Despite busy schedules taking care of patients and often running clinics themselves, it’s not uncommon to see doctors getting involved in ventures outside of their clinic’s four walls. From investing in pharmacies to serving as medical directors for new ART companies to starting software companies, REIs can be found doing a lot. No matter what the venture is, there is always the potential for creating a conflict of interest. So how do doctors draw the line? How are they able to ensure they are keeping the patient’s best interest at heart, and not just making decisions that are beneficial to the physician?
On this episode of Inside Reproductive Health, Griffin talks to Dr. Kevin Doody. Dr. Doody founded CARE Fertility in Fort Worth, Texas with his wife, Kathy, in 1989. He is also co-creator of Effortless IVF, which is a new ART technology treatment which uses INVOcells. He is also the Chief Scientist of Global Fertility and Genetics.
Together, Griffin and Dr. Doody talk about entrepreneurship in the fertility field and then, we dig into conflicts of interest in the field: what is acceptable and what isn’t.
Learn more about Dr. Kevin Doody and CARE Fertility at embryo.net.
Mentioned in this episode:
Episode 42, Jamie Metzl
Episode 16, David Sable
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
***
Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
JONES 2:58
Dr. Doody, Kevin, welcome to Inside Reproductive Health.
DOODY 3:02
Pleasure to be here. Thank you.
JONES 3:03
I wanted to have you on for a while because you're a private practice owner and you are involved in some other ventures. And I want to explore this dynamic in the fertility field for those that maybe they are practice owners or maybe they're just REIs at other groups. I've heard--especially a cohort of younger entrepreneurial folks that are either just finishing fellowship or just out of it saying, "I don't know if I want to even practice or to what extent I want to. Maybe I want to do a 50% practice load and then spend the rest of my time working for a Silicon Valley group or starting my own venture." And so I want to get some insight from you there. But can you give a context? You own your own practice in Texas and can you talk about a little bit of the history of that and then some of the other things that you're involved with to set the stage?
DOODY 3:58
Sure. Yes. Medicine was a little bit different back then. So I finished fellowship in 1989. And at that time, subspecialty in OB/GYN was a relatively new thing. There weren't very many subspecialists in reproductive endocrinology and infertility in the Dallas-Fort Worth area, and there were essentially none in the western half of the Metroplex. So, I joined initially a group that ran the county hospital residency program in Fort Worth. And the chairman of the residency program, Ralph Anderson and I had a private office where we would see our respective patients--he was a GYN oncologist--and of course, I started doing infertility and IVF. After a couple years, after a year, my wife joined me in practice-- in that practice--and then we got busy and really started off on our own into the what is now the Center for Assisted Reproduction. Initially, we had done quite a bit of work in hospital-type systems. And it became very apparent quickly that hospital administrators really had no clue as to as to what IVF and infertility was about. And so in January '96, we moved into our facility that we've got now, which is a freestanding ambulatory surgical center and IVF laboratory clinic, specifically focused on fertility treatment and fertility preservation.
JONES 5:49
Set the stage a little bit more and talk about some of the ventures that you're involved in today. I know INVOcell is one of them. I believe that you at least counsel practices in Canada, I believe, and work with groups in China. Can you talk about some of the other entities that you're involved with?
DOODY 6:06
So I am a Medical Director and I'm on the board of directors for INVO Bioscience, which is a company that makes a--and I happen to have one in front of me--a little vaginal incubator so that fertilization and embryo development can happen instead of these complex electromechanical devices, incubators in the laboratory setting, we get the eggs, mix them with sperm, put them in this little capsule that goes into the vagina for five days and the woman acts as the as the natural incubator providing the right temperature and CO2 oxygen environment, etc. for that. So, been involved with that for several years now. And I do have collaborations in China, I'm a scientific director and a partner in Global Fertility and Genetics, which has a clinic in New York and is also based in China.
JONES 7:06
How do you get to those involvements from where you started?
DOODY 7:14
So I think I've always been interested in research and kind of cutting-edge technologies. So from the very beginning, even though I was in private practice, we would publish a lot of our own research within our clinic, published a lot of abstracts at the American Society of Reproductive Medicine. Ultimately, began to be known for that. We were the first clinic in the United States to do extended embryo culture, or blastocyst culture, routinely on all of our patients and I think that got us some notoriety and so over the years, I've met a lot of people a lot of interesting people and presented with a lot of opportunities.
JONES 8:05
So is it in the case of INVO, is it something that, you know, you're working on something and say, I really like this or they approach you and we need someone on our board... who makes the first move in that situation?
DOODY 8:21
Right? Right. So I had been doing a lot of speaking across, actually Canada. And so one of the people that had been involved with that introduced me to a fellow named Jason Broome who had the distributorship for the INVOcell device in Canada before it was available in the United States. And he was not a physician, but he wanted to get some traction within the Canadian IVF community and felt that if there was some exposure, if somebody's doing it in United States that was well known to them that, that maybe it would help his business. So he showed me the device, it was quite fascinating. I was interested in it. It was only--it had been tested in South America and had been used for shorter embryo culture timeframes, up to three days. So let me back up a little bit. So I think people don't understand that, that culturing embryos, human embryos, is kind of tricky. Embryos don't have a liver, a kidney, lungs to filter out the impurities in ambient air and so we have to have very sophisticated air handling systems that scavenge out not only particles, but volatile organic compounds and things. And of course, electromechanical incubators that create a low oxygen and high carbon dioxide environment to create the right environment and enable the right pH up. So the concept of this could happen in a little plastic capsule in the vagina and outside of a complex, expensive infrastructure was certainly very interesting to me. But I was not interested in 3 day culture. I think that we had moved way past that. So I was interested in looking at it for a more extended timeframe. So I collaborated with the principals of the company, INVO Bioscience, to be able to get devices. And Jason and I kind of partnered, we went to an IRB, Institutional Investigational Review Board, to conduct research on human subjects and I did two trials--one just looking at the feasibility of extended culture, using patient's husband's sperm in the device in the vagina and looked at things like maintenance of sterility and pH and sperm survival. And then when we had a couple tricks that we needed to figure out, but when we figured them out, we were able to then translate that to culture and human embryos. We did a trial comparing the conventional incubators in the lab to the INVOcell device and found quite good results with that.
JONES
So this isn't a passive investment that I'm hearing, at least, you know, it's not like you're just you're not taking a X percent stock in a company and appearing on a board, you're leading these clinical trials and helping to construct the studies to determine feasibility. So that leads me into a question of bandwidth. You know, whenever I see someone described as a serial entrepreneur, I wonder how do they do that? You know, I own one company, and I think that I will be able to get to a certain level where I can start to invest in other things, and this will still be my stake and then the other ventures will be the side dishes, perhaps. But right now, I'm totally focused on this. And I see most practice owners being pretty consumed by not just their role as a business owner, which I often feel they don't devote enough time and attention to, but just their role as--their their caseload as a physician. How do you manage each of these? How do you decide how much time you're going to devote, attention? If one thing starts to feel like you're not giving it enough attention, do you correct? How do you make those decisions?
DOODY
I think there are kind of feedbacks that happen. If you're not giving adequate attention, you'll learn that pretty quickly. And you kind of turn it around and devote it. So I do do several things. But I've been I've evolved. You know, I started back in the beginning in the early days of all this, right? So I started practice before CLIA 88 was implemented, which is the law that required physician laboratories to be inspected and accredited. So I've been through that whole process. You know, I was there at the early days of embryology. So I am, you know, a laboratory director. I'm essentially an embryologist andrologist. I have to wear that hat. But I think you know, all of these things, although they appear to be disparate, separate things, they all have common features to them. And so it's not hard, especially if you've kind of evolved into these as the field has evolved to be able to handle it.
JONES 13:45
I want to talk about how that impacts collegial relationships and how someone might consider that because I own a marketing and business development firm and I'm in a few different mastermind groups of other digital firm owners or other creative firm owners. And when it's just us in the room, and everyone's just the owner of a firm, there's a different dynamic. But inevitably, somebody starts a software that they sell to other agencies, some, you know, might develop some sort of white label service for agencies, and then they become someone that also sells something. So they're still our peer because they own their firm. Now they have they have some other venture so that they sell to the rest of us.
DOODY 14:31
Yup.
JONES 14:31
And I think some really navigate that sea a lot more smoothly than others. For some, it feels like wow, he's still one of us. He's just offering this to us and to other people it feels like, I don't feel like I've got the same relationship with him now. How do you manage that?
DOODY 14:54
Right. So yeah, the software aspect is springs to mind that I've actually been doing software, too and so I started a company in 1998 called Digital Medical Data Systems or Digital MD Systems and we developed a software product that's an electronic medical record that serves the infertility IVF field and I do sell to my peers and my friends, right? We license our product for their use. But I don't know--I don't find those things particularly hard to navigate. I'm not a hard pressure salesman, so I don't try and pitch something that that I can't support. And I think it all works out.
JONES 15:42
I think our field might even more sensitive than others maybe or people--just because I just hear it a lot and now a lot of people are involved in different things. They sit on the board for a tech company, they sit on a board for a new AI company or pharma and--. I was hosting a meeting back when we could still host in-person meetings, it was January of 2020. And I had a independent REI practice owners roundtable. It was amazing. And the reason I made it that way was because there was no speakers, there was no sponsors. I said, "I'm gonna be there just to facilitate. Everyone else is going to be an independent practice owner." And 11 different practice owners from all over the US and Canada. And one of the topics that people wanted to discuss was INVOcell, and actually a few different people--I had them make the agenda and then we just rank ordered the topics and we said, "Okay, we won't leave until we talk about these different topics." And I don't remember even if we ended up--I don't even think we ended up talking about INVOcell, but it was on the topic list. And when I was inviting someone, they said, "Oh, do you work for INVOcell? Do you work for Dr. Doody? Are you trying--are you trying to sell us something?" Then it was--I was being suspect of am I selling something as opposed to facilitating a peer group. I said, "I've never met--I'm not a shill for Kevin Doody, INVOcell doesn't--if they're sponsored content on this show, you'll know about it, you'll know that it's sponsored content. I'm not getting any money from them. It was just something other people wanted to talk about. And so I found myself in that situation. So how do you recommend--you said yourself, you're not a high pressure sales guy, you believe in the products that you're dealing with. How do you recommend for people that are getting into a venture that they maintain that integrity?
DOODY 17:40
Yeah, I think--so I never would presume to push INVOcell on a clinic or know how they might use it in a clinic. But I'm enthusiastic about it because I can say what and how we use it in our clinic and I think it finds a very important niche that serves a population of patients that otherwise wouldn't be getting assisted reproductive technology care. So for us, it works really well. And I don't presume--medicine is kind of like politics. It's all local. There are different things happening in different parts of the country, different factors at play. But for me in my clinic, I think it's it's been very helpful for our patients and has attracted a great many new patients that probably we otherwise would not have seen. But again, I don't necessarily think that it would work in every practice. I think it depends on on how what you feel about it or how enthusiastic you might be about it.
JONES 18:53
This might be a good segue into the topic of conflict of interest, which I'm interested in your perspective on because you own your practice outright. And I've been more interested in this topic for people that are in multiple partner or in large partner practices, or maybe they're in the C-suite of large network or something. Because I think that's where there's more opportunity for conflict of interest. I own my company 100% outright. If I decide to have another venture, that's not really a conflict with my company. So I'm talking about more--I'm talking about more conflicts to the company as opposed to anything else. But I do sometimes see, okay, this partner has a stake in this company or this partner owns part of a firm and maybe you are in a good position because of your practice ownership? How do you see the conflicts of interest in a practice?
DOODY 19:52
So I think that's a, you know, a great concept to talk about, right? So I've seen people give a talk on let's say, preimplantation genetic testing. And of course, at the beginning of our talks, we have to have a mandatory disclosure slide--CME-type, continuing medical education type talk--and, you know, the individual said, "I don't, you know, I don't have any conflicts of interest." And well, oh my gosh, your practice is doing a lot of preimplantation genetic testing, I think your patients are paying for it. So of course, we've all got conflicts of interest. If, you know, if I talk about IVF, or if I talk about doing surgery, that's how my medical practice makes its revenue. And the same with the INVOcell. I think, if I talk about INVOcell and I'm telling you I'm using it in my clinic, I'm making money off of it. So you know, and in some sense, that's a conflict of interest. Now, if I were to say, "Hey, I think you should use this and you should buy it." And I don't disclose that I'm a shareholder in INVO Bioscience, that's kind of a more hidden conflict of interest. But I mean, I think there's no disadvantage of being totally open and honest about the reason I'm a shareholder in INVO Bioscience is because I believe in it, right?
JONES 21:18
So I wonder when you get to a point where you're in a much larger group, and as I'm calling on people, for example, and then maybe the CEO or the CMO is also doing consulting or part-time consulting work that they sell to other groups. So now it's kind of like, okay, you work for this group, but we're both potentially calling on the same people or even your group. I wonder--
DOODY 21:47
Right.
JONES 21:47
...what that's like because it's not the entire suite. It's just one person. It would be like if my operations manager who is in charge of vetting our project management software, our vendors also owned stake in a video company that we might use. And I wonder, do you have any thoughts on conflict of interest?
DOODY 22:07
Yeah, I think conflicts of interest--I mean, they it can be bad when they're not open and honest. I think conflicts of interest are totally fine as long as you're transparent about it. Right? So let's say--and I know this is happening, talking about IVF practices around the country--is that you'll have say, some venture that started where investors could be generalist OB/GYN doctors in an IVF laboratory. Right? And then the reproductive endocrinologist might have an equity stake or might be working as a salaried person, but there's incentive for referral from the OB/GYN to that particular IVF program because they feel like there's, you know, that they're supporting something that they've got an equity stake in. I think that's in general bad because I think that you've got a motivation for referral that, especially if you're not transparent about that to the patient as to why you're referring them, you know, it could be that you thought that this person is the best fertility specialist in town, and now he's selling some equity stake in the laboratory and you're saying, Oh, I'm investing because I know that's a good thing. All right, that's probably--but you still should tell that to the patient, right? I think more often than not, if it's less transparent, "Hey, I got approached by a venture capital person to invest in an IVF center. And I'm referring you there because I've got a stake in it." If you're giving that level of transparency to the patient, patient's not going to like that. I mean, I wouldn't like that as a patient. I'd be saying, what the heck, why are you trying to make money off of an IVF cycle and you're not even a IVF doctor or you're not providing the care? Why should you be trying to profit from that? So if you're trans--if you have a conflict of interest, and you can be totally transparent about why you've got that conflict of interest, I think you can feel good about it. I think if you're--for some reason you don't want to be transparent about it, I think that could be a problem.
JONES
It's that prevalence of transparency that is the number one thing that most people would agree with--at least would say they agree with that. Are there any conflicts that are simply too stark in your opinion? Some physicians really believe in the pharmacy owed model some really believe--
DOODY
I hate it. I hate that pharmacy owned and it gets back to are you informing the patient that you're making a profit from prescribing to a certain pharmacy? If you are, is it being hidden in a bunch of paperwork or is it just like one of these software End User License Agreement where they're not saying it? Because why would you do that? Why would you want to make money off of a business that you're not an active participant in? That's so ridiculous, actually, that I want to make money off of my patients buying their medicines. You know what? If I can't make a living off of providing medical care and the laboratory services that I, you know, sell to my patients, I think that looks bad. I don't like it.
JONES 25:15
I think I'm understanding the difference in your view with something like maybe a PGT company would be different because you're administering the PGT. Is that different? Or do you feel is that the same as physician-owned pharmacy model?
DOODY 25:28
I think it could be similar or it could be the same. If you're doing PGT in-house because it's convenient, you can offer it for your patient, a quality product for your patients at a lesser cost, and maybe you can do a fresh embryo transfer as opposed to sending it out and freezing. Okay, I get that. But if you're sending your patients to a pharmacy or a laboratory that you don't have--you're not involved in the running of it. And as a physician, you should be looking out for your patients' interests and constantly evaluating, "Hey, is this pharmacy giving my patients good service? Can I get two or more pharmacies to realize that I've got a lot of patients to give them not because I want to profit from them because I want to, I want good service for my patients." So they're going to compete against each other. No, once I've involved myself and once I bought an equity stake in a pharmacy or a PGT company, then I'm not going to be--I mean, let's be honest here. Are you going to say, well, maybe they don't have the best price, so I'm going to refer to somebody else now? No, you've got an equity stake in it. I think if you're involved in the running of it, so that you can say, "Hey, we're not being competitive enough. I'm going to, you know, we're going to lower the pricing or negotiate a better deal or," you know, you're really intimately involved in providing that service or that care. For sure, own it and profit from it. But if you're being paid for referral, which is especially that, it's essentially a kickback. Right? I mean, let's call it what it is.
JONES 27:04
I'm seeing the distinction between if the mere act is referral, then that is on one side of the line, where if one is actively involved in the management of the company, that is different because you're influencing it to the standard that you would ideally want.
DOODY 27:21
Let's go even more internal to that. I'll tell a patient, 'Hey, you have fibroids, I think we need to take them out.' I'm kind of referring that patient to me now as a surgeon, and I'm going to profit from that surgical treatment, right? As opposed to maybe you might think, oh, the person making the decision that they need surgery should not be the one profiting from the actual surgery itself. So is there a conflict of interest there? Yeah, maybe I'm referring to, but I'm at least I'm providing the service and I think I'm providing it for the patient because I think I can do a better job because I know how to do this particular surgery and I've done a lot of them, right? But I'm providing the service. And I think that's key. I know what service is being provided I know--and maybe when I'm 72 years old, I'll say hey, I know who needs surgery, you need surgery, but I'm no longer competent to do that--to be the best person for you to do it, so I'm going to refer it out. But again, it's--so I think that it's okay to self refer when you're actively doing a laboratory service or actively doing the surgery, you're actively involved in delivering the care that patients paying for. If I'm investing in a pharmacy, that's going to be selling my patient drugs, I'm going to have a bias. What good am I doing the company? What good? Did they need my money? No, they didn't. They need my referral. That's why they're selling me an equity stake. Let's be clear.
JONES 28:42
Otherwise, they'd sell me an equity stake.
DOODY 28:44
That's right. That's right. That's right.
JONES 28:51
So there are a lot of younger doctors who are having this internal dialogue right now of how much involvement they want to have. I spoke with someone who was fixing to open their own practice and when they do, they're thinking about this model. This is the ethical internal dialogue that they have to--what level of involvement might be sufficient for them to to think about it? Is an advisory role sufficient? Does that need to be explicit in its role? Well, I get to opine on this or I get to have this much involvement.
DOODY 31:02
No, I think it's okay to serve on an advisory board level for compensation, but I don't think--so I've done that before for when it was Good Start Genetics, say for a genetics company to get their input. This was when the expanded carrier screening was first coming out and they put together a group of people that they thought could give advice to them, but never was any comp and it was minimal compensation but never was linked to any referral for that. You know, I advise to pharmaceutical companies right? So I've been a consultant to EMD Serono, I've been to consultant to all the major players, including some players on the international level that have tried to do trials to get their drugs within the US. So I consult on their study design and their analysis and cetera, meet with the FDA and all that, but I feel better about doing it because I do it for all of them. Right? So you If I were to be aligned with just Merck or just Serono or just Ferring or--then that's where, first of all, I think as a company, you're more attractive to them you know, if you're doing speaking if they know you speak for other company because then you're already your audience knows that you're not in their pocket.
JONES 32:19
And that ties back to the collegial presentation as well that if one is involved in different areas, that it might be better than just talking to one group or--
DOODY 32:31
Right. And it goes with a PGT lab or the or the pharmacy if you're--I just think that's wrong.
JONES 32:39
From your vantage point, because you do business in the United States, Canada, China—any other countries?
DOODY 32:45
On a professional level, I have been involved in the professional trade org in SREI. So for SART, I've been very involved with Africa, with Uganda, and Nigeria, implementation, but these are non-for-profit-type undertakings, right? So--
JONES 33:02
So at least what maybe just from your perspective in doing business and working with other clinics--if we're maybe China, Canada or the US, maybe there's some other countries--from your vantage point, is the tendency to be involved in other types of groups or, I guess, like the kickbacks, the referrals, the things that are ethically gray, is that more or less or the same prevalent in other countries as it is in the United States?
DOODY 33:29
So I think we have rules here that are more strict than other countries. I don't--I think that there--I guess it's a mix, right? So I'm aware that in other countries, the pharmaceutical companies can say pay for the physicians to go to ESHRE, you know, to the European Society for Human Reproduction and Embryology or maybe ASRM, you know, so international travel, etc. That's not okay in the United States, so that doesn't happen in the United States. So I think that there are different rules that apply in different areas. In the US you can't, you know--so physicians are kind of weird about the kickbacks, and I think it's appropriately so. So if I refer a patient of mine to another doctor to do surgery, they can't pay me for that referral, it's illegal to do that. It's against the law. You know, there are ways that people try and game the system. I'm not--I think we kind of went into that, but it is against the law to do that and it's not the same in every specialty, right? So if you're an attorney, and you refer a client and you can actually get a kickback from it, that's okay. But, I think we treat medicine a little bit differently and we treat health care and all that and I think rightly so. I think you just don't want to have any conflicts of interest, but they do happen. So people are employed now by these big healthcare organizations that are horizontally integrated. And you've got, you know, primary care physicians who are financially penalized if they refer out of network to a specialist that might, in their mind, give them the best care for their patient, as opposed to somebody in network, but they're--I'm not going to say their hands are tied, they can do it--but they're going to get essentially discipline to reprimand it at the end of the day.
JONES 35:32
As the fertility field expands, and it becomes more than just as it already has more than dealing with simply patient cases that are cases of infertility as a result of a disease but we've had Jamie Metzl on the show and David Sable, talking about the expansion of PGT and we've also talked about fertility preservation and the demographic continuing to delay childbirth, 20% possibly of millennial and Gen Z patients being of same sex couples and needing third party--so as we just see a real growth in assisted reproductive technology, do you envision a possible future as it gets so big and the number of REIs are so small, that many REIs just have more to gain by not being in practice--whether for themselves or someone else they can be part of whatever solution and entrepreneurial venture, whether it's artificial intelligence or lab technology or anything else? Do you envision a scenario where less of the REIs actually going to practice and possibly just take the corporate route?
DOODY 36:42
No, I think for most REIs, their best opportunity to make a living is going to be doing what they're trying to do. And, you know, there's these booms and bust cycles of investment and, you know, there's a lot of seeing the stock market. Things are--and maybe I don't get it from a business standpoint, right? So I see companies that are selling for a lot of money that aren't profitable. That's very different than 30, 40 years ago, where how a company was valued depended primarily on what kind of profits they were bringing for their shareholders. And now, it's more like a game of musical chairs and the stock is valued at what you can sell it for. As long as you can sell it for more money than you bought it, then that's what it's worth. But ultimately, there's not going to be a buyer and that's when the music stops and if there's no other subsequent buyer, and it's not profitable, then it goes away. And I honestly think that's what our infertility field is doing. I think you've got a lot of people who are looking at it, and saying, "Gosh, this is a big industry, and it's cash pay to a large extent and it's untapped. And there are a lot of patients that aren't getting fertility care," which is true, right? So, you know, unfortunately, there is a decreased access to care, there are a lot more patients that need to have care than, than are getting it. And that's primarily due to the fact that it is in many cases, cash pay and it's constrained by the infrastructure and the physicians that are out there. But I think a lot of this investment and saying, 'Oh, you're gonna make--you know, we're gonna have an ability to aggregate a bunch of clinics, 'not even thinking about efficiencies with a common IT infrastructure or anything, they're not even doing that. Just saying, 'Hey, we're going to buy up a lot of clinics, and then we're going to sell it for more money for the next buyer.' And somehow that's creating value but now you've got who has to make money now to be happy? You've got to--physicians got to make money. The embryologist has to make money. That's always been the case, right? But now you've got some outside investor that's not part of the delivering of the care. That's got to make money, and maybe you've got somebody who's referring the patient who's paid for some of this infrastructure to have part ownership in it, because we're going to get the referrals and they want to get some return on their investment. And all sudden, we've taken a service, which is already expensive and we priced a lot of our patients out of it. Now, you got more people that are trying to profit from it at some point that breaks. I don't, I don't--
JONES
One doctor described it to me as everyone comes in and says that they're going to expand the pie, but they're just taking more of a piece of your pie. And to me, that's the binary success or failure of the value proposition of a business including my own. In other words, if we don't actually help people, if we don't help bring in more revenue, more patients, help patients more easily flow through the process--if we don't succeed in doing that, then all we are is a an expense. And if we exceed them, we're investment and people are happy it's more or less binary.
DOODY
Exactly. So what you have is you've got a lot of people who put their whole life and their sweat equity into building a practice. And in medicine, here's the deal, you can only charge unless you go through certain shenanigans, you're really only supposed to profit from delivering your medical care, right? So once you retire, you can kind of sell your practice, but what are you selling? You're selling your patient list, you're selling your goodwill, your brand, what have you, what are you selling--but a lot of people are my age, a little younger, a little older, and they're thinking of, you know, I've got a practice that I've built, spend a lot of effort, I want to monetize my equity somehow and somebody comes along and says, 'Hey, we've got an investor,' but ultimately, that person's not going to be practicing any longer. And so you're gonna have to have somebody delivering the medical care so you're gonna have to hire younger folks that that didn't profit from that sale. And so now you've got them delivering health care and, you know, there's only so much you can do charge for it to be competitive in the marketplace. And then how little am I going to take just to work for an established already up and running IVF clinic before I'm going to say, you know, maybe I can do better on my own, and I'm just going to start my own IVF clinic. And it's not rocket science, right? Why do I need to pay all these people who paid money to my predecessors? And IVF doesn't scale in a sense. So some things really do have a good economy of scale. So if you make software and you know, how much is one additional software license to produce? It's nothing. The cost was was in the production of the development of the software. On the other hand, medical care is quite different. And it's like serving food. So yes, there are some economies of scale that can be achieved through aggregation, but there are also complexities that arise from those from scaling and those complexities cause corruption whether intended corruption or just corruption because of complexity and create inefficiency, etc. So not all things scale well, and I think delivery of medical care doesn't always scale well.
JONES 42:10
So we've talked about some of the conflicts that can occur from commercial interests. We've talked about how to navigate some of those conflicts and framework for transparency and also which make more sense to be involved with and which might be on the far end of the spectrum might just be a kickback. And you've addressed some guidelines and some concerns--. And in concluding with our audience, who are mostly practice owners, mostly your peers, and also many fellows and people coming out of fellowship, how would you want to conclude? What are you paying attention to in the field right now?
DOODY 42:50
In my practice, what I'm paying attention to is the things that make me deliver care better, more efficiently, more value-oriented--for the patients, value-oriented--what that means is that I think Coronavirus has been a terrible thing, right? But there's a silver lining to it. So we've learned how to be more efficient and doing our consultations and our discussions and our patient follow-ups and things like that using Zoom and similar systems. And I think that that's going to continue to translate to, you know, greater efficiency, I think. I think there's been a lot of focus on clinics expanding their footprint by having satellite clinics. And I think a lot of that's going to going to contract a little bit because I think you achieve a lot of the same goals by using telehealth as you would by putting up an office that's 10, 15 minutes closer to a patient's.
JONES 43:46
And for many groups, they already were the "redheaded stepchild" of the group. It's, you know, it doesn't even have a webpage sometimes, or they don't have consistent hours and they're sending an NP out there--
DOODY 43:58
Right. And you're not going to do weekends out there at a minimum, right? So you can't--it's just not feasible to put an endocrine analyzer or, you know, or an embryology lab in every neighborhood. And so you had to centralize a lot of stuff anyway. What the satellite clinics were giving you was more convenient access primarily for new patient visits and some follow up discussions for patients in that little area. Patients were generally willing to take a little drive for their egg retrieval and maybe their hysteroscopies and procedural type things. I don't think anybody views that as a major inconvenience. So I think that this idea that you have to have a physical, large geographic footprint, I think it's going to be reassessed with this.
JONES 44:57
Dr. Doody, Kevin, thank you very much for coming on Inside Reproductive Health.
DOODY 45:01
Sure, pleasure to be here.
***
You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.