mindset, did inform them everything I knew. Everything that happened and not that I saved her life, but I help her out with the ectopic this would have been a serious condition.

But since then I'll make sure I call the patient if not the same day, the next day, because I figured this was a mistake on my end. I forgot that if I was a patient, I would want to hear from my doctor, not just from my wife, what the doctors told her. So I looked at this, that I think for those providers or people who are listening, who they feel like they're getting less video.

I think I would look why the patient, if something is unreasonable then of course not. But I would look what they said and don't like, rub it off. So, whatever, she had two children with us where she was denied care at another large academic institution in the Boston area. Like they told her, we won't treat you because you have no chance.

She came back, had a second baby after the first baby. And that if you're still out there, seven out of 10 basic, which is not bad, but still like it was seven out of 10. And, you know, I would ask those people who are listening, who are interested in deliver the bad news yourself and live with the news yourself, not your staff, not your nurse, not you wherever.

And back for her. That was my mistake by not go to answer this, then I'd be calling everybody. And most of them do appreciate it. I mean, it's not, everybody's like, oh, thank you for checking. Thank you for calling. 

[00:26:50] Griffin Jones: We're talking about patient satisfaction today. And I can't think about patient satisfaction without thinking about EngagedMD. I'm on EngagedMDs website right now, and there's fertility center after fertility center, the UK, the United States, Canada, some are in academic practice. Some are privately owned, some are in larger networks and patient satisfaction has been a result for all of these centers adopting EngagedMD because EngagedMD allows patients to access your learning plan and sign their consent forms on their laptop, on their tablet, on their smartphones. They get to do that at their convenience. It's on their schedule and they get to do that in the comfort of their home.

They can repeat it when they need to. So when they come in to see you, they're getting real care from you because they have that access to you in such a way that you're able to customize that interaction to their needs and they're coming in with a much better educational foundation. So if you want to take advantage of a couple dollars off, if you're one of the few people that still hasn't signed up for EngagedMD, go to engagedmd.com/irh and mention that you heard Griffin Jones talk about them, or you heard them on the podcast and they'll give you 25% off of your implementation fee. That's engagedmd.com/irh.

[00:28:20] Griffin Jones: I'm Interested in where this personal philosophy overlaps with and segues into process, because you were, are talking about your personal philosophy is that we take care of the matter at hand.

And because that's what you're coming for is for me to deliver care and socialists and more, a little bit more of that personal touch comes later and you've talked about how you break that into communication to account for that. So talk a little bit more about process because I'm looking at one of your positive reviews right now, and the person says one of the reasons that I know why he has a big following, I don't have to stay on top of the process, like with other clinics.

And so what is that process to stay on top of? 

[00:29:10] Dr. Rony Elias: I think it's starts on like a set from the transparency from the first visit. Basically make sure that they, I reviewed all your records. This is what I have, and I tell them maybe I missed something, correct me if I'm wrong.

Second is like, when you said, you know, we remain on top of things. That is a constant line of communication with the patient almost on a daily basis in the midst of an IVF cycle. If she ask the nurse a question, I'll make sure I train not to wait till 5:00 PM after sending the message to send me the message right away and I'll respond with it.

So the patient feels that she had a question today it's answered by the end of the day. And I tell the patient, if you don't get an answer by 4:00 PM to call us essentially. And if, for example, somebody who had like today, they should have had an egg retrieval yesterday. Her results were sub optimal today. I got some information from the embryologist before just talking to her and given her results.

You had this result today. I told her why, I think that happened, but I'm going to wait for the final embryologist report before I discuss with it. So she feels like I am on top of it. It wasn't like, wow. I did this stimulation from this point on it's on. And the lab is on your egg and whatever. And lastly, I probably, this is the most important one is whenever they get a negative pregnancy test, which is basically the, the measure of success in what we do, I'd like to call them myself either before the nurse or the same day.

I don't wait like five days later or something, but now I'm sure some days I didn't do that because I finished late or there was something, or my aunt. If they're positive, the nurse could call them before me. Those everybody wants to hit up, but once you hit a negative result, you want to add whenever you call them with that, you ideally want to have some, some idea by future, not just to give them false hope, but to tell them that, you know, you're on top of that case. Again, it wasn't like, well, just try again. We're going to do the same thing over again. 

[00:31:11] Griffin Jones: It sounds like there's a lot of manual who involvement from you, even if it's not from you, it's directing your staff. And so how does that work? You mentioned that you're in a big group and you have many other physicians.

How does that work? When one physician has a process, but maybe it is, or isn't the same as the other docs in a bigger group? 

[00:31:34] Dr. Rony Elias: That's a tricky question and it's a very good point. Now what I tell patients patient, because patients ask the same question every day. I look at every single patient of my increment, seven days a week, even when I'm not here, because we have now with the iPhone, with all of that we can log in.

So I do micromanage my patient behind the curtain everyday. So there is a certain place in the chart that is, I actually communicate to the nurse typically by one or 2:00 PM because the results are back what to tell the patient at that point. But I do tell the patient also because we are the back group, don't expect it.

I'm going to be able, I'll try to do your retrieval if I'm available, but that's not the most important part of the patient because there is so many of us and. We're all trained here because we all do a lot with all very experienced with that technical park, essentially. Like, you know, but the actual, which is the patient understands, once you mentioned it, you tell them, you know, like everybody does a lot every day. Everybody's trained. They think this is the critical part. It's actually not this particular part. Managing the cycle, not as much doing the actual physical, the retrieval or embryo transfer in a big group, but people are experienced, right. So you're not doing it. You're not having first year resident doing something like that.

So I think that's what it comes down to like on those 14 days, let's say leading up to your managing the certain days of them. And it's the last day that somebody else and the date of their fertilization is off. Meaning the day after the retreival either me or my direct nurse is calling them and telling them what I was going to tell them if I could get ahold of them, like I quite had four patients yesterday.

I called three of them already. The first one, by the time her results were back, I didn't have just a called her yet. 

[00:33:18] Griffin Jones: When does physician preference overlap? When does it become something that should be adopted as a process wider within a group? Like hopefully no group is saying. Is laying down every guideline of the way physicians should communicate with patients that has to be up to the physician but at a certain point. Wow, this really is necessary for our process. So we should adopt this into the page. Like there should be a step that happens in the patient portal or we should adopt another software or a two because this, these two doctors are doing this so frequently, manually. We should just get this software for the group. When does physician preference become a process that, that should at least be pitched to the wider group, if not adopted, by the wider group. 

[00:34:06] Dr. Rony Elias: I think it depends on all parties involved, meaning the patient, the doctor, and the supporting staff. Meaning if you have a lot of patients, you have to do that.

I mean, you're just gonna miss things something. If the doctors prefer that, which like in our group, 14 doctors, maybe 10 of them to something like that, four of them, four of them do not. You know, they typically the more senior one, the less busy one, et cetera. And obviously they're amazing doctor people come from all over to see them, but they haven't. And certain as importantly is, which I find it, most nursing said supporting staff. They would want something like that. Like they want that, that could, because the nurse was also like, you know, it's a lot when things are documented, especially if the nurse covered two different doctor, that varies is a little bit in the way that practice, you know, you would want to know, you're not going to be remembered.

You know, when you have, I mean, we do like more than 5,000 IVF cycles a year. Almost a hundred thousand visits a year or something like that, like between the different providers. So I think when, when you're going to have to start somewhere, I think either the patient dictating and the doctor being open-minded to do that.

And obviously I think the nurses that hold onto supporting staff should that the board on that I'm just fortunate that, you know what I mean, I'm busy enough to need to have to do that, to simplify my life and for safety. My nurses loved that. And I adopted it since whenever, you know, like we have the electronic system in place and I tried to do more and more and more and more.

[00:35:34] Griffin Jones: So what if it's about process that requires resources and this is kinda my obligatory time to always I do have a little bit of skepticism of the freedom of. REI is in academic institutions. I don't believe that it's as draconian as it can sometimes be described, but I do know that when I talk to people on face value, they're always the ones that get to decide everything.

And then, you know, you, you peel the onion a little bit, and there's a lot of red tape. And an example that I talk about on the show is EngagedMD and full disclosure. I'm a sponsored for the audience listening and they sponsor our show. But they do because it's something it's like, man, that's just such an easy win.

Like that's something that people, everybody should use. Not everybody's even able to make that decision. That's one, I think of another. I remember being in an actually in your office. This was several years ago. And I saw a magazine there and it just said, you know, property of Weill Cornell.

And I was thinking, oh Lisa Duran patient experience consultant would say, you know, never do that. So is like, well, is that a decision they can make or is the decision to hire a consultant like Lisa, a decision they can make? Like, so what about when you really believe in something. But, and, and it's part of the process that you feel is necessary to have patient satisfaction at this level, but it requires resources.

[00:37:00] Dr. Rony Elias: I wish you, you know what I mean, I agree with you. You are right. I'm not going to like, get, are when you're an academic face, even academic based, but get in a private place. And you're not the senior person or the partner, there is a limit on something that you can or cannot do. But I think with what we were talking about earlier, It's not a major thing basically. It just evolved maybe more work on my end too. I talked to the ITT develop, something in our, we all use epic. We have a software that actually web design it's called IVF for windows. It was designed back in 2000, 20 years ago. It's just for us, so we have four of three or four it guys that worked just for our department.

So they don't have to go anybody to add something in it. So that part I was able to get. But if it comes back to something like this set up at the magazine or marketing or advertising, I have to go to the higher up. And unfortunately many of them do not agree with what I would say less senior people are willing to do that just from a different mindset.

And you're right. That's a challenge. That's a challenge across the board. And I don't really know other than. Trying to navigate the system. I don't know if there is a theater answer here, how you can just force somebody to do something that they're not used to, although it's very helpful. 

[00:38:21] Griffin Jones: 153 positive Google reviews on one listing alone, seems like it would be leveraged in a conversation like that, you know, in terms of.

If there's something that you feel is really important for the group to do, you do at least have, you know, it's not randomized control, but you at least have something that's more quantifiable than anecdotal data that says this might work. 

[00:38:49] Dr. Rony Elias: You're right. I tried, to be honest with you. I tried, with this stuff, I tried.

Do you remember back then when we met with you, we still don't have anybody who does anything for us. Like oldest reviews that all personally, like they're not microbes or managed by anybody behind the curtain. They're not even like, you know, like they're just, they just happen. So I think this is the tip of that, where there's a lot way to get somebody, you know, how to manage it better.

Even the marketing, like, you know, if you look at more specific to our website. I mean, it's, it's bad. I think the reason why you have this is because of the medical kit, not because of that other stuff. And ideally I can keep trying, which I tried before, but now that we opened this discussion, it just going to make me ask again, but I really, I don't know how to convince the higher up people, unless my title change and I became charged or something like that, then it will happen overnight, but that's a long way. 

[00:39:45] Griffin Jones: Yeah, I think there's some things that are pure marketing. It's pure just getting people in the door and it's, it's a little bit less relevant when people are coming to an institution, but then there's other things I've talked about this when I had Dr. Amanda Kallenon the show from Yale and pretty much every guests that I have from an academic institution. I talk about this is that there is an overlap between what used to be business development and what is now the standard of care. And I put something like patient experience consult as a part of that, you know, it used to be, oh, it was just kind of a nice thing to call people by their first name and have everything ready for them when they walked in the door.

Get people to recommend the practice more, to get people in to get more new patients. But now it's not about getting more new patients. It's just, that's part of building rapport to deliver care or something like EngagedMD where it's, this is how we prepare our patients in order to be better educated so we can use the resources of our staff for them.

And so that overlap is something that I think I think are vulnerable to. Institutions, but let's try to make this useful for the people, assuming that they're on the end, where they can't make many of those decisions. What are some of the things that you would leave docs with that they can they have within their control, whether it's tied to any kind of system or process or not?

[00:41:11] Dr. Rony Elias: I mean, there's certain as much direct communication with the patient. Like I said, calling them not everyday, but calling them with the big results, positive tests, negative tests, miscarriages, et cetera, calling them after surgery. That's when people said no, but no academics. Call it or don't call or something. I think that it's just making me think of, obviously there's a lot of feeds do that already, but one of my favorites, one where actually the one from patient who were not successful, but they still live a commended me that actually really like, you know, had a special place in my heart. base the fact that, or getting letters or getting holidays card from patient who were not successful or for example said, I had a patient who I did surgery on her. She didn't multiple IVF. Didn't get pregnant. Did embryo donation get pregnant and made sure to reach out to me and telling me and other patients.

So I think, you know, being communicating with them directly, that's not everyday. Cause that's. It's impossible to do, basically. I think that's in your own hand. The other thing I'm just trying to think of something else that you could do is link up the expectation early on. I think telling the patient who is 45 years old, that the chances of you getting pregnant using your own eggs early on is this, it sets up the expectation somewhere versus patient expect one you have to be really different and that you have to make sure the patient understand this is not a mistake of her own. This is nothing that she could have done. That that's also something that you could do early on. This is human physiology, and this is the expectation you might do better than your average, but the average is such essentially, and actually ready important to what I do quite often, whenever something.

I told her I'm one of 40 people. I'm going to present it to the group and I'll come back to you with what everybody else was going to say. If they're going to say something different and I'll make sure I tell her when that's going to happen and to expect the call for me by that day. And it's not to each back, I do this very often for patient who 35 years old was they didn't get pregnant after two cycles, but everything else looked fine and make sure to do it internally.

And I encourage them. If they want to seek another opinion, everybody should be humbled. And I asked them. If you don't mind FTC telling me what they tell you, because maybe there's something I would learn from that. And that's not very common because typically most of those patients that come to us that are not pregnant, did fail multiple times.

They're not really the first, but occasionally patient goal, traveled to another state or something and get a second opinion. Or now remotely, they do it. What would I do? I mean, I have a patient now that she failed multiple plants before she did one cycle with us also. Unfortunately, didn't get pregnant.

She's actually doing donor egg from a center in Europe. But she has to do the monitoring with us, very happy, like the fact that she must, like, I didn't give her any positive outcome. She unfortunately didn't get pregnant, but she still wants to come do her monitoring here versus any other doctor that's around or the original doctor that she did with him.

That is also local. So that's also something that you could just. I think because I laid up the expectation early on, I retained her in a way essentially to, and I hope she's got pregnant with a donor and I think she was ended actually credited with that also. 

[00:44:31] Griffin Jones: What about those, those expectations that can be landmines for negative reviews?

Like the example of the prognosis of the 45 year old patient, I sometimes read negative reviews that say, this doctor called me old, or if it has to do with BMI, this doctor called me fat. And in many cases, I don't see that doctor saying those words. It certainly can be the case that some doctors may be crass.

 But in many cases, I think it's being. A totally different way than it's being delivered. And so how do you navigate that? 

[00:45:02] Dr. Rony Elias: I think it's all how you word it. In other words, if you tell somebody I tend to use the word age group, I was like in your age group, this is what we expect and this is keep in mind.

This is not diabetes. It's not cancer, not type it. This is not a disease. This is a human physiology in your age group. The average is this. And you have your average results. This is what I expected to do more or less unacceptable, same thing when it comes with the BMI. I don't really stress too much about it because there is obviously it's better for everybody to have a normal BMI for many health benefit, but between asking the patient to lose that a hundred extra pounds and waiting those two years for the female patient, basically, that's going to have a major impact on her egg, quality, et cetera. So there is a fine line where you can use that within a certain BMI that we typically don't see above it in what I practice.

 I agree with you. I don't think that most, if not all doctors say in your age or because you're old and et cetera, but I told them I tend to tell them actually, you know, your age as much as better than me, you know, your age and in this age group, this is what you should expect.

If you ask me, I want to do this once and all options at the table, of course, I would advise you to do it on an act, but that's a personal decision. You have to be comfortable with it. I didn't choose your partner. And I cannot tell you to choose donor egg, but to go through it. I don't want you to feel like we're dragging you into something with a certain success, knowing that you, you know, those are the us, and this is by no fault of your own.

You did not do anything wrong. This is humeral production and that's how it works. And then I think most patients. Kind of feel that not one of the times they didn't cause this, this is not, they didn't same thing. When I actually same thing along the same line, when patient have a miscarriage, I was like, before you asked me, you could not have caused that.

Except maybe if you smoked like crazy before you asked me to and they still ask by the way, but you cannot prevent the miscarriage nor cause one early on, and you have to know that. And I keep saying it over and over, over and over. And they still ask, but then they feel like they given them sense of relief.

Same thing with the age, nobody causes that age to be what they are. And you and I also another word, another sentence that I use comedy, which I also believe in the best time to get pregnant is when you get pregnant. It's not what I tell you. It's not what your mom tells you. It's not when your partner tells you, if you were not ready at 35 and now you're 42 and your ready. Now, it was a time to get pregnant. You know, if you're ready at 25, you would force that that's not good for you for the pregnancy for et cetera. And I think that makes many patients that kind of flight feel like, okay, I didn't do anything wrong. It is what it is. I'm going to do my best. 

[00:47:42] Griffin Jones: Yeah, those are two really actionable pointers.

I hope people get some wisdom from there. I didn't make a distinction earlier on in the show that I'm going to make now because at our company, it's official point of view that patient satisfaction and online reputation are not exactly the same thing. Online reputation overlaps with patient satisfaction, but there are ways to get representation on online reputation one way or the other, that aren't always representative of the entire patient population. And then there's also things that you have to do with online reputation to maintain that online. But it's not the same as patient satisfaction. Do you use any kind of patient satisfaction measure, a press Ganey and net promoter score?

Any of those? 

[00:48:51] Dr. Rony Elias: Not me specifically, but the center or the IVF center, they do that, but they tend to do that as more so I don't know how to kind of like explain it better, but we have the patient who is seeing there respective doctor, which we have different offices in my case, it's the office in Westchester and occasionally the one in the city.

But there's also when they kind of go through the IVF cycle when they go through that, let's say hospital essentially. So that's more so for the hospital part, the students with the IVF, with the billing with all of that, that goes, they don't really direct them towards the each specific physician, which now that you mentioned, I think we also should.

Maybe also look at specifically each of their doctor's office and practices within the bigger umbrella, they tend to be just for the bigger umbrella. 

[00:49:16] Griffin Jones: How do you want to conclude about the topic of patient satisfaction? Knowing that our audience is, it comes from a cost of fertility field, but it's really heavy on physicians.

So how would you want to conclude with that? 

[00:49:27] Dr. Rony Elias: I would go back to the first point that I said, and it's pure luck that we as a physician, wait on this end of the bed on this end of the table, anything we could be the other hand and it's not just saying it like which we would all use. How would you want to treat your sister or your yourself?

But I really mean it like, you know, once you make that mental note that what would I want to hear? What am I looking at? I think that. The patient will feel your doesn't matter if you socialize with her or not, she feels your friend at that point, you know, you really care about her. I think that's, if somebody could make it and, and it's, it's a practice you have to like, you know, remember that, you know, any day, one of us, all of us could be patient and how would we want to have be delivered the bad news? The good news is easy to deliver. Everybody could deliver them. It's more so the bad news. I think that's how I would advise the physician among the audience. For the patient, all our use our grade, but typically they're to the extreme, there not most people, most people are not going online to reviews.

Most people are taking care of their babies or doing something you know, or focusing on their care. So you should read it, but have the analytical mind to read anything that you see online, you know, it's typically not most people. I mean maybe you mentioned maybe I'm fortunate that most of the ones, you know, It's possible that all of my views are going to be good, but you know, I think most patients are not reviewing online most patient. So I always tell patients the best doctor is the one in our field is the one who gives you a baby, no matter what he's his or her reviews are no matter how much you socialize with him or her, the one, because I gained to my second point, you came for the service and you expect the service to be provided.

Once people provided it's become best friends with them. Don't ever go back to them. That's different, but make sure that all this focus on the chief complaint or the reason why you came in. 

[00:51:26] Griffin Jones: Dr. Rony Elias. Thank you for coming on the show and sharing your thoughts about patient satisfaction. I think people are going to get a lot out of it.

[00:51:33] Dr. Rony Elias: Thank you. I appreciate it. Thank you.

Don't Lose New Fertility Patients Before the First Visit: 9 Steps of IVF Center Lead Conversion

By Griffin Jones and Stephanie Linder

“Marketing throws the ball, but the practice has to catch it,”--Rita Gruber.

Digital marketing and physician referrals lead prospective fertility patients to contact you. Then what?

They move into the second phase of the Fertility Patient Marketing Journey, Leads (New Patient Inquiries) to Initial Consult. And just because prospective patients have submitted a web form or called the clinic, doesn’t mean they actually book. Let’s look at how to fix that.

You may use the term new patient inquiry instead of lead. They are the same thing. A lead is any phone call, web form, fax or chat requesting a new appointment or seeking information prior to scheduling. 

The way in which your staff responds to the first prospective patient interaction, determines the conversion to initial consultation.  If you don’t have the right processes and properly trained people, you lose new patients before they even schedule. 

And the point isn’t just to get them in the door, either.

Positive and negative patient experiences start at the first point of contact - often a phone call or the response to a web form/chat.  Expectations and rapport are built and broken from the very beginning. 

Fertility Bridge estimates that as many as 20% of negative fertility center reviews come from people who haven't yet had a consult. Patient dissatisfaction is often a result of unmet expectations that weren’t set early in the process.

MEASURING CONVERSION % FROM FERTILITY PATIENT INQUIRY TO INITIAL CONSULTATION

Two key performance indicators (KPI) measure how well your fertility center converts leads.

1)  Total # New Patient Appointment

2). Lead conversion % 

Lead Conversion % = New Patient Appointment / Total Leads 

One individual must be accountable for these KPIs.

The Lead Conversion System 

At least 50% of your leads should be converted to appointments.  If it’s less than 50%, you must analyze and revise your system immediately.  This is the system to increase that percentage. 

1. Dedicate a new patient line

2. Have a specialized new patient scheduling team

3. Unify scheduling across offices and providers

4. Answer the Phone

5. Offer the appointment 

6. Book shortest wait list 

7. Respond to voicemails and web forms within specified time 

8. Record Lead Interaction

9. Clearly identify next steps 

1) Dedicate New Patient Line and Form

Current fertility patients and prospective fertility patients have different needs. Having a phone line and an online request appointment form that separates new patient inquiries from current patient call backs allows your staff to better manage both patient types. 

2) Specialized New Patient Scheduling Team

Multi-tasking is detrimental to both lead conversion and patient satisfaction. It can cause frustration when a front desk person has to schedule a new patient call, fetch a medical record, and check in a consult simultaneously.

A dedicated role or team also decreases voicemails, unanswered phone calls and hangups. It reduces the time required for your staff to play phone tag and increases new appointments booked.

3) Unify Scheduling across offices and providers

When prospective patients have to be transferred from (or worse, hang up and call) one office to another, they often do call…another fertility center.  Your new patient call center is responsible for booking every office equally based on availability without preference to an assigned office or doctor.   

4) Answer The Phone

Missed calls are a great source of new patient appointments...for another fertility center. They are also as good for your patient’s experience as your cable company’s phone tree is for you.  Make a plan to hire the adequate number of staff and use data to ensure coverage during the busiest days/hours. 

5) Offer the appointment 

When prospective patients call with questions, most staff members answer the question at face value and go no further.  In order to increase conversion, mandate your staff “ask for the appointment” at least once with every prospective patient, regardless of the question being asked. Consistently offering and asking for the appointment makes an immediate impact on your KPIs, costs $0, and is a process that can be implemented today.  

6) Book Shortest Waitlist 

The longer the wait, the higher the risk of lost appointments, cancellations, and no-shows.

In a multi-physician group, when your waitlist is longer than 4 weeks it is the role of the call center to suggest a doctor with a shorter waitlist. 

Your call center won’t offer earlier slots with a different physician than requested without your blessing. Some docs cringe at this idea. Make sure your staff knows it’s OK and that the most important part is that the patient stay in your clinic ecosystem.  Do you want to be a single provider or do you want to be a practice owner? 

7) Respond to all voicemails and digital inquiries

Avoid being nailed by a negative review that comes from people who’ve never even seen you for a consultation.  Set specific expectations of call back time on your online contact forms’ thank you pages and voicemail. The sooner you respond the better, but you must be able to exceed the expectation. It’s far better for their perception of you to say “you will hear back from us in 72 hours” and get back to them in 48 than to say “you will hear back from us in 24 hours” and get back to them in 36.

You should always follow up more than once, but the cadence of lead nurturing is a topic for another article.

8) Record Lead Interaction

Document your interactions in a customer relationship management software (CRM). Using this data will help you identify drop off, automate follow up, and nurture prospective patients with helpful information.

9) Clearly Identify Next Steps

Before ending the interaction, your new patient team should set three clear expectations about what happens between now and the appointment:

• Welcome Sequence Correspondence

• Medical records and patient portal

• Appt time, correct patient info and acknowledgment of next steps 

CONVERT MORE INQUIRIES TO NEW PATIENTS

We’ve given you an actionable process for converting new fertility patient inquiries to new consultations, but we didn’t talk much about what your team needs to deliver concierge service. How your team responds to these patients is likely even more important than when they do it. 

If you would like Fertility Bridge’s help in improving your fertility center’s lead to new appointment percentage, or how to implement the steps listed above - book a Goal and Competitive Diagnostic meeting below. 

123: 4 Steps to Fertility Business Goal Setting That Speed up Execution with Griffin Jones

This week Griffin Jones highlights four steps fertility businesses should use for goal setting to speed up execution. Sometimes you need to slow down to speed up. Griffin lays out goal setting from an unique perspective and talks about the goal snowball effect. Listen to this episode to gain a better understanding of how to evaluate your goals based on the investment of time and money they will take to achieve. 

This episode covers: 

• How to set and attain goals

• How to prioritize goals

• What is the goal snowball

• The 4 steps to goal setting to speed up execution

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com

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. 

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Read the article here.

Leadership vs. Delegation in Marketing: A 12 Point Spectrum for Fertility Business Owners

By Griffin Jones

Leadership is a delicate dance for any business owner in the fertility field. For REI practice owners, it might be the Tango.

Striking the balance between leaning in and stepping away can be a struggle for any fertility executive, and there is usually an added layer of complexity that’s unique to physician practice owners.

If we look at the Entrepreneurial Operating System (EOS) accountability chart, we see where a managing partner might find themselves occupying many seats.

Visionary, whether they’ve sorted that role out with their partners or not

• Integrator, if a Chief Executive Officer or Executive Director doesn’t truly occupy the seat

• Operations, if they are the Medical, Practice, or Lab Director

• Physician, oh yeah. Remember your main job? The one for which you undertook fifteen years of higher education and training? That seat falls below the leadership seats under operations. 

Yes, executives of many companies, fertility or not, struggle to step out of many seats. Still, the functions of Medical, Practice, or Lab Director, and especially the role of physician, is a unique charge for physician practice owners.

The accountability chart for fertility practices is its own topic that merits its own article. In this article, we will attempt to get you out of the sales and marketing seat as much as possible.

Even when you properly delegate the sales and marketing seat, there are sales and marketing responsibilities that come with the visionary and integrator seats.

HOTEL SALES AND MARKETING: YOU CAN CHECK OUT ANYTIME YOU LIKE, BUT YOU CAN NEVER LEAVE

What do some of the world’s most iconic brands have in common? 

They had or have CEOs (Blakley, Jobs, Musk, ol’ Walt himself) that propagate the market position of the company in everything they do.

If you’re looking for a book on this topic, David Kincaid’s The Brand-Driven CEO: Embedding Brand Into Business Strategy provides plenty of real-world, current case studies from today’s biggest companies.

Leaders must be involved in positioning and branding because the marketing position of their companies is enforced or betrayed in every area of the businesses.

Because principals (the owner of an REI practice or chief executive of a fertility company) are no exception to the positioning requirement, it’s common to get bogged down in sales and marketing responsibilities that they should be able to delegate.

We don’t want that. If you’re struggling with the question of involvement versus delegation in your fertility company, you aren’t alone. 

We’ve broken sales and marketing responsibilities into a 12-point spectrum you can use to determine when you need to be involved in branding, sales, and marketing initiatives and when you can delegate.

12 POINTS FOR FERTILITY BUSINESS OWNERS

The external and internal presentation of your company is a relay race. You have to make sure the baton doesn’t get dropped as you run from one segment to the next. This means that you can’t go from leading your team to being completely uninvolved in one take. In business, a dropped baton leads to inefficiencies and expensive mistakes. In the fertility field it leads to patients feeling like they were baited and switched.

But, you can step out at certain points once the baton has been successfully passed. This spectrum allows you to ease off without sacrificing outcomes.

When you need to lead:

1. Positioning

2. Branding 

3. Growth Goals

When you need to be somewhat involved:

1. Brand Development

2. Growth Strategy

3. Operational Overlap

When it’s okay to be uninvolved:

1. Coaching

2. Brand Activation

3. Strategy Execution

When it’s time to reinvolve yourself in the marketing process:

1. Culture 

2. Brand Refresh, Redesign, and Extension

3. Accountability of Leadership

When the principal of a fertility practice needs to lead

1. Positioning

Positioning influences everything the business does. We’re talking about what differentiates your practice from the competition and what makes it unique. This includes your: 

• Vision

• Mission statement

• Core values 

• Core service areas and focus

• 10 Year Target

• 3 Year Picture

A marketing team can’t make these decisions for the company. They can only come from the top. 
However, it’s also important to note that if you have partners, everyone needs to be aligned before moving forward. Otherwise, the latter stages of the marketing process will become more expensive, more time-consuming, and less effective.

A fertility business can be in operation for decades. However, if they haven’t structured everything they do in a source of truth (that everyone in the company can point to), they haven’t outlined their unique positioning.

2. Brand

Part of the role as a leader of a company is chief brand ambassador (lowercase, let’s be modest here). Once you and your partners, if necessary, have decided on things like core values and which types of patient segments you especially want to serve, you can move on to branding. 

This includes the 

• Name of the company

• Unique value propositions

• Overall brand look and feel

• Key messages

Your marketing team will be a key player in this process (if they aren’t, something is wrong), but your leadership is still crucial. 

3. Growth Goals

Employees simply can’t decide growth goals because they don’t have the skin in the game that the principal does. As Gary Vaynerchuk bluntly puts it, “Your employees shouldn’t care about your business as much as you do.”

Unfortunately, marketing personnel are often not even incentivized to pursue growth goals. Worse, administrators and operations personnel are frequently disincentivized from pursuing growth goals because it means more work for them and they get nothing in return.

Your growth strategy is the measurable pursuit of your values, vision, and brand. It is the traction toward your vision put into numbers. Growth goals include:

• Revenue goals

• Net profit targets

• What type of business they want the company to be (like a designated B-Corp, for example)

• Patient satisfaction score targets

• Number of new patients served

When the principal of a fertility company needs to be somewhat involved in sales and marketing 

During this next phase, you can begin to dial things back a few notches. You still have some involvement in the sales and marketing process, but now your team is starting to run and you begin to extend your arm to pass the baton.

4. Brand Development

At a minimum, every company should have a set of brand guidelines, also commonly called a brand book or a brand style guide. These documents guide every marketing campaign going forward and they provide the templates of your company’s look and feel.

Your marketing team will work on these guidelines, but the involvement of the principal ensures that the brand comes to life in a way that supports its core values and overall goals.

5. Launching Growth Strategy

The baton is almost passed.  The principal doesn’t need to be involved in every aspect of planning the fertility company’s growth strategy, but they need to be the one to commission it’s execution. 

The principal must see and approve the plan before execution begins. Even when your team is fully incentivized to move towards the company’s growth goals, the principal must ensure that execution of the plan is underway before she or he can step away.

6. Operational Overlap

When you look at the Four Phases of the Fertility Patient Marketing Journey, you’ll notice that the closer you get to the outcome of getting paid and improving patient satisfaction, the greater the operational overlap.

Without continuity across these areas, there is a sharp decrease in the likelihood of the marketing team being able to complete the desired results. These areas are run by other people, and your marketers are not their bosses.

The principal must remain active until operational, administrative, and financial teams accept their role in the strategy.

When a fertility business’s principal can be uninvolved in marketing

We’re finally at the point where you can pass the baton, take a break from the relay race, and let your team take care of the heavy lifting.

7. Coaching/Management

There’s no need for a fertility business’s principal to be involved in coaching your physician liaisons, call center, patient navigators, or marketers. Their managers are in charge of the day to day performance and outside companies can train your teams, or train your managers to train your teams.

If you participated and led at the points you needed to, you can trust your team to get to work. 

8. Brand Activation

As the principal of a fertility practice, you don’t need to direct the brand assets that engage patients with your company.

You’ve approved your brand book; this is a job for your marketing team — they’re the ones who should handle brand activation initiatives like website design, social media templates, and launch campaigns.

9. Strategy Execution (with one exception)

You don’t need to schedule video shoots, write social media posts, edit blog posts, oversee advertising campaigns, implement CRM or EMR sequences, monitor lead conversion, or report on post consult follow up.

There’s one exception, however. 

If you’re being featured in a piece of content, you need to be available as the star while your team produces, writes, directs, films, and edits.

When the principal of a fertility business should get reinvolved in marketing

Periodic reinvolvement keeps the foundation of the REI practice or fertility company solid and ensures long-term success. 

In marketing you can set it but not forget it. As the leader of your practice, it’s important to check in, reinforce accountability, and ensure that sales, marketing, and operations have stayed true to core values. 

10. Culture

In most cases, I hate calling a company's workforce a family. Employees are most certainly not children and they are not your children. In the specific instance of who models the company culture that everyone else imitates, however, this wisdom from Gabrielle Reese is apt.

“[Children] watch you, they don’t listen to you.”

You are the matriarch or patriarch of your fertility business’s family in this sense. The family follows your example.

Really, culture is the ongoing commitment to your positioning, and the critical element of commitment is action. If you’ve decided that your company is going to be more in tune with the needs of same-sex male patients than any other organization, for instance, your team can only live up to that culture to the extent that you champion it.

11. Brand refresh, redesign, extension

Many fertility companies need a brand refresh, periodically.

Fertility centers that built a brand for Baby Boomers or Gen X-ers need to update because Millennials and Gen Z patients now make most of the patient and donor populations. They respond to different types of marketing because they have different concerns. 

If you decide to extend your identity with a new brand for fertility preservation or third party IVF, the principal must be involved in the beginning stages of those initiatives. If you are changing the identity of your IVF center or fertility company, even moreso.

12. Accountability of Leadership

Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

Finally, even trustworthy and capable sales, marketing, finance, and operations leaders need to be held accountable by the visionary and integrator of the organization.

As fertility experience consultant Lisa Duran says, “people do what their managers pay attention to”.

It’s not just about them. Periodic check-ins also demonstrate that you’re holding yourself accountable. Employees don’t need to be micromanaged with due dates and metrics. They should see that the principal is paying attention to the outcomes to which they contribute:

• IVF cycles

• Patient Satisfaction

• Egg freezing retrievals

• Third-party IVF recipients

• Third-party IVF cycles

• Tubal Ligation Reversals

• Donor recruitment

• New patients

• Specific provider volume increase

• Targeted region/office volume increase

Are you ready for a better relationship with your marketing team?

While you do need to be involved in many aspects of the marketing process, chief executives of fertility companies and REI partners like you also need to be able to free themselves of certain marketing responsibilities. 

Getting to the point where you can pass the baton only happens when someone else is completely in charge of the outcomes that grow the business. Pay attention to these twelve points to know when to lead, when to throttle down your involvement, and when to release.

Letting go can be difficult, though.

That’s where we can help. Get Fertility Bridge’s support in selecting marketing personnel, determining their responsibilities and outcomes, and more with our Goal and Competitive Diagnostic.

122: Attracting and Retaining Embryologists with Dr. Tony Anderson

This week, Dr. Tony Anderson joined Griffin Jones on the podcast to shed light on why there are so many embryologist openings and what you can do about it. He estimates that out of 420 clinics, there are 400 job listings for embryologists. Even if you do find one, how do you retain them? Dr. Anderson gives us strategies that you can implement now to help embryologists avoid burnout 

More from this episode: 

• How to reduce embryologist burn-out

• Why there is a huge demand for embryologists

• How to attract and retain embryologists

• Best way to train new embryologists

• What younger embryologists look for in a work environment

Dr. Anderson’s Information: 

LinkedIN: https://www.linkedin.com/in/tony-anderson-d-h-sc-eld-abb-8272a21b/

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

Website: https://ivfacademyusa.com/

Mentioned in this episode: 

Think Again by Adam Grant: https://www.amazon.com/Think-Again-Power-Knowing-What/dp/1984878107

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Transcript

[00:00:00] Griffin Jones: Want more embryologists right now? Yeah. You and everybody else. So today I talk with someone who has a plan of getting more and retaining them. His name is Dr. Tony Anderson. He's the founder and director of a program called Embryo Director IVF Academy. Before we get into today's show, the shout out, goes to Dr. Isaac Glatstein in New Jersey who made the connection for this interview. There are topics that you think that I should cover. And people that you think are very qualified to cover them, that the business side of the fertility field should here, please make those intros. I don't always take them, but sometimes I do.

And this was a case that I did. So I hope Dr. Isaac Glatstein is doing really well in my interview with Dr. Anderson, we talk about ways of eliminating some things in the IVF lab, so that current embryology staff are less burned out. We talk about ways of recruiting them some of the low hanging fruit for training and then growth programs so that they stay with you.

And that it isn't just about money. And we do talk about some of the current wages and competition for them in the marketplace. So enjoy this interview on today's Inside Reproductive Health with Dr. Tony Anderson. 

[00:01:54] Griffin Jones: Dr. Anderson, Tony, welcome to the inside reproductive. 

[00:01:59] Tony Anderson: Thank you Griff. Delighted to be here and welcome to be here. Thank you. 

[00:02:03] Griffin Jones: It was an REI mutual friend of ours that put us in contact. I was telling you before the show started that I tend to neglect the lab.

And you said that I often talk about a shortage of doctors and I do almost every episode and some, I very often forget to talk about the shortage of qualified embryologists and lab staff. And so that's something that you're working on. Why don't you first talk about what you see is the problem and then talk about what you're doing to solve it.

[00:02:32] Tony Anderson: Well, we've actually seen a large increase and the demand for IVF and fertility preservation of fertility genetics. I always use the example of, we've built our careers on the baby boomers coming through. That's where I built my career on. And today the gen X-ers millennials are the largest generation of the 20th century.

And all of these young people are coming of age and so there's higher demand. And with these young people coming up fertility age, we're not only just treating infertility. We're also preserving fertility. We're doing genetics and, there's a lot of at-home testing that we can do.

So the industry is just really growing. There's more demand for that. 

[00:03:19] Griffin Jones: So when we talk about the demand, that's probably going to increase for some time. Why is there a shortage of embryologist to meet the demand? Why isn't the supply of embryologist grown with the demand? 

[00:03:34] Tony Anderson: It's not a huge, huge career.

We're a very small group niche of people just like REI and fertility nurses. They're just a lot of nurses out there that in general. So we tend to recruit for nursing from other nursing departments, nursing careers, but when you get into nursing, it's, it's a whole new language that we speak. It could be a nurse for 30 years, come into fertility and it's a whole new career. Embryologists are a lot the same way. No one actually goes to school to be an embryologist. A lot of us are pre-vetted or pre-med or biology majors, and just bringing them into the careers, actually recruiting them as the hardest. And in my training program, I'm actually trying to recruit people to train and get them into the embryology career.

And a lot of people just don't know about it. And so going to the local universities, there's also a misconception to believe that you have to have a master's degree to become an embryologist. And that's not the case. You have to follow the regulatory guidelines. You have to have a minimum of a bachelor's degree and a science, a physical, chemical, biological sciences.

 So I'm always trying to recruit these people into the industry and embryology, but if you could go back to the very first IVF baby Louise brown in 1978 .I always like to say we're like a band. You always have the doctor who is Patrick Steptoe. You always have the embryologist who is Bob Edwards, and you have a nurse that was Jean Purdy.

You could just search Louise Brown in anything and you'll come up with those three people. And I always like to say, when you have fertility care fertility treatment, you have to have, the band is like, you gotta have a guitar player, but without the the bass player, the drummer.

It's really not a band. And so you really have to have those three people and, , working with medical practices, there's always the the control tower or the people running the front desk that are regulating the flow. So, it takes the whole group to put it together.

But my focus has really been working on embryology, recruiting them, training them. And I go through a three month training program to get them into the embryology and then help them find jobs. So that's what I'm trying to do, where there's a demand for it and to feel bad. 

[00:05:48] Griffin Jones: Who are we losing people to when there are people that could be great embryologists and they're out there pointing their career, when they're pursuing that or another scientific endeavor in the case of REI, we might be losing other REI to other subspecialties.

Maybe they're going into MFM, or maybe we're losing them a little bit earlier and they're not sub-specializing at all. Or maybe we're losing even some of them a little bit earlier than that. And they're choosing a different line of medicine then obstetrics and gynecology. So what are the other areas?

And I never asked this to Bill Venier or Shaun Reed or any of the people that came on to talk about lab needs in the past. Who are we losing people to? 

[00:06:31] Tony Anderson: It's not so much losing people. If you take the example of the REI. REI has only have so many fellowships a year per year. And so there's probably more demand for REI, then are actually going into the fellowship. And so OB GYN is go through residency. They want to get into a fellowship and some get accepted. Some do not. And, because of that, the demand there, maybe they need to expand that for awhile to meet the demand when I mentioned that we're treating the, this largest generation of our lives. Then, maybe we need to meet that demand now, but then maybe cut it back later, if the demand goes down. Embryologist there's not like a fellowship or residency, and that's kind of what I'm trying to create here. Rather than you don't have to go get a master's degree, it's just bringing them into it. A lot of people graduate. I mean, I've recruited people with biology degrees and they end up, they're working in cake shops and bakeries and lawyer, working in illegal offices, not because that's what they want teach them, they can go out and do something that they really went to college to do originally. 

[00:07:38] Griffin Jones: I want to talk about more, how you're recruiting them. You mentioned that there is no fellowship for embryology, and I believe that one of the biggest bottlenecks on the REI side is the. The fellowship and the fact that there's only 44, we're only making 44 new fertility doctors a year.

Could we be making a hundred or 200 that's for someone else to say, but it is part of the bottleneck. So without that accreditation bottleneck, what is the bottleneck for embryologists? 

[00:08:11] Tony Anderson: Really just getting experienced, one of the things that I see happening in the industry today is people, every lab, every there's 420 labs in the country, and there's probably 400 job openings right now.

And so if you have a lab, 

[00:08:28] Griffin Jones: Repeat that for me, the listener will have gotten it, but I want to make sure that I got to repeat that, please. 

[00:08:33] Tony Anderson: Well, there's, I believe there is around 420 lab laboratories in the country that report to SART. And I would say that there's probably 400 job openings right now. And so if you are going to another center to recruit from that center, there's still a zero net gain in that community.

And so we're really robbing from Peter to paypal and, we're not doing any of the community, a service or justice that way. 

[00:09:00] Griffin Jones: Is that 400 an estimate? That 400 job openings is an estimate Tony, how do that? 

[00:09:05] Tony Anderson: Just about every lab out there is recruiting and I mean, I'm doing some work where, like you mentioned bill and Debbie out in California, like we're working with ovations and the preludes and, helping recruit people for those centers too, because there's such a demand in them. And if someone is leaving one program to go another to another. Just a continual opening for four positions. I dunno if the ad 400 is an accurate position.

I personally when I'm looking for somebody, I tend not to advertise those jobs because , you want to, look for qualified candidates. And I actually, the last four people I've hired, I've actually hired off of indeed. And until recently I've never hired anybody off of indeed usually I, people will come to me wanting to be trained and, and I will work with them. And that's how I'm actually recruiting. A lot of my, my students were, through Glassdoor and indeed. And , sharing what I have to offer. And what's really funny is that a lot of feedback I get is because I offer an ISA and income sharing agreement where students don't pay anything for their training.

 And I offer that because I am confident enough in my skills and that I can train them and get them a position that I I'm willing to take that risk. And then once they get into their job, I work with a percentage of their income until the tuition is paid back. 

[00:10:33] Griffin Jones: A different higher Ed would be if that were model universally adopted. 

[00:10:39] Tony Anderson: Yeah, what undergraduate degree offers that are master's or doctorate degree offers that. And so that's what I'm doing. And when I get a feedback with that is that is too good to be true, like who would do that? But I just know there's enough demand.

And I've been doing this for 30 years that I I'm confident that I can get them a job if they're willing to be moved. I live here in San Antonio. It's where my lab is, there's only like four labs in San Antonio. So if you want to be in San Antonio, that really limits what I can do.

But if you're willing to go anywhere in the country, there's no doubt in my mind that anybody who comes through will have a job when they're done. 

[00:11:17] Griffin Jones: So talk to us about what you were doing before and then how you decided. You knew that there was a demand, but how did you decide that you could meet this market need for training more embryologist?

What were you doing before? And then what was it that got you to leave your day job? 

[00:11:35] Tony Anderson: Yeah, we all, just like anybody, when I left my undergraduate looking for a job. I ended up cloning cows working in the bovine industry early in my career. A lot of us from the bovine world were recruited into the human world.

And worked with some really great people in my career work with Klaus Wiemer, Jacques Cohen, Santiago Munne. Like I had some great mentors along the way. And I always had this euphoric dream that I was going to train my group of people. And I would retire with that group of people.

And over time, as I felt like I was constantly training people. I ended up doing my masters at Leeds University, distance learning program. And my doctorate degree was at Nova Southeastern where, one of our projects we had to do, we actually had to create an educational program. We had to create our own class. And through that, I thought, why not create this, training program through this? And so I started putting it together and just kind of experimented with a few people, not really knowing if it was going to do anything. And I ended up training a few people for free and getting them jobs and they are doing really well in their career. And I actually, one of the my medical director at the time Francisco Ardando, he's like you actually are really good at training people that actually putting it in terms that people understand and not trying to make it sound all flowery and fluffy.

And so, I just started doing it and put it together and put together the program started marketing it and it was really kind of funny. It's kinda like, I thought, well, my reputation, if , people will come, I'll build a website, they'll come. They didn't come. And really that's when I started kind of doing my, booths at the shows and people start realizing that this is a real deal.

And so it was actually training program of the kind in the United States. And I believe there's a couple more, you mentioned bill out in California and bill and Debbie, but yeah, so we just built it up. And in this year I decided to go out full-time on my own and doing this whole time.

[00:13:42] Griffin Jones: So tell me about those booths. Where are you recruiting people from? How are you finding people? Because as you mentioned, a lot of people don't even know that this is a potential career path. 

[00:13:53] Tony Anderson: Yeah, well, I mean, really honestly, it's really kind of getting the trust from my peers. I've been working in the field, so it's a very small field.

We tend to all know each other and basically, there's two types of people like there's people currently in labs and IVF labs. Like I have two people coming in next week. They, are coming in from New York. To train for five days. Those are short-term courses so the, the booths are really that I recently started doing the long-term courses, the three month courses, this past year. And I'm recruiting those. A lot of those people from going to the schools, going to universities, collaborating with some of the bio biology departments and really kind of recruiting from indeed as well, to bring those people in and train them from scratch to nobody from zero to hero.

[00:14:42] Griffin Jones: So the short term courses are people who are working in labs right now. It's IVF centers are sending those folks too. And the three month longer-term courses are for making new embryologists. 

[00:14:54] Tony Anderson: Yeah. The real low hanging fruit for in the centers right now. If somebody wants to, they're short and the embryo lab, like you can train somebody pretty quickly into andrology usually around just, I usually I call my andrology course a five day course, you can do basic semen analysis count motility, morphologies, and then you could do the IVF, perhaps IOI, perhaps usually within five days, you can do that, but it's going to take quite a bit more time for the embryology piece. So a lot of those, a lot of these labs, I think one of the real criminal things that we do to some of our teams is we have somebody in andrology that they've been there for nine years and they are hunger for an opp opportunity to get into embryology and then they don't. So bring those people into embryology. You can always recruit people into andrology and let that kind of feeding your embryo lab. They learn the quality control. They learn how to keep things organized and manage it. And if you make a mistake with sperm, you can always go back and get another sperm sample.

Do you make a mistake with an embryo? You can't go back and make another embryos. So, I always say that the andrology lab is a great way to recruit people into embryology and let me help you get them to competency faster. The real talk real struggle is that is the labs are really so short staffed that they can't find the time to train them.

[00:16:22] Griffin Jones: So let's talk a little bit about that because their so short-staffed, there's a lot of burnout happening in the lab and there's someone on social media. We both likely know that I'm trying to get on the podcast. I won't mention this individual's name because they're not ready to talk about it on the podcast, but on social media frequently talking about burnout for lab staff.

And on one hand, of course, they're being asked to do so much. On the other hand, I don't know what the alternative is. There's that many people that need IVF cycles. And, and so can you talk a little bit more about the burnout and the busy-ness and how do we solve for this at a long-term bigger picture issue, if we're too busy to do anything but cycling right now?

[00:17:09] Tony Anderson: Yeah. Well, one of the things that we also have to recognize too, is who are our employees? Who are these, we're, they're not people like, I mean, I don't want to like in the generational piece, but, people don't always work for money just because you're going to pay him more money.

Doesn't mean that they're going to want to work more for you. And so people, I like a lot of the people we're recruiting the gen Z, gen Y. They would rather make less money and have better quality of life. And, I gotta say like, maybe they have more right than I did. And so when we talk about burnout, one there's just such a demand, I keep hearing these stories about embryologist, making sure demands of like really huge salaries and working seven to three and not going to work a minute more after that, but just saying, it's kind of odd. You can't do that in embryology, you can't go home to the work's done, if you work in a business office, if the work's not done, you can always pick it up tomorrow where you left off, you can't do that in biology. So we tend not to work, regular hours, regular weekends, and then that's where the burnout comes. Cause it's a 365 day a year. And it sounds kind of crazy. A lot of times when someone comes to me, it sounds like I'm trying to talk them out of embryology because it is. There's probably only one industry that demands more of you than an embryologist. And that's the dairy industry because in the dairy industry, cows need to be milked twice a day, no matter what it doesn't stop. And embryology is a lot the same way. One retrieval a week requires seven days worth of work.

And if you freeze embryos, those embryos never go home. You're caring for them every day, the Cryotanks.

[00:18:51] Griffin Jones: So is there anything else we can do except I guess, invest in training programs like yours. Is there anything else to do though when the demand is so high, it's like I get that you want to work weekends and we'd love to offer you more time off, but or have you do less cycles in the course of a week. But we are beyond, we've got a two month wait list for our new patients. And we're trying to cycle as many people as we can. 

[00:19:17] Tony Anderson: That's a great point. And actually there's a book that I recently read. It's called Think Again by Adam Grant.

It's a spectacular book and I think any embryologist medical director, really anybody in any walk of life will get something out of this. And the idea is that just because we've been doing it one way, all of our careers and all of our lives doesn't mean we shouldn't rethink some of those things.

And I'll use an example of, some of the things that, when I first got into embryology, it was very simple. We did retrieval. We fertilized, we transfer, the next day, like literally two days later pregnancy rates were terrible, but as we did more, we added oil culture. We added ICSI, we added genetic testing.

So it's gotten progressively harder and harder over the years. And the way we were able to do more. With less people, as we stopped making our media, we stopped making micro tools. We stopped doing some of the day two assessments, the day four assessments. So maybe there's still some things that we can do, and this is going to be out there in left field.

And some of my peers might think. But maybe we could get away with not doing fert checks because we're doing genomic testing on every single case almost. So if we're not doing the fertilization checks, then, we're doing the genomics. We're going to know if the genetics is okay before we transfer it and I know a lot of programs are stopping the day three assessments. And so with the day three assessments, it doesn't really matter. Most of us are going to the blastocyst and I always say that if you're going to do a day three assessment, it's kind of like trying to pick the winner of a horse race, on the back turn kind of thing.

So if you're going to the blastocyst, the only way to really know anything is to look at the day that you're going to at the finish line. And one of the things that I'm actually encouraging, some of the labs I'm working in is getting some of these embryo imaging, incubators, where we can look at some of them along the way.

Maybe not have to bring them out and just look at them at time when we have the time and hiring people to outsource things that we're not doing, like data entry, emailing the patients, embryologists do a lot. I always say it's about 60% bench time, 40% admin time. You could increase their bandwidth if you took that 40% admin time away and let allow them to work doing what they were doing, but they'd best at. 

[00:21:43] Griffin Jones: Well, whenever anyone is at capacity with anything. The first thing to do is eliminate anything that's possible. You've given us a couple ideas then automate and then delegate or outsource, and even as like a couple of ideas for that. So that might be able to help some folks with burnout temporarily. I want to go back to something you said, because I want to see if you think it's true when you're talking to these new candidates, when you said a lot of the millennial and gen Z are willing to make less money in order to have more time, I hear it all the time. Tony, I had see it in some HR statistics and stuff. I'm skeptical that it's true. I think they want that. I think they want the time that the older generations didn't have and they want the money and they want it.

 That's what I'm seeing when I hire, especially I know the last year or so has been a fluke in the entire job market or a riff, you might say I'm not convinced that it's ever going back to normal. Even if we see a recession, I know things will, sometimes they admin in the favor of employees. Sometimes in the favor of employers, but I really think that this could be the new normal, where six figures is the basement for anything like being a manager at a retail store and anything. And, and they want to work 30 or 40 hours a week tops. And that drives up the real, the market for, for highly skilled labor, like embryology.

And so what are you seeing, when you're seeing these younger folks start to take positions? 

[00:23:19] Tony Anderson: Well, I agree with you can't hire somebody at a base salary and I don't, I've never operated this way. You can't hire somebody at a base salary and expect a 3% a year that, I always use the magical 10,000 hours after you've worked 10,000 hours.

You should be a master of your trade. And so, when you're training with me, I'm going to give you like 400 hours, during that three month timeframe, but you're not going to be an expert till you've done a good solid five years of what you do. I can fully train, I've actually just recently published as submitted a paper for publication on the training and how well it works. But at the end of the day, when you hire somebody, you have to be willing to give them five and $10,000 raise that raises for that first year to get them to where they're at, you have to pay them fairly. And that's where, if you hire someone who's going to use a random number like if you hire someone for $50,000 , straight out of school with some training the program or 60,000, that in five years, you probably need to be up there in that, six figure salary. If you're still paying them 55,000 or 60,000, or even 65,000, they're going to go somewhere else.

So you have to pay them fairly enough. And then also give them, I think with a lot of the younger people, they don't want to be micromanaged. So in some ways I agree you can't. Just let them work from eight to four or eight to three and pay them six figures. But the goal is that, if you think you can get to that point, then they probably will.

When I'm recruiting people, I have a coffee talk with them and just like I'm having, what do you want your base salary? Where do you think you'll be in five years? What what's gonna make you happy? And if you're not, if I can't make those expectations, then I don't want to recruit them into the program.

I actually had worked with the EVMS program for awhile while I was teaching them. And I had one of the students come out and say like, they expected their base, their first salary to be $80,000. And I said, I got some good news. I got some bad news. Sunday you'll make 80,000, but it's not going to be your first salary out of school.

It's you have to work up to that and they if you make a plan for them in the beginning or where they're going to be and where they're going to be in five years and you'll have some loyalty and commitment and not have to make them sign non-compete contracts, I never had anybody have to do that.

My goal is to support them along the way and be there as a director, I also offsite direct labs and that's how I recruit people in here's your growth plan for the next five years? The real challenge is after five years, what are you going to do? That's been my real challenge is after five years and you're not learning as much.

You're not building those skills. And now you have to kind of really drill down as a person, that person that you have hired, how are they going to get better? And at that point, maybe they should consider master's degrees and doctorate degrees to maybe grow in the supervisory level and lab director level.

[00:26:21] Griffin Jones: So is that sustainable though, at a time when people can constantly one up the other with salary, I guess. So even if you were so money motivated you maybe want a greater work-life balance, but okay. I'm either going to be working the same or they're both going to work me like a dog anyway. And all of a sudden this other person across the street is offering me 25% more than I'm making now because their need is that bad.

And they need it now, I guess. How do you maintain loyalty? 

[00:26:57] Tony Anderson: Well, I would say that a lot of these people that are jumping from one place to another, to another, that if I saw a resume that did that. I wouldn't be real hesitant to hire that person. 

[00:27:07] Griffin Jones: If you're so desperate, Tony, like I think some, somebody still might pick up Antonio brown next year for all the football fans that understand that they still might do it.

Even though that is a fire of a resume, but some buddy might be desperate enough to do it. And, and when there is such high demand, I think people will look well, eight months here, a year and a half here. I still see people getting hired like that. 

[00:27:33] Tony Anderson: Yeah, honestly, I actually know people recruiting people that way too.

And I really actually hate to see that recruiting from other centers, you get a bad reputation as a lab director and an organization when you do that. And you have to be real cautious about if you're the one leaving and because I have had peers that they jumped from one program to another, to another, and some large cities you can get away with that San Antonio, you can't because if, unless you want to leave to another city but , say like if you're in New York, if you jump from program to program, you can do that for awhile.

But after awhile, what are you going to do it? And even if they do offer you more money, are you really worth that amount of money? And just because you have a desire to do that. And there's another thing that I also always say, if you don't like where you're at, because of personalities or something like that, then wherever you go, that's where you'll be.

I have another way of putting it, the reason why the grass is greener on the other side is cause it's covered. Cause it's covered in crap. When you get over there, it's the same crap that you're sitting in. So just because you're moving and jumping around from program to program, doesn't mean you're actually worth it or things are going to be better when you get there.

[00:28:45] Griffin Jones: Well, let's talk a little bit about other ways of motivating in keeping embryologist to justify training them because I'm not totally satisfied with the wage prior to my friend, Dr. Eduardo Harrison is listening. He and I had a debate about well, the cost of fertility treatment go up or down.

And in the next five years, I still see it going up. And one of the reasons is I think that the salaries that you mentioned for recruiting people into the field are, are too low. I th when I hear that compared to what I pay my people, and we're a marketing firm, for example, it's like why there's so many other places everywhere across the workforce.

And maybe that will like I said, maybe it will add back to the other way to employers, but it sounds to me, like there might be too much competition that even if somebody isn't money motivated, it's like, wow. Like if I could do this for 30% more, 20% more I think that's a hard thing to overcome, but lets you and I are in solving for that today. One other thing that I want to think about is how do you keep people engaged in a way that justifies investing in them? I wonder if embryology is too boring for some gen Z folks or for some millennials. And the example that I have is I was talking with a junior embryologist who was applying for a position with us.

And I think that they're doing pretty well for themselves and they're in a very busy area. But they wanted to get out of the lab itself. They wanted to stay in fertility. They wanted to work like in a biz dev role in fertility. So if there are lab companies, give me a call, connect you with this person.

But I think that they just didn't want to stand on their feet all day or sit in a chair and be in a lab. All day and this person could, could accelerate a lot more in, in their career and be, and do really well. But they weren't interested. And so how do we either screen for that or help people grow that they actually want to stay?

[00:30:48] Tony Anderson: Yeah, that's those are you bring up some really good points and there's a couple of things that came to mind while asking the question, kind of going back to, people in embryology, one of my challenges was, because it's not cheap, to have an embryo training lab, like I have to have the exact same amount of equipment that an IVF lab would have even more. Because if I want to train more than one student, I have to have multiple micro stations at a a hundred thousand dollars a piece, microscopes. I have to have all of that stuff, liquid nitrogen and embryos. It's very expensive to operate, so it's not cheap to train someone.

And so one of the things I would say, when you talk about cost is not going to go down, but if you're a medical director and you are wanting to invest in your people, when you invest in your people, that means you have a faith in them. You want to keep them there and that's how you're going to keep them engaged, keeping them going to meetings and, investing in them, not just treating them like the carrot in front of the pony and taking them along. But let's just say, if you were to go put $5,000 into training somebody, an Axiom biopsy course now when they come back, when they do for ICSI, or four biopsies. Now you've made your money back every biopsy and ICSI after that, they're going to keep making you money. That investment is going to make you hundreds of thousands percent versus, if you were to put $5,000 in the stock market you might make, if you made 10%, you're going to make $500 a year.

But if you invest in one training course, as you know, two training courses that say $5,000 all year long, every time they do a Biopsy for you, it's making you money. It's the best investment of fertility center can make in their people right now and showing them that they believe in them and showing them that they're going to continue to invest in them and their growth and in hiring people that to, to to help them have this quality of life and, and and to grow in their careers. 

[00:32:55] Griffin Jones: How's AI going to change the work flow that we've talked about in the lab on the clinic side. I've talked about with Dr. Bob Stillman about the possibility of like minority report with the huge screen.

And REI is managing hundreds of cases at once using AI. What is it going to be like in the lab in the next decade do you suppose? 

[00:33:20] Tony Anderson: Oh, well, AI is going to, a lot of people are afraid of AI and a lot of people are afraid of the robotics and a IVF in a box that is going to take our jobs away.

I think it's going to simplify our work and we're, increase our bandwidth to do more. We won't have to manually do the assessments. Everything will be done by the machine, through like Embryoscopes or, MIRI, embryo imaging type incubators. And historically those incubators haven't been shown to make any clinical improvements, but if you can save a safety and time, then those types of pieces will be good.

And people are been able to overlay big data. That'll help you select the best embryo. People like me, who've been looking at embryos for 30 years. We can look at an embryo, back one of my prize, paper nominations. I had a few years ago that I could select an embryo and have just as good a pregnancy rate as a PGT embryo.

And just knowing how the embryo grows. Well, maybe some of the young folks won't have to learn all of those things and that actually make their training go faster. So AI is actually going to be a tool to help us do more with less people. And that's where I see it going and I think we should embrace that.

I think we should embrace the idea of having witnessing systems and bring those into the laboratories to increase safety.

[00:34:40] Griffin Jones: How close are we to some of that? How close are we to AI doing the assessments, for example, and I wait two or three years away from that, do you think it's not on the horizon and you have no way of knowing.

[00:34:52] Tony Anderson: No, it's there now Embryoscope will actually do that now, in there even actually overlaying AI on the genomics testing to take the human variability is out of it. One of the things that is going to make it more expensive because an Embryoscope is a $180,000.

A Casa, computerized assistance semen analysis system is anywhere between 40 and $80,000. If you have a witnessing system it's gonna cost you probably another 50 to $60,000 a year, depending on how large your program is. And so you have to put that cost onto the patient, unfortunately, but with that, the systems, well, if they would all work together that's one of the problems is that, , one company has this system and other company has this system. If they all talked to the EMR, then they would actually be a very powerful system. And so that, really any EMR, if you could get the data to automatically upload into the EMR just like we do with lab core we send a blood to lab core.

All that data automatically goes into the EMR. If we could get our incubators and witnessing systems to do that for us, it would really make life a lot safer and simpler for the laboratory team. We spend a lot of time. It takes a lot of resources to make sure you get it right every time. I always say it's like, when you're going to land on an airplane, a pilot comes in at the runway and if he or she, doesn't feel comfortable with the runway, you can always come back up and come around and do make another attempt at it.

When you're an embryologist, you get one shot at it. Every single time you have to hit that runway every single time. And so these systems are going to actually make our lives better. But it's going to make an investment. Casa systems have been around for 30 years, but you'll find very few in the laboratories because they are very expensive and most docs will be like, well, I can pay that person $30,000 a year versus buying the system for 80,000.

[00:36:51] Griffin Jones: Well now maybe they can't. So maybe that's the tipping point for some of this. So Tony, most of our audience is practice owners or execs for other companies in the fertility field. How would you like to conclude today's topic? 

[00:37:04] Tony Anderson: Well, it's been a pleasure to be here and I appreciate the invite to come and just hope that working, collaborating with the people that are recruiting and seeking embryologist to help them to bridge that gap and to fill that those areas that they need. 

[00:37:21] Griffin Jones: Where can people find you? Where can people find you? And we'll also link it in the show notes. 

[00:37:25] Tony Anderson: My website is https://ivfacademyusa.com/. And my email is dranderson@embryodirector.com. 

[00:37:37] Griffin Jones: Dr. Tony Anderson. Thank you so much for coming on Inside Reproductive Health. 

[00:37:41] Tony Anderson: Thank you Griff. I appreciate you. 

121: Thriving as a Fertility Practice Without Taking Insurance with Dr. Eyvazzadeh

Griffin Jones and Dr. Aimee Eyvazzadeh discuss how she is successfully running her practice solely accepting cash-only patients. The days of losing money due to insurance companies’ refusal to pay are far gone for her. The secret to Dr. Eyvazzadeh’s success is her massive top-of-the-funnel marketing strategy and her efficiency of weeding out patients that aren’t a good fit before she or her staff spends time with the prospect. What matters most in fertility marketing isn’t what most people expect.

In this episode, we cover: 

• Who would be able to run a cash-only only system

• How Dr. Aimee has developed a massive top of funnel engine

• Why success rates aren’t the marketing factor most think

• Why Dr. Aimee attracts 15% of her patients from out-of-town

This episode is 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. 

Dr. Aimee Eyvazzadeh’s Information:
Company: Aimee Eyvazzadeh MD, Inc

LinkedIn: https://www.linkedin.com/in/aimee-eyvazzadeh-12715932

Twitter: https://twitter.com/_EggWhisperer

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

Insta: https://www.instagram.com/eggwhisperer/

Mentioned in the episode: 

NoHold ( https://www.nohold.com/) 

EggWhispererSchool.com

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[00:00:00] Griffin Jones: Insurance employer benefits can't live with them. Can't live without them. I don't know. Today. I have Dr. Aimee Eyvazzadeh on Inside Reproductive Health. She was on the show about a year or so ago. It was episode 88, if you recall and I just kept asking and trying to figure out why does she have this system for patient attraction of all the content that she's putting out there of this brand and messaging. If she's not trying to scale an enterprise, she would certainly have more patients than she knows what to do with it. If she didn't especially being in the San Francisco Bay Area. Well come to find out. It has partly to do with the fact that they only take self pay patients at Dr. Aimee's practice.

And that's when the light went off. And we talk about the funnel that's necessary today. What kind of market that you have to be in and a couple of other requirements for. Being a self pay only REI practice. Many of you wonder about this and you wonder if, well, I keep getting lower reimbursements on this service from this insurance company, this employer benefits company.

Well, there might be a way for you to just forego that altogether. And I recommend that you listen to Dr. Aimee's take before you do that. So I really hope you enjoy today's show about being a self pay only practice with Aimee Eyvazzadeh.

[00:02:12] Griffin Jones: Dr. Eyvazzadeh Aimee. Welcome back to inside reproductive health. 

[00:02:17] Aimee Eyvazzadeh: It's always great to be talking to you, Griffin. Thanks for inviting me back.

[00:02:20] Griffin Jones: If anybody has listened to episode 88 and a lot of people listening now will in episode 88, when I had Dr. Aimee on the first time, I'm just trying to get after, like, I keep asking you questions, like why build a brand like this?

Why build something that is otherwise meant to scale? If you're not trying to scale, like you're not trying to. Open more offices, hire more docs, things like that. And I could, like, I kept grilling you. I was grilling the crap out of you the whole episode, and I still couldn't figure it out why after the conversation.

And then sometime after, like in one of those detective movies where there's a benign clue that set something off and the client's like Washington street that's right. The suspect was from DC. And then he runs back to the headquarters and it was like that when I learned about your. That you are a self-pay practice that you don't take insurance and other types of you know, like the employer benefit coverage.

And I was like, that makes sense. It all is starting to make sense now. So can you talk a little bit about that model and then I'll talk about how I perceive it from a branding perspective with the questions I have there. 

[00:03:32] Aimee Eyvazzadeh: Yeah. I mean, the thing is that I don't own an IVF. Right. And so when you accept insurance, you have to accept the rates that they're going to give you.

And if you don't own the lab, it's hard to carve out the global fee for the physician fee and then the lab fee. So I was taking insurance up until 2013 and then I started paying for my patients, I guess. Because I felt so bad that their insurance was denying the claim on the ICSI. For example, the patient expected that to be paid, but the IVF lab expects to be paid $2,000 for ICSI.

And then I was writing the checks out and I'm like, this is just, it doesn't make sense. Like why would I be paying for people to do IVF with me, I just can't, you know, sustain a practice like that. So then I said, you know what? I have to go cash only. And if people want to receive care for me, they're going to have to, you know, forego the insurance.

And we're so lucky in the bay area like, everyone's my friend here. There's so many fertility doctors. So if there's a patient that really needs to use their insurance, I happily make, I call them warm introductions to doctors that I think will be a really good fit for them after I meet with them and talk through their story with them.

So, you know, I do a lot of, you know, first consults for fertility patients, you know, second opinion consult. And then I just hand them off to a doctor that accepts their insurance.

[00:04:44] Griffin Jones: So it was 2013 that this change happened. Was it ripping off the band-aid all at once? How did you do it? 

[00:04:52] Aimee Eyvazzadeh: Well, it was slowly because obviously you have to give notice to the insurance companies and then it was no new patients with this insurance up until, you know, I could actually, you know, say absolutely no new patients at all with insurance. And it was hard for me emotionally, because I felt so bad saying no to people, especially patients who were well-established who want to come back for, let's say another transfer. That was really tough to say, you can't use your insurance with me, but again, because they could still use their insurance at the IVF lab, they could easily just transition over and I was there to help and guide them. It's not like I abandoned them in any way, but that, that was tough. It was really hard. My accountant was like, Aimee, look at how much money you paid the IVF lab. So you could do cases there. You actually lost money, you know, helping these patients. And for me, you know, there's a good reason why I don't own a lab.

And the reason is I would do everyone's idea for free, literally. Like I would just be like, oh, you don't have to, but now that I know, like I have to write a check for that patient to have IVF that for me, makes it so that I can still run the office the way I do and take care of as many patients as I can take care of.

[00:05:53] Griffin Jones: So how long did that take? 

[00:05:56] Aimee Eyvazzadeh: About a year to go from, you know, well, it was something that I had been thinking about for awhile. And so finally, once I did it, it took about 12 months to get to the point where I can completely just say no insurance at all. 

[00:06:07] Griffin Jones: And what is the arrangement with the lab, like in order to be able to do that?

[00:06:14] Aimee Eyvazzadeh: To say no insurance. Well, it's a facility agreement, just like a surgeon has privileges at, let's say a surgery center for me. I have privileges at different IVF labs and the same fees that a patient sees. It's all very transparent. So let's say one of the centers charges the patient, you know, let's say $3,000 to do an embryo biopsy.

Well, rather than them paying the IVF lab, the $3,000 for the embryo biopsy fee, they pay one fee for their IVF cycle. And then I pay the lab for the services performed base on that. 

[00:06:43] Griffin Jones: Okay. When I've seen the model of not owning a lab before, very often, the person has one lab that they use. And I think, you know, the three or four examples that I'm thinking of, they all, each use one lab. You use multiple lab?

[00:06:59] Aimee Eyvazzadeh: I predominantly use one lab, but the thing is that like, we're all again, like we're all friends here in the bay area and you know, I have patients that, you know, go to another lab because now they have insurance at another lab, but then they want to come back to me and have me do the transfer for them, for example.

Right. Rather than move the embryos to another lab, I can go to that lab and you know, do the transfer for them. So it just makes it easier for the patient. For example, who let's say wants another perspective or, you know, still wants my help after doing IVF somewhere else. And I can still go to that lab. So yeah, I have privileges have many different labs, but it's all just to help the patient and make things harder on me.

But I do it with joy and it's fun for me to just see people and say hi to them again and see how things are going in their lab. 

[00:07:43] Griffin Jones: Yeah. Would this work, if you owned your own lab, would you be able to do this self pay model? And if not, why not? 

[00:07:52] Aimee Eyvazzadeh: I think you could, I mean, if you own your own lab, you can do self pay, but just really depend on where you are, you know, like the demographics in the city that you're in. I'm really fortunate in the bay area, but I'm in a situation where when I make a recommendation to a patient for a treatment plan. Like I think, you know, you're 40 years old. I think you might need two to three IVF cycles.

I think we need to bank embryos. We need to genetically test them. Patients are like, okay, I'll make that work. I'll see what I need to do financially. But I know that there are parts of the country where that's really hard, even for patients to even consider one IVF cycle. So even saying the word a couple thousand dollars can be really a challenge for some people.

So I know I am in a unique situation here. And it's not definitely something for every community, you know, every doctor across the country, but it definitely is something that I've been able to do in the bay area, just because of, you know, the area we're in. And also I do have patients that come in, obviously from out of town as well.

And so they come here knowing, you know, upfront what the cycle fees are here and they're different and you know, in every area of the country, they're going to be a little bit different based on you know, the cost of living in that area.

[00:09:03] Griffin Jones: I don't suspect you'd be able to do that in Akron, Ohio, and that's somebody practices in Akron, Ohio.

I don't know them, but, or I could use any other town as an example. I'm not picking on Akron, but I think my hypothesis is that this works in more affluent coastal cities with very large populations. I had somebody asking me about this years ago, it was closer to when I first came into the field so it was probably five or six years ago. And they're asking me if this was possible, and this was my hypothesis that you would have to be in a really large market. And then you'd also have to be in a, you have to have a wide funnel. That narrows down into that short spout coming out of that funnel, that would be the wide funnel, meaning your, your marketing message attracting people, because you're going to have less people that are able to pass through the bottom of that funnel.

And so it's gotta be wide at the top because it's shorter at the bottom. And I want to talk about that funnel with you and the brand. But I have one question that's probably evidence of my ignorance as a non-clinician, but how do you report success rates in that way if you're using different people's labs? 

[00:10:23] Aimee Eyvazzadeh: I say, if you share with me your age, your follicle count, your AMH and FSH, I'll let you know what your individualized pregnancy rates are. And based on the information that I have about you and I can give that to the patient individually. I don't think it's fair for, let's say a 39 year old with an AMH is 0.1 to compare herself with all, you know, the start data on 39 year olds, because obviously her chances are going to be different.

[00:10:45] Griffin Jones: So that I've think circumvents, a lot of the challenge of success rates to begin with, like the whole controversy around success rates is that you're positioning something like really broadly you're cherry picking data. Everybody complains about what everybody else is posting on their website or how they're choosing.

And, and so it's like, you're, it seems to me like you're avoiding that all together. 

[00:11:12] Aimee Eyvazzadeh: Yeah. I mean, when a patient asks, like where can I find your success rates? I went to start and I don't find you. I say, well, I can't, you can't take the lab that you're going to as a sign of your potential success rate. But I can tell you, you know, just based on the data that I've learned about you, what I think your chances are.

And again, we're so lucky in the bay area. Like every lab here is basically amazing and awesome. So you can't really go wrong with any of the labs around here. 

[00:11:38] Griffin Jones: How often does someone ask you that? 

[00:11:41] Aimee Eyvazzadeh: I mean, my patients are really educated, so those conversations sometimes has come up, you know, maybe like one out of 50 patients will ask me the question.

[00:11:49] Griffin Jones: One out of 50. 

[00:11:50] Aimee Eyvazzadeh: Yeah 

[00:11:51] Griffin Jones: Yeah. That's not a lot. And it was amazing to me cause when I first came into the field, I came through surveying patients. And they talked about success rates in the clarity of success. There was a theme that came up, but like one in 50 is not a lot. And also it's not one of the most traffic pages or the highest converting pages.

There was a discussion about start and marketing guidelines at ASRM couple years ago is the Denver one. And I had my laptop and I opened it up while the speakers were talking. And I went into some of our clients, Google analytics, and it just looked at their most traffic pages and their highest converting pages and success rates weren't in the top 20 for IVF. 

[00:12:35] Aimee Eyvazzadeh: Yes. And I think patients know that it's not so much about what's reported. It's about like how they feel at the clinic. And obviously, you know, that's really important about being heard and cared for, but also like, depending on where you are, some patients just don't have. You know, they don't have a choice as far as like which lab that they can go to because they have to stay close to home for different reasons. So, yeah. 

[00:13:00] Griffin Jones: I don't want to say that it's not important because I've heard patients say so many times about how important is, I'm just sharing what, how the behavior seems to map out from what we can actually measure. And it seems like other things are much closer to the main influence of the decision. So, okay.

So you, well, you have this flexibility to be able to accommodate patients at different labs. You don't own your own lab. It took you about a year to, to wean off of the insurance drug. I think that there's probably a louder, a lot of people list. Well, now you might call it the employer benefit drug too. And that can be a mis-characterized, I mean, there's many people that aren't going to get care otherwise, so I'm not dismissing insurance or employer coverage. I think it's a net benefit for people. So I want to make that perfectly clear. I'm just saying on the other side that I do see providers being the ones to get squeezed very often, they're in the middle of this and I've seen some of the reimbursements that people get and it's like, they're not even breaking even as you said, in some cases. 

[00:14:17] Aimee Eyvazzadeh: And there is one of me, I have 17 full-time employees. I can't survive on insurance with the volume that I'm at, not owning an IVF lab, it's just not feasible at all. So with the amount of time I want to provide, you know, no matter who you are, every patient to me is VIP.

And I want to make sure that I can, you know, provide that level of care without feeling like Costco, like, you know, just so many people coming in and out. I can't give so much of myself if, if I'm doing that, I'm already seeing a lot of, I'm seeing over 30 patients a day as it is. I do all my own scans.

And so I had to do something to, to actually basically limit the practice a little bit as well. 

[00:15:00] Griffin Jones: Why do all your own scans? 

[00:15:03] Aimee Eyvazzadeh: I feel like, you know, I went into IVF or fertility medicine wanting to take care of patients and wanting to do my own scans, my own retrievals, my own transfers. And I feel like sometimes the date of loss in between scans when you have inter observer variability, and sometimes, you know, other people making decisions about, you know, what you should do based on data, not other people, but sometimes the data is not consistent because they're different people scanning.

And I feel like that's always been important. And those are the things that I see when I review records and I can see things like, oh, that's interesting. You can see that, you know, you can tell that different people were doing the scans throughout the cycle. Like I had a patient once and many times where she would find different people scanning her in one cycle and that I think it could have affected her care.

And so that's why it's important to me to scan my own patients. And it also provides that, you know, they hear from me. I have that sparkle checklist. You probably know it, I give them all the elements of what's going on the size of their follicles, the protocol. Am I happy? The lining, when the renewables going to be, with the lining looks like you know, all that kind of stuff.

They'll get that in real time without wondering what's going on. 

[00:16:08] Griffin Jones: Well, it seems to me like you're in a position to be able to make that decision for yourself that doesn't seem like pure efficiency, but that's okay. This is your business, your practice. And you're in a position to make that decision because you're not being squeezed on margins and other areas, or are having to bring in a tech to do it for to be able to pay that bill. So I suspect that there's probably a lot of people listening that envy you, that are in that smaller practice group. And especially like the one to two doc groups that if they're selling to private equity, it's not at a big, multiple, maybe it's enough for them to be happy with retiring, but it's not the same as like these seven doctor groups are getting.

And I suspect that there's a lot of, one to two REI practices, listening that envy you and want to be able to do this, but they're also scared. They think that well I might not be able to meet that. And I might not be able to, to make ends meet that way, meet the volumes that we'd need to do if insurance or an employer benefit company, isn't paying for it.

So, do you see this drying up at all? Do you see on the horizon? I don't think that there's enough cash pay patients out there as employer benefits, increases insurance coverage and mandates increase. 

[00:17:28] Aimee Eyvazzadeh: No, I don't see that. I think there's plenty of patients for all of us and it's never about competition. I don't necessarily see me as someone that people would envy.

I feel like if anything, they might feel sorry for me because I work the number of hours that I work seven days a week. I see patients, Saturdays and Sundays. I'm not taking a single day off this year. The only day I'm not seeing a patient is on Christmas day. And so most people don't want that kind of life.

And so I've chosen that for myself, for my own reasons, just because of just my personality and who I am. But I think most people would like the option to not scan every single patient, but still be able to communicate that with their patients and you're right. They might have that fear that they can't do that just because there is just not something that they actually want to do. Most of my friends were like, I don't want to do what you do. I don't want to see patients seven days a week. I want to break. You're crazy. And I'm like, yeah, I I'll take that. I'll take it as a compliment. 

[00:18:21] Griffin Jones: Yeah. I know that you're a meteorite.

And it's like, when I hear people talk about like entrepreneurs or people that just have seemingly unlimited bandwidth and energy. That's at least how I perceive you. I don't know deeply personally, but I also don't see how you do, like, it's not a requirement that you have to scan your own patients because they're not taking insurance. Right?

[00:18:42] Aimee Eyvazzadeh: No, not at all, but I think patients come here because they want that. They know that they're gonna get that.

You know that they miss that in their last cycle, they missed, like they share experiences where they did an entire cycle and never saw a doctor once. And then they met the doctor that was going to do the retrieval for them. And that's not the doctor that they met at their new patient, 15 minute video call, you know, and so people want that. And so they know that they're going to get that here. So that's why they come. 

[00:19:09] Griffin Jones: Well, staying on the topic of the scans. What's the difference between the physician being with the patient the entire time for their scan versus having a tech do it? And then the physician popping in and saying, oh, hey, catching up for three minutes. 

[00:19:22] Aimee Eyvazzadeh: I mean, it's efficiency. I mean, I can do a scan, communicate with the patient. I actually do my own blood draws. So within like 15 minutes, I can have it all done. The patient feels heard and she's sharing her symptoms. I'm telling her what to do next and I can make the decisions right then and there without any delays.

So I think it's more efficient than having someone do it. I pop in, I say, oh, I'll meet with you the end of the day, we'll have another interaction. It just seems more efficient to doing all the same. 

[00:19:47] Griffin Jones: How many of your patients come from outside of the bay area? If you had to ballpark percentage wise?

[00:19:54] Aimee Eyvazzadeh: A lot. I mean, I think this week I have at least five in a hotel, doing a cycle with me. So if I were to say percentage wise, probably at least 15, maybe even 20% are from of town.

[00:20:07] Griffin Jones: So that has to do with the funnel that you have from the top. They're finding you from social media, from your podcasts, from your mainstream media appearances.

[00:20:19] Aimee Eyvazzadeh: That's right, exactly right. So people seem to like code in the New York times or you know, some other piece you're right on the news of the today show. Then they'll see my name and they'll reach out and they'll do their Facebook research. They'll go into the groups on Facebook and then have people also say, oh, I went to her and then it's more affirming for them to reach out and set up an appointment. 

[00:20:37] Griffin Jones: I should have asked Dr. Eyvazzadeh, if, she uses EngagedMD, because technology making life easier for your patients and making the work experience better for your team is EngagedMD. In a nutshell, you've got a limited amount of time to cover with each patient, EngageMD allows your consults to be more productive.

So you can do what you're meant to be doing nurses can doing do what they're best at you're spending less time answering the same questions. You're then tailor, fitting that time to more educated patients, patients with truly informed consent because enrolling patients in EngagedMD is easy. It takes like 20 seconds.

Then they get some of their time back. The patient that is because they're watching the video modules with their partners on their time. They're completing the knowledge checks with their partners. All of this is sequential. They're signing and submitting. And EngagedMD documents, everything so that your physicians, your nurses, your team members, don't have to get back to doing what should be involved in a technological solution.

Anyway, if you go to engagedmd.com/irh, they will give you 25% off your implementation fee. That's EngagedMD.com/IRH now back to our conversation with Dr. Eyvazzadeh 

So you've got this massive top of the funnel, which I was asked, which is what I was grinding my brain about. The time, we talked on this podcast, why, why? And it makes complete sense because the wider, the funnel that you have, the more you can have mechanisms in place that allow people to self-select, if there's one type of not one type, but if there's a narrower funnel of people that may be able to be a good fit for your model. And we do that with our firm, like Inside Reproductive Health is for everybody. I want everybody to listen to it. I want the drug reps listening to it. I want docs listening to it.

It's mostly practice owners and execs, but I want everybody in the field to pick this up like it's the wall street journal. That a business person reads or watches, Forbes. I want people to watch, listen, to read Inside Reproductive Health every morning. I want this like weekly podcast to be just the beginning and I want to create a lot more content for big top of the funnel, but then I have a very, you know, kind of narrow bottom of the funnel. I don't really have sales calls with people because I don't have a sales team. I don't want to hire a sales team. I have my delivery team. I have people that manage accounts, but I don't want to hire like this entire sales apparatus. So I've got this big top of the funnel, social media, the podcast, the speaking, and then the middle of the funnel is all about our points of view, of how we do things.

And then the bottom of the funnel is like, if you want to engage us, here's this $600 engagement that that allows you to test it out. And I don't really talk with people. If somebody wants to send their marketing director, I don't talk to them to me, that feels like an insurance equivalent of like, no, that's not a good fit for us.

 And, you know, I might talk to a principal for 15 minutes, but it's just about our process. And if they want that $600 offer, that's, if there's no commitment that gets people in and hopefully I've created enough content to help them decide for themselves, if they're a good fit or not. But how do you narrowed down that funnel when you have such a huge top of the funnel? People are seeing you from all over the country. How do you start to narrow it down? Well, We don't take this insurance. We don't take these employer benefits. This is why do you weed that out so that people aren't pissed at you when they're contacting you.

[00:24:29] Aimee Eyvazzadeh: It's simple AI. So I have an amazing AI tool. So for anyone who's listening, who is interested, I work with no hold. N O H O L D. And I'm working on systems to automate many things that are inefficient in the practice. And so we've started with new patient onboarding. So it's basically a virtual assistant that we've created with their help, of course, they actually created it, but all the language comes from me and my assistants here, so that patients at the start of the onboarding process understand what their they're onboard. And for, and their onboarding for an experience with a physician that will not take insurance. And so before, you know, when people were picking up the phone, my new patient coordinator would get all the information and then tell them, by the way we don't take insurance.

Is that okay with you? And you're right. Like, that's not how it should be. So from the very beginning, It's you know, welcome to the practice. Click here. If you want to be a new patient, then the very next thing says, Dr. Aimee does not participate with any insurance companies. It's self pay only. Please click here to continue.

And if you don't want to continue, we send you a really nice message about my IVF classes of courses. EggWhispererSchool.com is where people can go. So if people don't want to engage. Like formally through being a patient, you can certainly take one of my classes that I do on IVF or egg freezing or fertility testing.

[00:25:52] Griffin Jones: So are they seeing this only after they contact the practice or is there some content that you put out in different forms? 

[00:26:02] Aimee Eyvazzadeh: Yeah, so it's we actually don't do any consults without patients going through the website first. So if someone were to call the office, we would simply say, please go to the website and click schedule a consult, and then they'll find the information right there.

And then they can continue the process. It's about 10 to 15 minutes of questions that they answer. And then my new patient coordinator will get them into the portal, send them all the forms they need to sign and get the medical records and schedule appointments.

[00:26:28] Griffin Jones: This is another benefit too. That's another bottom of the funnel requirement that I think people would love, but the top of the funnel isn't big enough.

And this is another way of looking at why you want the top of your funnel to be larger. So most people today are busier than they have been in years. They have more new patients that they know what to do with in 75% of cases. If you have a wider funnel, the wider your funnel is the tighter, you can make the, the requirements of the middle and the bottom of the funnel.

And for most people, I think that they would love that if their patients had, to do that before they scheduled a new consult, but they don't feel like afford the attrition for those that wouldn't do it. 

[00:27:24] Aimee Eyvazzadeh: Yeah. And you can include even insurance, you know what I mean? It's not just using a tool like this isn't just for people who are like me, you can use it for insurance and then it would capture the insurance information right away. And then it could, that information can go to the insurance. The insurance folks in the office that, you know, check benefits and tell the patients with their benefits are before they come in to prevent again, that the hard part of having insurance is when you get to the clinic and then you're told something that is different than what your insurance told you, and then there's issues surrounding that.

But, you know, I'm so lucky that I don't have to deal with anymore.

[00:27:57] Griffin Jones: So there seeing this, which in the no hold was the AI? 

[00:28:02] Aimee Eyvazzadeh: Yeah, no hold,is the company that I use. Yeah. So they're the one that set it up and they're working on onboarding other clinics as well. 

[00:28:08] Griffin Jones: And so that's still at the bottom because of the funnel, because that's when people are contacting you, do you have it in like the middle of the funnel?

Like the videos that you do or do you let people know, even before they contact, we don't accept insurance?

[00:28:21] Aimee Eyvazzadeh: No, it's not something that I advertise or talk about on my podcast because my podcast is really for, you know, education for everybody, for the masses. I don't put it out on my blog articles, like in asterix, by the way, Aimee doesn't accept insurance.

It's just something for patients who are ready to meet with me, then they can get onboarded and they'll find out at that point.

[00:28:43] Griffin Jones: Do you ever get people that are pissed at that point? 

[00:28:48] Aimee Eyvazzadeh: I haven't, I mean, if they're pissed, they don't let me know. I mean, certainly they're sad, you know, sometimes people contact me through Instagram for example, and they're like, do you take my insurance?

And I say, no, I don't, but I'd happy to give you a second opinion on your case. And then I'm happy. to like do that warm intro with a doctor in your area that I feel like would be best suited for you or but I've never had anyone get pissed at me in space. I mean like, no. That is no.

[00:29:13] Griffin Jones: Yeah, it must be my face.

There's a lot more easy to get pissed. And maybe it's the beard. Maybe it's maybe it's the, the hair. I don't know, but I do getting people basically to go from the top of the funnel, to the bottom pretty effectively. And that could have your, you were joking, but it could have to do with your persona. Maybe I know that we've had to invest more in the middle of the content because sometimes it do get people pissed at me when they're reaching out.

And they're like, and it tends to come from the industry side more because we serve the industry side and we think a lot of what we do translates to it, but we have definitely, we think we still know more than any regular marketing agency, but we have not built the systems to the degree that we have for practices and so we tend to do, a little bit more consulting upfront, and so it's a bit more expensive and some people are like, well, it sounds like you're just charging to get to know our situation. Like, yes, that's exactly what I'm doing. I charge you to get to know your situation. And I think what you have to do to be able to do something like this, where you are inevitably going to have to turn many people away.

And in your case, you're sending people to other channels that do need care in order to be able to do that. You have to have other places that you can refer to them and have resources for them. So I don't feel bad about turning people away because I put out a hundred and thirty episodes of Inside Reproductive Health and articles upon articles have really in depth points of view on physician outreach systems and IVF conversion systems and things that take me 20 hours to create.

And so I feel like, you know, if somebody is like, well, we think we should just be able to talk to you. It's like, if I haven't given you enough information to decide that 600 bucks or $1,500, then I haven't done a good enough job, but I do have those things to be able to give them for free. And the vast majority of people are understanding and so you have that. So you talked about some of the things that you do, what are some of those resources that you give people when they are in a position where they can't afford to pay out of pocket? 

[00:31:27] Aimee Eyvazzadeh: Well, my IVF classes. So I have a live class every month. I have an egg freezing class, for example, fertility awareness class, like teaching people, what level, you know, what to get checked, you know what to ask your doctor.

So those classes are pretty affordable. They're anywhere from like 30 to $60. And then have my blog and then my YouTube channel and then the podcast. And so, you know, those are the different ways that people can engage with me without paying to, to see me formally as a doctor. I always tell them, obviously that whatever I share with them is not to be considered an expert opinion because I'm just sharing information and not medical advice and soon hopefully in the next, you know, six months, I'll have an app where people can engage with me more formally without the being fully onboarded as a patient. And that might be a price point, kind of like a subscription model where they can get their questions answered. And for me, it's going to be helpful because right now I get questions, there's so many different social media channels, and it's hard. I feel bad. Like, I want to reply to people, but I just can't. Cause I can't go back. Like if I ask, you know, someone will be like, you know, what do you think about this account? Well, I can't engage back and forth with them because I'll lose with the number of messages I get.

I won't be able to go back to that. But with an app, for me, it'll be really nice because I'll be able to track the questions and be able to answer them. And then that would be a really fun thing and hopefully remember the entrepreneurial side of me, you know, I don't plan on working forever. Right. We all end up not being able to work at that mean I'm not planning on dying anytime soon, but this could be something that. 

[00:32:54] Griffin Jones: I thought you did plan on working forever, I thought you are just gonna, do a retreival and then keel over. 

[00:33:01] Aimee Eyvazzadeh: That's probably what's going to happen my grandfather, God, rest, his soul did that.

[00:33:04] Griffin Jones: I remember that story.

[00:33:06] Aimee Eyvazzadeh: Yep. So I, hopefully will not, you know kill over like the Peloton guy. I hopefully won't do that, but you know, that might be something, you know, cause I don't have a practice to sell. I don't think there's much to sell when it comes to, you know, what I do, but that might be something that would have value in the future for somebody.

[00:33:24] Griffin Jones: Well, if you want it to, you could absolutely sell that brand as a huge funnel for somebody. So there's something to sell there. Well, I have that for another topic, but I think that having the subscription model something that's low cost, having all of the free content, including the classes, something that's free is absolutely necessary to do something like that, you do it, we do it. But if somebody contemplating this idea, Yeah, you have to be able to give people something, especially because they're turning to you for something so serious. And so I don't think that you can do this without doing that. I mean maybe you could viably, but I think it would be a liability to reputation.

And also, I think you probably feel pretty crappy if you had to turn people away, completely empty handed.

[00:34:13] Aimee Eyvazzadeh: Right. 

[00:34:14] Griffin Jones: So I still think that some people are envying. I still think that some people are listening to to this thing. And while I wonder if we could pull this off, you talked about how much you're working, but is that a requisite for being a self pay only group. I feel like to me, it seems like just you, like that's just Aimee Eyvazzadeh but somebody could work the same as, as, as they did when they're taking insurance. Right. Or sometimes even less because you would have less staff now, you'd have to have less billing staff and so much less resources dedicated to that. It seems like you could work less. 

[00:34:53] Aimee Eyvazzadeh: My issue is saying no. So I have people like that will reach out today and they'll be like, I just found out my IVF cycle didn't work. Can you get me in for a cycle this weekend? My fear is going to start and I'll be like, yes.

So I can't say no and not work as hard as I'm doing. You know what I mean? It's like, you know, I'm trying to say it's like, that's the issue that I have is if someone needs me, I'm not going to say, well, call me in March and then I'll put you on a list. There's no list with me. Once you're in, you're in and I, you know, once you're my patient, I will get you in right away.

And so that's, the issue is just the number of, patients ask me, like, how many people are you doing IVF at at one time? And I'm like, I don't know. I don't count. I don't think about like, when I'm going to see my last patient of the day, I just like look forward to each encounter and just keep going. And I don't have that kind of monitor in my head.

[00:35:44] Griffin Jones: Does that number keep going up then? 

[00:35:47] Aimee Eyvazzadeh: Yeah. 

[00:35:48] Griffin Jones: It gets more than it was last year than it was two years ago than it was three years ago. 

[00:35:52] Aimee Eyvazzadeh: Yeah, it is. 

[00:35:53] Griffin Jones: Okay. And so for you, it's just squeezing those patients into whatever minutes you have in the day for other people, that's going to look like an increasing wait list.

Which many of them are already dealing with? I think for some people there think, okay, well, is my market big enough? Like the New York, San Fran's LA. Those are the markets where I see this working. I don't think the Fairbank's Alaska's or the Buffalo new York's or some of the smaller markets, but then I'm wondering about the Houston's, the Dallas's, the Charlotte's, the Atlanta's and I think you probably could, if you had the right funnel, especially if, as you say 15% of your patients are from out of town.

[00:36:36] Aimee Eyvazzadeh: Right. And I wake up, you know, I start seeing patients at 6:00 AM. So if I have, let's say my equitable scheduled at nine, and I have patients between nine and 10, I'll just start an hour earlier to see them. So it's not unusual for me to start at 6:00 AM and then I'm not, I don't, I basically don't stop working until I sleep. 

[00:36:53] Griffin Jones: Well, other than that, of your inability to say no, because I think other people would just say, okay, well, let's make that a wait list. And even if we get to that, it's a good problem to have, because it, this wages are concerned that we wouldn't be able to meet the volume without having the insurance or the benefit paid patients.

Is there anything else for people to consider before they jump into this. And one thing I'm thinking about is the debate I had with Dr. Hariton on this show where I see more people doing this because I think that there's too many people that feel that are at a point where they're like, well, this just economically the decision is made for me.

And So anyway, before they make that decision, what else do they need to consider? 

[00:37:40] Aimee Eyvazzadeh: You can't do what I do and own a lab. You just can't. I mean, I couldn't possibly.

[00:37:44] Griffin Jones: Wait the minute but we are in the episode that I asked if you could do this with a lab and you said you could. 

[00:37:48] Aimee Eyvazzadeh: I mean, no, no, you could go cash pay, but you can't do it the way I do it.

You can't see as many patients without cause the lab would take more like it would just be another thing to deal with. Like I'm already dealing with the practice and the HR stuff with employees and hiring and day-to-day stuff. I couldn't also then focus on the lab. And deal with that as well.

You know what I mean? So the reason why I can do this and do it as much as I do is because I don't have the responsibility of overseeing a lab at all. You know, I don't have to worry about staffing the lab and you know, what's going on there because other people who are really good at it, way better than I would ever be, are doing it for me.

[00:38:31] Griffin Jones: I just love people in business that makes their own thing. Like to me, that's what being an entrepreneur is about or a small business owner. They're not exactly the same thing, though. They're on the same spectrum, but the. Ideal of either is being able to craft something that you want. And if you craft something with a huge scale, you have to meet to the demands of the marketplace.

But if you're crafting something, that's, it doesn't have to scale to the entire market. You could say, all right, well, is there a segment of the market that allows me to do exactly. I want to do it doesn't matter if, if it's not for a hundred percent of the market, if I can even craft out 1% or two temper, whatever, it might be just enough to support the vision that I want to meet.

That's what I really admire about different business owners that do that. And I think you are just like, you're the example, the standard of who that person is. So how would you want to conclude to our audience? That is mostly. execs in the field. And a lot of them are practice owners, whether they're thinking about this or whether they've dismissed it, how would you want to conclude about this model of building a practice that self pay and so that you can run it the way you want to. 

[00:39:54] Aimee Eyvazzadeh: I would just say, don't be scared. You know, the patients will come. If you provide the best care, they're gonna find a way to work with you, even if it means not working with their insurance. And so if you care about people, they're going to know, and they're going to feel like they're not going to leave your practice if you make the change. 

[00:40:11] Griffin Jones: Dr. Aimee Eyvazzadeh. I know how damn busy you are and so I appreciate you obliging me to come back on Inside Reproductive Health within less than a year of each other. Thanks so much for coming back on. And I hope people really enjoyed the show. 

[00:40:27] Aimee Eyvazzadeh: Thank you, Griffin. Pleasure to be on hope to see you again, maybe in another year.

[00:40:31] Griffin Jones: It'll be my pleasure.

120: Inside 3 Fertility Business Sales with Richard Groberg

This week on Inside Reproductive Health, Griffin has a conversation with Richard Groberg, a man who helped facilitate the acquisitions of The Sher Institutes to Integramed, eIVF/PracticHwy.com to private equity as well as many other business owners exit their business through rollups, sales and consolidations. A common thread through a lot of acquisitions is that he sees fertility business owners lose out on millions upon the sale of their company because they don’t categorize their accounting correctly. Richard gives his insights on roll-ups/consolidations from a private equity group, and he believes that he has not found a consolidation that has been successfully operated.

This episode covers: 

• How to get the biggest evaluation of your business

• How to survive the ‘proctology exam’

• Why roll ups from a private equity groups haven’t been successful

• When it makes sense for an owner to sell his/her business

Episode Sponsors: 

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.

Richard’s Information: 

Email: Richardgroberg@outlook.com

LinkedIn: www.linkedin.com/in/rsgadvisorsllc

Mentioned in this Episode:

Built to Sell book: https://builttosell.com/

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[00:00:00] Griffin Jones: If you're thinking about selling all are part of your fertility company. You're going to want to listen to this episode. It doesn't matter if you have a practice or a pharmacy or an EMR or a lab manufacturing company. You want to listen to this episode with Richard Groberg and you'll probably want to listen if you've sold and maybe you're having some sellers remorse.

Richard gives his framework for. What, how he helps practices and other companies in the fertility field to sell. He's been in the field for many years. And in the past three years, he has helped with, uh, three major sales. So we talk about the. This is an area that I don't have complete expertise in. I've never bought or sold a fertility company.

And so when Richard gives very specific examples, I don't, I might reference a conversation that is particular to an episode. It was publicly discussed on this shell. Otherwise. You know, de-identify whoever I'm talking about, because this is not my area of expertise, why I had Richard on. And if you have a different point of view, you're welcome to come on the show too.

If there's something that said that you disagree with, tell me what that is. And come on the show. The show is an open platform and anytime. I have some money on that talks about some of the challenges or problems with private equity. I'm willing to have somebody come on that talks about the pros of private equity.

We keep this conversation pretty balanced, but if there is something that you disagree with, you're welcome onto the show. And otherwise just enjoy this conversation with Richard Groberg.

[00:02:20] Griffin Jones: Mr. Groberg, Richard, welcome to Inside Reproductive Health. 

[00:02:24] Richard Groberg: Good morning. Happy to be here with you. 

[00:02:26] Griffin Jones: You're on because my knowledge of clinical operations go so far. That's why I have clinical ops guests on, and my knowledge of finance goes so far as for my firm. I try to shade in all of the parts of the Venn diagram, where sales and marketing overlap with finance and overlap with ops, but I'll never be a pure ops consultant.

I'll never be a pure finance consultant. When I reach the borders of the realm, I need to talk to somebody else. And one of those people is you, and I don't know why it took me randomly bumping into you in Las Vegas to think I need to have Richard on the podcast, but I'm glad I did. And I'm glad you're here.

So I want to start our segue into the topic with what have you been helping fertility centers for a while, but what have you been helping them do specifically in the last two or three years? 

[00:03:12] Richard Groberg: Well, in the last three years, I've had a couple of different avenues where I've helped fertility businesses.

I've worked on three transactions where fertility, one fertility practice, and two fertility related service businesses have partnered with larger groups and private equity, both to get a partial cash out and also to get access to management resources, to build more depth for long-term growth. I've also worked with smaller practices that were dealing with selling part of their practice to a doctor trying to expand do I open satellites? How do I buy other practices? And most recently, thanks to you. I assisted a fertility doctor who was a minority owner of her practice uncoupled from a corporate roll up group and become an independent practice majority owned by her.

[00:04:08] Griffin Jones: So of the three where you helped sell to a private equity group, where they all private equity of those three, where some of them high net worth individuals, where they all private equity firms that they were selling to, or where some private equity firms and some were networks backed by private equity firms.

[00:04:26] Richard Groberg: Two of the deals were sales of, of related companies that were related to the fertility industry specific practice highway EIV F and ReproTech. Two private equity that was interested in the space. I also helped Boston IVF wanted to rid parts of its original sale to the British group.

That was a large fertility network outside the United States, but had no presence in the United States that would also was ultimately private equity back. But it was a pretty large sort of fertility roll-up. 

[00:05:00] Griffin Jones: So when you get a call, it says, Richard, we're interested in doing this. I'm interested in maybe, maybe I'm interested in exiting or maybe I'm not interested in exiting.

I want to just expand and bring in someone to help with that scale. What is your checklist? Like? How do you start the process to it's a big elephant. So what is the first bite that you take? 

[00:05:25] Richard Groberg: Well, the first couple of steps or a little bit like a health exam for potential fertility patient have to understand the nature of the business, its financial performance, its challenges, its growth opportunities and what the goals are of the current owners.

There are cases where owners want to sell on leave. There are cases where owners want to partially sell, but need access to resources that they don't have for growth or the depth of management. So the first step is a practice evaluation, not, not a valuation, so to speak like a formal evaluation, but assess the health and the goals of, of the practice.

After that is the part that most people who've never been through this before. Don't understand and forgive the terminology, but I've called it the proctology exam on steroids of, it's not as simple as you call up somebody and say, I want to sell and you give them a couple of numbers and they shake hands and the deal's done.

That's where the process starts. They do an extensive evaluation. They do due diligence. They review your contracts, they review your financial numbers and your, your, your pregnancy rates and other statistics. And before you're prepared to do that, you have to get your house in order. So there's a lot of housekeeping to be done to prepare for that, that extensive painful review.

The determined is the price we've agreed to in the terms fair. And am I getting what I think I'm getting from the buyer's perspective? A lot of times these companies, because they're private businesses aren't necessarily prepared for the scrutiny in terms of expenses that you run through the business that most private companies do, that might not remain after a transaction.

And I can tell you all kinds of fun stories about unusual things.

[00:07:21] Griffin Jones: Like the business trip to Hawaii. Shout out to Dr. John Frattarelli. Cause I bet everybody wants to visit Dr. Frattarelli because oh, well that was good. We took the family and we stayed for two weeks, but it was for visiting Fertility Institute of Hawaii.

Is that what you're talking about? 

[00:07:37] Richard Groberg: Oh, yeah, I would give you some examples or the car that you expensed, or the fact that you're paying your mortgage and utilities and all your vacation expenses. And this is an important concept. I had one scenario where a business thought it was making $3 million a year because that's what he saw in his bottom line.

But between one time expenses that aren't recurring. And personal expenses running through the business. By the time we got done evaluating it and recasting their financials to properly reflect those non-recurring and what I call private company expenses, he actually was making $4 million a year. And when a buyer is coming in to pay, I'm picking a number for illustrative purposes, 12 times your profits, that extra million dollars of, of, of profitability that you can substantiate and prove in that particular case, put another $15 million in his pocket.

[00:08:37] Griffin Jones: I've jotted that down because I want to come back to that and get some examples from you. I want to try to go in the order that I'm thinking of you dealing with fertility companies that are in this process, you mentioned the first is, is assessing their goals. One goal might be exiting.

Another goal might be having financial capital to, to scale or to take over some other business side of the operation in those two. What are two different paths for those two different goals? Why are those two goals important? Like why is it important to make a distinction between the two? 

[00:09:13] Richard Groberg: Well, if I'm buying a fertility practice and let's just say it's a three doctor practice and two of the doctors want to retire and go away.

As the buyer, what I'm buying is not as valuable. And obviously the purchase price is not as high as look, I want to partially cash out. But I can't really compete. I want to expand, but I need money to expand. I need access to other resources and I'm going to stay and I'm not going to take a hundred percent cash out.

The business is now more valuable to the buyer and will garner likely a higher purchase price. The two large transactions I initiated and negotiated for service providers to the industry got a very high valuation because the seller was staying and retained a 30 to 40% ownership stake in the business post-closing. He's got skin in the game. So that's an important distinction because at the end of the day, The buyer, if they're buying a fertility practice, the buyer is to a large extent buying the engine and the engine is the doctors running the practice and performing the service. 

[00:10:28] Griffin Jones: So it makes sense that if the seller's staying that the business would be worth more, especially if we're talking about providers and the scarcity of REI's, so it seems like if they're staying, then the practices worth more, but one perception that I have, or at least it seems as like the value is in it, for those that are exiting, like okay, I'm going to, I'm leaving the I'm going to retire in a year.

So whatever happens to the practice, I guess, is the decision of the people taking it over. I'm cashing out all of my equity and for, I guess, what is the upside for a seller staying as opposed to a long-term hold strategy of their asset and retaining all or more of the equity.

[00:11:19] Richard Groberg: Well, let me give you an example.

There's a practice in Utah that recently sold to Boston IVF. One of the doctors was retiring, but another doctor, who's an outstanding doctor, medical director. Who's older, but committed to stay for four or five years. And there's another associate there that practice obviously is more valuable to the buyer because there's continuity there.

But to the seller, he's getting now access to this big corporate group who hopefully will provide services better and less expensive leave in a solo practice can provide, give him access to recruiting and hiring other doctors, give him access to the network and hopefully. Two to three years out when he is ready to retire, his practice is bigger, it's more profitable and his ultimate exit will be at a higher valuation.

We can now slide into a whole other discussion of whether all the past roll-ups have worked and whether people who've sold into them for some future consideration have benefited or not the doctors who sold into Integer Med, it obviously didn't work, depending where you were in the spectrum of prelude.

Maybe it did work. Maybe it didn't work. Doctors who participated in ovation strategy benefited handsomely when ovation did a second transaction with another private equity group, I guess a year and a half ago at a higher valuation. They got a second payday that was successful for them. So there's always the promise of that.

It's no different than when a smaller practice that wants to get bigger buys another practice and they merge. And now the practice that got bought is now part of a bigger practice, theoretically, that could be worth more to that doctor later down the road than if they just gone on their own. 

[00:13:17] Griffin Jones: Okay, well maybe you can be the tie breaker in something that Dr. Andrew Meikle and Mark Segal each said in their respective episodes. And I don't want to paraphrase them too much. So I encourage people to go back to listen to the episodes. If my memory fails a little bit, go back to the episodes. But in each conversation asked about building value up until the end.

And if I'm paraphrasing Mark correctly, he felt that, it's sort of feudal just to keep adding value to the practice, right when it's too late, if you know, you're going to sell within a year and Meikle said, no you should be adding all the way to the end. And from my vantage point, especially when you're looking at that, for the case that you just talked about, we got three doctors in any given scenario, I'm not talking about a particular case.

We have three doctors, two of them are going to retire. One is going to stay. Well, it seems to me that if those, if that one is going to stay has a robust brand, that's attracting more patients. That has a recruitment pipeline that younger staff want to work at especially younger docs want to work at that.

I would want to keep that flywheel moving and invest in that until I'm out for the reasons that you talked about, but where do you fall on the debate of it's too late to add value. If you know, you're going to sell in a year versus keep doing it all the way to the end. 

[00:14:38] Richard Groberg: I, you never stop making your practice a better practice because a deal might not go through.

But I also believe, and I have a very close friend in the veterinary business. Who's been through a number of roll-ups. He operates an independent practice. Everybody wants to buy him. And he's like, I'm three years out when I'm, when I'm a year and a half hour, I need to start preparing so that when I go through that proctology exam on steroids, I'm prepared for the process.

But up until the day you close, you always risk something negative happening that gives the buyer an opportunity to renegotiate. So you constantly want to be making your practice more and more attractive unless you're selling and walking away. But even then again, one of the mistakes people make small practitioners and lots of businesses is they get so focused on the sale process. They lose focus on their business and suddenly something gets delayed and your volume is dropped by 20% and you're not as profitable. And the buyer comes in at the last minute and goes, you know, things have changed a little bit where to renegotiating the price or I'm having a hard time attracting the doctor you need because your practice isn't doing so well.

I mean, if Griffin, if you're walking into a, to a dance and you're looking for a date, I mean up to the very minute you walk in, you want to make sure that your hair is bright and your beard is straight and everything looks good. And there's nothing that gives a negative impression. So that's my view.

[00:16:14] Griffin Jones: So I want to ask you about the proctology exam and if I'm doing Mark Siegel's argument injustice, please listen, episode 100 and Mark if I'm still doing it injustice. You're welcome back on to clarify at any time. Let's talk about the proctology exam. Richard, what does this involve you? You mentioned that as the second step, but you said before the financial house has to come in order.

So let's talk about what that means in order to be prepared for the due diligence. 

[00:16:44] Richard Groberg: Oh, and a lot of industries, not just the fertility industry, private businesses don't necessarily keep their financials expecting third-party scrutiny. They run expenses through the business that are personal. They may not be tracking non-recurring or one-time expenses.

They may be expensing things that are most setups are things that should be capitalized, but for tax purposes, oh we bought this piece of equipment. Let's all expense it in year one. So that that data needs to be cleaned up. So it's ready for the review, from a perspective of a roll up group or private equity, who's going to have banks and financing sources and investment committee approvals to understand the financials and that all needs to tie to your contracts, your ownership structure.

So all of those documents and contracts and historical data and financials need to be ready.

[00:17:42] Griffin Jones: Meeting employment agreements, contracts with vendors. 

[00:17:45] Richard Groberg: Absolutely and again, most people not out of any fault they're operating private businesses. They never expected this. And all of a sudden, someone's at their doorstep saying, I'm going to buy you for 12 times your profits.

They're not prepared for this. And frankly, they don't have the time off and to stop and get prepared for it. And one of my other favorite expressions, if you've never been through this before, you don't know what you don't know about the process, about the descend on you, it can be consuming and overwhelming and you need to be ready for what's about to come.

Because again, it's not so simple as, oh, you're making $2 million a year. I'll write you a check for $24 million. I'll see you at the closing table in a week. 

[00:18:29] Griffin Jones: So with regard to the expenses that you said detract from the bottom line that are necessary for that against a multiple are worth that much more if they're added back on.

So is your advice to not take any of those as business expenses? Or is there another way of accounting for it? 

[00:18:51] Richard Groberg: They're there. I don't want to give away all the secrets, but there are ways to pet to track it or go back and recast it so that you can track it.

And like, for example, again, when a private equity group or roll-up group buys you, they have an independent accounting firm that does, what's called a quality of earnings review, which is like getting a 360 body scan. And if you can demonstrate that, Hey, these are the expenses that were personal or time, and here are the receipts and I can run a report that shows them, and I can provide you the backup to prove it.

And in the contract, they won't continue afterwards. Then you can get credit for. When I was in the animal hospital business, there were practices that didn't record all their cash. And then they'd have a little piece of paper that would show all the cash that got deposited in the account that never went through their POS system or accounting system.

If you can't prove it, the buyer's not going to pay for it. So there are different, I'm not suggesting that you don't do it, but you have to be able to track it and prove it. If you want credit for it in a transaction. 

[00:20:01] Griffin Jones: I don't want you giving away all the secrets, but you do have to give me a little bit of free consulting right now.

Here's the, here's an example. So one thing is because I'm not married yet, we'll be soon, but I'm not yet. I don't. And I've rented and living in different cities. I haven't itemized my own tax returns. So when I do charitable contributions, I don't have anything to deduct on my own tax returns.

So one of the charities that I support is Nuestros Pequeños Hermanos. It's dear to my heart. So many people listening have donated. When I've asked them and I'm so grateful for that. And so one of the things that I've done, you know, for example, is I will have Fertility Bridge sponsor a gala, and it will be Fertility Bridge advertising.

 We'll get the logo on the page and in the pamphlet. And I will invite fertility, doctors, fertility, clients, to the gala with me. So they're at my table and that's business networking. I don't know though that it's something it's not something you would do if someone else was running the business though, right?

Somebody else would pick some different kinds of avenue. So is the advice that I categorize that somehow differently? 

[00:21:10] Richard Groberg: The advice is if you know, now that at some point in the future, you're going to be borrowing money, selling partnering, track it, take the extra time to track it, categorize it. Even if you put it, like, if it's a personal expense and use QuickBooks, put a class code in for P so you can always run a report that everything that's P for personal.

So if you think now that you're going to have to do this going forward. When I work with new companies, if I know they're going to be raising money selling at some point, there are things we do from an accounting and tracking standpoint that anticipates the proctology exam a couple of years out so that you don't have to double back.

And say, okay. Mr. And miss bookkeeper go back and find every personal expense that you've run through the business and reposted with a code so that when we get to that point, you can prove it. 

[00:22:12] Griffin Jones: There's a book called Built to Sell, and I haven't read the book, so I'm not necessarily recommending, but if the audience is curious enough, we can link in the show notes, the books called Built to Sell.

But I believe the value proposition is to business as though you're going to sell it regardless of whether you do or not, that you have that it is a business that someone would want to buy. And that seems like a tenant of that having your books categorized in such a way. 

[00:22:40] Richard Groberg: Well, it's a good book. And again, that is good advice.

 If you've anticipated, you will save a tremendous amount of time, aggravation money and not getting distracted from continuing to manage your business by having to double back and figure all this stuff out at a later date, when you're ready.

[00:22:58] Griffin Jones: When you're helping fertility companies get their financial house in order, what are some of the main booby traps or the most common booby traps that you see when you're, when you're taking the PNL against the income statement or excuse me, when you're taking the income statement against the balance sheet, what are some of the common things that jump out to you?

Like, eh, this isn't right. Or something needs to be fixed?

[00:23:21] Richard Groberg: Well, it's the personal expenses and the non-recurring expenses that aren't tracked. It's I haven't reconciled my bank statement in a year. And my books are an up to date. It's, it's again in the cannabis business where I've done some work and what I used to be in the animal hospital business.

It's not recording all the business, I did. The other area in the fertility business is some doctor owners pay themselves big salaries and show little profits, some take little salaries, and then have all the profits. Well, if you're selling to a corporate group, you're going to negotiate what you're getting paid for your work as a doctor post-closing. So that's one of the other things that you have to have an understanding of and then recast your numbers to accurately reflect the past. As if it was the future post-closing. 

[00:24:12] Griffin Jones: I want to talk more about the due diligence and the proctology exam, but I remember what I wanted to ask you about when we were talking about goals and that was had to do with earn-out.

So is it simply the case of one goal as well? I'm just ready to leave the business or, and one is, well, I'm going to stay , is the case, even if you're going to sell, is there still an earn-out and how long is that typically that I need to stay for two years or I, or a year or three years. And how much of my buyout is tied to that earn-out? And how much should I expect to get in cash? You can talk about earnouts for a little bit.

[00:24:51] Richard Groberg: Let me address that first from the buyer's perspective, if I'm buying a fertility practice unless it's a large multi-doctor practice, a big part of the value is the producers. And if they're cashing out and leaving it's worth less So most buyers want one form or another of incentive. I call it a golden handcuff to incentivize and ensure the continued performance of the drivers of the practice, whether it's the younger doctors who were taking over or the existing doctors. So if, and by the way, I have another line, favorite expressions there.

That's why there are 31 flavors of Baskin Robbins. Well, every roll up group has a different way in which they like to do it. They want you to own part of your practice or have a profit participation or percentage of the revenues above a base or a percentage of the profits of a base. Or do you have stock in the, in the parent company or little, all of the above, you know, elevation, you still own part of your lab and you won't stock in the parent one way or another.

The practice is more valuable to the buyer. If the seller still has an incentive to grow the practice and grow the practice profitably for the bot. So for the buyer, the seller standpoint, if the seller is selling and staying, he wants to participate fairly again. If I, if I sell my, if my business is worth $60 million and I keep 40%, I sell, I take a partial cash now, and I keep 40%.

I want that 40% to be more valuable later on. That was part of the story of every roll-up group Ovation is the only one that's even partially worked with. There's been a profitable partial cash out for others, obviously Integra Med, didn't work and peoples, including mine and residual interest was worth zero.

So you want the interest of the buyer and seller to be aligned one way or another. So that business becomes more valuable. And when I eventually get my next cash out, it's for a higher number than today, because that's why I'm selling to you and letting you tell me what to do and putting your services in place and helping me grow focus, do more.

None of that matters if you're not improving my quality of life and, or making my residual interests more valuable later on. 

[00:27:25] Griffin Jones: We're talking about improving efficiencies to increase the value of a fertility company. When I think of improving efficiencies at a fertility practice, I immediately think of Engaged MD. Whether you're going to sell or not, we talk about how important it is to add value and increase efficiency to the end, to improve the quality of work for your employees and the experience for your patients. That's Engaged MD.

If you go to Engage MD's website, you'll see at the bottom of the homepage, it's like a CNN ticker of different client testimonials that they have saying we took what used to be a 90 minute consult and turned it into a 50 minute phone call. That's because Engaged MD is taking so much of the headache and the manual one-offs that your staff has to do that is not efficient for your staff and not effective for your patients and helps to scale that with their comprehensive ART eLearn  library, they're embedded knowledge checks, they're actionable patient comprehension, insights, compliance tracking, automation, automated patient reminders, video replay. This is just taking the manual labor that isn't efficient for your team to do and scales it to patients through software so that you can customize the time that you have with your patients and that experience to be just about them so that they're educated prior to treatments, that they have true informed consent so that you can deliver what should be delivered in the way that only you can. And they're coming in with a much better foundation. 

Go to Engage Md.com/irh and you'll get 25% off of your implementation fee by mentioning that you heard them on Inside Reproductive Health, or you heard them from Griffin Jones. And please do that if you're doing business with them, let them know that you heard them on the show because it's one of the things that allows us to provide you with more content and to keep giving you more resources like this episode. And we want to do a whole lot more. So please mention that and take advantage of what Engaged MD has to offer, because it's one of the simplest largest upside moves that you can make for your practice in 2022.

Now back to the show.

So for how long, because owning 40% of a company that one built is different than owning 100% of the company that one built and having all of the say. And I suspect that this is where a lot of the problems could come from as well.

I don't own the whole thing anymore. I, but I'm still on the hook for, uh, I'm still on the hook for. Listening to what the new leadership or the new ownership has to say. And I do have a financial stake in, in retaining this 40%, because how long does it, like when, when somebody sells partial, how long does that stay?

For 

[00:30:26] Richard Groberg: every scenario's unique, it depends on whether a doctor is 40 years old or 60 and, and what the goal is of the buyer. So again, every situation is different and unique. I mean, but understand that every private equity group, every buyout group, every roll-up group, no matter what they tell you, their goal is for them to either sell to somebody else at a higher price or go public.

So 

[00:31:01] Griffin Jones: is there typically, is there some sort of. Remaining buyout agreement. I don't know. You know, if you would call that a buyout agreement within the new agreement that, okay, if this isn't happening, the remaining partner has to sell their 40% or those typically in 

agreements, 

[00:31:18] Richard Groberg: Yes there has to be some mechanism for an ultimate exit when a doctor retires or dies, what happened no different than in a group, private practice, whether it's HRC or one of the other groups, you know, when someone's ready to leave retire or die, there has to be in mechanism to buy them out.

And for other people to get their equity, 

[00:31:41] Griffin Jones: do you have to have a mechanism for the evaluation in that agreement as well? So that, you know, well, we say it's worth it Well, I think we grew the value to this, and now my 40% is worth Y when you're saying it's worth X, is that evaluation in the agreement?

[00:31:56] Richard Groberg: Absolutely. I mean, and that's, that's no different in any kind of equity this morning. I was on the phone with someone who was offering me. Equity to join a board of directors. And I said, well, if you're issuing the equity every 

single year, how do we value it? So you have to mutually agree on a valuation methodology, whether it's you have an outside appraisal or it's the last transaction that raised money.

But yes, you have to, you have to button up every open issue so that both sides know what the future holds. 

[00:32:28] Griffin Jones: Okay. So you talked about the roll-ups that have happened in private equity. Can you first, how do you define a roll-up? Is it just any network? Consolidating, I guess consolidating in, in this instance is self-defined because they are moving more practices into their network or company of practices.

 First, can you define, roll up and then we'll talk about some of the things that people have to consider? 

[00:32:56] Richard Groberg: My understanding of roll up and roll out is a roll up is rolling in any business is rolling up other businesses in the same industry, a roll out is a strategy which could be part of a roll up where you're opening De novo locations.

So you might have a roll up rolling out satellites. You might have, you know, there've been some models out there that open new locations, you know Kind Body, which is opening new locations. That's a rollout, but they're, I know they also may be buying practices. So that is a roll-up and it happens, they've been roll-ups in the veterinary industry all over health care. Now in the cannabis industry, businesses are being rolled up. 

[00:33:41] Griffin Jones: So what are some of the considerations that for not just fertility practices, but any company that the fertility field should consider, if they're going to be a part of their being approached by a larger organization that wants to roll them up into their portfolio.

[00:33:58] Richard Groberg: So if I'm the seller it starts with, what are my goals? Am I looking to cash out and leave, or do I want to stay three years or five years? You know, this organ transaction that recently closed, they were looking to be part of a bigger group and have access to resources and have a partial cash out. But it's not, this is a very important point.

It's not just the price and the terms. If you're going to be there the morning after, operating your practice that you built and you've run, but now somebody else has bought you in. You have to understand that you they've now bought the right to make some decisions, to have veto power, to insist that you do certain things certain ways.

And once you get past price in terms, what the relationship is going to be like in the morning after? What are you going to insist that I do? What are you, what am I not going to do? What's your strategy for providing value added to my practice become as important, if not more important than thank you you valued my practice at 60 million. I'll take my check and go home. And the, this industry, unfortunately to date is littered with. Not overly successful roll-up strategies that have had ultimate exits, but why there are a lot of new groups coming in. I'll address that in a second. There are a lot of new groups coming in.

There's a lot of private equity money saying, wow, this industry is growing. Let's do here. What we did in other industries, you asked why hasn't it worked? I'll give you my personal opinion. The driving force of these practices, the doctors, whether it's in the animal hospital industry, where I used to be, or the fertility industry or other industries.

And when you buy a practice that is entrepreneurial and self owned, you're immediately, no matter what anybody says, de incentivizing partially the driver of the business. That's part one part two is. The roll-up only makes sense. If the roll up group creates economies of scale, can we purchase cheaper?

Can we negotiate? Third-party payer contracts? Can we do things that manage for your practice better and or less expensively than you can as an owner operator and to date? I don't want to talk specifics to date there, I don't believe there are many real success stories of people look in the mirror.

Now they're unbelievably fabulous practices like Shady Grove and others, Boston IVF, and others that CNY and Hunting HRC that within their own group have expanded, have centralized certain services have provided value added to their doctor partners. But when. You start getting 5, 10, 15, 20 of them across multiple states that aren't born within a central strategy named me one that's worked in a long term.

[00:37:16] Griffin Jones: I don't know that I can yet, but I would suppose maybe the jury is still out. And I suppose if we had some of them on, they would say that it is working right now and so.

[00:37:26] Richard Groberg: The jury is out and I hope that there are some success stories, because I think that if you can build better, if you can do the accounting better, if you can centralize buying, if you can do that for a solo practitioner and let them focus on running their location and the practice of medicine, it does create value for that practice.

So in theory it should work. 

[00:37:51] Griffin Jones: It sounds like you've got a strong point of view on this, and I'm wondering why haven't they been able to improve the economies of scale? You said that's one of the things that they have to do is their value proposition. I've got, I don't know that this is true in the fertility field, but I did observe something back.

My first job out of college, Richard was selling radio ads. Just here's the phone book, kid, go, go slang. Some radio ads, a hundred percent commission. I did that for five years in my early and mid twenties. And I noticed that it wasn't the McDonald's and the Verizon's and the Geico's. They got the deals because if the large companies, Citadel, Clear channel, Cumulus, Entercom gave those companies deals that would just obliterate their revenue. It was the additional people that got it was, you know, your local driving school, your local jeweler, the scrap dealer. Those are the people that I could cut any deal. I could sell five bucks in O8-O9 during the recession is a particularly egregious example, but I could sell, you know, things that were, should have been a $200 spot for $30. And I could sell the evening spots for five bucks a piece and give away the overnight spots and all of that type of thing. And so I don't know that that's happening in the fertility field. So one question is, is it? 

[00:39:05] Richard Groberg: Let me double back, because I need to amplify at the end of the day, the corporate group needs to be able to generate value above and beyond the cost of its infrastructure. So, and I remember back when I was in the animal hospital business and we had 15 locations, the cost of getting up to 15 of a corporate infrastructure was very high.

When you went from 15 to 30, you didn't need a lot of incremental infrastructure. So you have to have enough infrastructure to provide value added, to pay for that infrastructure and create value for the practices. Otherwise, you're just adding overhead that doesn't create value. The other side of the equation.

And I recently worked with a solo practice that was minority owned by a doctor, that was part of a roll-up group, where the question was, are the fees we're paying to the roll-up group worth the services we're getting the answer was no. Now we have to replace some of those services, but they were doing billing collections.

They were doing accounting. They were running the call center and the doctor right or wrong thought that she could do it better or less expensively for herself. If that's the case, then the roll up fails. But if the roll up can provide those services more efficiently, less expensively than the practice can and add value to the practice in a way that creates incremental value above the cost of that corporate infrastructure, meaning Integra med drowned under its corporate infrastructure among other reasons why Integra med fail.

[00:40:54] Griffin Jones: So is it because is it sometimes because there's redundancy or is it simply because of the inefficiency and expense I could do, I could be doing this myself more cheaply and cheaper and more easily. 

[00:41:10] Richard Groberg: Again, at the end of the day, if you choose to outsource something in your business to a third party, it's gotta be less expensive than what you're doing, free you up to do other things which will add value more than the cost or it's not worth doing.

So if a fertility doctor can let somebody else manage his billing and accounting and it frees he or she up, and the cost of having a third party doing it is less than having your own person doing it. Well, then it may be worth it. But if not, there's no value added because at the end of the day, it has to create $1 more value. Then the cost of doing it. 

[00:41:57] Griffin Jones: You mentioned thatIntegra med was kind of the pinnacle example of all of this. What are things that people should be looking for to make sure that they're not in a similar situation right now, or, you know, if you could have gone back in time three years or however long, I suppose to have people look out for the things that happened in that situation, what would you advise people that could be in a similar situation right now. 

[00:42:24] Richard Groberg: Let me, I'll give you an example. On another industry years ago, when I was in the animal hospital industry, there was a group that had raised money at what I call stupid valuations based on their promise of we're going to buy a hundred hospitals and we're going to add value to them of blah, blah, blah.

And they wanted us to sell our group to them for a combination of cash and stock in their business. And they were going to pay us an artificially high valuation. But most of the pro pro proceeds we were going to receive was in their stock. That was artificially inflated. So my partner then used to say, what makes us think that the stock we're getting at 15 times earnings is going to be worth that five years down the road?

 It's, doesn't make sense. Now sometimes fundamentals don't matter, but fundamentally if you're taking highly inflated stock in whatever business, and then the other is you have to believe in the strategy of the buyer that they'll be successful. Otherwise, again, you know, my partners and I took seven figures of stock and Integra med.

It was ended up being worth zero, you know, had we gone back. If we didn't believe their model, if we didn't believe that they were going to be successful, why would you make a bet in them by taking their they're artificially inflated stock? So you got to believe who you're getting in bed with, again, as I said earlier, especially if you're going to wake up the morning after and have to work with.

[00:44:00] Griffin Jones: When you're talking about, in this case, you're talking about inflated stock, but previously you were talking about the multiple of EBITDA that sometimes people are selling, selling at use the example of 12 and two or three years ago. I was wondering, I was with one of my earlier clients, and I told them that some people are selling at 12 times EBITDA

and they said, no, that's not true Griffin. They did not believe me. I said, it's absolutely true. I'm not saying it's true for everybody. The only times I've seen that high is through like very large groups selling to strategic buyers and you know, and having an established brand and clearly a system in place.

But I think four is like the lowest I've ever seen. So what's common nowadays? 

[00:44:41] Richard Groberg: Well, the market's gotten hot again, because there are groups that have emerged with private equity backing that believe that again, make them buy so big groups that have a brand that have multiple doctors seem to be selling a double-digit multiples in some combination of cash stock or ounce notes.

But again, if you're a one doctor or two doctor practice, you're not as worth as much to the buyer. So those multiples can be four or less. Because again, if you're the buyer and you're buying a one doctor practice, you're taking an enormous risk. And that's why when I work with smaller practices that are thinking about exiting, well, you need to get multiple doctors.

You need to open satellites, you need to buy people. You need to get bigger so that you're more valuable and perceived as more valuable to the next roll up group that wants to come into your market and expand their market share. 

[00:45:41] Griffin Jones: I want to do a whole episode on a topic that I think where a lot of upside is if there is a single doc group.

I actually think that's one of the areas where somebody coming out of fellowship or a young associate doc that is either leaving academic practice or they were at somewhere else for two years. That can make sense for them if it's done. Right? Because if that younger doc can bring in that younger doc is in a better position to recruit other younger docs and they have more time to do it.

And so if somebody vehemently disagreed with me when I was talking about this with them at MRSI. So I want to know if you disagree with, they think there's too much risk in that. But I see huge upside.

[00:46:19] Richard Groberg: If you find like I recently worked last year with a doctor in the Southeast great practitioner, great practice.

He's getting older. He's a solo doctor. He had a young doctor working for him and to sell that doctor equity on the cheap may seem like you're giving it away. But two, three years from now, when they're ready, when he's ready to sell or retire, his practice is significantly more valuable because it's a multi-doctor practice.

That's reduced the risk. You and I have a friend in Florida. We almost did business with a couple of years ago. In the last year he's hired two doctors. He's opened satellites. He's made himself. Instead of being worth three to four times, he's worth six to seven or eight times now when he's ready to cash out.

[00:47:09] Griffin Jones: So, okay. So we're looking at this, you know, if you could be looking at under four, if you're a single doc group, and if you don't have a brand and you don't have things in order, if you do have a really robust brand, you have a lot of docs here. You're talking a well in the double digits of multiple. So I'm still curious, like, do you think my economies of scale hypothesis applies to the fertility? Giving the local businesses the deals, but less so to the McDonald's and the, and the Geico is that one of the things that's hindering economies of scale, I don't know that this is happening at all in the fertility field, but I do see when I look at people in the industry, side's target list, their target lists are all the same.

It's these independent groups that still multiple doctors that are still the, the, the biggest in their market. If it's a mid market or at least the third biggest in a large market, these are the ones that everybody is courting. And so it seems to me like they would have more purchase power, but I could be wrong.

[00:48:11] Richard Groberg: Well, first of all, I want to comment about the lack of supply and demand is such that if there are a handful of roll-up groups with a bunch of private equity money saying, we need to go after this industry that drives up multiples because the law of supply and demand is that there are multiple companies bidding on the same handful of larger independent practices, which is why multiples are escalating now.

And I don't think most of these practices in the long run are worth 10 to 12 times. So I would say it's a great time to be a seller. There are some economies of scale there, theoretically should be some efficiencies of consolidation. I've seen aspects of it work. But again, that doesn't necessarily mean that a smart solo practitioner can't negotiate the same deals, but you only have so many hours in the day.

It's why practices hire practice managers, because that way the doctor can go back and practice medicine, deal with the patients and staff and leave someone else to do what they do better. If they can do it better. And if they can do it less expensively than the value they're creating, if it costs $2 to make one, it's not worth it.

But if it costs $2 to create five, well, then it's worth it. 

[00:49:31] Griffin Jones: What about, I guess if you're, you know, in your early forties and you own maybe half of a group or a third of a group, and you've got a one or two partners, and then there's a young associate doc in there is I, I guess I'm still, we, I asked you a little bit about the, the long-term hold strategy and, and I briefly read a paper from HBR Yales paper about that holding a whole longterm hold strategy is more profitable in the long run. When is it the more viable option if it ever is to just say, you know what, I'm going to own this thing for outright. I'm going to slowly increase the value and be a hundred percent or majority equity owner?

[00:50:15] Richard Groberg: There's no one right answer. But if I'm a 35 to 40 year old physician in this industry or the animal hospital industry, another industry, and I believe in myself and I believe in growing the practice and I have the wherewithal to do it unless I'm lacking something that a corporate group can give me, or I want to hedge my bet.

Why would I sell now? And you know, if you've convinced me that I should sell, and the residual interest is going to be worth much more, three years, I'll answer the question by telling you a story years and years and years ago, when I was buying animal hospitals, I met this guy in Westchester who had the largest animal hospital in Westchester.

He was making a ton of money and frankly, he was under-reporting about a million dollars a year. So he was really making a ton of money. And he said, why would I sell my practice now at five times my earnings, even if I add back the cash, when I'm 40 years old. And I said, there's no reason for you to, until you're ready to retire die, or you told me you eventually want to move to Arizona with your girlfriend and become a professional illustrator.

And he went you're right. Thank you. For being honest with me, two years later, he called me and said, I'm ready to go. So, you know, there was no reason for him to sell. He had plenty of money. He had plenty of growth opportunity. There was nothing that anybody could provide him that would add more value. Now, if someone comes in and says, I'll sell you an I'll buy you at 15 times your earnings, that means it would take 15 years for you to earn enough, to, to be equal in actually does come down to partially a mathematical equation.

And then, you know, our friend in Texas who sold his software company, reached a point where valuations were so high and he needed management help that it made sense, but until it made sense, it didn't. 

[00:52:27] Griffin Jones: Do you want to talk about some of the principles where you've done the deal and then you find out it didn't make sense and now you're unrolling up?

[00:52:36] Richard Groberg: Oh boy. I know we've only got a few minutes. There are a lot of cases where the roll-up group didn't perform the way it said it was going to perform and all those things I talked about didn't make sense. And, and especially for smaller practices, where does it make sense for the roll-up group to have a one doctor practice?

People have cut the umbilical cord and uncoupled. The complexity there is if the corporate group has been doing your billing, your collections, your accounting, your new patient generation, doing all kinds of things for you. You better be prepared to take that back in and manage it yourself and not disrupt, you're doing what Stephen Covey calls keep the most important thing, the most important thing and practicing medicine and running your practice. There've been lots of examples of where it's done. And it is because the corporate group didn't live up to the promises in the eyes of the seller. They didn't get me more doctors.

They didn't grow me. The services they're providing aren't worth what I'm paying for it. You know, I can't get anything done. So cut the umbilical cord. Let me do it myself. 

[00:53:48] Griffin Jones: Richard, this interview has been so much value for the audience. I think they're going to get a ton of value. I want to do a live event with you in 2022, where people can jump on and ask questions.

Are you open to that?

[00:54:01] Richard Groberg: I love to you, you can tell, I've been in this industry since 2001. I have a passion and a personal interest in the industry. You know, I've got lots of friends in the industry. This is an area where if I can answer questions. And help doctors through these different processes.

I love to help. 

[00:54:19] Griffin Jones: There are some episodes that I go back and listen to because I need to get all of that information. I can already tell that I'm going to be an early 2022 at the gym listening to this episode. So hello, future Griff, while your listening to this. Richard how would you want to conclude about the topic of selling a company in the fertility field, whether it's a practice or not any, whether it's a pharmacy or an EMR company or a lab manufacturer, how would you want to conclude? 

[00:54:47] Richard Groberg: Prepare for the process and make sure you have the resources to go through it, to understand what you're getting into and to live with what you're going to face the morning after

[00:54:59] Griffin Jones: Richard Groberg. Thanks so much for coming on Inside Reproductive Health. We'll link to the places where you can find Richard and where are some of those places? Richard we'll link to your LinkedIn in the show notes. Where can people get ahold of you? 

[00:55:10] Richard Groberg: Through my LinkedIn is the easiest place or Richardgroberg@outlook.com.

[00:55:18] Griffin Jones: Connect with Richard. And Richard thanks so much for coming on Inside Reproductive Health.

[00:55:23] Richard Groberg: I really enjoyed it 

No More 'Hurry Up and Wait': 4 Steps to Fertility Business Goal Setting That Speed Up Execution

“Hurry up and wait.”

Far too many fertility companies, practice or not, rush into their goals… only to abandon them when they realize that the strategies required to reach those goals require more work and investment than expected.

Whether they like it or not, all fertility practices are entrepreneurial enterprises. Still, many independent centers don't approach growth like their corporate competitors, who actively set and pursue explicit market goals. Corporate fertility groups sometimes set goals but fail to align their efforts to achieve them.  

When an REI practice is in a hurry to catch up to what competitive fertility providers are doing, they may make hasty decisions that paradoxically waste more time (and money).

Some example requirements of different business development strategies include

• Reserving provider availability for subject matter expertise for digital content or events

• Creating content to support an advertising or public relations campaign

• Scheduling staff to stay late or stop seeing patients early to shoot video

• Restructuring your call center to fix the attrition of new patient inquiries to consult
  

These are only a few.  When centers face challenges like these without a committed goal in place, they are far more likely to abandon the pursuit having wasted time, money, and effort. 

Some fertility centers even hire marketing personnel only to fire them in a year when they aren’t seeing the results they expected. 

The way out of the cycle is for fertility businesses to set and commit to (or not) goals in four steps.

Slow down to speed up

While goal setting produces real value for any business, in these four steps, we use examples that companies in the fertility field have to consider.

Stop the dreaded “hurry up and wait” cycle once and for all because when you slow down goal setting, it’s easier to speed up the growth of your REI practice.

The four steps of goal setting for fertility businesses are: 

1. Opportunity

2. Priority

3. Alignment

4. Resource Allocation

1. Identifying opportunities for REI practice growth 

Fertility specialists have no shortage of ways to grow their businesses — there’s a virtually endless array of services you can provide and demographics you can serve. Growth opportunities you could pursue include

• IVF cycles

• Patient Satisfaction

• Egg freezing retrievals

• Third-party IVF recipients

• Third-party IVF cycles

• Tubal Ligation Reversals

• Donor recruitment

• New patients

• Specific provider volume increase

• Targeted region/office volume increase

• Specific patient populations, like LGBTQ+ fertility services and other diverse family-building paths

For each potential opportunity, you first need to benchmark your current volume, set a goal, and calculate profitability. 

A basic formula you can use is (Goal Volume-Current Volume)Profit = Opportunity Potential

Using IVF cycles as an example:

Goal of 1,000 IVF cycles with a profit of $4,000/cycle = $4 million

Currently at 500 IVF cycles with a profit of $4,000/cycle = $2 million 

(4,000,000) - (2,000,000) = $2 million opportunity

At this stage, many practice owners look at the numbers and think, “We have to do everything!” That’s a natural impulse. You want to care for as many people as possible and you don’t want your fertility business to lag behind its peers.  

We’re not making any decisions yet, though. Pump the brakes and slow down so that you can move much more quickly when it’s time for execution.

2. Prioritize the ‘infinite’ goals of a fertility practice

Research suggests that having too many goals leads to diminished outcomes. That’s why it’s critical to narrow focus and prioritize. If every goal is the priority, none of them are the priority.

The prioritization calculation has many moving parts. In order to effectively prioritize, your practice needs to:

1. Rank opportunities by profit potential using the calculation above.

2. Estimate effort--goal against current capacity Does the goal represent unmet capacity that the practice can easily meet? Or, will you need to add more doctors, staff, office space, or equipment to your business?

3. Subtract effort from goal. You may be able to pursue a more profitable service, but how much effort will it take to reach that goal?Ex: a practice wants to pursue fertility preservation instead of IVF, because of a higher profit margin. If their practice isn’t positioned well, or in a challenging market for egg freezing, filling out IVF capacity may be the quicker win.In addition to helping you rank priorities, estimating the effort of achieving a goal reduces the likelihood of wasting time, money, and effort by abandoning it.

4. Consider your mission. You are a clinician first and a business person second. If  your personal practice is about advancing fertility preservation, serving LGBTQ+ patients, or treating recurrent pregnancy loss, that has to impact which goals you prioritize.

5. Weigh brand/market liabilities, particularly strengths and weaknesses in the marketplace. If your practice doesn’t make a move on a certain opportunity, will a competitor take it over and make it difficult for your business to get back in the game? Will it make your brand appear antiquated if you don’t pursue?

You might worry that other goals will be ignored if you choose a single priority to focus on first, but that isn’t necessarily the case. Other areas of the practice almost always benefit from a snowball effect.

Goal Snowball

Here’s an example of how prioritizing one goal can benefit others. Let’s say an REI practice has ten physicians with very different workloads:

• Two or three REIs have a higher than normal capacity and they have met it. They each do more than 300 retrievals per year.

• Five REIs are each at a normal capacity of 180 retrievals per year.

• Two or three physicians are below 150 retrievals per year so they are a financial and access-to-care constraint.

This group has many goals, but they have ranked specific provider volume as their biggest priority. As a result, they:

• Streamline their call center to balance waitlists. They achieve their highest priority of increasing the volumes of the lagging physicians

And

• Progress toward their goal of increased patient satisfaction because they have improved the early interactions between practice and patient.

Prioritization doesn’t mean you’re ignoring the other goals of your fertility business because it maximizes the effectiveness of your resource allocation.

We’ll discuss resource allocation shortly. Before we get to that part, though, all of the practice’s partners must be aligned on the priorities.

3. Aligning your partners with the goal (and each other)

Even when the managing partner of the fertility practice or the chief executive of another fertility company has final say, alignment with the partners is crucial.

The fact that partners need to achieve alignment doesn’t mean they don’t already have a healthy relationship, though it can. It simply means that they must be explicit and clear about an initiative so that everyone can come to a mutual agreement.

When everyone is on the same page, it’s much easier to work through any obstacles and questions that arise in the process of reaching a goal.

When it comes to aligning a practice’s partners, third-party support is often the most effective and efficient way to reach a consensus. This isn’t about moderating for conflicts, necessarily — it’s about

• Prompting necessary conversations that are easily put off when everyone is focused on a new goal.

• Bringing new ideas for partners to consider.

• Acting as an objective sounding board in discussions between partners.

4. Resource allocation: Time or money?

The goal snowball means that the strategies required to meet different goals often overlap. It doesn’t mean they’re completely imbricated.

The amount of overlap will vary based on your available resources:

• With more money, you can plan and execute multiple strategies concurrently over less time.

• With more time, you can sequentially plan and execute more strategies for less money.

The goal snowball allows for a progressive return on investment. That means you can continue to invest in your fertility business without decreasing your income.

How will you set goals for your REI practice or fertility business?

Before investing time and money on a plan to achieve a goal (not to mention the execution), slow down so you can speed up:

1. Quantify opportunities

2. Prioritize them

3. Align the partners

4. Allocate your resources accordingly

If you would like outside expertise and experience, we can help. This four-part methodology is part of how Fertility Bridge helps fertility practices and other fertility companies navigate their biggest business challenges.

If you’re ready to set and accomplish goals for your IVF center or fertility company, sign up for the Goal and Competitive Diagnostic here.

119: The Catch 22 of Opening a New Fertility Clinic

In this episode of Inside Reproductive Health, Griffin tackles the challenge of opening a brand new fertility center. Griffin explains the five  operational and five marketing phases you need to work through before opening up your new center. It is certainly not a perfectly linear process and will come with a different set of challenges, but going through these phases will save you time, money, and stress. If you are considering starting a new clinic or in the infancy stage of your fertility center now, this episode is for you.

In this episode you’ll learn:

-> 5 operational phases of launching a new center

-> 5 marketing phases of launching a new center

-> Understanding how to assess the risk vs. investment of starting a center

-> Whether or not launching a new center is right for you

If you would like to learn more about these phases after listening to the episode, check out our blog post, where we go more into detail! https://www.fertilitybridge.com/inside-reproductive-health/the-catch-22-of-opening-a-brand-new-fertility-center-and-the-5-phases-to-escape-it

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.

---

More On Engaged MD:

This overlay of the operational sequence in the marketing sequence is probably the perfect time to talk about our sponsor Engaged MD. Because if you're any fertility center, you want to have a competitive advantage in serving your patients better and improving work-life for your staff. But if you're starting a brand new fertility center, you really want them.

And Engaged MD  is one of the simplest investments that you can make with the biggest return for improving the patient experience and improving the workflow for your staff because Engaged MD allows you to have true informed consent and to have pre-treatment education through technological solutions through software.

This is one of the most innovative platforms in the field, in my opinion. The reason why I have that opinion is because I hear from practice owners so frequently how much they appreciate Engaged MD. And when I did that first sponsorship read people, emailed me to say it's so cool that you have Engaged MD as a sponsor.

We started using them six months. Yeah. We love them. You have a limited window with patients in order to make that impression in order to be able to serve them. And when they're a deer in headlights, when you have to do something that should be procedural or general, you lose that time and that opportunity to build rapport, to better educate them, to tailor, fit their experience.

So. It's the best standard of care for them and with Engaged MD, whether it's there, whether it's medication teaching, or injection teaching or any of the other pre-treatment education modules that they're going through through Engaged MD, they can do it at their pace. They can do it through a sequential model.

They can, they come in educated, they come in having true informed consent so you can tailor fit that experience to them. So if you are a brand new fertility center, in my opinion, you have to have Engaged MD when you launch. And if you're one of the few groups remaining that isn't using Engaged MD you're behind, this is one of the areas where you will see.

An improvement almost immediately. So go to engagemd.com/irh. You'll get 25% off of your implementation fee by mentioning that you heard them on Inside Reproductive Health, or that you heard it from Griffin Jones. Please do that because one, you'll get a couple bucks off. And it helps us to continue to grow the show and bring you more content.

And the immediate benefit is in using Engaged MD  go to engagedmd.com/irh.

THE CATCH-22 OF OPENING A BRAND NEW FERTILITY CENTER AND THE 5 PHASES TO ESCAPE IT

Staffing. Construction. Leases.

Successfully opening a new fertility center takes months of meticulous planning. Then you actually have to launch it into the marketplace. But when? And what if you can't?

In the last three years, Fertility Bridge has advised seven aspiring fertility centers prior to market launch. Only one of them opened on time.

The other six faced delays of three months to two years, and some decided against the idea altogether.

Owners of brand new fertility centers struggle with an inherent Catch-22 in the timing of their go-to-market strategies.

Invest in strategy, content creation, customer service systems, and advertising only to have your opening date pushed back indefinitely

OR, equally bad

Have only days or a few weeks to create everything you need for a full pipeline of new fertility patients.

The Catch 22 is a result of a concentration of risk and investment. I’ve separated the operational sequence of opening a fertility center from the sequence of launching it in the marketplace. To solve the Catch 22, we have to be able to distribute the risk and investment across the sequence at the correct corresponding phase.

The 5 Operational Phases of Opening a Fertility Center

The operational phases aren’t my area of expertise, but as far as I can tell, IVF centers face opening challenges in this operative sequence:

1. Market selection
   Choosing the geographic market, funding sources, and partners.

2. Lease or purchase

   Real estate sales fall through right before closing. Landlords don’t include something in the lease agreement that was important in the discussion. A physical or zoning limitation is revealed at the last minute.

3. Construction

   Even when you lease space in a ready-to-go medical office building, it’s likely that you will need to remodel the plan for your IVF center. You were going to put your collection room on the other side of the lab? Turns out there’s a multi-split HVAC system that connects to the outdoor unit from there. Call the architect. Again.

4. Staffing

   You’re likely not opening a new center without a few saved numbers in your phone. But how many of them are certain to be the Renee Zelweger to your Jerry MacGuire? Lab Director, Nursing Manager, Office Manager? Then you have to negotiate their salaries, start dates, hire their direct reports, write their operating procedures and train them.

5. Compliance

   You need insurance (malpractice, liability, worker’s compensation), tax certificates, a payroll executor, an IT/communications provider, EMR, billing software, scheduling software, practice management software, compliance training (OSHA, HIPAA, CLIA, Stark). Each of these requirements comes with the possibility of delay.

I can’t offer much insight into the operational phases of opening a fertility center. I can sequence the Fertility Center Market Launch into five phases to reduce your risk and progress your investment in a successful business in the fertility field.

Below I've outlined the Five Phases of the Fertility Center Market Launch — a tactical approach designed to help you circumvent the Catch-22 of opening a brand new fertility center.

The 5 Phases of Fertility Center Market Launch

1. VIABILITY

   If you create a successful fertility business, you will spend millions of dollars in expenditures, maybe even in your first year. Before you do, spend a fraction of that investment assessing the total investment requirements of your plan.  The viability assessments come before you make your final decision to start your venture, but before you create a go-to-market strategy or secure a location.  

   At the time of writing, Fertility Bridge helps with part of the marketing analysis for just $597. You'll also want to hire good operations, finance, and compliance consultants. I can recommend a few of them. In total, you should expect to invest a couple of thousand dollars to make an informed decision about moving forward with your venture or not.

   You paid handsomely for a worthwhile education in medicine; consultants are sometimes your highest yield education in business. You can't lose here. Either you move forward with a more educated foundation, or you abort the idea, and you've saved yourself a fortune in time and money by making your decision at the right time with the right information.
   
   

2. POSITIONING  

   While you assess the viability of your practice, you have to consider the positioning of your vision before you commit to bringing it to life. It’s called positioning because it sets your brand, company culture, and growth goals. These are the first steps in establishing your brand identity, so if your positioning doesn’t excite you more than the anxiety deters you, do not start the company. Decide your positioning while assessing market viability. Do this before developing the rest of your brand, creating a marketing strategy, and buying or leasing a location.
   
   •Core Values
   •Main Focus
   • Ten Year Target
   • Three Year Picture

3. BUSINESS DEVELOPMENT AND MARKETING STRATEGY

Congrats! Your vision for your practice is viable in the marketplace. You are excited about the position it will occupy, and you’ve made a down payment on the facility. Now that you’ve reached the point of no return, it’s the right time to craft the marketing and business development strategy for your first 18 months in business. Your strategy includes your systems for the various points of the Four Phases of the Fertility Marketing Journey. You begin creating your strategy as soon as you start construction or remodeling. If done correctly, it should take about two months to craft your marketing and business development strategy.

1. If opening is delayed, you don’t have to invest in deploying the strategy. That comes later.

   What if remodeling is minimal and there are no delays? What if you’re already compliant and you have a burgeoning payroll, and you need to start seeing new patients within weeks or even days in order to meet your financial obligations?  

   The third and fourth phase of the Market Launch is where the Catch-22 is most acute. Under increasing financial pressure, many practice owners fall behind. That's when they get into trouble.
   

   4. IMMEDIATE MINIMUM IMPLEMENTATION

   Here, we break up the concentration of risk and investment to reduce your risk and maximize your long-term return: do not rush the formation of your strategy. Implement the bare minimum in the meantime.

   It doesn’t matter if construction is delayed. These processes, content outlines, advertising strategies, and brand development aren’t just for acquiring new patients. They convert inquiries to consult, consult to treatment, and measure and improve patient satisfaction. They inform who you hire, for which outcomes they’re accountable, and how you train them.

   Remember, three months is a liar’s six months. The timelines that agencies, marketers, and freelancers estimate are often half or a third of how long it really takes. Sure, a monkey can get a website up in a week. The site you really want, with your developed brand and content that represent your points of view, probably takes six months.

   So why not just be honest about that and separate what you need at this very moment from what you need for the foundational health of your fertility center?

   Open your patient acquisition pipeline without sacrificing the planning of the long-term productivity of your fertility practice by covering these four bases:

1. Initial brand assets (name, logo, colors)

2. Home page

   Let them know your positioning statement, method for scheduling new visits, and that you can’t wait to show them your new brand and website later in the year

3. Digital real estate

   URL, social media accounts, and local listings of your brand name. You’re just claiming the real estate here. The only content you have to create at this time is a similar message to your homepage and the documentation of your opening journey if you so choose

4. Google listings for providers and practice

Implement the minimum after you put a down payment on a facility, while you work on your strategy, but before you start seeing new patients.

5. DEPLOYMENT OF STRATEGY

Time to start delivering care according to the standard you’ve envisioned! 

When fertility centers rush to the fifth phase of Market Launch, they sometimes make errors that take them years to fix. The most common of those errors is hiring full-time marketing personnel. Depending on your growth goals, you may indeed need marketers on your staff. You don’t need them right away. In the beginning, your needs are too varied for one person, and it isn’t cost-effective to build an in-house agency. The time needed to build a new patient pipeline is shorter than the learning curve for someone who’s never done it for a fertility center before.

You deploy the rest of your marketing and business development strategy only after you are ready to see and treat new patients. This is when you film the videos, write the content, produce the referring provider assets, roll out a Customer Relationship Management software (CRM), and hire marketing staff.

ESCAPE THE CATCH 22 OF LAUNCHING A BRAND NEW REI PRACTICE

New fertility practice owners might think that their marketing strategy must be 100% in place on day one — or worse yet, they rush to create one and miss the foundational advantage of setting up their practice the right way. 

Separate the operational phases of opening a new fertility center from the five phases of the go-to-market launch. Break up the concentration of risk and investment by distributing them across the sequence at the right phase.

If you’re thinking about launching a new practice, you might consider our introductory engagement which is only $597. If you would like Fertility Bridge’s help with assessing the viability of your fertility center’s market launch, and our framework for your opening sequence, start here with our Goal and Competitive Diagnostic.  

118: Clinical Operations Meet Marketing

Today’s conversation between Griffin Jones, Dr. Milroy, Dr. Supogay, and Dr. Yanni explores the overlap between clinical operations and marketing. The fact of the matter is, you cannot totally separate them. More often than not, when our clients first come to us, they aren’t able to fit more patients into their system so we first have to work on clinical operation efficiency before driving more patients through the door.

In this episode we explore:

• The REI bottleneck and how to optimize your REI’s time

• Referral patterns from other professionals in your community

• How patients choose an REI

• Why OBGYN education improves the quality of patients

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.

Guests:

Dr. Milroy:

LinkedIn: http://linkedin.com/in/colleen-milroy-37a45ba1

Colleen Milroy, MD, FACOG is a board-certified Obstetrician gynecologist, and board certified Reproductive Endocrinologist and Infertility physician. She currently leads the Billings Clinic Reproductive Medicine group serving the state Montana, parts of Wyoming, North Dakota and South Dakota.

Dr. Supogay:

LinkedIn: http://linkedin.com/in/anna-sapugay-md-facog-66932714

Anna Sapugay, MD, FACOG is a board-certified obstetrician gynecologist who practices in Northern California's East Bay Area. She currently serves on the Compensation Committee, Strategic Oversight Committee and Anti-Racism Working Group. Sutter Health is a not-for-profit healthcare delivery system that operates 24 hospitals and over 200 clinics in Northern California.

Dr. Yanni:

LinkedIn: http://linkedin.com/in/leanne-yanni-md-9b6117194

Dr. Leanne Yanni serves as Vice President Medical Affairs, Richmond Market, Bon Secours Mercy Health and the Chief Medical Officer of St. Mary’s and Richmond Community Hospitals. She is board certified in both Internal Medicine and Hospice & Palliative Medicine.

Website:

https://www.hsph.harvard.edu/mhcm/

---

Transcript

[00:00:55] Griffin Jones: On this show, it's half me interviewing my guests, half them, interviewing me. I'm not going to go into their intro and bio here because I do that a little bit in the beginning of the conversation, and then they introduced each other, but they're three different MDs in three different areas of medicine that are also in the MBA program at Harvard.

And. In today's show, we talk about OB GYN, referrals, OB GYN, relationships. There's some really good insights for you there. The show is really about where the nexus of clinic operations and marketing come together. There is a place after the overlap where I can't go any further and these three could, and there was a part where they wanted to go deeper in terms of using marketing to set up.

Client operations and I was able to go there. So I hope you enjoy this. This is the nexus of where the bottleneck of the REI field is addressed, where clinic operations and marketing come together. 

Doctors Yanni, Sapugay and Milroy, Yanni, Anna Colleen, welcome to inside reproductive health. This is a little experiment that we're doing sort of on the fly. These are three MD MBA. Students at Harvard and Dr. Milroy, I know through the field of reproductive health and they are interviewing me about a project that they have.

If I can provide some insights, that's the reason you're listening to this podcast episode. And if you're not, it never made the light of day. You're my podcast editor throwing this episode in the garbage. So Dr. Yanni, Leanne, tell us a little bit about the team that you have and the venture, your.

[00:02:48] Dr. Yani: Excellent. So I'm Dr. Yanni and I'm an internal medicine doctor at Bon Secours Mercy Health in Richmond, Virginia. And we have my colleagues, Colleen Milroy, who is a fertility specialist in billings clinic in Montana. And Anna Sapugay who is an OB GYN at Sutter health in California. And we are all currently enrolled in Harvard, T.H. Chan school of public health, the master of healthcare management.

So very special, a masters it's focused on physicians. It's a two two-year program designed to support physician leaders and physician. We are currently taking a marketing class, taught by Linda McCracken. Who's very well known across the country for her marketing expertise. And our project is to define a clinical problem and a marketing strategy.

I'm using focused marketing techniques to address the clinical problem. And we have really chosen to focus on fertility and with Colleen. Expertise in billing Montana with her fertility expertise, we're going to focus in that area. So that's why we're talking to you today, Griffin, and really glad for the opportunity.

[00:03:54] Griffin Jones: The pleasure is entirely mine. Why did you choose fertility? Did Colleen strong arm, the rest of you? Or how did, how did you choose that? This was the opportunity in the nexus of medicine and business that we want to explore. 

[00:04:11] Dr. Sapugay: So, you know, infertility, afflicts, not only insured patients or the wealthy, but it all, it afflicts all kinds of women in all walks of life and with expansion in billings. Our goal is to. Have health equity, even within the infertility sphere

so if we are able to reach patients with infertility issues in rural America minority women that would be something. That we would like to enter and possibly, you know, reach patients who have not been reached before in the infertility sphere.

So in your experience, what has been the best way to reach in for fertility patients?

Is it by engaging them directly? Engaging their community or going through the providers that they see, like their obstetrician gynecologist or their primary care physicians and for our target population. Would we do that differently for patients in rural America. 

[00:05:28] Griffin Jones: So the second, the answer to the second question, would you do it differently is likely yes.

Because the answer to the first question is it depends on the area. There's effectively three different reasons. Why a patient selects a fertility provider. There's more, but three reasons make up more than 60% of patients. Number one reason above all of the others for choosing an REI the first is a referral from their physician.

That's 21% of patients say that that was their number one. Factor in influencing their decision referred by another physician. The second is referred by a friend at 20% and the third is location. At 19%. I could be mixing up two and three. I don't think I am. If I am I'll, I'll correct it in the show notes, but those three are on the heels of each other.

21%, 20%, 19% physician referred by. And location. I actually, I think location is number two. So I'll clarify that in the show notes, but they are all close to being on the heels of each other. This isn't to say that only 21% of fertility patients are referred by a physician or only 20 19% are referred by a friend.

It's just to say, that's what they say is the most influential in choosing their decision. So when you're asking this question, I tried to add a little bit more light on attribution and how attribution needs to be triangulated for fertility patients. We don't have a perfect CRM customer relationship management software that integrates with EMR perfectly.

That does not exist yet. Till we have that. And even when we do, we need to triangulate attribution, one way is volumes from whatever we're promoting. The second is in digital attribution, through a CRM, through Google analytics, through any other digital platforms that you have. And then third is patient self reporting.

And when you do the third patient self reporting, that is where you asked the question. Of the main ways that you're trying to reach patients, whether it's online reviews, social media, if you are spending a lot in traditional media, you would want to know, is somebody hearing us on the radio or seeing us on TV and the answers to those questions need to be binary?

Yes or no. There should not be more than eight of them. There should not be less than four. Then the exact number depends on exactly how heavily you're marketing in different areas, but they have to be binary. Yes or no. Last question is of all of the, of these ways of these four different. Four to eight ways.

What was the most influential in choosing your practice? And that's how we get to, to those numbers. So MD referrals are still extremely important, important. They're just not the lion's share that we sometimes think we are. And so I'll take a breather to let you ask any followup questions before we talk about what that means for Montana.

[00:08:49] Dr. Milroy: So Griffin, this is Colleen. We have been learning a lot about market segmentation, and you're saying you take the data from those sources, you collate it together and then use that to segment your market. Correct, and to different segments. 

[00:09:04] Griffin Jones: You use it to prioritize your marketing efforts. So once you have a general baseline, which I've just given, then you also want to do it for your own.

You want to do it for your own patient base. So every practice should be doing should be triangulating attribution in this way for their own practices. And because those numbers might. Different. That's a net, that's a U S average that I just gave you. And so they will be different, but if you're so much lower and if you're finding that, wow, only 30% of our patients say they were referred by an MD.

That's an area where we probably want to invest more in physician outreach. And so getting that attribution one knows where helps you to know where you're going to prioritize. And then two, it helps you to see as you're investing in those priorities, what's being returned so that you can invest more in those areas.

[00:10:07] Dr. Sapugay: So Griffin, what I'm hearing is, so we have basically two target consumers, the physicians and then the patients themselves, when it comes to the am I right? 

[00:10:20] Griffin Jones: Well, you, I, those are the two from the top, but you start to have more, as you start to have employers that have employer coverage. And so we've even started to expand.

Were you referred by, by your employer? Benefits broker did, did a progeny or a kind body or a carrot say. Well, here's who we've got on our network and, and this doctor's available. There's also apps in and lead generation and, and the friends themselves are a market in a way, but that could be a little bit tangential.

Let's just say you've got your, your, your, your top two patients physicians, and then a quickly emerging third, the employers and the employer benefit companies.

[00:11:02] Dr. Milroy: Okay, so I'll go up with the next stuff. So we have been learning and part of our project is to design something that has an improvement in the public health area. And so our question for you is clinical design solutions more important or is a growth solution more important. 

[00:11:20] Griffin Jones: Can you define each, not just for the audience, but, but perhaps for me as well, if I'm being honest, I could guess what each of those mean, but I will help.

[00:11:39] Dr. Milroy: Yeah, a clinical design solution would be something that would improve either access or patient flow or things like that that would make the patient experience a little bit better or easier on the patient. A growth solution is where you're trying to right. Compete and grow in a market. And which one right now do you think is dominating our field in terms of being a.

You know a goal for fertility practices. 

[00:12:08] Griffin Jones: This is very hard for me to answer. I feel that you're asking, which is more common place right now. 

[00:12:16] Dr. Milroy: Yeah. What's the number one issue right now?

[00:12:19] Griffin Jones: Clinical operations is the bottleneck.

And so. That's partly inhibited growth. The experience that we have as a firm, when I came into this field, it was about new patient acquisition in some time in the past couple of years. Oh, let's call it 2018, 2019 we really had to. Away from that as a firm, because very few centers want for new patients.

The bottleneck is on the clinical operational side. So as a business development firm and a creative firm where we've started to step in is in the third and fourth phase of the. Of the patient marketing journey at least the second phase and really only using the first phase to set people up, to move through the journey faster.

So not using content so much just to get someone in the door, but using content creative the way we answer the phone videos, digital. All to help people move through the journey faster and more easily. Take up less of clinician's time. Take up less of support staff time, not call support staff with. With redundant questions, not when they go see the financial counselor, they have some familiarity with what they're going to talk about, who the financial counselor is.

And so we have focused more on supporting, not, not supporting ops directly, but on the content that allows ops to operate more smoothly, as opposed to just getting new patients in the door. And so. I think that growth is inhibited by this bottleneck that we have in the field right now there's 1100 of you calling there's 1100 board certified REIs in the United States of America.

Give or take and of a population of 330 million people. And so. Things that I was hearing when I first entered the field in 2014, we would never use someone. That's not a board certified REI is one of our docs. Never. They have to be board server. We would never use a physician assistant. We'd never use a a nurse practitioner to help with retrievals, except they are now 

and what was only a few people doing that a couple years ago now, very many people are, and the answer is because that bottleneck has to be solved for, and I would love for it to be solved for, because I would love to go back into super growth mode. But, but operations absolutely precedes growth as, as the need.

[00:15:03] Dr. Sapugay: Which is interesting question. Oh, go ahead. 

[00:15:06] Dr. Milroy: No, I was just going to say out of 1100 board certified physicians, there are two in Montana that cover the entire state. So operations is going to be your bottleneck, right? There's only two of us, so that's a great, great influencer in our lives. 

[00:15:21] Griffin Jones: And I don't believe that the two are, are mutually exclusive.

I don't think that they're divorced from each other when we're having this conversation. We have to choose then yes, I'm going to say operations, but the way I've built my entire firm is to support that operation so that, so we take what was growth in terms of acquisition and turn it into. Patients that have more, that are better educated that understand the process of the clinic that have rapport with the physician so that operations can move.

I don't think that they're totally divorced from each other. And I think. Too compartmentalized is a mistake, but to your point, Colleen, about there being two of those in Montana, that's the case in a lot of states and cities across the country. And I've talked about it a lot on the podcast that it concerns me.

I don't have data, but it just seems to me, if I talk to 10 fellows a year, eight of them are going to a handful of cities, right? It seems to me that 20 of the cities in the country are getting 80% of the fellows. I don't have data to support that, so it could be wrong, but it really seems that way to me.

And I would love to get that data for people. You know, it's interesting. 

[00:16:34] Dr. Sapugay: You say that because we have alum, I'm the director of OB GYN in my department. And, and et cetera. And there's a long line of infertility specialists who are trying to present to my department of 34 clinicians. So there's a lot 

[00:16:51] Griffin Jones: And tell us again where you are

[00:16:52] Dr. Sapugay: I am in the San Francisco Bay area. 

[00:16:57] Griffin Jones: Yeah. And many of the people that have been on the show, including some of the fellows who have gone to the San Francisco Bay Area. So I do talk a lot on this show about what will become of your Buffalo new York's, where I'm from, or your Youngstown Ohio's or your billings Montana's.

And I try to make a. Plug that I think this there's actually a lot of opportunity for REIs and fertility centers in those areas, but that could be tangential to what you're looking into today. Or, or maybe it's not tell me more Colleen about what you're, what you're hoping to do, or at least exploring as a venture in these underserved areas.

[00:17:45] Dr. Milroy: I think so, one of the things that we're reading is something called blue oceans. It's a an evaluation in an article by Kim and Mauborgne and at the Harvard business review. And it talks about. You know, there are red ocean strategies that really are more in a competitive market that are driven by dog eat dog.

And then there are blue oceans and blue oceans are opportunities where companies, you know, really create long lasting, visionary, successfully evolving new markets. And so they're actually not competing necessarily. They're creating their own new pie. And so that's really what we're focusing in on is how do you create this new pie maybe?

And how do you serve a market that, you know, in a health equity, you know, access issue over the course of history has not really had an opportunity to visit us an easy way. So I'll let Anna kind of ask, cause I think, or, or Leanne had some questions about the actual products that we're thinking about.

[00:18:46] Dr. Yani: This is fascinating. And so one of the marketing questions that I have Griffin is you were referring to the advent of interdisciplinary expertise that is moving a little bit away from the physician as the sole owner of this type of. And, and really building up other expertise around our limited physician, which is our, our bottleneck as a marketer, how do you set the expectations of your population that you're marketing to?

That we do have interdisciplinary expertise and that is evolving. And, and while a physician may be at the helm of someone's care, there's a lot of steps along the patient experience that engage. Other clinicians and others with expertise that that can help them be successful 

[00:19:31] Griffin Jones: Early and often is the answer to the expectation setting question.

And because we live in a world that is content dominated and we have yet to catch up to that as a field. That we live in a world that is content dominated every hour of many professionals day is dominated by the content they consume about what they're going to purchase, what they're going to eat for dinner, the research that they're doing for their work.

And using that to reset the expectations is necessary. Can't be the first time that someone calls on the phone. So, okay. So great Griffin we, we need to use content to set expectations about how it's thinking of content in the form of a Russian nesting doll. So if you think of all of the content on a topic, as deep as your point of view can go on something.

That's the, you might say that that's the. The tiniest hole doll within the Russian nesting doll and then an infographic or a shorter blog post, or a video might be the next level. And then a infographic might be the next shell. And then the next shell might be a Tik Tok representing the entire point of view.

And so when people are thinking of what's the best form of content that we should use as long form better is short form better. They both serve purposes and they both can lead to conversion both in form of acquisition and conversion to treatment. And they're both necessary for setting expectations.

But if you think of your point of view and start with. The point of view on any given topic. And in this case, we're talking about the support staff and including other doctors besides REIs and how they contribute to the comprehensive care being delivered. That point of view would start. I recommend starting as a really long article.

Really form that point of view. And then we create video from that. Then we create shorter. Then we create literally Instagram posts and then we create Tik TOK because they're all going to be seen by different people. And sometimes by the same people in that increases frequency, but we want people to. To receive these messages in different ways.

Some of them are going to some of them, it's just going to be straightforward. Some of them are going to be funnier and cuter, and that will depend on the brand voice of the people delivering the message. But to the extent that you're varying the content in this way, you can set the expectation with people that.

Don't have to always see the REI for everything. And I might be inferring into your question too much, Anne so tell me if I am, but I hear this from REI is very often that they think they equal the standard of the. Standard of care in patients eyes. And I don't think they universally equal the standard of care in patient eyes.

The bottom line is the patient has to feel and be cared for. The REI is a part of that. How much of a part of that will depend and needs to be experimented with, but. To the extent that we're setting people's expectations ahead of time that, Hey, you're going to see this person for this. Then this is John, your ultrasound technician, and this is Mary, your phlebotomist.

And this is Dr. Patel or this is your nurse practitioner to the extent that people are familiar with these folks ahead of time, it makes it a lot easier. That the REI doesn't have to be involved in every single thing all the time. 

 [00:23:23] This topic that we’re talking about today, the REI bottleneck access to care, the convergence of growth and improvement in clinical operations, is the perfect segway to introduce our new sponsor for the show, that I am so excited to announce to you. You know who it is? It’s EngagedMD. You know why I am so excited about this? Because of the 7 years that I have been in the field almost nothing has been so lopsidedly positive as the feedback that I've heard about EngagedMD. I have been recommending them for years, at least since 2015. I hear nothing but good things from the clients that use us that we recommend to use EngagedMd and from other people in the field and you’ve heard it too if you’ve listened to this show people come on this show there have been several episodes where people just bring up EngagedMd without me even asking. That’s why I had to go get a sponsorship from them. And I am so pleased to do it because this is a great time as you’re starting to think about you’re 2022. You’re sitting down, the investments that you're making to make life better for your staff and for your patients. The pretreatment education that EngagedMD allows you to scale, so that you have more rapport with your patients, so that you have true informed consent not just sticking a handful of papers or stack of papers and having them sign it but true informed consent. So that you can tailor the patient education that they need, the standard of care that they need. Talk to them about their diagnosis, their prognosis because they are better educated, they have true informed consent. That’s the type of scale that EngagedMd provides. More than half of our clients use it, I guess I gotta to talk to the remainder that don’t because everyone loves EngagedMD. And now that you’re planning for 2022, now is the time. It’s a quick win that you can give to your team to advance your practice because this is one of the leading companies in the field. They’ve got a product road map that’s as long as my arm, and they are going to be around for a long time. And you have the opportunity now to get a couple bucks off. Go to EngagedMd.com/IRH and you get 25% off your implementation fee. That's for new customers. If you're talking to them tell them you heard them on Inside Reproductive Health. Tell them you heard them from Griffin Jones. You get a couple bucks off with 25% off your implementation fee and you'll be starting your practice on the best start that you could have moving towards scale and moving towards patients who are better educated and have true informed consent with EngagedMd. EngagedMd.com/IRH. EngagedMd.com/IRH.

[00:26:14] Dr. Sapugay: So Griffin, going back to my question. Well, first of all, thank you for that.

But going back to my question of reaching our consumer, would it, from your experience, would it be different trying to reach rural America or specifically Montana where, you know, people. ARe four or five hours away that you're trying to reach. 

[00:26:37] Griffin Jones: Probably, I can give you one thing that tends to be true for rural areas that is less true for

urban coastal areas, which is the readiness of how effective organic social media is. And I'm not talking about paid social media, running ads. I'm talking about organic social and the reach that comes from that I've known when ever we work with a small Midwest market group that. And I see they don't have much of a social media presence, but as long as I can tell, okay, these are good people.

Their patients are really happy with them that it's like taking a match to dry Tinder. And that doesn't tend to be the case in larger urban coastal areas. And my hypothesis is again, I could be wrong about this, but I think that it's because. In billings, Montana or Youngstown, Ohio, or Omaha, Nebraska, if you're 28 years old and you don't have children in many of those communities, you are not part of the social fabric.

And there's very few alternatives for you. And. The center in this case has the opportunity to stop and say, where do our community? You do have a community, you have lots of neighbors, and you actually know some of these people. We're not going to identify them, but we're going to be here. And as you start to identify yourselves, you'll, you'll start to, to perhaps talk to each other.

And now we, as the center are. At at this we, the IVF center at the center of this social community, that is a means, that's an advantage for rural centers that doesn't always exist for urban centers. And the good news for them is that it doesn't, you don't have to spend a lot of money on advertising necessarily.

You do have to spend the time to, to create the content.

Did that answer your question, Anna, what was that? Did I take that off the rails? No, 

[00:28:52] Dr. Sapugay: it, it, it answered my question. Would you focus more on the providers then that are serving these patients and, and reach them through their providers? Because. As you said, if you're 28 and you don't have kids, you're sort of out of sync with social media.

[00:29:07] Griffin Jones: If I'm in a rural area, in a small market, I'm doing organic social first, the first thing I want to do is set up the attribution. So I know that if I'm wrong about this, but if I'm just having to pick something from the bat in a, in a rural small market, not even necessarily rural, but in a small market that tends to be a place where, where family is the social fabric and.

Not a Manhattan or a San Francisco, then it's, hasn't been the case every time or has it, I'm really trying to think almost every single time. It's the case that that what's missing is, is people knowing that my friend, my former coworker, my cousin. To all one went through this, but two went and saw this specialist that they're thrilled with.

And that tends to be the lowest hanging fruit in markets like this. It doesn't mean that physician outreach strategies necessary it very well may be. It tends to be the case in those marketplace that if, if, without digging into the attribution, which I would do, if I were actually talking to a client, if I'm just guessing, that's what I would do.

[00:30:21] Dr. Milroy: Chris. And I have a question. There's been an uptick into the direct consumer kind of fertility testing. And I just wonder if that is a way to reach the customer in a rural market or in a lower socioeconomic status or lower access, lower health equity area. Could that be a way that we connect with them 

[00:30:45] Griffin Jones: first?

Well, I think anytime that you have to drive three. Plus hours to a physical location anytime. And for those of you listening, Colleen putting up or hands just up to eight hours in some of these, in the interior west, that can be the case. Yeah, these are absolutely areas that expand access that ultimately serve as lead generation for treatment and for centers.

So, you know, I've had. Afton Vechery the CEO of Modern Fertility on the podcast to talk about this concept. And some people might say, oh, that's not as good as the way we would do our testing here. And that may be the case. You can come on and debate it. I'm not a clinician. What I am saying is. It is a gateway into the next step.

And to the extent that we can take out testing from the office one, it serves as lead gen two. It improves access because people don't have to travel the distances. But third is, it goes back to tying in this theme of growth and this theme of client of clinic ops, where. It's triage for the clinics.

And in many ways, if you have a bottleneck of people a two month wait list of people trying to get in, well, wouldn't it be great if, if some of these people had more information coming into the practice and you were maybe able to refer out to some of those things that an OB GYN or even a PCP could do.

So I think triage is a part of. Of this, as well as bringing the themes of growth and clinic ops together. 

[00:32:32] Dr. Milroy: Yeah, I, I wonder often, you know, in many of these kind of rural parts of America, the small critical access hospitals, many of them don't have the ability to run some of the tests. We would like them to run.

And so that direct to a patient's home where, you know, in the privacy of their home, when they don't have to go to this small town hospital where they know every single person who they walk, you know, walk by and really have to devulge this very private and scary, you know, diagnosis that, you know, they could be doing that in a little bit of a different way and putting it in the mail.

And I think that could be a really great way to, to access and to really, you know, care for these patients in the right way.

[00:33:16] Dr. Yani: I have one last question for me is do you think the future is directly working with payers and insurers to use this sort of home assessment kit in a way for fertility, for those who have a you know, basically ICD 10 diagnosis of. 

[00:33:36] Griffin Jones: That's a great question. It might be above my pay grade.

Do you mean that the providers would, would require of the, the payers to, to, go through these at-home tests before. They sent the patient to the office. 

[00:33:55] Dr. Yani: Well, so to give you an example payers are now acting in many ways, almost as a clinical conduit and a good example is, is colorectal cancer screening.

While you can't do home colonoscopy you can test your stool for blood or specialized tests to determine if you have a higher likelihood or higher risk of cancer. And so, you know, we can imagine a future state where someone has been officially diagnosed with infertility and context, their insurance company, and they're able to actually directly administer the tests.

I can imagine a future where then they direct them towards a fertility specialist that's in their network. 

[00:34:34] Griffin Jones: I think this is part of the lead gen system that many of the tests themselves are trying to do. So you're bringing up something to me of that it's interesting of, of the employer benefit brokers being the insurance company.

Doing it and being a part of it, many of the, of these tests. And there are many of them, there's a couple leaders like the ones that we mentioned, but there's so many that are trying to get into the marketplace that are raising 10, 15. It's somewhere in the 10 to $25 million ballpark of funding. And part of this business model that they have in their minds is that they want to do exactly that well.

Okay. Well, here you go, Dr. Milroy, we have these patients for you. They're ready to go. We've screened them. And so far nobody's been terribly successful at that, partly because they've been looking at the. Provider to, to pay for that. And I don't think that that's the right model. I think anytime you can go around the providers, listen, I own a client services firm and we work with providers.

I'm telling you, it's not the best way to go. If, if you can get somebody else to pay for it, that's typically better. And so I can't speak to if for certain that I think that. Having the employer benefits and insurance companies providing for it, but it could solve the challenge that has come from the providers not, and I'm thinking of one company And they were pretty good at actually nurturing the patient and getting information.

And I don't remember to what extent they did a testing, but they actually received the money from the patient and they paid the clinic and they still couldn't make that business model work because the clinic fought them on attribution. So. I'm sorry that I don't have a, a great answer for you Anne other than here's where it hasn't worked on this side.

Maybe it could work on the insurance side and if it does attribution would have to be. Either not a part of it and because the insurance company doesn't care, they want to, they want to do triage and send less people to the expensive people first that they can. Or you know, that that attribution model makes sense for them.

[00:37:02] Dr. Yani: Yep. I think that's a great answer, Griffin and got us thinking about what is that blue ocean and how do we work out those bottlenecks and those issues to, to really expand this access for those who really, really need it.

[00:37:16] Dr. Milroy: Griffin, that's all we have for you. Do you have anything for us that you'd like to ask us? 

[00:37:22] Griffin Jones: The question that, that I have is where do you see the provider involvement evolving in the next few years with regards to advanced providers with regards to OBGYN, what do you see happening in this area? Because if the bottleneck can open.

Bring a lot more water into the bottle right now, my firm is focused on, okay. We have a limited, we have a narrow passageway. We need to make sure that the what's going through that passageway is going through as quickly as it can, but I would love to open up the passageway. What do you see happening on the, the provider side?

[00:38:11] Dr. Sapugay: So I will have Colleen the last word, but as an OB GYN in my neck of the woods we actually do a lot of the initial work up and some of us do it all the way to, you know, our regular ultrasounds to look at follicles and then do intrauterine insemination. So we do do that, but it's also a very.

Saturated market in the Bay Area. And and so for some OBGYN who don't even do the workup, we have the REIs who will do it from scratch and, and take the patient all the way through. 

[00:38:55] Griffin Jones: So I, as a marketer, that seems like the logical path to providing more access, getting more people in, but I'm not a clinician.

So I can't speak to that. Colleen play devil's advocate for a second. BV old, the old hawty REI that says only REIs can be doing this. What is the argument against having a non. Board certified, a non REI board certified OB GYN. Do the workup, do the IUI, maybe even do retrievals. If that's two arguments, you can break them into two.

But what was the argument against that? 

[00:39:38] Dr. Milroy: So historically I would say it is training within that field enough that you feel comfortable really talking about the nuances and the side effects and the risks associated with things. I would say that's old school and I actually, Griffin, argue the other way, often where we are covering such a large geographical market we have to use position assistance.

So each physician is paired with a physician assistant. The physician assistant does the simple IUI, the ultrasounds, the simple infertility patients. PCOS patients. And then when those patients go through the process and they're getting to more of the difficult stages of things or surgical stages or IVF stages, that's when they're coming in to see me.

So I think it's operations and really who you train and how you train them. I think you know, we took a whole class, the three of us this summer on operations. And one of the things that we learned in that class that was super important to patient access and flow is what's called a complete. And so the way you optimize me as an REI is really to give me the patient tied up with a little ribbon and a perfect little package.

And so it's already to go. So that means I'm not ordering the basic test. It means I'm not ordering, you know, and then having them follow up with me to talk about a semen analysis, it's that all of that data. All of my team knows needs to be there before they see me is ready to go and perfectly ready for me to evaluate.

And then I can really use my degree to say, what do we do with this? What is the data out there telling me to do for next steps? You know, where is your highest chances? What's your quickest time to pregnancy. And so you're using my brain and that way, rather than ordering tests and so complete kits I think are super important.

We identified it in our operations project as one of the keys to really opening up access to fertility centers. Similar to, 

[00:41:47] Griffin Jones: Well as a non-clinician I would love to see this. I would love to see the patients that are. Coming to the REI, the ones that are in most need of the REI, but there's a couple of things that I'd see sometimes.

And the only reason I'm seeing this, I was a D student in high school biology. So no clinical background I'm coming from just, I'm looking at referral patterns and how do we get people to move through the process more quickly? And sometimes I see people. That are coming to the stay at their OB GYN for far too long.

The OBGYNs doing time intercourse, they're doing IUIs. They're doing they might be doing some other things, but they haven't even tested the male partner for a semen analysis. And I'm like, oh right. Here's this other referral source. So. That gives me a glimpse into all right. That's probably a clinical oversight.

I'm not a doctor, but, so how do you create the framework that that is the right OBGYNs that are doing this, that they have. At least some training and maybe not an accreditation, but to get you what you need to have those patients with the bone. How does that happen, 

[00:43:00] Dr. Milroy: Anna? And I can answer this together with her being a general OB GYN in the fact that I share

What I know as much as I can. And so when I go talk to the OBGYN when they are contacting me, I am sharing not only what we're doing, but why we're doing it. And so things like timed intercourse without a semen analysis probably not that helpful. And so right. Reminding my referral patterns where we live, it's not just OBGYNs, it's family practice doctors, it's critical access hospitals, it's nurse practitioners and physician's assistants that are actually really referring to me who really not never got training in this space.

And so it's really creating outreach for education for the, for my rural providers out there who may be see this three times a year. Right. And, and don't feel comfortable in that space. And so they're just trying to do whatever they can to help the patient. But in reality, they're wasting time. And so I think, you know, having access to me, like when they call me, we always answer them and always quickly respond.

And then spending time really educating them on what. What's really helpful for these patients. Anna, do you have another thought being an OB GYN? 

[00:44:14] Dr. Sapugay: I was just going to say so basic infertility management is actually part of our training 

[00:44:20] Dr. Milroy: for you as an OB GYN. Absolutely not for my physician assistant.

Who's at a rural access 

[00:44:27] Dr. Sapugay: hospital and one of the things I cannot emphasize Colleen's point on education enough. So part of my condition, actually, whenever an REI presents to my department to try to get our referrals is to do some teaching to the entire department as part of their introduction. So educating clinicians, not just OBGYNs, but to Colleen's point, you know, primary care providers is key so that the patient's time is not wasted as they're getting worked up. 

And, you know, one of the first things I always tell my patients who are coming to see me with infertility is men make up a huge proportion of infertility problems. And so that's actually one of the first things. People should be testing for and not always just assume that it's the woman's problem. The other thing though, that comes into the equation is insurance companies actually less when the OBGYNs or the primary care clinician does the testing, I suppose to when the the REI does the testing.

And so that's another reason people come to us first. 

[00:45:41] Griffin Jones: Well, what you just described is why I don't think referring provider outreach is going away as a, as a strategy, as a business development strategy. It's not the end all be all of the single source of patient attribution, but it also ties into what's needed for triage to help qualify patients that are.

To the REI to move them through more quickly. So I've enjoyed this conversation with the three of you. It's having this clinical operations framework meet a marketing framework. They're not totally divorced from each other. It is a Venn diagram and they do overlap. So I do reach a point where I say this is as far as I can go on the train.

And and it's been nice to, to talk with the three of you of where those areas meet Dr. Yanni , Dr. Sapugay, Dr. Milroy, Leanne, Anna, Colleen, having three of you guests on, I wish you the best of luck in your MBA program. And thank you for doing that extra curricular business study to improve the quality of the standard of medicine and for coming on Inside Reproductive Health.

You’ve been listening to Inside Reproductive Health, sponsored by EngagedMD. For technology to streamline patient education and informed consent, visit EngagedMD.com/IRH for 25% off your implementation fee. That’s EngagedMd.com/IRH.

117: Improve Conversion Rates by Keeping Scholarships in your Arsenal with Pamela Hirsch

This week on Inside Reproductive Health Griffin Jones interviews Pamela Hirsch from Baby Quest Foundation. After witnessing her daughter struggle to conceive, she launched Baby Quest in  2012 and has since awarded grants totaling $2.3 million. Grants like the ones from Baby Quest are not only beneficial to the patients, but also to the clinics by increasing conversion rates from consult to treatment and getting paid quicker than from insurance claims. 

In this episode we cover the topics of: 

• The perception of scholarship programs among doctors 

• Where to learn more about fertility scholarships

• How to utilize these programs in your arsenal to increase conversion rates

Links: 

Pamela Hirsch: linkedin.com/in/pamelababyquest/

Baby Quest Foundation

Website: www.babyquestfoundation.org

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

Twitter: https://twitter.com/babyquestgrants 

---

Transcript

[00:00:56] Griffin Jones: On today's episode, I talked to Pamela Hirsch. Pam started, Baby Quest is a scholarship for those undergoing fertility treatment. They've awarded $2.3 million so far just have had their 120th baby, born from the scholarship. I'm gonna go into the details of why this is so pivotal at the finance stage between consult and treatment inside the fertility center to have relationships with scholarship programs, like this have education about them.

Today's shout out is going to go to Dr. Lora Shahine. Dr. Shahine hit me too, Baby Quest, she was a board member for. Time still, maybe as far as I know, but at least she was, and I don't know if I've shouted out Dr. Shahine. I may have, I don't really keep track of the shout outs guys. So please let Lora know that I shouted her out on this episode.

And if I already did. two shout outs is just fine. It's good to be benevolent with your shout outs. On today's episode. It's not that Baby Quest is the only good scholarship program. And I feel like people are going to be like, why the hell didn't you mention mine? I'm sorry. ECG scholarships is another really good one.

There's there's a few more that I'm forgetting that people are probably going to remind me of in the emails, but they should, and they should be on your list as well. So finance is one of the stickiest points of moving people from. Consult to treatment and having a list of scholarships and having different places that people can apply is the final catch.

For those that aren't able to get employer coverage, aren't able to get insurance coverage. Maybe you can't get a loan maybe you can't get money from friends and family. It's important that you have all of those steps. We want to reduce. The number to as minimal as possible of people that can't afford treatment and scholarships are your last line of defense, everybody needs to have them.

And so we talk about what that's like with Pam and how they interface with clinics and pay clinics, frankly, a lot more easily than many insurance companies do. So I hope you enjoy this episode with Pam Hirsch.

 Ms. Hirsch, Pam, welcome to Inside Reproductive Health. 

[00:03:10] Pamela Hirsch: Thank you. Thank you for having me here today. 

[00:03:13] Griffin Jones: You were brought to my attention organization was brought to my attention by some people that have been on your board. And I do get a lot of requests from non-profits to come on the show and sometimes I have them on and other times I'm too busy and sometimes it's little.

Of luck of the draw. So I hope people don't hate me that have wanted to be on the show, but haven't been, but Baby, Quest I knew of, because I know some of the docs that have been on your board for a few years today, I want to talk about how you work with or how you interact with. With clinics, but let's first just start off with some of the backstory of Baby Quest.

You've awarded more than $2 million at this point. You've got, you have almost 120 babies born. 

You've got 10 pregnancies right now from Baby Quest funds. So let's just talk about how. Got there and what it is that got you there 

[00:04:12] Pamela Hirsch: and actually to correct you as of yesterday, we have 120 babies. 

[00:04:17] Griffin Jones: There we go yesterday and down what a milestone

[00:04:21] Pamela Hirsch: it is.

I started Baby Quest almost 10 years ago. It will be 10 years since we've given out the first grant. This March March, 2022 will be 10 years. And I was totally out in a different area, different workspace than fertility. I was one of the founders of a group called the Princeton Review Test Prep Company.

And I had worked in education for a long time. And. After I spoke my part of the company very soon after our younger daughter started to experience issues, trying to have a child. And she and her husband first, she had a miscarriage. Then there was Clomid and there were many IUIs. And then for IVFs, each ending and miscarriage until it was discovered that she needed to have a child via surrogacy, because she couldn't carry.

And this opened my eyes to the world of infertility and seeing the disparity of those who can afford, procedures such as IVF and surrogacy and those who can't. And the fact that many people don't have insurance coverage for this. So that's when I started Baby Quest in March of 2012, that was when we first gave out our first grant.

And that was maybe $9,000 to grants. One very small one for IUI, one larger one produced the first baby in Reno, Nevada. And since then we've grown considerably. We, as I, as you said, we've given out over $2.3 million now, and 120 babies and counting, and we do this twice a year, giving out grants. 

[00:06:08] Griffin Jones: So, how did you start to get some doctors on your board?

How did you even get a board? If I look at your, I look at your board, I recognize 5, 6, 7 names on here. And so how did that come to be? 

[00:06:24] Pamela Hirsch: Well, let's see. When I first started, I pretty much saw somebody on the street and said, oh, you want to be on my board? I have no idea what, whether it would be able to be around next year, but here's the idea.

And as we progressed, obviously we became more selective and I started going to some conferences and I met some amazing doctors. I actually knew Dr. Marc Kalan first here in Encino or Los Angeles. And then, eventually by word of mouth because of what we were doing connected with several other doctors.

I believe we have six doctors from all around the country, on our board now, and we're very fortunate to have their expertise to guide us in the medical part of evaluating applicants. 

[00:07:17] Griffin Jones: So how do you evaluate applicants? One of the things that I look at from, fertility patient journey standpoint is you first, you attract their attention and.

And educate them on the problem that they're facing, then educate them on your approach to solving the solution. Then you have to get them into the office. And there's a gap from when they contact you to when they actually come in and people can fall off there and then you get them in the office and you, you ostensibly educate them or test them depending on when follow up or the first visit comes.

But then you have a gap between that consult and treatment. And in that. So between the second and third phases, finances is hugely at play. And so anything with finance. We tried to help with the system that people use on the clinic side and the information that patients are prepared with before hand.

But you're coming in, you, you are helping with that, but 120 people out of, out of all of the people that need help. Of course you are. You're helping as many people as you can. And that's a fraction. Who needs help. So how do you make that decision? 

[00:08:30] Pamela Hirsch: Right. Well, first of all, as far as when the people consult us, we, we get applicants after they've been sitting in the business office and they know what their treatment plan is.

They need IVF they need surrogacy. They need sprayed donor sperm, donor. Genetic testing to eliminate cystic fibrosis or taste, acts, something like that. And they sit there in the financial counselors office and they learn what the price tag is. And they start to cry and realize that they don't have the money.

And that's when people start to do their research on what's out there for me, you know, my insurance won't cover this, my employer, you know, won't cover this. What kind of resources are out there? So that's generally when somebody reaches out to us and when they apply and we have two grant cycles a year we receive hundreds of applications and we.

As many applications are good. We just are obviously strapped by how many donations we get. And we can only give out the amount of money that we have. So it's a very selective process and the way applicants are selected There are several committee levels. Our board consists not just of the doctors that you mentioned that will come into play, but also of financial people of women's health advocates of surrogacy agency owners of people who have dealt with infertility in their own lives and have.

Oh, an expertise in the subject, whether it's personal or professional. So the first round of applications is looks in the application is looked at, does this include everything? Did the person submitted doctors evaluation? It's everything there. That's the first round next round. We have a fantastic committee of seven people around the country and we go through the applications one by one, and we eliminate is the person asking for more than what we think.

I can give just a myriad of, of different, different criteria. Are 

[00:10:43] Griffin Jones: you investigating their coverage as well? Like they broke down in the financial office, but wait, turns out they actually do have progeny coverage. 

[00:10:51] Pamela Hirsch: They submit their insurance information and we don't do that for everybody. But we do that when it becomes, when the group is more limited, we can't do that for hundreds.

And there's. That are just, you know, if somebody is, is asking for $50,000, we can't give that to one person. And the thing with our grant is that if somebody needs. $10,000. For instance, their procedure is 15,000 and they have 5,000 of their own. They need $10,000. If we give them a thousand and say, we're giving a grant, what does that person going to do other than save money for another five years and not be able to proceed?

So our grants cover. The major portion of what the treatment plan is, whether it be IVF service, the egg donation, sperm donation, egg freezing, embryo donation, whatever. So after the first two committees, we have a financial person who looks at the application. Does the person, does the applicant seem to be spending their money wisely?

Do they have three cars for two people? Do they How, you know, if there are, do they have enough in their savings, but they just don't want to contribute it. They'd rather have somebody else paid for it. Things like that. Then after the financial committee looks at the application, the finalists go to the medical doctors, and those are the doctors that you mentioned five or six doctors who look at the same medical piece of information for each of the finalists.

Give us their judgment on this person has a decent chance to have a viable pregnancy. 

[00:12:35] Griffin Jones: You had five or six judgements back when you do that. Yes, I will 

[00:12:40] Pamela Hirsch: say yes, very true. And it makes you realize that this is not a precise science whatsoever. You're you're, you're totally right on that. There are certain times when there is just something there that maybe we haven't caught and the doctors will say, oh no, this is just not going to work.

And if that person is consistently low. On every evaluation we realize this is not a good candidate, but it's difficult. There is no perfect solution. Every single time we've done this, we have improved it. We've made corrections. We've become more diligent and there's it's. There's no perfection. Unless we had a million dollars and then we can give money to everybody, but that that's not going to happen.

[00:13:29] Griffin Jones: But speaking of a million dollars, how have you raised the 2.3 that you've been able to distribute thus far? 

[00:13:35] Pamela Hirsch: Grovelling at first, because 

[00:13:39] Griffin Jones: To whom to anybody that you could have a cocktail party with in LA, who are the first people that you graveled to. 

[00:13:46] Pamela Hirsch: Friends who charities I had donated, or my husband and I had donated to for years and years and cocktail parties and not fun chicken dinners, that cost $500 a person that we had gone to for many years.

And I had never called in any favor so that they were first on my list and I didn't make any enemies. So that's good. And then word of mouth and then social media. It just grew you know, I been very fortunate in business and I just run, you know, even though I came from the for-profit world, I really run Baby Quest as a business.

And hopefully I'm very fiscally prudent in the choices that we've made. And we, we just, it, part of it is luck. And the other part is a lot of 

hard work.

[00:14:40] Griffin Jones: So the first was from, from friends and growing the network. When did it become fundraisers or now, do you have a systematic approach for, do you have any corporate philanthropy?

How is it. 

[00:14:55] Pamela Hirsch: Sure. Started out as individuals probably crying when an earth screaming. When I got my first check, that was over a hundred dollars. I kept on like that for awhile. Then we started with some small fundraisers, again, like hikes or what did we do? Small cocktail parties, just telling people a little luncheons, telling people about Baby Quests and it kept growing word of mouth.

And now we do have a much more structured program. We offer the giving hope grant, which is for companies, corporations. If they contribute a minimum of $12,000 on a yearly basis, they can choose. To adopt one of our recipients. And that has happened a couple to several times. We have couples who've come along who have been very fortunate with their own journey to parenthood, through IVF or surrogacy.

And they'd been, they acknowledged the fact that they have been fortunate financially, so they want to pay it back. So they come to us and they say, you know, here's a grant, here's a donation of $10,000. We want to help a particular couple. They can remain anonymous. Or they can actually communicate with the couple who they, more or less adopt.

And that has happened, you know, several times, quite a bit as well. But 

[00:16:13] Griffin Jones: Can couple's earmark as a scholarship at earmarks, not the right word, because I don't mean to say set it aside for a particular case, but rather can they, can they title their scholarships so that it's, you know, it's, it's coming from Baby Quest, but this is the.

Janet and Tim Rodriguez Scholarship.  

[00:16:36] Pamela Hirsch: Exactly. We have a company called an escrow. One of the surrogacy, one of the companies that many people use for surrogacy to put their money in an escrow account, Seed Trust, and they have adopted, if you want to call it our sponsors. Recipients two or three times we have a surrogacy agency, Abundant Beginnings, which happens to be owned by my daughter who knows the surrogacy agency owner.

They have sponsored a grant we have a celebrity from real Housewives of Atlanta, Kenya Moore, who, whose hometown is Detroit. And she great generously sponsored. Two couples from Detroit one, will be having a baby next month and her grant was the Giving Hope Grant. So definitely couples, some choose to remain anonymous.

Some definitely want to name their grant. And the companies generally, we have Brides For a Cause, which is a company in Seattle based out of Seattle. And they have been very generous with sponsoring recipient. 

[00:17:43] Griffin Jones: So as you start to grow forward, I imagine the board might change every couple a years or some seats stay on for longer.

Are there, are there fixed terms? Do you have board needs now? What's that. 

[00:17:58] Pamela Hirsch: The, the term is two-year renewable. If the person wants to. And many, fortunately many of our board members have stayed on for quite a long time. I believe there's 18 of them and we just recently added two new board members. It's always good to get a new infusion of ideas.

And since our focus has changed recently to try to do more corporate outreach. Some of our board members were not adding physicians at this time, but we're looking at board members who have some corporate ties that might be helpful. 

[00:18:37] Griffin Jones: Speaking of corporate ties, have you noticed the demographics of the.

Especially the geographics of the patient population that you're awarding scholarships to start to shift because, you know, 10 years ago you had very little corporate benefits and now it's far more common and in some marketplaces it's more common than it isn't. And so, as you know, progeny and carrot and others that are trying to enter that race kind body as they start to.

Broker benefits and now you've got Facebook and Google and Amazon and Microsoft offering those kinds of benefits. Are you starting to see different folks apply for the scholarships than you were some years ago? 

[00:19:26] Pamela Hirsch: Not really now there's always a need and no matter what companies are offering insurance, which is wonderful.

If that happens, there's still a need. And we see so many nurses applying fire, firemen, policemen social workers. Just now it I wouldn't say that really has changed that much. And again, it seems as though we do get more applicants from certain cities, whether that's word of mouth, whether if the clinic telling people, but some of the major cities, Philadelphia, Dallas, Atlanta, Los Angeles, Seattle.

They see, you know, those are cities where we get a lot of applicants. 

[00:20:19] Griffin Jones: Proportionally. Do you see far fewer from mandated states than you do mandated states? 

[00:20:25] Pamela Hirsch: Not really it well, yes. In one instance, I will say that. Yes, Massachusetts. We just gave the first grant we have ever given to Massachusetts it's same sex, male.

From the military actually using a surrogate. And we, I would say Massachusetts, per people in Massachusetts apply the least amount number and the least numbers of just about anything. Populated state. I mean, if you look at a state like Montana or Wyoming, no, we're not. We don't get very many applicants from 

[00:21:02] Griffin Jones: that.

Sure. So how do you work with clinics? You know, my interest in working with clinics is always getting the prospective patient through. Journey with the least pain possible, meaning the least, the least pain to them. They know what they're getting themselves into. They're prepared. The clinic has rapport ahead of time, the least pain possible to the staff.

They have less resistance. They're getting less questions that could be answered ahead of time and spending more of their individualized time with the patient actually individualizing their care and not doing redundant things. Causing more stress and extra work for them. And at the financial end, anything that I can do to prepare.

Patients to be ready for that discussion without giving them the wrong information ahead of time. That's kind of the hard thing family is when people want financial information. Well, you could tell somebody that the base price of an IVF cycle is $15,000. That is even though you're trying to be transparent, that's not really transparent because one, they might need just timed intercourse, and then.

Kind of scared somebody away that that just needs to see a consult, even if it's with an app in your office, even via zoom, like you've just scared somebody away from that. Or it could be somebody that needs a gestational carrier. That's going to need a multi-cycle guarantee. That's going to need donor gametes and then.

And plus the meds and then all of a sudden $15,000, this is hardly a drop in that bucket. And, and, and then you've totally bait and switch someone. And so what I try to do is get someone to think about, okay, this is where in the journey you are going to get the accurate information. This is how you are going to get it.

This is how you are going to learn how to pay for it. And so preparing them of how they're going to receive the right information, as opposed to giving them the wrong information. What you do because you really come in at that place between the second and third phase between consult before treatment.

And it's for those that have gotten stuck in the financial counselor, that is, that is one of the things in the arsenal that clinics have that I think they often forget about. And so can you talk about how you work with clinics?

[00:23:23] Pamela Hirsch: We generally get the applicants after they have a plan. And actually, because we can't do the research, let's say that somebody applies and they say, well, We don't know what we're applying for. We don't know if we need an IVF or we don't know if we need an IUI or we don't know for sure if we're going to need donor rate, you know, whatever, we don't have the manpower to go through 200 or 300 applications and help the person decide what they need.

And we're not doctors to begin with. So we really. Take that applicant when they have a plan, that person has been to the clinic. In fact, okay. For donor eggs, for example, somebody who's worded need. Donor rate or surrogacy, that person really needs to have a plan because if they submit an application to us and they say, well, we may need donor eggs

we may not. The price is going to be 15,000. If we don't need them 30,000, if we do. We don't have the manpower to call each person and say, let's talk about your plan. What your, your ovarian reserve, what does your doctor say about this? What are the champ? You know, how many IVFs if you've gone through, have you had an egg retrieval and none of the eggs have turned, you know, been able to be fertilized.

We get the person really when they have a. And the plan is concrete. This is a person who has spoken with the financial counselor has explored his or her options for insurance coverage. And basically has said, I'm going to either need to take out a big loan if I don't have the money or. I, you know, because I've been denied insurance coverage because my insurance coverage will only cover the diagnosis.

It will not go one step further. So that's when we get the person. And so we have to proceed from that step of this person needs. $9,000 to proceed because they have a little bit of cash that they can do it. We will call the doctor if we love this person, if this person proceeds through all the committees, the different levels.

And we come up to an application that is really wonderful with a personal story. And we're just so impressed with the person they've spent $12,000 already on failed procedures and here they are, and they just don't have the. To proceed. We'll call the doctor office and ask if there is any chance we've asked already in the application, but we'll call and say, you know, you've indicated that you cannot give the discount to this patient.

Is there anyone we can get $500 off or a thousand dollars off so that we can help this patient and take that $500 that you give us off. And give that to another, add that to another grant for somebody else. Anyway, that's the place where we meet the applicant. 

[00:26:39] Griffin Jones: How often does the clinic meet you there on, on a request like that?

[00:26:45] Pamela Hirsch: Less than 

[00:26:45] Griffin Jones: 50%. Less than 50? Yes. All right. Well, that's why you're on the podcast because I want that number up when we talk, I want it better be hearing everyone that's listening that better be 75% next year. I want that number going up so that you can benefit more people. But other than that, so, so hopefully you get a little bit of a discount because then you can put that back and.

Some helps more people, but even if you don't get it, is, is there anything you really need from the clinic? 

[00:27:20] Pamela Hirsch: Good communication cooperation, as far as Servicing their patient returning phone calls to their patient, just being, being the clinic that anybody would expect them to be as far as customer service, as far as us.

In fact, this just happened this week. Last Monday night we told the six people who got grants. That they had received a grant. The next day we sent them paperwork explaining exactly what their grant entailed, how much money, what medications, if any, and everything. And then the procedure is we tell the clinic, your patient got a grant.

You know, the clinic had filled out some paperwork because they have to for the medical part and we tell the clinic, your patient got a grant. There are some clinics that we have worked with before that are a pleasure. I mean, the nurses responsive, the business office is responsive. It works like clockwork.

There are other times when, the patient has received a written signed statement of this is what the procedure will cost. And all of a sudden the costs seem to change and they always change in the higher, rather than the lower we are their advocates. We will fight for them. It does not happen.

[00:28:44] Griffin Jones: So, so not a lot, like the, you don't need much from the clinic and so they are better off having you in their arsenal. Like, so every clinic should have a number of these scholarships in their arsenal and. And, and you're one that has been among the more established and proven, and it had longer tenures, but there is no reason that.

Every financial office should not have a list of these. Now, the order in which that comes in there, you talk about where that comes in, but there is a last line of defense when people are like, well, we don't want to bring in people that are, are totally unqualified. Well, you, you let people make that decision as they go through the system and you can get them some information earlier to think about things, but there is a way to get people.

Paid for, from a number of these different scholarships and the better relationship they have with you. And the more they have, the more people that are going to be able to serve. I 

[00:29:50] Pamela Hirsch: think one of the things that to me is so annoying is that, and this still happens after 10 years. I understand if this would have happened 10 years ago but,

we'll get a personal story of somebody who applied has to write a two page story. And we've seen some of the comments in the stories. Even recently, my doctor says this is a scam, my doctor said I shouldn't apply. Do you know that makes us even want to give that person a grant even more so that we can show the clinic that.

We exist. And it's interesting that within the past week, even one of the clinics mentioned to one of our recipients and very skeptical, well, how in the world are we ever going to get paid from them? And it's just amazingly easy. Let's say that somebody that we've told the person that we will pay $9,000 of their clinic fees, they come to the day when that patient needs to pay the $9,000, she's at the clinic, or she's going to go there tomorrow for her baseline or for her egg retrieval, depending on when the clinic demands payment, the clinic picks up the phone calls our office

I answer or somebody else, I give them a credit card on the phone. They charged the credit card and that's it. There is no thousand pages of paperwork. There's no bureaucracy. There is somebody else with a credit card, paying the bill for the patient. Who 

[00:31:28] Griffin Jones: did I say? 75%. When I said that should be the number of centers that give you.

Discount when you ask for it. Yeah. What that number ought to be 90% by next year. Cause guess what, Pam, they are already doing that with the insurance companies who are beating them up with the corporate benefits companies that are beating them up. And and so maybe, I mean, that could be reasons and people are slammed, especially the last year and some change fertility centers are slammed.

And so I could see well, why should we do that? It's like, well, because. Partly the, if, if the need based reason isn't good enough for you, which I hope it would be, but if it isn't because of what Pam just said, you're not fighting these claims. It's talking to Baby Quest on the phone and getting a credit card number. 

[00:32:17] Pamela Hirsch: What's interesting is we have, I could actually get it out.

It's a one, what we send the doctors or what's the doctors have to fill out when somebody applies, they print our application. The website, they fill out the 15 pages of financial information and education and profession and insurance cards and insurance information and all that. And then they have three pages they take to the doctor.

Two of those pages are medical four pages, I'm sorry, assigned HIPAA form, authorizing us to be able to see the medical information. Two pages of. Height weight BMI. How many miscarriages, how many, what's your egg count? What's your AMH levels of semen analysis? That kind of stuff. And the recommendation from the doctor, what procedure do you recommend that the patient do?

And the last page? Is a letter that says to the doctors we're going to, if this big and it's in bold, if this patient is selected by Baby Quest to receive a grant, will you match our grant? Give a certain amount, give a dis count of a certain percentage, or are you unable to give a discount. And that business manager checks that were unable to give a discount so fast.

And a lot of times they'll make up an excuse. Oh, our prices are already low. Obviously they're not low enough that this person was going to be able to afford it without a grant. So that's and we reiterate. And the last paragraph, this discount, the you're allowing the patient to have is only applicable. If this person is selected for Baby Quest, if this person is not selected by us, it's your decision.

You don't have to give them. A hundred dollars off or $500 off for a thousand. You know, it's only if they're selected, but it's really easy to put that check mark there. And these are people who have spent this has happened 15, 20, $30,000 at a clinic and have had no results. And they're asking for a discount of.

A thousand dollars, $500, you know, and it's almost a crime to me that, 

[00:34:46] Griffin Jones: yeah, in an instance like that, it would be much better, especially if they've already. I spent a lot of money without success. And the fact that you're, you're not asking for one, some allows some discretion because frankly there are some centers that are a lot more expensive than others.

And some, there are a few out there that have really done everything to be economical. We've had some of those folks on the podcast and and they almost have like a different model, but. It allows them to have the discretion and say, well, you know, even if it's pretty cheap, it's like, especially if they've already been with us a couple of times, could we knock a couple hundred bucks off?

And if we are on the more expensive side, then maybe you do, maybe you do knock some more off. And that's where you would. One thing that as I'm thinking about this, Pam is I've advised people not to really be so much in the middle on pricing, strictly from a positioning, standpoint not an access to care standpoint.

If it's an access to care standpoint, It's entirely within the heart of the physician, but I still would recommend perhaps channeling that difference to something like this. And here's what I mean by positioning that the, the low cost IVF, the affordable IVF model draws people based on that, but the middle of the road doesn't.

And so in the middle of the road on pricing, very often, you're just you're just sacrificing your own margins and you're not elevated in, in the eyes of the patient, but if you feel like, well, I, I want more people to access care. This is something else you could do if you didn't want to take the middle of the road on, on the position, but you are still feeling saintly.

And do you want more people to have access to care? You could be applying that. The wins that you're having in the margins or the safety that you have in the margins there to discounts like this? 

[00:36:45] Pamela Hirsch: Well, I won't say that it is across the board bad. I mean, our board members, our own doctors who are on the board have generously when, and we don't want to overload them.

We, we never would send more than one person. I would say a year two at the most. To the same clinic, because we're not saying, oh, you have to be our clinic. And we're going to send you a ton of, of patients because we don't want to overload somebody who is giving us a discount. Who's generous enough to be doing that.

But on the other hand, some patients, it's hard to understand that. If, if this is a really great person who really needs the, the IVF and has a great chance for success, and this person is not going to be able to proceed with treatment. Wouldn't the clinic be? Happy to give a thousand dollars off and say, oh, we get a patient versus the patient is not going to be able to afford it.

If, if they don't get a grant. Yeah. 

[00:37:51] Griffin Jones: Well, well, some of them might, what if some of them want you to slam them with a with a couple of cycles? I'm thinking most probably wouldn't with how busy they are right now. But I think in. There was one market that we did. Two groups. We, we evaluated two groups this year in the same market.

It's a very competitive. Well, top 20 market growing. And that's an area where you've got really large competitors. And especially if you feel like, well, maybe we're not converting as many people we should be. Maybe this is an angle for us, right. 

[00:38:26] Pamela Hirsch: That's right. Yeah. It's just, as I say, you know, it's very disheartening to open the application.

Find a great application. Somebody who's really put the work into the application, poured their heart into their fertility journey and to see that. That there's no cooperation. And that does not mean that we won't give them a grant and people will say, well, does it mean if, if our doctor is not willing to give us a discount, does that really disqualify us from getting a grant?

Well, obviously it means, it means we have to pay a little bit more for their procedure, but it does not disqualify. Sure. We'd love everybody to be able to get a discount from their doctor, but it's not going to happen. And we're not going to disqualify somebody because we need to give an extra $2,000 in a grant because the doctor won't won't do that.

But then again, if a clinic will give a 20% discount, which usually comes up to about 2000 on the phase that, I mean, we understand clinics, can't give a discount or cannot. Promise a discount on the anesthesia, which isn't that expensive, but they can't promise that because that's out of their control and independent, some clinics can't discount.

The facility fee. They don't have their own facility, but those clinics where they do have their own facility. And we ask if they can just count the physician and the facility fee or the physician and the lab fee, if they only. Their own lab and that if it comes up to a $2,000 discount for a patient, it's fantastic.

It really helps everybody. 

[00:40:07] Griffin Jones: Well, I hope you get a few more discounts between now and next year. Maybe, maybe someone's listening. That would be a good fit for a board member, maybe a couple donors, Pam Hirsch. Thank you so much for coming on Inside Reproductive Health.

[00:40:23] Pamela Hirsch: Thank you for having. I appreciate it.

116: Transition Your Sales Efforts into Marketing

In this episode, Griffin expands on his past two articles about selling to fertility centers and differentiating your company. There is a right way and a wrong way, and he almost fell into the trap of doing it the wrong way. Along with telling his story in this episode, he expounds on the 7 challenges that face sales organizations today including fewer qualified prospects, limited time and access, more gatekeepers, detached point of sale, high regulation, short sales window, and paradoxically,  long sales cycle.

Listen to the full episode to hear: 

• 7 challenges of sales

• How some companies overspend on brand awareness

• Proper positioning in the market

• The transition from a sales mindset to a marketing mindset

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com

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Transcript

Griffin Jones: Hi friends, on this episode of Inside Reproductive Health. I talk about the diminishing returns of fertility business marketing, and why fertility businesses are positioned as commodities in the eyes of practice owners and the execs who buy from them in the fertility field. What I tried to make different or go into more detail in the episode than I did in the written content, and I talk more about why, I think conference parties are so dangerous, I talk more about how fertility bridge directs our own sales process. And one thing that I didn't talk about in the body of the episode, Think I wanna use for the intro here is why I've doubled down on this point of view of shifting from the sales process to the marketing process.

Because every time I skip this step and try to do the things that I should be doing in positioning in the sale, I regret it. And the most recent example was at the end of 2020, because we were off from COVID. We weren't at ASRM. We weren't an MRS and PCRS and CFAS that I was just. Impatient. And even though Fertility Bridge's revenue was still going up and profit was still going up and client numbers were still going up.

I wanted to be where I wanted to be, that where I probably would've gotten, if I just had the help of some of those other things that were going on. So I decided to go on a sales blitz at the end of 2020. That was not entirely fruitless, but overall not net beneficial and not in service. To the value position that we really aspire to have.

So where I aspire to constantly develop expertise and constantly craft the points of view and put those out there to the field so that some of you hire us at least some of the time that is where. We get our value and our, how we're viewed in the eyes of you and our prospects goes up from that. And then here I am at the end of 2020 calling people, Hey, you want to do a goal diagnostic and running a sequence where we're emailing every couple of weeks and calling every couple weeks.

And again, it wasn't entirely fruitless. Some business did come from it, but it was not in service. To our brand and why it's like why that would just for eight months, because I was impatient of where we are now eight months ago, and I knew that we would be there within six months to a year, but I was captain Ahab on a whale.

And I know for some of you, it's not just being in that position. It's, you've got higher ups to report to, you've got shareholders to report to. The principle still is the same for having a little bit more of a long-term game. And then how that speeds things up later on. So those mistakes that I feel like I made, I just never want to go back to that.

There's a time where you have to do that in your career. And that should be like at the beginning or the very beginning of your company. I get it. Some people have to make the calls. They gotta they got to get any engagements where people are treating them like a vendor and they have to work their way up to either build the portfolio or everything else that's necessary for building a really good company, but it should be aspirational for most of us to get past that.

It's certainly aspirational for me. I really believe in hope that I'm past that part. There's no financial reason. For fertility bridge to do that and where we've seen the best growth where people treat us the best, where we get the best clients from that are both the most profitable that our team enjoys working on that is the highest value to the clients is when we take our time to really build out our points of view, build that into a content system, build that into a marketing system that segues into.

Genuine sales conversations, where the parameters are set by us. That level of detail, I did not go into the article, but you should know that. That's why I, that's why we did this. And so on with the show. And I really hope you enjoy it. Let's talk about selling to fertility centers, selling when fertility doctors, fertility, practice owners, and a couple of executives are the key decision-makers. Cause that's easy. Isn't it? I put two articles together. You may have read each of these articles. So I am going to give you a little bit more nuance in the podcast form.

And then in the email write-up, I will try to include. Different or new in the podcast. Some people like reading, some people like the podcast and some people like both so that, know, if you want to listen to read a different time, sometimes there's going to be more or less information in each one, even when we cover the same topic.

So the first topic I want to talk about is the challenges that fertility centers are facing. Excuse me, the businesses that call on fertility centers are facing, and then. Why the shift in sales and marketing has relegated them to vendor status they're related, but I'm going to start with seven main challenges at least that I can identify.

Why is it so damn hard to call on fertility centers? Some of these are new and some of these have probably been for as long as the field has existed, but the first is fewer qualified prospects. That's newer limited time and access more gatekeepers long sales cycle. Short sales window, paradoxically detached point of sale, and high regulation.

These are the seven challenges that I can see. So the first when I'm talking about fewer prospects it's cause I'm talking about consolidation. Stat news says that there are twice as many private equity affiliations made from 2017 to 2019. So if we think of that means. Major customer growth for some people that have the right deals.

And then for others, that means fewer customers. I know some groups that they can't make the decisions for their own group anymore. When it comes down to buying office supplies, when it comes to buying lab equipment. Which PGT provider they use. And so for some people, that's going to mean a lot more prospects. And for some people it's going to mean a lot fewer prospects because those groups have been consolidated.

Second challenge that we're facing is limited time and access. This has always been the case, but as. The field grows and the industry side of the field grows. I'm using that word deliberately because the commercial realm of the field is growing much faster than just the clinical part. And so as that happens, We're seeing more people call on the same people in the bottleneck.

And I've had Dr. Paco Arredondo on the show. I've had Dr. Andrew Meikle on the show. They have different views on the definition of entrepreneurship. I tend to agree with Dr. Meikle we'll link, both of those episodes in the podcast, but dammit, Paco. The more I think about it, the more. I just want to argue with Paco on this.

So, and Dr. Arredondo finishes Medical Preneur. He is going to come back on the show. We're going get you some free advertising to, for medical-preneur, Dr. Arredondo. I will read the whole book first. I will go through it with a highlighter and we'll talk about the exact parts where we agree and disagree.

The point is that there's a lot of people still in the owner's seat, the visionary seat for their company that are in so many different seats in sales and marketing, finance, and operations, and the seats underneath them, that it makes it even harder to call on those folks. They have not really delegated those responsibilities.

They've delegated some of the tasks, but very often not the decision-making. And that means there are more gatekeepers. This is a challenge. Number three more gatekeepers. We often think of gatekeepers just as somebody who's a receptionist who is the gatekeeper to the actual communication, like has the executives email or calendar?

That's only one fraction of who a gatekeeper is. It's much more useful to think of gatekeepers in these terms. And I think that I came up with this definition. If I didn't, you can find it someplace on the internet. Tell me why I'm a liar. But I think that I came up with this one. A gatekeeper is anyone who cannot say yes, they can only say no.

Long sales cycle. That's our fourth challenge that we're having is that sometimes it takes months for you to be able to call on somebody in order to even get that first meeting. And then to between the first meeting, when they're actually ready to purchase, they've got construction delays. They break up with their partner, they get consolidated, the recruiting, somebody.

Sometimes they wait for the pain to hurt worse, and it usually takes a long time to get in the door, get all the stakeholders. For the first meeting for the follow-up meeting, get the, yes, get the signature, finally get the payment. And so because of that really long sales cycle, the next one might seem paradoxical, but you think of the two as ying and yang challenge.

Number four is long sales cycle challenge. Number five is a short sales window because you've got your long sale. Your long sales cycle. You've got a short sales window because it's always hurry up and wait. It's like, when's the next fish going to be around to get on the line. So it's hurry up and wait until it's hurry up.

Again, the practice might just be opening up right now. They might not need another office for a couple years. They might not need another lab. This is, might be really big equipment that they only buy for a couple years or even decades. And maybe they just got out of a network affiliation or got rid of their EMR and hope.

God willing. They'll never have to do that again. The short sales window is the ying to the long sales cycles yang. Yeah. Challenge number six, that we've got a detached point of sale. And that sucks because in most areas of commerce today, that we're used to, as consumers, we have an attach point of sale.

I can get a handyman directly to my house. Now I can get somebody to pick me up and take me to the airport. I can book all of the arrangements for my honeymoon, with the click of a button. And it's only in a segment of. Business to business sales, where we still really don't have that. You don't buy an IVF club IVF lab at the click of a button, and that makes attribution hard.

There's not a single point of sale. And that makes some marketing efforts really difficult when you want a single source attribution. And in many cases, you're just not going to get it. There's many different ways that people are choosing you. They're coming in at different points of the sales cycle and there's various decision makers. 

All of this is compounded by high regulation, and I'm not saying that's a good or a bad thing, but there are some segments of the fertility industry that the disclaimers have to be longer than the content there's limits to the interactions. They can do the joint ventures, the messaging they can do with physicians, practice owners.

And that difficulty might be obvious, but that challenge compounds how we move from. Where we are now in the sales process to where we need to be in the sales and marketing process. So I'm going to talk about that exact shift right now. So we've got these seven challenges that are really messing us up with sales.

How do we blunt some of that? And the answer has to do with moving from a lot of our efforts that are currently in sales. Towards marketing. The example that I started the other article with was who pays for dinner, because this was something that my account manager who had worked on the industry side again in air quotes of the field for a number of years, was really surprised by it.

When we go out with our clients virtually without fail, they want to pay for dinner. I like paying for dinner. I like paying for drinks to sometimes I pick up the tab, but I really like that they want to do that because it shows to me how they view the relationship. And this was not the case a couple of years ago.

And I see so frequently in our field, you're practically a vending machine. I see sometimes docs inviting their friends and it's like, oh, let's all go out to dinner on this person's bill. And sometimes it's like, it's, that's just because that's their relationship. And, but even then there still is that expectation.

And I don't like being so lopsided on that side of the value balance. So how is it that a tiny little firm like mine that had no money? Remember I came into this field in 20 14, 20 15, moved back to the United States. Virtually no money, never got any VC money, never got any, you know, like money from mommy or daddy or a commercial loan.

And also I'm not from the medical field. I don't have a clinical background. So how is it that we've been able to totally. I wouldn't say totally. I would say largely been able to move the sales process to the way that we can most help people and not acquiesce to people's unreasonable terms and do it in an efficient way where I don't have to hire an entire sales team.

I don't think that everybody in this field looks to us as the golden advisors yet, but I think I've got a lot of strong cases to make that we are moving in that direction. And our billing shows it, our client engagements show it, the people that are reaching out to us show it. And that's because we have moved more of what's in the traditionally in the sales funnel to the.

Marketing part of the funnel. If you go to the Fertility Bridge website, Google fertility, businesses as commodities, you're going to see an illustration that's by Steve Patrese that I credit on the site where you can see the marketing and sales funnel, and you can see what used to be just marketing.

What used to be just sales and how that's inversed over the last decade or so it's because. Reps. And sometimes entire companies are positioned as vendors and practice owners because they're doing too much in, in the sales and too little in marketing. The result of being over invested in the awareness stage and undifferentiated in the sale is if you're not, if you're not following this concept, there's a couple, there's two different examples that I'll give you.

One is massive industry sponsored parties that happen at our conferences. That is an over-investment in brand awareness or often an over-investment in brand awareness and expensive dinner bills and overpriced field reps, often a symptom of being undifferentiated in the sale. Don't get so mad at me.

I'm not saying that these are categorical mistakes. I will go to your events by the way, as long as we're back on this year, I'm there. You'll see me. What I'm saying is that they can be a tremendous competitive advantage when they're strategically sound. But even when they're strategically sound, I still have a couple of concerns about each.

I think it's worth saying this again, because it's probably like the ninth that I've said this on the podcast conference parties need to be careful in their positioning in of themselves guys, because they are a major PR liability. If not illegal liability, we work in fricking women's health.

And sometimes at these parties, I see behavior that I I'll say like, no, man, like don't do that, but I can't speak for other people because maybe both people are engaging, but I would not let someone. Talk to my employees like that, or do stuff like that in front of my employees, especially my female employees.

And that sometimes happens at events that are hosted in the field. And all you need is for somebody to put that on Tik TOK or put that on IG Reel whatever replace Periscope and and get picked up by the Huffington post. And now that is associated with your brand, I think that's a real liability.

So if you're going to do parties, Please have some sort of positioning for the parties themselves. Like this is why we're doing the parties. This is what we don't want to happen at our events. I do think they still are a net benefit for the field because they get us together in a way that allows us to build relationships that are really collegial because we're hanging out together.

We're not just in a conference room, going over the docket from the plenary sessions. But I am concerned about what these could do to your brand. So to just be careful. Okay. And be intentional. And let me know if you need some help with regard to the reps, the best ones are worth their weight in crypto.

They are worth hundreds of thousands of dollars a year, but so many of them do nothing. To drive sales too much payroll, too much travel, too much entertainment is wasted because reps are doing the job that you would just want your well-produced content to do. So this is how you position for expertise and value.

If over investment over and under investment in certain stages is what's causing you to be positioned as commodities. The solution is. Flipping the sales and marketing funnel a little bit. So if you go again to Fertility Bridge.com, you can either find it from the articles that will link in this podcast page.

Or if you go to Fertility Bridge.com on the homepage, you'll see a profile for your persona. If you are a business to business fertility company, click on that, you'll find this funnel and you'll see how you can adjust your investment at the different at the different phases I'm telling you right now, it's a mistake to treat the funnel merely as a checklist, you probably do webinars.

You probably do have client testimonials. It might even have a brand video. If they're the same as everyone else's, if they don't fluidly set up the sale, it doesn't matter. What are you listening to right now? Are you listening to the Griff Jones show? Are you listening to Fertility Bridges Podcast? Or are you listening to Inside Reproductive Health?

Why is this little podcast from a D student who came into the field with no money who owns not a big genetics testing company, but a little seven figure client services firm have the biggest following for the business side of the field because we've differentiated. So when I'm talking about differentiated, I got to give another shout out to Dr.

Arredondo because Paco gave me this. Stat a couple of years ago that I've gone back to it's researched by Bain that shows that 80% of companies say they provide a superior experience, but only 8% of customers say. So So I think about this all the darn time, knowing that my stuff will always stink. Hopefully I'll have that attitude until I die and that I will always have the impetus to want to improve it because.

There is huge expectations, inflated expectations, by the way, from customers everywhere, including in the fertility field, in business to business. And there's also inflated egos on our end that we think that we're meeting the regular expectations, much more of these inflated ones. So this gap, 80% of people saying they provide a superior proposition, 8% of customers agreeing with that.

Equals satis allows, provides the formula satisfaction equals per perception, minus expectation. Let me try to say that again. Satisfaction equals perception minus expectations. So we've got this huge expectations we've got huge expectations to begin with. And so using like what we think is that like quality measures as a differentiator is a bad idea.

For that reason because the customer almost never perceives it that way, even when you really are, because everybody else will say the same thing. So if somebody else can say it, it's not a differentiator. Here's a little test for. Take all the marketing agencies in the entire world and ask them how many people are human communicators.

How many people are creative? How many people get results for their clients? How many people really get their clients? Almost everybody would raise their hand. But if you say, how many of you mother-lovers have served more than a dozen fertility companies. It would be me and three or four or five other people raising their hands.

And then you ask how many of you have exclusively sub-specialized in just the fertility field, nothing else. Bridging fertility, marketing and sales together. That's us. Raising our hand. That's what I mean by differentiation. So changing in this way, moving to adapt the shift in the buying behavior is critically important because there's just too many of you all.

And there's too few of the people that we're all counting on and it is a supply and demand game for doctor's attention. And I'm going on this, expanding on this element a little bit more, because I was so surprised at how many doctors and practice owners clicked on those emails and read those articles.

I thought that it was going to be a lot less red and opened email because I thought, well, you know, only part of our list is from the industry side, the docs, the practice owners will be less into it. I don't think so. It was one of the most popular articles that we've written in a long time and a lot of doctors were reading it.

So if doctors and practice owners are listening now and how I'm counseling people to get to your attention is doing things that make it make you want to actually spend. That fractionalized time. And that comes through content. We've put out more than a hundred podcast episodes. We've written dozens and dozens of articles.

And now I'm in a position where I don't get to dictate the sales process, but I do get to very clearly say, this is what it is. And if people really don't like that, then they just don't enter into it because I can't help people. If they don't meet a couple of criteria, I really just can't help them. And it sucks because they'll, you could still get them to buy from you, but then you're an engagement in five months and they're questioning the value or it just doesn't work.

And so I get to qualify. A lot more readily in the sales process, but there's a catch for me being able to do that. The only reason why I'm able to put so many demands on the sales process and the demands that I'm talking about putting on my sales process are I don't talk to people that aren't the principal of the firm.

If they're not the chief executive it's, if it's on the industry side or they're not. Well, the one of the owners, one of the managing partners of the practice, I just don't talk to people in this sales process. And that's not me being a jerk it's I can't really help people if there's not buy-in and alignment from the very top.

I know that I can't help people over the course. A longer period of time. So I vet that very early on. And so that's one of the things that we say in our sales process, like your principals have to be there. You've got to be on video. So the people that are in our sales. Every once in a while they'll be five or 10 minutes late, but they're not 20 minutes late.

They're not rescheduling at the last minute. They're not then expecting us to go over it's they are generally on time, which for very busy doctors is pretty darn good. And they're not calling me from the. Yeah, the 4 0 1 expressway they're calling me while they're sitting at their desk with their team and they're on video and they're face to face.

Another constraint is that our various early engagements are advisory engagements that are paid. I'll talk to somebody for 15 minutes on the phone, if they're the principal and they just need a little bit of assurance or a little bit of clarity, but that's it. It's somebody is either going to show up.

They think that it's valuable enough for them to pay for. And then we go through the process and our engagements are phased in, but the reason why I'm able to do, like, why would somebody, why would any of you pay $1,500 for advisory with us? Why would practice owners pay $600 for just a little bit of advisory with us?

It's because we've already given them that much value in content by the time they're ready for that. They're not questioning it. And so when we've put out a hundred plus podcasts episodes and several dozen blog articles and a 60 page ebook with all of these guest authors, It's to show these people in advance.

This is the way we think here's our thinking in it's unapplied form. If you want it in supplied form applied to your situation, you have to pay. But having all of this content out there allows them to decide, like, I think Griff's a loser that has no idea what he's talking about or. Wow. They have really built these systems.

They've really hired the right people. They've really reiterated this over the years with multiple different clients in multiple different markets. Yeah. I think they're probably worth at least that conversation, at least that initial engagement. And so what I'm encouraging all of you to do just by virtue of what we've done.

These last few years is to start to build this content army through the brand and through the creative messaging that connects all of the dots from marketing to sales and moves a lot of those sales efforts into marketing so that sales can truly just be what sales is, the final relationships and the closing of.

What you have established through the marketing. If you want some help with that, we do that in the goal diagnostic. If you'd like our help taking a look at your funnel, taking a look at what you're doing and just giving you a little bit of advice of how you build that machine. I hope you've enjoyed this episode and we'll do more business to business content in the future.

I promise.

115: Exploring the Role of Obesity in Fertility Medicine with Evan Richardson

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

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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. 

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.

The Diminishing Returns of Fertility Business-to-Business Marketing

It’s just B2B fertility sales. How many challenges could there possibly be?

Oh, not many, just...

1. Fewer qualified prospects 

2. Limited time and access

3. More gatekeepers

4. Long sales cycle

5. Short sales window

6. Detached point of sale and

7. High regulation

Other than that, I can’t think of a single reason why it would be harder than ever for companies to sell to fertility centers. In other articles, I'll address why lack of change has relegated many B2B fertility companies to commodity status. Here, I will attempt to define the principal challenges that fertility companies face in marketing and selling to fertility centers. I will also try to explain why these very challenges inhibit fertility organizations from investing in alternative approaches to solve them.

1. Fewer prospects

Stat News reports more than twice as many private equity affiliations were made among REI and OB-GYN groups from 2017 through 2019 than were made in the previous seven years. For some companies, this means huge customer growth. For others, in certain cases, it means half as many potential customers when networks negotiate exclusive deals with other vendors. 

2. Limited time and access

When the groups are larger, the dynamic usually changes to an enterprise sale where there are more decision-makers (though many small fertility practices have the characteristics of an enterprise sale). Even when there is still one principal decision-maker, she or he frequently needs the blessing or inclusion of many others. When committee decision-making takes over, it only takes one skeptic to derail the verdict. Most of them are gatekeepers.

Among independent fertility practices, who are often the most viable prospects, the senior partners’ responsibilities as physicians almost always take priority over their responsibilities as business owners. I agree with Dr. Paco Arredondo that physicians have the intelligence and training that can set them up to be entrepreneurs, but I agree by Dr. Andrew Meikle’s definition, that most of them are not. I won’t go into why--I wrote a four part series about why most fertility practices are not entrepreneurial ventures--but this business owner-physician tension greatly reduces the time that they have to make business decisions. When they have so little time to focus on the core responsibilities of a business, they often delegate the duties without the autonomy. Also, gatekeepers...

3. More gatekeepers

Fertility sales reps often view gatekeepers as administrative assistants or receptionists. Here is a more encompassing definition of gatekeeper that will better direct your attention to the access you need. A gatekeeper is anyone who cannot say “yes”; they can only say “no”. 

4. Long sales cycle

It can take months and sometimes years from first meeting to when the client is actually ready to purchase. They have construction delays, breakups with partners, and sometimes they wait for the pain to hurt worse. It usually takes a long time to get in the door, wrangle stakeholders for follow-up meetings, get the yes, the signature, and finally get the payment. 

5, Short sales window

It’s “hurry up and wait”... until it’s “hurry up again”. A practice is opening up now. They won’t need another office for years. They may never need another lab. They only buy this type of equipment every several years or even a couple of decades. They just got out of a network affiliation and hopefully, they’ll never have to do that again. The short sales window is the yin to the long sales cycle’s yang.

6. Detached point of sale

You don’t buy an IVF lab at the click of a button. There isn’t a single digital point of sale for many business dealings in the fertility field. Because of the long-term relationship dynamics of the enterprise sale, single-source attribution of marketing efforts is sometimes impossible.

7. High regulation

For some segments of the “fertility industry” the disclaimers have to be longer than the content. There are some limits to interactions, joint ventures, and messaging with and to physicians and practice owners.This difficulty may be obvious but the challenge compounds because it prevents many companies from making the necessary move to being a media company.

CAUSE OR EFFECT?

These seven challenges have certainly made your job more difficult. Still, it’s the (not so) strategic response to these challenges that compound the sales pain many fertility companies are feeling. The solution involves brave decisions in positioning and the activation of the position by putting forth oneself as a media company. I’m not talking about putting out a couple of webinars. Be sure to subscribe to Inside Reproductive Health and Fertility Bridge to be alerted about the coming content that describes the solution in more detail. 

Read about how we help B2B fertility companies differentiate themselves and increase sales here.

114: Fostering Better Communication Standards in the Workplace with Lisa Duran

In this week’s episode Griffin Jones and Lisa Duran talk about the challenges that leaders face in the ever-growing infertility field as their clinics’ needs change and develop. They discuss consistency and coaching methods that can help make a professional team stronger.

Lisa Duran is a consultant who has worked with a multitude of organizations with the focus of bringing teams and customers to the forefront of care. She has worked as the Chief Experience Officer for Inception, Reconceived,  the DiJulius Group, VP of Patient Experience with Vivere Health, and was Formerly Chair of the Association for Reproductive Managers through ASRM. She is an experienced public speaker that has spoken at a range of fertility and health conferences. 

Today’s Episode Focuses On:

• Efficient Delegation Practices

• Consistency in Behavioral Standards

• Navigating Through Negativity in the Workplace

• Utilizing Different Personality Types Effectively

• Healthy Communication Strategies

Lisa’s Social Media Links:

Linkedin Handle: 

https://www.linkedin.com/in/lisa-d-4025494b/?trk=public_profile_browsemap_profile-result-card_result-card_full-click

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Transcript

Griffin Jones: [00:00:40] On today's show of Inside Reproductive Health. I've got Lisa Duran back with me and we talk about leadership and the struggles that leaders are facing in the fertility field right now -  being so insanely busy, crying out for help. We talk about some of the things that they can do and the tools that they need for support. Before I get into today's show with Lisa. I know who I'm going to give today’s shout out to. It’s to  Terry and Ed Malanda from Mandell’s Pharmacy. And the reason why is because if you ever hear, when I welcome somebody onto the show and I say, Hey, Dr. Smith, welcome Joe. And I do it in that order. It's partly because of Ed Malanda. I did it like one time and Ed commented that he liked it, that it was the right mix of formal and familiar. And so because of that positive encouragement, that became the tradition for the show. So if you think that super annoying, you've got Ed to blame from it. But today’s  shout out is for Ed and Terry at Mandell’s Pharmacy.. Today's show with Lisa is about leadership. We talk about how sometimes there's mutual mystification between partners.

You know what I'm talking about  - sometimes there's negativity. People complaining that management level and that seeps through because somebody is allowed to get away with it and talk about change, not being enacted because sometimes it's just a conversation with no follow ups. So we talk about the resources for what leaders need to impact that positive change.

 Lisa has been in this field in different corners in solid stints for a while. She was the chief experience officer at Inception. She's been a consultant for the DiJulius Group, she was the chair of the association for reproductive managers, which is how I met her so many different years ago. She's been an individual consultant, so if you want her help, she has that experience and I recommend reaching out. And so I hope you really enjoy this episode with Lisa Duran.

Ms. Duran, Lisa, welcome back to Inside Reproductive Health. 

Lisa Duran: [00:02:47] Thank you. I'm so happy to be back.

Griffin Jones: [00:02:49] By the time this airs it’s going to be like episode 114, somewhere around there. And I looked just for giggles of when you were on last, and it was episode 24.

So you were on  90 episodes. It was pretty early on into the show. The audience has grown a lot since then.  Overdue to have you back and glad you're here again.

Lisa Duran: [00:03:11] Wow. Well, thanks so much for having me. What an honor it is to be back. And after so many episodes, you clearly are doing something right and something well, so thanks Griffin. 

Griffin Jones: [00:03:19] Well, you too, because you had different tenures around the field and not just like a short little stint here, but you've done good yeasts multi-year blocks in different roles as a consultant in house for a clinic at the executive level of a larger company. And so you've gotten into so many different clinics.

You've probably seen the insides of more than I have, and you have also done it in very different business models. So I'm curious as to, if you could even come across commonalities being that some of them are so different. What are some of the biggest challenges that you're seeing leaders face in fertility centers?

Lisa Duran: [00:04:05] Yeah. That is such a good question. And such an important question that we ask right now. It's interesting because when I started consulting again, I wasn't sure if I would be consulting more on the patient experience side or more on the team member experience side and and the consistent ask is for the leadership experience really, and equipping the leaders because what's happening is that pretty consistently across the board? What an amazing time it is to be in the field of infertility? What we're seeing across the board of course is great. And people are realizing that they want to have a family. And so we're seeing, you know, great growth in the industry and that is, gosh, just such a blessing and such a great thing.

What has happened in the clinics is with great growth, comes different challenges. And you know, the clinics are trying to ramp up their staff. They're trying to hire appropriately. They're trying to onboard and train while navigating, you know, the explosion of growth that they're seeing.

And what we're finding is leaders are just asking to be equipped. Equipped to lead and to go from doing to leading and, you know, the challenges are pretty universal out there. It's navigating the growth. And while keeping, you know, your team morale up and keeping the standard of care where it needs to be.

Griffin Jones: [00:05:26] What are the differences that you're seeing between things that are involved in building the patient experience versus building the team or leadership experience. What are the differences? 

Lisa Duran: [00:05:37] Well, you know, certainly in the leadership experience, you know, you're equipping them with leadership skills and we'll talk a little bit about those probably in a little while, you know, you really are trying to influence one to influence the many, right?

And then with patient experience, you know, you’re really pouring into everybody, you know, typically at one time, and then the leaders would follow up, you know, with the standards and coaching and rewarding recognizing, and then coaching for behavioral change. So it's really teaching the skills to the leaders to do all those things.

And I've been really enjoying it. I, most of my consulting lately has really been in leadership and I'm really enjoying it. 

Griffin Jones: [00:06:21] What are the skills that they need help with? 

Lisa Duran: [00:06:24] Yeah. So pretty universally, there are three things that they are asking for. They're asking to learn how to delegate well. And again, it's going from doing to leading.

That's not an easy transition. So how do they transition that and not make their team feel like they're trying to shove work on them. Right. And we can talk about that a little bit more in a bit, but the second one is coaching for behavioral change because what's happening is they are so afraid of losing good people and losing people because it's hard enough trying to hire the right fit, you know?

So they're so afraid of losing people, what happens is that at times - it’s natural - sometimes we let behavior slide that, that, you know, the behavior that doesn't exactly meet our standards. Sometimes we let it slide or we make allowances or where we give special attention or circumstances, we allow circumstances to dictate what the decisions are and sometimes we'll give people a little bit more. And then you know, and not stick to the standard. And so what happens.

Griffin Jones: [00:07:29] What you just said, Lisa is the reason why there is a crabby office lady or crabby office, man, in so many practices across the world because of what you just said well, but he's really good with the, you know, he's really good with balancing the books. She's really good with billing and or they're the only person that knows this darn EMR as a super user. So we'll let this behavior, I see it all the darn time. And I got to tell you, even as hard as this job market is, we have had some conversations with people that we, you know, we use something called the people analyzer and it's saying like, Hey, this is where you're being rated on. This is where I'm rating you. They give their input and ultimately letting them say, okay, maybe this isn't for me. And even in a hard job market like this, it's been so worth it, even being a bit understaffed because even when you're understaffed, if everybody else feels like everybody else has their back, they're willing to put through the grime of being understaffed. But if you have somebody that even if they're good at the technical aspects of their job, then it's, they're saying, well, why the heck am I going the extra mile? If this person gets away with it, I think that's what you were pointing out.

Lisa Duran: [00:08:53] Yeah, very much. And when there's lack of consistency, on what is okay and what is not, you know, what one person can do versus another and what one person can get away with versus another, that creates resentment. And then with resent, you know, when there's resentment in a team, right, that's not exactly a positive environment.

And then we're asking those teams to deliver a great patient experience. And so that consistency and adhering to the standards and making sure that you're not giving special allowances to people because you're afraid of losing them. So that coaching for behavior change in a very positive way is very important.

And you, people will respect the leader more. And when you know what's expected of you and that's very clear it, people perform better, right? 

Griffin Jones: [00:09:39] I want to zoom into the delegating part of that, you mentioned, what trouble are they having with delegation?  

Lisa Duran: [00:09:45] Yeah. So, you know, the biggest thing with delegating is first of all, the stigma and delegating people think that delegating is pawning off my work to somebody right. And then, so that, you know, it's letting go of responsibility, it's assigning work and forgetting about it and so. 

Griffin Jones: [00:10:01] For some people, it is some people that's it. That's an earned stereotype. 

Lisa Duran: [00:10:08] Yeah. I have to tell you that. Being in the centers and being with the leaders, there is not a group of harder working individuals that truly have a heart, not only for their patients, but for their teams and their heart is to keep morale up. Their heart is to deliver a great patient experience. Their intentions are in the right place and they want to learn how to lead. And this is part of it. And they're so afraid to delegate because they don't want their teams to feel like they're giving them more work when they're already feeling a little overwhelmed and you know, so that's really the heart of it. And so it's really changing the mindset that really delegation is sharing work and it's really sharing authority, which can be very exciting to somebody. Who's possibly, you know, who has thoughts and ideas on things or who may want to move up, it's sharing that authority.

And it's also providing team development, right? What a great opportunity to pour into people and develop and raise up that, you know, that next leader. And so it's really changing the mindset and then giving them tools on how to do that. 

Griffin Jones: [00:11:15] Where are they getting caught up then? Is it that? Well, my team's already overworked and I just don't want to add more to them, is that the only place they're getting hung up?  Where else? 

Lisa Duran: [00:11:25] That there's a, yeah, that's a great question. Another place is that they're afraid to give it to them because they are fearful that if that person drops the ball, it's going to affect patient care and that's a valid concern, but done in the right way.

Yeah. With, you know, checking it as a leader checks in on the progress and making sure that before it's, you know, delivered that things are going in the right direction. It won't go there, but that's a big fear they have, you know, “I know how to do it, I can do it”. Right. You know, and I don't know that this person can do it like I can do it. You know, they all have such high expectations and standards for themselves. And that's why they're in leadership positions. 

Griffin Jones: [00:12:05] Sounds like that might be in the tool set that they need. What are the tools that they need to delegate? 

Lisa Duran: [00:12:11] Well, and I actually take them through some very simple steps that helps them to do that and it would certainly identify the things that you need to let go of and making sure that they're getting the commitment and the buy-in from the team member, but teaching them the process, sitting down with them, you know, a 10 to 15 minute conversation of teaching them the processes, if they need to learn it will be beneficial in the long run.

And so teaching them the process and then having regular check-ins is essential to making sure that again, that it's not going to affect the outcome and accountability. And then also it's an opportunity to encourage that person you're delegating with and, you know, give them encouragement and that they're really doing well and that's, and the teams need that right now. 

Griffin Jones: [00:13:02] How often is it that you see positions not having outcomes because I can't speak to the rest of the clinic, but at least in the marketing sales biz dev side, I'm so often seeing no outcome for the position. I think that's a problem. I wrote an article called should I fire my fertility center’s marketing director.

So if you're looking for outcomes, I break it down at each level of marketing. This is what this marketing role can be responsible for. In outcomes because I'm seldom seeing these are the outcomes that I'm expected to fulfill as a marker, which makes delegation a lot harder. Is that how common is that in the rest of the practice?

Lisa Duran: [00:13:43] You know, it really just depends on what they're delegating, you know, they can deligate, things from patient care to administrative tasks. And that is, and that's part of what I teach them is how to discern what to delegate and how you discern that is really knowing that team member that you're delegating to knowing their strengths.

Knowing their sweet spot, understanding are they detailed, are the big picture, right? Are they thinkers? Are they feelers? You know, really knowing them and discerning what you can and can't delegate to. So yes, if you delegate, you know, something very administrative and detailed to somebody, who's a big picture person, the outcomes aren't going to be there and it's going to backfire right and so, that happens.

Griffin Jones: [00:14:26] It happens all the time on the marketing side, where people are given responsibilities and in the practice owner's mind, they're thinking I want profits to increase by X, but the person has no authority over influencing X.

They are given a responsibility or a set of responsibilities that may or may not contribute to X. At all, but they probably do partly, but there are probably other things that are necessary to actually influence the outcome, but their responsibilities are, if not entirely divorced from. They're not entirely unified with those outcomes.

And so can you talk a little bit about the relationship between outcome and authority to affect the outcome? 

Lisa Duran: [00:15:16] Yeah, well, and again, that goes back to the responsibility of that goes back to the leader and being very clear on expectations and getting mutual, understanding on expectations and those constant check-ins.

If those check-ins aren't happening, if it's not going the direction that it should have, you will see it along the way. If you're not checking in then and, and the outcome doesn't happen, right the way you expected it to really, it's kind of a shame on you. You haven't checked in and making sure that, you know, the needle was pointing up or, you know, things were moving along the way they should have been moving.

And then you know, As you work with that person and can trust that person more, the check-ins become less and less, but that's essential and making sure that the outcomes are exactly what you are expecting and making sure that the person is very clear on the outcomes. 

Griffin Jones: [00:16:06] I think that's a huge reason for, well, just a lot of conflict between leaders is one, the outcome isn't spelled out too, even when it is the person doesn't necessarily have the ability to impact it. And you have to give somebody that seat to own that outcome. 

Lisa Duran: [00:16:26] That's right. They've got to have the authority, but you know, it's I think when I talking about delegating probably more in the centers probably it's more of those things that a leader can let go of more probably administrative things. Those things that, that really. Bog them down and stop them from being able to give them the bandwidth to lead and to develop, and rather than big outcomes of whether it be profitability or whether it be patient retention or things like that. You know, that's a whole different level of delegation and right now, these leaders are just are trying to function. They're trying to do so they're trying to be nurses and they're trying to be patient services, you know, advocates. And they're trying to, because they're still doing that as well. And they're trying to lead people and they're trying to hire and onboard and all those things, so really the delegation the tasks that we talk about are probably smaller projects that we'll just take some things off their plate that will allow them some bandwidth. 

Griffin Jones: [00:17:30] Do you find that resistance or if not resistance, just difficulty to delegate is more acute where it's an independent practice owner versus a group that is within a large network that supposedly, maybe does or does not have a lot of the corporate support?

What's the difference in the ability to delegate between those two different profiles? 

Lisa Duran: [00:17:58] Gosh, you know, that's another really great question. I, as you were saying that, I was thinking about that there really isn't a big network versus a single or practice or one practice owner,there really isn't a consistent I guess pattern, if you will or strength, if you will.

I think it really depends on the leader. You know, there are some leaders that are doers and really just have a hard time prying their hands off things, you know, whether they be in a network or in a smaller practice. And there are others that, you know, that are like, yes, come and help me and so it really just depends.

It really depends on the leader. It's not necessarily. A large network with maybe more support, more corporate support versus the smaller practices. It's really very individual. 

Griffin Jones: [00:18:42] So with those leaders, and I was thinking about what you said is that sometimes they may be smaller projects, but I think maybe sometimes they're not smaller projects.

I try to write about where I really, think someone can walk away and where a leader can not walk away. Example in marketing is that I do not believe that the principal of a company can walk away from positioning Fertility Bridges positioning is set by Griffin Jones and I can bring it down to a level that my creative director then makes the brand guide with me.

And then beyond that, I can move out of some of the some of the things, but the positioning has to be set by the principal. That's an example in marketing. How do you help people determine where the leader must be involved versus what they can delegate? 

Lisa Duran: [00:19:34] Again, it's really, it's helping them to discern what the desired outcome is and knowing the people, knowing what they can delegate, you know what they can delegate into who, you know, the teams are. So yeah, every team is so different, you know, you walk into a practice and you've got a leader that's been there 20 years that, you know, does this in her sleep. And she's got a team of people that she can delegate those bigger projects to and be very confident in the outcome.

And then you've got a leader that is a new leader. That's really, frankly, is just buried in trying to, to keep their head above water and trying to function. And so, you know, it's, again, it's very individual and just really teaching them discernment that is so big on what the one with the desired outcome is and then and then two who they can delegate to. So, but, you know.

Griffin Jones: [00:20:26] It's a vicious cycle, aren't it?

Lisa Duran: [00:20:27] Yeah, it really is.

Griffin Jones: [00:20:29] If, when your time is so consumed, it is so difficult to step away to actually do the things that the leader needs to do like, you know, when we are in between hiring for positions, guess who's back in helping out in that creative director role Griff guess who's back into the senior digital role sometimes at least for parts of the things.

And that prevents me from building out more of the things that's just part of. Building a business. It's two steps forward. One step back, you get yourself back together and you keep moving forward as a leader. But it really is a vicious cycle that I think many people, I don't know if they've attempted to escape it.

My whole career is about attempting to escape that so that I can build these systems so that other people can do them. But if you can't, if you can't step away to be a leader, then you can't. To delegate those things, which in turn fulfills the prophecy. 

Lisa Duran: [00:21:27] Right it's the prophecy. Well, and you know, typically you would say you've gotta be okay to let some things fail.

Right because that's where the learning happens and that's where the accountability comes. And that is really where, you know, again, where the growth happens. And what's challenging in infertility is those, if some of those fails are results in patient care, of dropping the ball on patient care, right, that's not okay. And that's not okay with the leader. And that's exactly what I find is that leaders are so afraid and rightfully so that tells you, you know, about their heart, know, they really want patients to be well taken care of that. They're not willing to risk a patient, not being taken care of with the standard of care that they're wanting them to, or that they need to, right? And that their practice promises.

And so that is exactly why, you know, when you start to delegate, you delegate those projects that are not necessarily going to affect directly. Patient, perhaps it's something, you know, in the process of patient care, but it's not necessarily directly you know, the fail is not affecting a patient, you know, communication or care that and so those are the things that we talk about.

But one of my favorite things to do is when I'm working with like, I do a pre-assessment. I asked him, what are the pain points? Where are the, tell me some of the tasks that really prohibit you from giving you bandwidth to lead.  And then when I go in, I'll ask them to identify someone and together. We will sit there and we will go through the conversation of delegating that task and we will do it together. And so that she, or he can watch it in action and feel good about it. And then I will follow up with them. And how did that go? What results are you seeing? Are you doing your check-ins and things like that?

And I'm telling you when they see the results of that, and when they see, you know, how much they can start to let go and when they start to see the growth of their team and how it just really made people feel valued it's powerful.

Griffin Jones: [00:23:24] So you've got an assessment that helps people to measure them.

How else can we help leaders during this time of  growth? 

Lisa Duran: [00:23:31] Yes. So, you know, the second thing that I was talking about is that coaching for behavioral change. And so, yes, so I teach them, you know, how do you coach for behavioral change? How do you turn that around in a positive way, but yet holding them accountable and keeping consistency in what you expect from everybody.

So that's and that is a skill that is good in life. Right. And especially in leadership if you expect the phone to be answered like this, if it's not answered like that, right. It needs to be a quick one minute coaching you know, a redirect and making sure that the person understands the standard.

They've got their commitment, they've got the tools they need, and that they know that, you know, people don't do what organizations expect they do. What's paid attention to. And also that one minute coaching right away, all the way. Really powerful. And so that's the second tool that I teach them.

Griffin Jones: [00:24:23] That's something that you taught me six years ago, that I still think about people pay attention to what their managers pay attention to. And absolutely true for my team. If I'm not paying attention to it at a high level, it will go away. And if I'm firmly paying attention to it, then they are definitely making sure it gets done.

But some of that sounded like procedural change. When I first, when we were exchanging notes and we were talking about behavioral change, I was thinking skeptically to what degree is that even possible to change someone's behavior. So can you talk a little bit more about behavioral change? Because I often find, maybe it's, I don't know if that what evidence supports or is it against my presupposition? That many personalities are not so malleable. 

Lisa Duran: [00:25:10] Yeah. Well, you know, I think about it, I'm a parent that, you know, my kids are older now, but I think about how different my kids' personalities were and one was very malleable and the other one, you know, really pushed on everything that I, you know, that I tried to direct her on and and you know, I had to be much more intentional with her and I had to be much more diligent on not letting anything go by if I, you know, if I expected. You know, a tasks to be done and I didn't follow through with it. It's my fault again, that it didn't get done. And so I don't believe that the people can't change their behavior.

I think that there's, you know, there are two reasons why people complain and there are two reasons why people's behavior don't change typically why it doesn't change and that's, you know, they don't want to, or they don't know how to, it's just become. Right. And so, you know, so figuring that out now that I don't want to, and digging in the heels, that's not acceptable in a business and especially in a business of care.

And so that person should not be on your team. That person should not be working in a company. Right. And but the one that just doesn't know how to, or the one that's been allowed to get away with it for so long that it's just become habit or there's no consequence to it. That's changeable. 

Griffin Jones: [00:26:28] I remember you saying your daughter was a J on the Myers-Briggs J which means, which is judger on the Myers-Briggs scale, which means which, and I know because I'm a hard J which means like, we like a plan and that's a different index than like the detail.

I don't need a detailed level of planning. But if I, you know, if I'm making plans with somebody, I'll see you next Thursday at here at seven o'clock, you don't need to send me a text reminder. I'm going there at seven o'clock. And if something changes, you better let me know so I can adjust my whole schedule. And so that's something that you mentioned that you learned about your daughter, and I think that's what you're using for behavioral change.

How much are personality tests involved in the assessment? Are you using it for this purpose?

Lisa Duran: [00:29:45] Very much, absolutely in everything. Absolutely. You know, that, that is such a great tool of Myers-Briggs is such a great tool for teaching communication skills. Right. And for teaching understanding, and being able to delegate based on strengths and certainly in coaching for behavioral change, because if you know, you've got a J or a P, or if, you know, where you have to be a little firmer or, you know, where you can be a little bit more lenient or a little bit more broad.

And so, yes, those every clinic I go to, we start with those, we with those perspectives.

Griffin Jones: [00:30:18] I think I talked about it in episode 24. So, but people probably haven't listened to it in a while. And  just liked the story so much that I've got to say it again, but there was a year at, oh, it was at ASRM or something and you separated the group into two and you said, all right, all my big picture folks, if you described yourself as big picture, go over here.

If you described yourself as really detail oriented, go over here and then. Picture. And it was like a picture of Christmas and all of the big picture people were asked to describe it. And we said things like it's a snowy winter's night and Christmas. And someone is finally come home to, to lie against the fireplace.

And the rest of the group was like, there are 12 candles, there are four rings on the rugs. There are three logs in the fire. And I was like, oh my gosh, they really do see the world differently than we did. Yeah. Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.  

Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.

Lisa Duran: [00:34:09] Well, and again, it's, you know, leadership, I love quoting Spider-Man or a leadership with great power comes great responsibility. There's a responsibility as a leader to know your people and to know their strengths and to ask them, listen, are you detailed?

Are you big picture? You know, do you, or do you make decisions based on thinking or do you make decisions based on feeling so they can adapt their coaching if they don't already know. But it plays a big part in how you coach and it plays a big part in how the person receives it, most definitely.

I recently did a different exercise as it relates to communication with Myers-Briggs and it was the best one. And I thought I'm going to do this everywhere. I go now, where where separated the judgers and separated the perceivers so that remember the judges as, you know, want to make a plan and stick to it.

And that they typically yes, they're more organized and more structured where the peas are a little bit more spontaneous and typically a little bit more on big picture, but much more spontaneous. And I had each of the groups, they had to create a poster of a party invite, but they had to create the poster in the other person's language.

So the Js had to do a poster that would appeal to the Ps. And the peace had to do a poster that appealed to the J's. And it was so great because the J's poster was like, Party starts whenever,  ends whenever, you know, food is going to be great. We're going to swim sometime, you know, and you know, and we're going to have a guest, we're going to have a guest, a celebrity guest, and then the Ps how they made the Js invitation, the Js invitation was party starts at seven ends at 12, right? And here's the schedule 7 0 5. We mingle and we have cocktails. I mean, they went all the way through the schedule and at the very end, you know, 11:30 Ubers come and pick you up. And it was just such an eye-opening experience for the way people communicate differently and how they receive communication.

And that it, you know, again and as leaders, it's our responsibility to understand that with our teams. So that's part of this coaching. 

Griffin Jones: [00:36:12] It's funny because I described myself as well.  I am a big picture person and I'm also a J because I like to know when things are, because I want to move things around, but it sounds to me like the P’s poster would be more or it'd be more interesting to me. Or,  I don't know, but I know with Myers-Briggs either you take these four different combinations and then you ultimately end up with four times four, you have six, 16 different profiles and it's pretty remarkable how. When you have yours, that it really gets you, you know, one of the things that mindset is I do like to I sometimes get discouraged if I feel like I'm pushing people, because one of the talents that I have is I'm a motivator, but also I have found in my life that it’s sometimes led me to try to get people riled up about things that they don't really give a crap about. And so, and I'd sometimes get like, emotional about that, of like, well, why don't you want to conquer this? And so really strongly that profile hit me. How do you walk people through their profile. 

Lisa Duran: [00:37:22] Well, I deal with the entire team so I always do it with the entire team, including the doctors. That's, it's so much fun and to really be able to dialogue communication styles. And I hope we get to talk about physician support in this too, because that's really key in a lot of this and what's happening throughout the industry.

But I do it in the entire group. The ideal is get the entire team together and we do the profiles together and, and I have the table share their profiles, and then we take some common profiles and we stand up and we really. Then we dialogue them and then we do some you know, some different activities based on what some of the objectives are for that day but it's powerful.

Griffin Jones: [00:37:58] That personality finding might've been the reason that I started the goal diagnostic. Cause I was like, I just want to find out. Off the bat. Do I care about this person's problem more than they do? Because if I do, I'm not moving forward. If they don't care enough about it at this tiny little level, then I am not investing a darn thing left and it's been super helpful, it allowed me to totally emotionally divorced from that and run a much more profitable and well organized business.

But so you're doing this with the teams. You wanted to talk about the lessons and support, and I think I'm gonna set you up for that subtopic with a bit of a loaded question. When you were saying with great power comes great responsibility, a saying that I have is, ”the fish rots from the head”. So I wanted to ask where you see the most, where at what points of the leadership chain you’re seeing the most help.

But my view is that if it's not coming from the top. There's no hope so can you speak to that a little bit? 

Lisa Duran: [00:39:06] Yeah. And I'd like to touch on one thing before I speak to that, because it really feeds right into it, you know the which was the third thing that people are asking for, and it's positively navigating negativity in the workplace.

And you know, what happens is when everybody's busy, everybody gets, you know, of short and negativity happens. And then the physician is frustrated because, you know, they're sending attitude and, but yet the teams are frustrated because they're being asked to do things 5 billion, different ways.

And so that, you know, it kind of goes hand in hand, but I'm going to speak to the positively negative navigating negativity first. And then I'll answer the question on the physicians, because again, it really ties in,you know, I talked about earlier how there, you know, there are two reasons why people complain.

This is from the John Gordon book, the no complaining role, it's I absolutely love it. And he talks about how, you know, people complain because they feel helpless, hopeless, like things aren't going to change or it's become habit. And so, so I absolutely love whether it be with leaders or teams. And we talk about that and I have them write down all the things that you complain about, you know, no one's going to see it.

I give them little journals, write down all, everything you complained about. And then John, in his book, he goes through three steps and how to turn a habit or a mindset. And do you know how to change that just with very simple steps. And and so, you know, first of all, teaching the team, that concept, and then teaching the leaders, how to expect that from them and how to condition them.

You know, one of my favorite quotes from the book is complaining is like vomit. You feel better afterwards, but everyone else around you feels sick right and isn't that the truth. 

Griffin Jones: [00:40:52] A hundred percent and it spreads and it's very common in office environments. It might be even more common in, healthcare office environment.

So how do, so what, how do we support the physician in a way that? 

Lisa Duran: [00:41:09] Yes. And so what I found I've actually had some really amazing meetings with some physicians where they've, you know, I've had one on ones where they've said, gosh, I don't know what I'm doing wrong, but I feel like I'm complaining or I'm yelling at them all the time because they're not doing things.

And you know, my, because I'm a pleaser my first reaction is like, oh no, Fine. But I have found myself in, in, in these years, the older I get, I guess the more season I get, I find myself a little bit more bold you I, you I tell them, I said, you know what? You are such an amazing physician because you do things the way you do them.

And you putting your personality into your spin, you know, fighting for what you feel is right. Whether it be a process or a protocol or a delivery, whatever it may be,  and I need you to understand what that does to the team, you know, can you imagine, I tell them, can you imagine starting a new job and saying, this is how you schedule an appointment and then you have four different physicians saying my patients, this is how it's done.

And you have four different ways of things and then you wonder why three months later, that person leaves and you're frustrated because now the ball's being dropped because your patients are being taken care of it's because there are, these teams are having to navigate not only how to, how to do everything and how to, how to give a great experience, how to give great care, but they're learning how to navigate different processes with each doctor.

And especially in those larger clinics, it is so challenging. I feel so bad, you know, I keep thinking, you would never hire me on patient services because you would fire me. I don't know that I could remember how everybody wants to do, how differently everybody wants to do it. So, I tell them you've got to let go of some stuff and, and, and the team of doctors need to come together and you guys need to try and create some continuity.

What are some things  that you can let go of to create some consistency, to help the teams out? That's how you can support them. 

Griffin Jones: [00:43:10] But that's a leadership issue in and of itself, iIsn't it of having, this is my way. This is our way. That's not a united kingdom. That is a different section of fiefdoms controlled by different warlords that allied together sometimes for certain resources that is not a United front.

That's where I really push people when I've had people like Dr. Eckstein on the show and I'm pushing people. And I'm saying like, how do you rule by committee and consensus? And there's some people that have good and like Dr. Washington has good thoughts on that, but I really am just skeptical of the whole thing. It's part again with like this little gold diagnostic thing that we do, what we're doing in the very beginning is can we get all of these people on the same page in the beginning? Because what I used to find, when we would get into agreements with people, we would find out three months, four months, That the other partner is a totally different idea and it would just,lik, throw a wrench in works and what the hell man.

Like if you're not successful, I'm not successful. And that affects my reputation. And so, that was an issue of leadership. It's like, okay, we have to get people in the same damn room talking about the shame. Damn.

How do you get that united front? 

Lisa Duran: [00:44:30] You know? So to be honest with you, Griffin. I I have just barely started having these conversations with physicians, but I will tell you that I'm dying to have them have me back because I, you know, I tell them, I'm like, look, you know what I will facilitate, you know, let's get the four of you in a room, let's first identify before we do that, let's get the team together and identify the top three things that are very inconsistent with all of you. And where consistency will make a huge impact. Once those are identified, then get the four of you in a room and let's look at those processes or those protocols and figure out where you can create some consistency, but having someone facilitate that again The out the objective being to make the lives easier for everyone to lessen their frustration as physicians and to, you know, for team retention.

So we're not turning our teams so much. And you know, in boosting them around and also having less things to have to be frustrated with them about, you know, let's do that together. And I've had a lot of, you know, a lot of physicians say, that's great. I'm willing to do that again. It's just, let's do it.

Right. Let's do it. Let's take that step now. It's going to be just a little, you know, I mean, that's it's a huge issue. Right? And so I'm not claiming that I, you know, that I can even begin to try to fix it, but I figured, you know, what, if we fix, you know, if we can fix three things and create some continuity there, then let's start there.

And then three months from now, let's visit another three, you know, or six months from now, let's visit another three and let's visit another three. And let's just try to make some progress because we've been talking about this for years, right? Right. 

Griffin Jones: [00:46:15] Yeah. There's a lot of mutual mystification between part.

I hear it all the time. Like, well, you know, I'm talking about selling to this group or I'm talking about hiring this person, but I don't want to tell Dr yet, because. They own X percent of the company. You might want to bring it up before the last minute. And I think of all the groups that we've worked with, there's been one where we have been like their mediator in this way, but I haven't a  hard conversations is a part of leadership, isn't it? Yes. Isn't it like the most important part of leadership, because otherwise you end up leadership is about getting all the boats to row in the same direction. If you can have hard conversations, you can't get the boat rowing in the same direction.

I have a key team member that within the last month or so we had to have an uncomfortable conversation and it was important because there was just a bud of resentment on each of our ends and we're able to nip it in the bud and come to, but if we didn't have that conversation and we had to have two of them, then just that little resentment would have grown more and more. And so  how.

Lisa Duran: [00:47:29] And that is exactly how it happens. 

Griffin Jones: [00:47:30] How do you facilitate  the, all I do is just get them in the same room and act like a dick. And they either team up against me or, or realize, oh yeah, maybe we should be doing this, but how do you do it more constructively? 

Lisa Duran: [00:47:45] Frankly, to be honest with you, a conversation is not going to do any.

I'm just being transparent with you. You know, we can, I can, you know, bring people into a room and have a conversation with them and say, Hey, you need to line up and you need to be, you know, whatever. Or I wouldn't say that, but I'd facilitate that conversation of how, you know, how are you feeling? How does this make you feel?

But really it's going to be in the action. So, and that's exactly what I'm talking about the, you if, if you've got buy-in to going, okay, let's look at the processes and then you walk away right. Then they don't have time, facilitate that, you know, that exercise and you know, the, again, the practice administrators and the leaders, they're the most hardworking, amazing people, I know, you know, they are trying so hard. And so, so it's really investing the time. It's really investing, you know, a couple hours, you know, every three or every six months. And to not just talk about it and not just get agreement, but, and maybe not even get agreement, but really just talk about it and big and not just talk about it, but figure out the solutions, take a very specific protocol or a process.

And do it right there. And then have it be, you know, when everyone walks out the door, whether you like it or not, you know, some things you’re gonna like some things you're not, and this is how we're going to do it. We've all done. This we've all worked on this together. And so, know, really it's gotta be a lot more than just conversation. 

Griffin Jones: [00:49:10] Because that's the solution to one of their two reasons for complaining, which is it's helpless, nothing's ever gonna change, or it's always but the other one has always been this way. That by changing it and reducing that negativity. And when you brought that up, it made me think that my people almost never complain about clients and it's because I almost never complain about clients. And that wasn't the case in the early days, I notice that my team would like, complain about clients a little bit.

And they were getting that from me. It's ‘cause I would make like a snide comment about something. How do they not have this together? And then I zoomed in and realized, well, it's one of two things - either I'm a know it all and I'm not appreciating what somebody else is going through in their business, or we have a saying in our company where there's no such thing as bad clients, there's only bad prospects and bad process. And I had to look at myself and be like, what is it about my process that is allowing these relationships to manifest in that way, and it wasn't easy to fix it. I really had to change how people come into the company, but once they do, like, we have a really good relationship with them and now I'm not complaining anymore, which means my team isn't complaining anymore, which is good because we should not be complaining about our clients who are working their fricking tails off.

But it was something that I had to fix at a fundamental level. So what are those to do's that you're giving people? They can take a while. 

Lisa Duran: [00:50:40] Yeah, they really can. And I'll share those to do's with you. But I want to tell you that this was a very personal journey for me as well. And I picked up that book because cOVID really got me in a funk. You know, I'm an extrovert on steroids and I love being in the clinics. And for me to be, you know, in my home office, by myself for 10 hours, I was like in the fetal position, you know, when people and I found myself chronically complaining and it just became habit. And that is not who I am.

And it was really ugly and I began to not like who I was. Right and I'm like, who is that? That's not you. And I love, you know, there's a, there's a saying that I absolutely love, and it says. Of your heart. So your mouth speaks and so, you know, I realized a lot of this was a heart issue and a head issue.

And so when I picked up the book, you know, I was like, okay, I gotta change my heart. And I got changed my head, you know? And so, you know, the hearts, one thing, the head is another. And so what are those tools? So those tools, there were three things, he gives you three things which were so great, number one is  you start with the they get two versus the half two instead of I have to do this by five, you know, I get to do this by five, right. Instead of I have to stay home in my home office, well, I get to work from home and you know what I can be in my yoga pants and a t-shirt all day, you know, replacing and changing the mindset. And so you replace half two with get to, and that's a very practical thing.

And so I did the exercise where I wrote down all the things that I typically complain about. And then I  crossed out half two and forgot two and so that became, you know, what I did. So step two was racing the butt and doing the and, you know, and not saying something great. And then saying the but right. But this really sucks so this really stinks, you know, replacing them and seeing him saying things like, you know, wow. I'm just, yeah, I've got so many projects right now. You know, and I'm, I'm going to get them done, not, but I don't know how I'm going to get these done. So, you know, again, replacing that and so changing some of the verbiage helped change my mindset, but the third one was the most  powerful. And that is the one where there are boundaries set in place that I had to get people on board with me, people that I would talk to all the time. Tsey-Haye, she's a good friend of mine from Inception. I'm gonna tell her, I'm like, you gotta help me keep these boundaries, you know?

And the boundaries, we're you know, you're not allowed to just complain any time. You're not allowed to vomit on me all day long and leaders. And that's why I tell leaders. I said, if you're walking across the floor and you're going to see a patient and you let one of your team members come up and vomit on you about something, and you're going to go see that patient unacceptable, they may not vomit on you while you're, you know, needing to go do something. So, so how do you know when can they, you know, people should be able to complain, but turning complaining into productive solutions. And so, you know, that is the key. So creating the boundaries on how they do it, and we've all heard the don't come to me with a complaint without being part of a solution, but he really breaks it down very nicely.

 And really holding people accountable for being part of the solution so one of the things I work on with leaders is how do you actively listen, validate their feelings of their complaint and saying that is, you know, those are some great points. And tell me what ideas do you have to fix this?

And what part are you going to play on this? I want to support you right. And then holding them accountable for that. I'm telling you when you make people be part of the solution, not just say it, but make them be part of the solution. You're good, they're not going to come back and complain to you very much.

Griffin Jones: [00:54:19] Yeah. My operations manager says you have something you want to do at Fertility Bridge, bust out the mirror because that's the person that's going to be doing it. But as you're talking, Lisa I'm seeing the reason of the importance. For this reason as connected to each other, meaning it's so important to not have complaints and be complaint driven only, and to be solutions focused, partly because of how sensitive the self-awareness has to be to improve as a leader. Like the things that you're talking about, I don't have to, I get to -  that’s counted all joy. That is a very difficult mindset to get in and there's just so much of a leader where you have to be brutally self-aware about everything that you've built.

It's like everything I’ve built like this still, is that good or this still needs to be improved, this particular part. And because you have to be so introspective. It can feel like salt in the wound when somebody just comes on like, well, why aren't you doing this? And we had somebody, we had a candidate, a job candidate last week that was like, well, why don't you have this type of social media post is like, oh, I don't know, because I'm busy making payroll from a company that I built from. Absolutely nothing. When I called Lisa Duran from a fricking orphanage in 2015, and I'm building all these systems and serving nineteen different clients and building a point of view for everything, because I never took a dime of that's why,

like just as you're talking, I think that they're reciprocal, the solutions orientedness has to be what makes. Wound not stinging so much when you are being introspective enough to actually pursue the change. 

Lisa Duran: [00:56:13] No you're so right about that. And it seems overwhelming to a leader, but, you know, I used the example of, you know, you've got, let's say you've got a group of team members that are gossiping or that are complaining about something.

How powerful is it? And, there's kind of a ringleader in it is when a leader takes that person aside in their office privately, and just saying, Hey, listen, I know I heard a lot of that going on. And you know, I know that we all want this to be a great workplace and you know, I know that I trust you and I want you to trust me.

And in order to trust you, I need to know that you're going to have my back on everything. And I want to have your back on that. Let's talk about that, to talk about that hard stuff, but the reward. Yeah, the relationship and the strength of the relationship, the reward, and that the leader walking away going.

I just taught somebody to, you know, to navigate some negativity, to possibly do that. And I just strengthened a relationship. I talked about something really hard and, and I got a partner. Right. And so intentional. It's hard, right but the reward is just so great. And  I would just, you know, when people do it and they feel it and they see it's powerful. 

Griffin Jones: [00:57:29] You've given us some you've walked us through personality assessments. You've given us the framework for getting leaders on the same page, how to support the leaders so that they can support the next leaders and to delegate. How do you want to conclude with supporting leaders in the fertility field?

 Lisa Duran: [00:57:47] You know, my heart really went when I go into a clinic, I just want to grab them and hug them and just say, you're doing amazing. You're doing amazing because again so many of the leaders out there are just really struggling with feeling like they're doing enough. And so, you know, part of, you know, what I love doing is inspiring them and equipping them first, inspiring them to them to know that they're doing enough and then equipping them to do the things that are going to make a difference in, you know, it's going to help give them bandwidth and help their teams just feel so good about, you know, what they're doing.

And so, I, you know, I think that's, I just want to conclude with I'd love to tell leaders out there. You're amazing. And you know, this time, this busy-ness and the craziness of the growth is just so wonderful. And the season will pass. They'll be some low leveling off, or you'll be able to breathe.

But the growth, you know, the hard times don't produce heroes, the hard times bring out the hero in you. And so I think that I love just watching the hero being brought out in people who've, who it's always been in fight of them. 

Griffin Jones: [00:59:00] I get to become a hero.

Lisa Duran: [00:59:02] Yes I get to become a hero, that's right.

Griffin Jones: [00:59:03] I get to become a hero. There's probably a lot of people that could use that right now. Thank you so much for coming back on us. 

Lisa Duran: [00:59:11] Oh Griffin, thank you for having me. I'm always so honored. I have to tell you, I was talking to a clinic today and I said, I've got to go. I said, I got to quit. I'm on a podcast with Griffin, from Fertility Bridge.

And they're like, oh my gosh, you get to do that. And I was like, yes, I get to do that. So I think you're kind of famous there Griffin so. 

Griffin Jones: [00:59:29] There really is full circle. Thanks so much for coming back on, Lisa. 

Lisa Duran: [00:59:32] Thank you. Take care.

113: Building Out an Effective Referring Provider Strategy

In the latest episode of Inside Reproductive Health, Stephanie and Griffin explore if MD & DO referrals are still king or have been overthrown by internet resources as top referral sources. Knowing where most referrals come from can help you build an effective strategy to capture more new patients and convert those referrals at a higher rate. We also layout 6 pillars for an effective referring provider strategy that you can either give to your physician liaison to start implementing or outsource to a company like Fertility Bridge. At the end of the day, if your PL does not have a system, you are leaving money on the table.

Listen in to the full episode to learn:

• The 6 pillars of an effective referring provider strategy

  • Make sure your reporting is in line and cohesive

  • Ancillary services

  • Building the right content

  • Having the right events

  • Outreach of referring sources

  • Converting referrals that come to you

• The % of patients actually referred by a doctor (and what that means for your clinic)

• If a physician liaison is needed

• How to attribute referral sources properly
  

Additional Resources:

Referral Pattern Blog Post: https://www.fertilitybridge.com/inside-reproductive-health/the-6-pillars-of-the-fertility-referring-provider-system

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com

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Transcript

Griffin Jones: [00:00:40] On today's episode, Stephanie's on, we talk about our six pillars for referring provider strategy. It's important to get these right before you hire a PL if you're thinking about that, if you're a big company, you've got dozens of PLs, it's important to get this right. And in working in this framework to make sure that you're getting the results that you want before I get into this topic, today's shout out, goes to Dr. Paul Lin from SRM in Seattle, because go Bills, that's why in today's show, we talk about these six different pillars of why it's even important to still address physicians as the referral source that they are, but not to put them on the pedestal of being all or nothing. Talk about the facts beyond that and then we break down each of the six pillars even more finitely. So I hope you get a lot of actionable advice from this episode. Let me know if you need any help and enjoy.

Hi, Stephanie. 

Stephanie Linder: [00:01:38] Hi Griffin. 

Griffin Jones: [00:01:39] Welcome back to talk about referring providers. But before we get into that topic, I do have to tell you that I got a call from someone that I'd never met before. A doctor on the complete other side of the world who listens to the show. And we were talking about other topics, but one of our more recent episodes came up and he said that he agreed with you about the referring wellness providers being listed on the website. And I knew most people were going to agree with you. I even said that in the episode, but I also knew that it would stroke your ego if I brought that up. 

Stephanie Linder: [00:02:15] Yeah, it does. So thank you for sharing that. That's a good start to the podcast.

Griffin Jones: [00:02:18] Yeah, well, now I have to find something to ruin it for you and be pedantic about something to be right about and catch you off guard later in today. But we are in your wheelhouse about referring providers. So I might have my work cut out for me. The reason why we're talking about referring providers is because I've seen the attitude shift from  even when I first started talking to people in 2014, 2015, still many people thought that referring providers were everything that all the good patients came from referring providers, that it was like, it was almost singular as a referral source. And now I'm hearing people say that it doesn't matter anymore. And that's just not true either. I've kind of seen the pendulum swing here and we have some facts. We were doing an abstract.

And then in spring of 2020, when the world started to go, we were going to submit it to ASRM 2020. And then when the world took a turn, I decided that was not anywhere near the top of our concerns at the time, but we did get 250. Responses from REI patients, all people who had done at least one consult at an REI practice from all over the U S and what were the facts that we learned from them?

Stephanie Linder: [00:03:38] Yeah. So we asked these patients several questions and one of the first questions was, were you referred by a physician? Yes or no. And 60% of the REI patients said, yes, they were referred by a physician now that's still a lot, but it's still very far, of course, from a hundred percent. So then we asked another question, okay of all the different ways you can learn about a practice, so physician referrals, online search, you know, online reviews, there was seven or eight options, which of these were the most influential? And what was really interesting MD referrals while still number one, only 21% of people said that was the most influential and what was number two and three was also really important data.

So it, number two was location coming in at 20%. So neck and neck with the MD referrals, and then number three was recommendation from a friend or relative coming in at 19%. So very interesting to look at this data in this way.

Griffin Jones: [00:04:41] So Step another way, 40% of your patients on average are not being referred by a doctor at all.

And that's huge, but it still is really important. It's still 21% of people say that it's the most important physician referrals are the most important influence. Their decision of an REI practice. So that's still important, but it just a lot closer and a lot more segmented than we may have otherwise thought.

And I know that I have to make an important disclaimer here, which is when Stephanie and I say MD referrals. We mean physician referrals. We mean MD and DO referrals. There's a couple of DOs listening that are like, what the hell, man? Sorry. That sometimes really. It's just quicker than saying MD and DO referrals.

And then we don't have to say physician referrals, doctor referrals all of the time. So that's an important distinction to make you have multiple reasons that people are selecting the practice. You do need to know which is the single most influential. And that's why you have to do multi-source attribution.

So many people listening are doing single source attribution. You're asking people, how did you hear about us? I'm sorry. That's a very dumb question. I've talked about this on the podcast before I've argued with Rob Taylor about it. Who's an amazing marketer and you should listen to his episode, but single source attribution is like saying which beer got you drunk after you've had 12 beers. It was the 12th beer that got me drunk. Well,  sorta, but not really. And so when you get the best of both worlds in multi-source attribution He's asking people binary. Did you see or hear us  hear yes or no? What about here? Yes or no. And then all of those different options become the options where you ask of all of these, which is the most influential in making your decision.

And when you do that, you can start to see your patient's referral patterns change over time. So you don't swing from MD/DO referrals are everything to, now the internet is everything. You can see the nuance and the truth is that people  are coming to you from a lot of different ways.

And they're making the decision from a lot of different ways, but they tie in together and you need to be able to see that now that we've shown you, that it's not the most important, but, or it's not exclusively important. It's irresponsible to view it as exclusively important. Physician referrals still are super important.

We're here to talk about that strategy because of it. What are the six pillars that build a referring provider Strategy. 

Stephanie Linder: [00:07:24] So the six pillars that build our strategy around referring providers are number one. You have to make sure that your reporting is in line and cohesive. And we'll talk about that.

Number two is all the ancillary services. That's inclusive of things like semen analysis and HSGs and getting those ready to go. So OB's or any kind of physician can refer very easily to you. We'll talk about that as well. Number three is building the right content and number four is having the right events to promote and support that content.

Number five is the outreach with all of the referring sources and number six is actually making sure and following through that, those referrals actually come to you and convert. 

Griffin Jones: [00:08:10] We're going to go through these six different pillars. And it's important to do that because one of the questions we get asked all the time is should I hire a PL or not?

And that's a secondary question first is that you have to have the system. Then you can decide if you need one person, if it's worth it, having one person working that system most PLs will not be able to just set up a system like this. Some will, some PLs are worth their weight in gold. I think that many PLs are walking billboards and you're straight up wasting your money on them, but some of them are true physician liaison. So they are actually the liaison of the relationship between yourself and the other physicians in your area. They should be treated like gold. They should be compensated well. And if you're listening and that's not, you come work for Fertility Bridge because we're going to be, we're going to be opening up that client operational marketing seat to be its own position.

I might even already have that commercial in this podcast. I don't know if it's done. But Steph gotta be busy managing accounts. So if that's you and you want to do that for multiple clinics, you can come work for us. But for most people, I just don't, they're just not good at they're walking billboards.

So first before we hire somebody to go do that, we have to have them in a functional system. And then you don't have to worry about the walking billboard part, either fulfill the system or they don't. So what is reporting built from Stephanie?  

Stephanie Linder: [00:09:38] So when we look at reporting, we want to be sure there's very specific KPIs that are enjoined with it.

So here, we're looking at two specific KPIs. So what is your new patient volume and what is the total number of referrals, but within that number of referrals, we also want to look at the percentage of attribution, so the patient reporting. So these are the things that we'll focus on and you want to make sure that everything ties up to these two things. I guesse.

Griffin Jones: [00:10:07] And if somebody is listening, Hey, that's three KPI's. It's like, well, oh, well there's two main ones. And one of them gets split. So if your practice or your goals, aren't large enough to do a lot of outreach. Then you just need to measure these two things you need to know, okay, what are my new patient volumes easy?

And then I need to know the number of referrals, but they should be measured against each other in the ways that Stephanie says, if you don't have such big goals for growth, you can more or less stop there. You don't even necessarily need to do the rest, but before you put any substantial effort and resources into outreach, you should be reporting on activity across a few different categories.

So, okay. So we've got the main things to report on volume referrals and how referrals are split up. But once we decide we're going pass, what we're actually going to be doing enough outreach. Then we need to be monitoring the results of that activity. And you could break that up into six categories, which are what Stephanie?

Stephanie Linder: [00:11:14] So there's really three main reports. You will, of course, want to look at the people that are referring to you. And within those that are referring to you, you've not want to, not only want to look at the practice level, but you also want to look at your top 20 providers. So I say top 10 practice, top 20 providers.

And the reason is that there will be some folks that there's only an, a practice of 10 OB GYN, maybe only one is referring. And so they would normally fall down to the bottom of the practice lists.  But if you also look at it for providers, you can target and, you know, change your strategy a little bit to get that top referring provider, to start speaking to their partners and kind of spread the referral, use them to spread the referral patterns within that OB practice.

So that one is the most important, but I was the second most important is who are your targets for those that don't refer so same strategy. We need to look at the top 10 practices that don't refer. And then who are the top 20 providers that you want to target, whether they're in or not in that practice?

The next one is something that I don't see our clients do very often, so I wanted to bring it up. Who do you share patients with, but they have not referred? So all of your patients that get pregnant will need to, well that most will need to be sent back to an OB GYN for care and graduation. Very often those folks that you send back to, if they're pregnant, if they have successful pregnancies, you're naturally having a word of mouth referral and building your brand and reputation.

Hopefully your patient is speaking highly of you. But I was always shocked that people don't look at this list more often, because for me that would be the lowest hanging fruit. Hey, I'm sending patients back to why aren't we starting kind of a circle of referrals. So that would be the third, a report.

Looking at it again in the same way, both at the practice level and then also at the provider level. 

Griffin Jones: [00:13:23] I want to make that distinction for the listener too, because it wasn't immediately obvious when you and I were first talking about this, the referring targeting, not I thought, well, what's the difference between the non referring target at first?

And of course you could use this non referring patient sharing group to inform your target list, but it is kind of different, it's you have people that are, because we know that 40% of people are not being referred by a doctor. Well, they're still going to an OB when they have to deliver, they probably have a gynecologist, and those are the people that you share patients with.

And so if they're not referring to you, you still have that common patient that you can use to build that referral pattern. That was an important distinction. That you made that I think makes sense. If people want to see this visually go to the Fertility Bridge blog, you can see this article where we put in the different columns.

So you can see the different axes between practice and provider and then referring non-referral target, non referring and sharing patients. And so. If you're doing all of these things, you want to record them in you want to record your activity in a CRM. If you have somebody that's out there calling on these people and they are actually working a top 20 and top 10 lists for all of these, that's a lot.

You want to record that activity in a customer relationship management, a HubSpot  or Salesforce, you record the results, meaning who's actually referred in the EMR that, so if you've got your reporting set up, then we can start to look at other things that bring in referrals and what comes next on our pillars.

Stephanie Linder: [00:17:44] So the second pillar is ancillary services. And I want to share a statistic that I love sharing with our clients and really is kind of an aha moment is that 30% of patients that see your practice or a referral semen analysis or HSG will return to your practice for fertility consult within one year.

So this is a huge opportunity to get a referring MDs used to your practice. A lot of clinics don't do these ancillary services very well. Painful. So if you can make this process seamless, you will win over a new physician and it's a great entry point to get them to build trust and start referring for that initial consult.

 Griffin Jones: [00:18:27] So what are the steps in order to build that offering? 

 Stephanie Linder: [00:18:32] So we broke this down into four steps. The first thing is you just have to begin accepting outside semen analysis and HSG referrals. Most clinics do this, but I'm always surprised at folks that don't have an HSG machine or don't necessarily have andrology on staff.

So first make sure that's available and offered at your clinic. Second you want to promote that separately separate from, you know, the typical marketing brochure or patient facing brochures you drop off, you need specific content, and we'll get into that a bit later that promotes these services.

How do you send a semen analysis patient? What's the turnaround time? Make that very clear and contents. The third would be to provide a really good service. So your turnaround time at maximum to get these results back to patients. Should be 72 hours, if not sooner. And the fourth is educating these referring providers on what to do with these results.

And this can come in a lot of different ways through content, through events, through consults. I see a lot of people use our advanced providers to share this information back with the referring providers clinics. But it's clear that you educate them and be that source of education so they can begin to build trust and credibility.

So you can begin to build trust and credibility with these referring provider sources. 

Griffin Jones: [00:19:53] Okay, so we've talked about reporting, we've talked about ancillary services. What's the third pillar? 

Stephanie Linder: [00:19:57] So the third pillar is content. So once you've identify these ancillary services, you need a way to promote them as I referred to.

So you need to create this content, but even before jumping into the content, you need to make sure your foundation is set and you know, your brand guidelines are set. If that is not established, you need to work with fertility range, our work with your marketing team to make sure those brand guidelines are crystal clear.

But if that is establish, what you want to do is make sure that you pull out there were the three unique differentiators of your clinic, be of interest to the referring provider. Now I'm not talking about the same three differentiators that you talk about with patients, although it's quite possible they can overlap, but the three differentiators will fall into three categories.

And these three categories are your performance. This is an encompassing of success rates. What unique technology do you do? What happens differently in your lab? Is there anything unique with embryology? The second one will be all about the patient care. So this is where you get a chance to talk about your staff.

You as a physician and the way you communicate with patients. And then the third is the access to care. So are there financing options? Is it easy to get an appointment? Do you take a wide variety of insurance or if you don't, why don't you? So those. Differentiators are he to pull out again that are different from just the unique differentiators that you talk about to your patients.

Griffin Jones: [00:24:08] And this is where you can get really creative with things too. It's not just the pamphlet anymore. And I think you've all gotten the idea now that you're seeing so many of your colleagues destroyed Tik TOK and destroy Instagram that oh, doctors really are using this social media platforms. The rest of you that aren't doing that are using LinkedIn, like it's 2010 Facebook.

And so your doctors are in these places, this word is where you use your creative, because you're going to put them in different places, your referral pads, your referring provider page, which should be on your website. You should have a differentiator checklist, a preconception panel, and then how to interpret the essay guide.

And if you want to talk about that last one, I'll yield the floor to use absence. You said often find that's something that's missing. 

 Stephanie Linder: [00:24:59] Yeah, absolutely. So what often happens, not every clinic, but a lot is that they'll send the results of the seam and analysis back to the provider. And the patient is just unsure where to get the interpretation of the results.

Every REI listening to this podcast will agree with this when, how many times does a patient call you and can you give me my results of the semen analysis and your staff is tasked with no, you have to go to your OB for that. And that patient is very confused and that I've seen that lead to bad reviews on the fertility clinics page when it's not the responsibility of the REI, it's a responsibility of the person who ordered the semen analysis.

So the point of this all being is that if you can educate your OBS through written content through a guide, Through a video that says, this is how you talk about the semen analysis results with your patients. This is what a total modal count means. That will just prevent that from happening, which has such a ripple effect into your community, your referrals, your online reputation, et cetera.

So when Griffin talks about, you know, the pieces of content. That one is one of the most key ones that is not really done well in most clinics.  

Griffin Jones: [00:26:17] Should all be cogent with the rest of your marketing. You shouldn't be here's doctor outreach over here. That's just something we do to, we call on people. We invite them out to dinner every now and again, it's part of your brand.

It's part of the content that you create and getting creative is really important to have creative people and in messaging. These things is what helps you get apart from the herd that is doing the exact same things and having the same diminishing returns. So once we've got our content, now we can use that as a baseline for events, which is our fourth pillar, when you've got really good content, then you can create events about that. About those. And so what are some of the different events that people can build upon beyond lunches and dinners? 

Stephanie Linder: [00:27:10] Right. And I'm glad you made that caveat Griffin, because I think a lot of folks just think, you know, for sales reps or PLLs or physician liaisons that, oh, they just do lunches all day long.

And with the advent of COVID, all of a sudden folks are like, oh, there's no access. And they've given up, well, it's time to get creative. It's time to stop using lunches can be good strategically, but it's time. You know, just throwing $400 at the window and seeing what sticks. So the four events that you can leverage is the provider to provider meetings.

One-on-one I know we want to be useful of your time as a provider, but that sometimes they'll go further. Even if it's a virtual meeting than a lunch with 30 staff and no doctors. The second is provider to group visits. This can absolutely happen. And where a lunch strategically would make. But also a lunch does not always have to be done.

It could be something coffee in the morning, a snack people also just want to come and meet the provider for educational value. So if you can come and give them some kind of value or something, they'll learn that they can take to their patients. That's where you'll see the most ROI. The third is open houses.

I know Griffin, you challenged me on this a little bit. People want to see what happens behind the curtain, AK in the lab. And if you have a beautiful space, you have a lab with really cool technology. It's a huge opportunity to show this off, now this would be strategically used with a new doctor, a new location opening.

But I still think they are very useful and the last would be single topic, educational events. So it ties back to what I said is that OB's and you know, sometimes primary care providers, wellness providers are desperate for education around fertility. So if you can say, look, we're doing a virtual event, an in-person event, we're going to talk about, you know, the five markers that you need to look at for your fertility patients, people want to come to that. They want to learn and they want to meet you. So make it valuable. 

Griffin Jones: [00:29:09] All four of these can be turned into they can all be in person, they can all be virtual and go ahead and turn them into a lunch and dinner. If you want to. All I'm saying is the content of each of them should be good enough that you don't have to be buying somebody lunch or dinner if it's not relevant.

Okay. So we're making our way through our six pillars. We've talked about reporting. We talked about ancillary services like HSG and essay. We've talked about content. We've talked about the events that you build. Upon and beyond that content. So what is the actual outreach like? 

Stephanie Linder: [00:29:42] what's important to know as even with the best physician liaison in the world, especially as a newer practice, new location, new doctor, no one can replace the true REI and their relationship with a physician.

So your reputation must be trusted in order to really build and accelerate the referral network. Bottom line is you need to be accessible. You need to be present and you do need to communicate with these referring providers. So there are some places where the PL just can't fit in for you or replace you.

And so this would be allowing residents to do rotations. Just this, the relationships you have with medical schools, shadowing, and coming to visit your practices because eventually those. The OBS of the future. All the relationships that you made in residency are so valuable as you go into your future practice, our into your practice.

And the third would be your memberships in the specialty society. You need to show up to those. That's crucial to make those relationships after hours. And then also it's the grand rounds and the journal clubs. Again, you're educating the doctors of the future. And so what you do now does pay off three, four years down there.

Griffin Jones: [00:31:03] It's this ties into the content via events and everything else. Because as a referring as a physician who is referring, it was being referred to by other physicians. It's your relationship. And the more that you have to build upon and include the rest of your team and the rest of your practice, the more you are extending that relationship of which someone else can be the liaison.

And even though it's not your field, you can kind of get the example from what Stephanie and I do. Many people bought  Fertility Bridge for Griffin because people heard me on the podcast, et cetera. But guess what? I don't manage accounts at Fertility Bridge, Stephanie does and part of the reason that we're able to make that transition is one Stephanie's in the first sales call with people.

So even before somebody becomes a true client or at least in the goal diagnostic, She's in there. And so people are meeting her. If we decide somebody's going to move forward, we bring our project manager into this second meeting so that they're meeting these folks before we even move on. And since you haven't been on the podcast, Stephanie people are prospects. Oh yeah Stephanie, she's on the podcast with you. And so it's even more familiar to people. So you were including these other people with you in the content so that you can distribute the relationship. 

And it's almost like a boomerang with the content, because not only are you  being featured in the content, you're also contributing to it. And you're also getting your orders as far as our philosophy from it. So you're contributing, you're receiving and that's should be true for the entire group.

So all of our points of view, we are really firming out as you've been able to see. So when. Stephanie's talking to somebody there's a lot more for her to go off of Fertility Bridge knowledge than just, oh, this is what I think Griffin would say. And so by you really participating in the content in the events, you're creating a cannon, a Bible, or an authority for which your people can both contribute and they also have their orders to go off of from there. So I harped on that for a little bit, but I just don't think it can be stressed enough. You are the person from which people have the relationship. They don't want to make the substitute if you just drop it on them. But if you bring in the other people and they trust them, then it's a much smoother transition and you can do it too.

From the ways that we talked about the ways that your PL is going to do this is through total office calls, updating the target accounts, they should be also updating the wellness providers. They should be touching these people twice a month. They should be doing the coordination of the content and events, and they should also be checking up on those referrals after those events.

So that brings us to our sixth and final pillar. What is referral? Follow-throughs Stephanie? 

Stephanie Linder: [00:34:13] Yeah. I want, we'll get into that in a second, but Griffin, I want to make a point too, is that when you say, you know, your senior physicians bringing in. There are supporting staff. It's of course it's a physician liaison or the marketing team if they have it.

But this is also great for when you have a new physician, join your practice, you as the seasoned physician or a medical director, bringing the new physician in almost as to say together. Like you can trust them, just like you trust me. And that's also how you start to build a book of business and see the ROI on that new fellow or that new position.

And you almost give your blessing. I think that's really important because that's a really important thing to any medical director that is hiring new doctors. Like they need to get them busy as quickly as possible. And that's one way. But going on to the referral follow through is, okay, great, we're getting people to refer to you now. It's how can I, how do we keep them happy? So there's four key things that you need to do to make sure that this follow through happens. Kind of going old school with the first one is sending a thank you note for that first referral. Now we're talking about people who have never referred to you before and start referring.

So the old school written thank you, notes, Griffin. I know you're a big fan. But it goes a very long way and people just don't do it anymore. So Hey, Dr. Jones, thank you for the referral. The second is just making sure that you are tracking your semi monthly touch points twice a month in your CRM. And you're checking in, you know, this is what's updated with your referral.

This is some new collateral we have, et cetera. The third is the  post console or referral note that is sent back to the OB or primary care doctor immediately following the patient's console. 

Griffin Jones: [00:35:53] Talk a little bit about how that's different from the thank you note? 

Stephanie Linder: [00:35:57] So thank you. Note comes after, you know, you get the referral, let's say, you know, your PL or you as a physician or whomever, it shouldn't be checking weekly to say, okay, Dr. Jones sent me a patient for the first time it's marked in the EMR. Great, I'm sending them a thank you note right away to say this patient booked their console, thank you so much, you know, you don't have to get as detailed, although some people do to say the consult actually in six weeks, we'll keep you updated.

But the post consult referral note six weeks later when that console it happens with the physician. It's the physician's duty to say, okay and they have their specific criteria, again, we don't want to get too clinical, but there's specific criteria that say, okay, this is what they were diagnosed with, this is what we discussed. This is their plan of treating. And maybe they even less, like some of the genetic testing that they're planning to do, each clinic will be a little bit different, but it's basically a note to update the OB so they can keep it in their records to say, okay, my patient, I referred them.

They actually had the console. This is what they're moving forward with, whether it be IVF, third party services, et cetera. So it's a way to keep them updated on their patient. And then a way for them to know that eventually they'll be coming back to them for pregnancy care. So very easy to do this when you're a new practice or you're not busy.

This one often gets pushed to the side as a practice gets busier. And so the key is to create a workflow in your practice that this is templated a bit, or this becomes a part of your operations and it doesn't get pushed to the side. Once you get busy. 

Griffin Jones: [00:37:34] There you go, there are your six  pillars for referring provider strategy, reporting, ancillary services, content events, outreach, and the referral follow through. You need this system before you hire a PL if you're thinking about doing that, if you have a PL or multiple PLs, and you're not seeing the results that you want, or you have no idea what the results are its because one or more of these pillars are broken in the system. If you would like Stephanie and my help and Fertility Bridge's help, we can talk about that in a gold diagnostic, $600. It's quick, it's easy. You can make sure your people are on the right track. And hopefully this podcast was $600 of value just listening to it, Steph, thanks for coming on and going over this with us. And I look forward to getting into more detail in future episodes.