Inside Reproductive Health follows up on fall Wall Street Journal article
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BY: MALLIKA MITRA
Fertility clinics still face a shortage of specialists to meet the demand for their services.
Proposed solutions include funding for REI fellowships from private equity-backed clinics — and shortening the length of Fellowship. Inside Reproductive Health followed up on the Wall Street Journal’s report of the debate, published in early October.
Funding REI Fellowships
There are just 49 reproductive endocrinology and infertility fellowship programs in the 2022-2023 academic year, according to the Accreditation Council for Graduate Medical Education (ACGME). In the past five years, there has not been an unfilled reproductive endocrinology position once matching algorithm was processed — every available REI position in the matching program was filled, data from the National Resident Matching Program shows. Data on obstetrics and gynecology fellowship matches for the 2024 appointment year show there is just one reproductive endocrinology fellowship unfilled.
More recently, private-equity-backed private practices are showing an increased willingness to self-fund fellowship programs, said Rachel Weinerman, MD, of the University Hospitals Fertility Center. The challenge is that the goal of private equity may not align with that of academic practice, Weinerman said: The goal of private equity backed groups may be to increase profitability while the goal of an academic practice is to train a well-rounded fellow who is able to further scientific knowledge in the field.
Dr. John Storment, an REI practicing in Louisiana, said there isn’t an issue with allowing private equity to help with the growing demand for REI fellowships as long as the fellowships and training remain pure and without any strings attached.
“We have to maintain our integrity… and not let the industry dictate how we treat patients,” Storment said. Private-equity backed fellowships should not have different admission criteria, job benefits, salaries or opportunities than other fellowships, and they can’t be allowed to require a fellow to later join the private practice that’s providing the training, he added.
Storment said he is not afraid that private equity funding is currently compromising integrity. But ensuring it stays that way should be a top priority, he added.
Beth Zoneraich, CEO of Webster Equity Partners-backed Pinnacle Fertility, said multiple options need to be considered to meet demand. She is working on creating a program with key industry partners to train OBGYNs to assist REI physicians in practicing fertility treatment. She said that with appropriate training and REI supervision, OBGYNs could support REI physicians by performing initial fertility assessments, basic fertility workups and various REI procedures. They can also oversee routine follow-ups and monitor patient responses throughout the treatment process, guided by REI physicians, she adds.
“When you look at needing to meet a supply-demand imbalance, certainly increasing the number of REIs — either through reducing the time of the fellowship or increasing the number of fellowships — are both options that should be considered. But also looking to OBGYNs to help is critically important,” Zoneraich said.
Potential of Shortening the REI Fellowship
The REI fellowship was initially two years but was expanded to three years to account for an extra year of research. There is now talk in the industry of shortening the fellowship back to two years in an effort to increase the number of fellows.
“The importance of training motivated, talented researchers in the field of REI should be maintained as a paramount goal,” said Kate Devine, M.D. and medical director and chief research officer at US Fertility, which is owned by Amulet Capital Partners. “That said, we can't turn people who are not researchers into researchers, and that is the rationale behind potentially shortening the fellowship to two years, rather than paying to support 18 months of research training for every REI in training.”
Jay Rose, managing partner and co-founder at Amulet Capital Partners could not be reached for comment.
Devine added that shortening the fellowship to two years could be a good solution if and only if two things were guaranteed: extra funds that would result from shortening the fellowship were used to train additional fellows, and that funds would be earmarked to provide the best possible training to those trainees who were motivated and talented in research.
An ad hoc committee of the Society for Reproductive Endocrinology and Infertility (SREI) co-authored a white paper, which was endorsed by the American Society for Reproductive Medicine (ASRM), in September that recommended not shortening the fellowship to two years.
“Our lens is that of what’s best for patients, what’s best for patient care and what’s best for our trainees so that they can go out and optimize patient care,” Erica Marsh, president of SREI and board member of ASRM, told Inside Reproductive Health. “That generally requires that they spend time learning about not only the physiology and pathophysiology of the diseases that we treat, but also understanding how to interpret research and apply research findings to clinical care independent of whether or not they ever conduct research.”
OBGYN and Advanced Practice Provider (APP)’ roles
TJ Farnsworth, CEO of Lee Equity Partners-backed Inception Fertility, said more practices have to better utilize APPs to the highest level of their licenses to try and improve the capacity of REIs. That would include more complex ultrasounds, IUIs, pre-consult workups and minor procedures. He added that there’s a move toward using generalist OBGYNs to provide fertility care, but his company has decided not to do that at this point.
“Using generalists as part of fertility practices to me makes sense as long as you’re talking about them doing general care,” Farnsworth added. That may include hysteroscopies, HSGs, and surgical cases so that the REI can focus on fertility patients.
Zoneraich agreed that there are places where APPs can and should do tasks that they are able to do instead of having the physicians do them, such as monitoring ultrasounds, baseline testing, consultations for less complicated cases and intrauterine inseminations (IUI). That will give physicians the ability to do more new patient consults or follow-up consults, for example, she added.
The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser
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