Dr. Cindy Duke is the founder Physician, Medical Director, and Lab Director at Nevada Fertility Institute in Las Vegas. While finishing fellowship, Dr. Duke began to pursue a unique start to her career in fertility: a de novo clinic for a fertility network. Combining her passion for research and patient care, she was able to form her own clinic, all while remaining under the umbrella of a supporting network.
On this episode of Inside Reproductive Health, Griffin and Dr. Duke dig into why she chose this career path and just how she was able to get a nationwide network on board. Dr. Duke also shares the balance between influencer and leader in her clinic and the field as a whole. Griffin and Dr. Duke also reminisce about Rochester, New York and the benefits of “small town” fertility clinics.
You can find Dr. Cindy Duke at DrCindyDuke.com or on Twitter @DrCindyMDuke.
Mentioned in this episode:
Bret Weinstein’s Intellectual Roundtable.
To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com.
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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 2:06
Dr. Duke, Cindy, welcome to Inside Reproductive Health.
DUKE 2:08
Hello, welcome. Welcome. And thank you for having me.
JONES 2:10
I came to know about you from Dr. Harriton's program of a few months ago in summer 2020, which was directed to fellows, REI fellows and explore different career paths for them. And then anyone that has more than a couple letters after their name I'm interested in. So anytime I see an MD MBA, I usually try to bring them on the show. When I see an MD PhD, I'm interested in. With you, you have an MD, PhD, and you don't work in academics. So I would just often assume that someone with that academic past would pursue a career within academic medicine--working in REI Division at some hospital system or some university system. That wasn't the case where you, but let's start maybe with just a bit of background of why you went both--why you went both the MD and PhD route, and then we'll go into how you went down your career path?
DUKE 3:16
Yeah, absolutely. So you know, I always intended to be a physician-scientist and I entered medical school with every intent to do a PhD, such that I applied only to MD PhD programs, and was accepted to the NIH-funded medical scientist training program. I did my MSTP training at University of Rochester in upstate New York. I spent eight years there. Fun story--when I entered medical school, I thought I was going to become a pathologist. So a lab science person, which is kind of ironic given that I ended up with a career working on the exact polar opposite of the medical spectrum, which is starting and forming life as opposed to the person examining cause of death, etc. But I fell in love with women's health and OB/GYN and reproductive endocrinology infertility, while a medical students. I had the opportunity to rotate in OB/GYN actually in my first year of med school and I was assigned to work actually at the resident clinic. But the person I was supposed to work with had an emergency and so in sort of a scramble to place me, they sent me to the fertility clinic there at University of Rochester and I met people like Dr. Queenan and I just fell in love with the specialty.
JONES 4:42
Is that Strong Fertility?
DUKE 4:43
Yes, Strong Fertility, yes, University of Rochester. And, you know, it was--for me, it was like the perfect melding of all the things I was interested in. I'm someone who loves to use my hands, and I realized that they did a lot of stuff themselves. They are still operating, not many REI operate. But I saw my first model of a fertility specialist was there in Rochester, and they weren't only doing assisted reproductive technology and the general things that you think of fertility doctor does, but they also were very much strong academicians who did surgery. And so I started just talking to them about that--talking to Dr. Queenan and he was very supportive, so were other members of the division, and so I always kept that in the back of my mind, as I continued through medical school. I, you know, after two years after doing my MD training, being the MSTP program, you then go off to graduate school to complete your graduate work. So I spent four years working on my PhD, which on the way to getting the PhD, you get a master's degree, My PhD was in microbiology and immunology, with a focus on virology. And so I spent my four years working on human viral vaccine design and development and testing them in small mammals, including mice, and, you know, primates. And so I spent four years doing that, but Rochester is so unique in their MSTP program, and that you can also design what they call your longitudinal clinical rotations during your four years. So I spent my four years rotating through all the clinics I was interested in and the specialties I thought would be of interest given my own desires, which as I entered medical school as a biochemistry major undergrad. So I was always interested in the chemistry and science of how the body's messaging functions. And so I rotated through the endocrine clinic because I was studying HIV and other viral things that infect humans and designing viral vectors. I also worked in the infectious disease clinic, rotating with a few really amazing people, including, you might know, [spelling unknown], who was pretty special when I was there. And so I did a lot of those things, pediatric oncology, all the things I thought I could potentially be interested in to make sure I wasn't pigeonholing myself with what I already knew I liked women's health and infertility. And by the time I--
JONES 8:25
So you mention that you got research is part of your career now. But why didn't you end up going into an REI division or a virology division or an immunology division?
DUKE 8:37
Yeah, I looked at all options. I think what was nice was having all this training meant that I could look at all the different avenues. So when I was finishing up my fellowship, I was--I looked at academic sort of the old join of REI Division, I looked at industry with, you know, just go straight to work with companies like say, Merck, Pfizer, Roche--these are all companies I interviewed with. I looked at straight private practice. And as I looked at everything, I realized that I had an opportunity to really create something of my own, where I can still achieve all that. The truth is also if we're talking to most academicians right now, and I really study the academic model, in terms of most of the research that's happening nowadays, as it relates to the field, a lot of it is actually coming out of the hybrid practices, meaning they have an affiliation with academics, but they're actually functioning out of the private practice side of the field. And, you know, I am the first to tell people, I really believe there's no longer a very defined academic path in the world of REI, or defined private path. I think there is tons of space for hybrid, and you look at the world of, you know, the EVs of the world, the RMA New Jerseys of the world, the Shady Groves of the world, a lot of the research that's actually driven the field forward is happening at least hybrid type practices in the United States and outside. So for me, it wasn't a hard choice, because I wasn't choosing, really. You know, you look at the people who are even academics today, many of them were actually out in private practice and return to academics as their careers grow. So I've never felt like I was, you know, somehow locking myself out of one to choose another. And I still don't feel that way.
JONES 10:32
There's a hybrid model, and then you can stratify it even further, because what would have meant private practice 20 years ago can be stratified even further today, between network or independently owned, etc. You are at the helm of Nevada fertility Institute in Las Vegas. And that's a member of the Prelude/Inception network, is that right?
DUKE 10:57
It is now yes, it didn't start out that way. Correct. So I started this clinic, we started as part of the by Vivere network. So we've certainly seen a number of acquisitions from the network management side, which is we've moved from Vivere to Prelude and now Inception/Prelude. So yeah, that's also an interesting aspect that I'm happy to talk about,
JONES 11:21
When you started--so sometimes, and for those listening that are sort of curious about how this all starts sometimes networks acquire clinics, sometimes they start them de novo, which means bringing a brand new lab and a brand new clinic to a market and building it from zero--
DUKE 11:41
This was de novo.
JONES 11:42
Yours was de novo starting with Vivere, is that right?
DUKE 11:45
Correct. Yes. So the way it worked, basically, I reached out--I started reaching out to a number of groups across the country. So around my second year of fellowship heading into my third as I prepared to start interviewing, and like I said I interviewed very broadly because I knew what I was looking for Cindy, as opposed to, I wasn't interviewing, looking just at what people were looking for in an applicant. And so somewhere around my third month into doing interviews, I realized that, you know, a lot of the questions I'm asking of practices and asking of industry and asking have established academic divisions versus private is, they're all things that only I could create if I could start a practice myself. And so I started reaching out to a number of groups. It's ironic, because one of the groups I reached out to in the beginning was Inception's predecessor, Aspire. But I reached out to a number of groups--I talked to at the time, there was a partnership between Shady Grove and RMA was short-lived, but there was the Fertility Associates Partnership, I talked to a number of different groups and ultimately settled with Vivere at the time, because one, the markets I was interested in, they were interested in. The model I was looking to start, they were very much in tune with that, which is I get to build my clinic, I get to build it out the way I'd like to manage and practice it. And so that's why we went with Vivere, which was just ironic to see us end up still ending up being a part of Prelude and now Inception.
JONES 13:21
On the entrepreneurial scale of zero to 100, on the 100 end, you might have someone that is building clinics all over the country,all over the world, maybe that doesn't even need to see patients themselves or want to because they just want to hire docs, build offices, build labs, scale the system. On a zero, you might have someone that says, don't even bring me into a business meeting, I just--give me my patient load, and I want to put in my hours, see my patients, served my cases very well and then go home. And so where does someone that is, is starting a de novo center for and with, I should say, with another network? Where do they fall in that? And what's unique to that?
DUKE 14:08
Well, I think, you know, you could fall as 50/50, some people probably will be 75/25. For me, I'm pretty hands-on from the entrepreneurial side, which I think also boded very well for my practice when all the transitions were happening because my clinic could continue to function on our side, because I was so hands-on. And so, you know, I was hands-on from the moment of design all the way to staffing, to hiring to determining salaries, all that stuff that was me involved with that. Marketing, you know, when there were budgetary constraints as certain mergers and so forth are going on, there wasn't a whole lot of marketing funds allocated. So I did my own marketing, I can say with pride, that I took the helm and marketed--social media, we you know, we're a de novo practice in a city that I wasn't born or raised in and we were still able to establish a firm footprint and name recognition because I took it upon myself to head out there and just market my practice. And so I would say, in my case, I know it's probably more like 90/10 in terms of entrepreneurial, but I grew up in an entrepreneurial family as well. So I'm not here to tell anyone that you have to be very entrepreneurial to do what I did. I think, you know, there are some people for whom they also come in. So as a partnership within a network, which is they'll have a family member or a trusted business partner, someone who looks at the business side while they start the practice, or they'll just focus on the political. I think, you know, what's important is for people to know that you can have different ratios and still make it a success. And for me, I'm a very hands-on person. And I was mentioning, I discovered that as I embarked on the interview process is--I liked being hands-on as a fellow at Yale. I was that fellow who wanted to know how our practice was running, how are we making money? How are we getting reimbursed? That sort of thing. And so, it depends on who you are, but I don't think it takes one personality type at all.
JONES 16:21
What is that other 10 worth even said, on entrepreneurial scale, you might be at 90, so why not say, forget it, I'm doing the staffing, I'm doing the marketing, I'm doing a--you know, I'm setting this vision, why even bring someone else in that can mess up my vision or that I have to split with or any, if that's the case?
DUKE 16:46
Yeah. For me, I was coming straight out of fellowship. And so I really felt that I needed to have sort of as a team member, as a partnership, people who I have done it before. Now, Vivere had only had one other de novo clinic and so we did discover a lot of learning things along the way, which I think we learned together. You know, the state of Nevada, for example, is very unique in startups. So we discovered that we discovered a lot of things. But I did want that whole--okay, there are people who know how to build their people, who know how to do some of the day to day financial aspects, so that we can hit the ground running. And that was especially important to me. You know, if I were someone who had already been practicing solo for a while, maybe I would have done it differently. But I would say that was a big consideration for me as I was coming out of fellowship, and I wanted to make sure that there was no stone left unturned in the theoretical side of it.
JONES 17:51
So, whether this option is actually widely available to a lot of fellows, or maybe it's just sometimes and a fellow says it might be with or close to one program talking to them and say, Okay, you guys are in--just pretend you guys are in Dallas, but I want to go to San Diego. Sometimes I'll hear them say, well, the Dallas group offered to start a new place in San Diego and have me, I don't know how serious that often always is. But let's pretend this is an option that's widely available to fellows or younger docs that are thinking about leaving cities, and you interviewed with--or I guess you'd say you courted or have or had them court you however--you look at the the process of a number of different networks, you took you ended up choosing one, what should people consider when they're having this conversation with potential networks to go start a de novo clinic for?
DUKE 18:54
Yeah, to be clear, I was not courted. I had to reach out to everybody. Nobody bought it.
JONES 19:00
You were doing the courting?
DUKE 19:02
Yeah, I did the outreach. I think that's actually a conversation that people need to have. Because I think a lot of the practices out there, the established networks only will court--if they courted new fellows, they tended to be male, I'll be honest, they tended to court male fellows. They didn't think to court female fellows, they certainly weren't thinking to court a fellow of color, I can say that with confidence. I know they'll agree because they didn't. Some of them weren't very excited when I approached them and told them my idea and my thought. They just didn't--they hadn't envisioned it, there wasn't a thought. But if you are interested, I would say, based on my own experience, you'd have to be front footed about it. And you reach out to people and you tell them what your thoughts are. It's good to have your what I call your no and your yes list, meaning for me, I had a sun list. So I had a certain list of cities and locations I was interested in. And I approached the different groups with that, first and foremost, which is these are the places where I can see myself and I consider them for a number of reasons, you know, size of city, diversity of city, proximity to my own family, languages spoken, those were things that I looked at when I was talking to them about different cities. But I think you really need an introspective search before you approach places about starting a new practice. Because the first question is, is this really what you want to do? Are you really prepared to do the work it takes to grow a practice? Because even if they have a phenomenal marketing team, at the end of the day, once a patient enters that door and starts interacting, a big part of what retains the patient, and the practice is who you are. And so that's a very important consideration. The other is recognizing that you will learn as you go. And you know, you describe the entrepreneurial scale from zero to 100. Well, I think there's some people for whom that thought of entering practice as I enter practice, I get a fixed sum. That's how much I get paid. And I go home and the rest of the time is my life to do what I like to do. For others. It's Yeah, I'd like to build something and build a legacy. For others, it’s I'd like to build something clinically, but I have no interest in the business side, it's really important to know all those and know upfront, because that's important. For me, I had a PhD as well. So I understood the lab side of things. I was very open and direct about laboratory studies and work. And so you know, I also had no problem becoming my lab director. I think that's a question that people also have to ask because if you're starting a de novo particularly if it's not a satellite office, meaning you don't have one central lab somewhere, then you also need to have that conversation. And you know, I have this conversation now over the last four years with a number of people who've since gone on to start their own practices or join networks, and start a new location for a network. And I think the biggest, biggest thing here is overcoming the fear. I think for fellows, especially a lot of what we're taught in our traditional fellowship is you can't start anything, you can't run a practice. And we aren't really taught the business side of medicine, nor are we encouraged to learn the business side of medicine. And so for most people, what I've discovered is more fear of starting something they were never told they could do. It's not that they can't, most people can when they're put to the metal as being able to believe you could do it.
JONES 22:37
I think that that yes/no list is not just helpful for if you want to start de novo. That's what you need for deciding any next step of your career. And I call it must haves and nice to have, nice to have some of the things that if everything else was met, it wouldn't matter if it was on there not must have rights are even if, if all of the other things were met, if this one thing isn't that, then it's no good. That's a must happen. So I think that as in what you described as some of the some of the pillars that people should have in judging your yes/no list is useful for everyone. So, you talked about it can be a bit of where it is a lot of work, even if you have a great network helping you get started, you're still the captain of the ship, and you're still bringing this all to existence. And that made me think of something I wanted to talk to you about, which is the dynamic between influencers and leaders and Brett Weinstein has a podcast and one of his shows was an intellectual roundtable--and I’ll have Katelynn link that in the show notes for anybody who's into philosophy--but he's talking about the difference between leadership and influencers. He feels that one of the reasons why we have so many challenges in our countries, because we have a deficit of leaders and a surplus of influencers. And you're in a position where you're both. You are the captain of your ship at Nevada Fertility Institute, you built this thing up, you hired the people, you put in the operational systems, you gave the direction in the lab because of your PhD background. That's leadership. And then you're also an influencer. You've got a big following on social media. You have your own website, I think you'd write for publications like Refinery 29, is that right?
DUKE 24:39
Yes, I work with Refinery 29. I'm a featured writer now with Medium, Forbes Business Council, I joined and so I write there, too. Yep.
JONES 24:38
Do you perceive a difference between influencership and leadership?
DUKE 24:44
You know, I think now I do. In the beginning, I didn't actually think there was a difference. I thought all leaders became influencers by default. And I certainly over time have come to realize that some people can be leaders but not be very good influencers. And vice versa. You know, I would say yes, everybody now calls me a medical influencer and female entrepreneurial influencer, etc. And I wear it proudly, and I take it seriously, which is I do believe that my day to day how I deport and comport myself, actually might be influencing someone who was on the fence about a thought process, whether it be a business idea, the idea clinically to you know, we know the face of medicine is changing. We know the face of healthcare is changing. And yet there are a lot of people who have an interest in becoming leaders who don't feel like they're represented. And they're afraid to take that step toward leadership in terms of traditional definition of leadership. And so I've become an influencer in that regard, which is by seeing me do it by seeing me happy at it. And I am, I'm truly happy, I don't have regrets about the path I chose or the way it's evolving. And it's important to emphasize the evolution of it is, I think, my showcasing what I've done and how I've done it and how I've navigated the path. So my journey has influenced many others to at least be brave, and take that step forward. Whether it be simply deciding, you know, what, I can become the director of my practice, the group, my practice group, I can take that step I can launch out and maybe start becoming a blogger. I can start, you know, just talking about fertility and medicine on social media. You know, unfortunately for a lot of us, when we were training, we were told that social media was scary. You have to stay away from social media. Doctors shouldn't be there, you can't talk about medicine, you're just setting yourself up for liability. But as we all know, now, social media is becoming a really important toolkit for the practice, whether your academic or private practice, writing about my experiences has been phenomenal, but not just for those who are looking to work in the field. But patients--I've discovered my patients find me that way. Many patients come to us from outside of the city of Las Vegas, and they come because of that influence, they find me because of that influence, or their family members or friends say, you've got to talk to her because of that influence.
JONES 27:34
I think your role as an influencer is given credibility by your role as a leader, I'm talking about you specifically, I also think probably a generally applicable principle. But one of the biggest problems that I have with influencership is there's so many damn people out there talking about a whole bunch of stuff that they've never done or haven't done enough reliable at. And so until you've made 10,000 sales calls, don't tell me about how to do--don't tell me about the principles of sales. Oh, yeah, hoping the customers until you've actually done it. And you can describe the nuance and the challenge of bringing it to bear to tell me about that. Don't tell me about hiring people and building a company culture, if you've never sat down-- someone if you've never gone through the arduous process of waiting to find the right person, interview, and start an interview. And which is not easy at all.
DUKE 28:29
It's a very special skill. And I'm glad you brought that up. Because yes, it's a very special skill and understanding dynamic, it also means understanding people, you know, you can have someone who on paper seems like the perfect match. And then you meet them for a couple interviews, and you start realizing Ooh, no, not because culture is critical. You know, you may have someone who on paper is ideal for the job description, but not the culture. But and vice versa. You may have someone who culturally is a fit, but skillswise, won't work.
JONES 29:05
--and it doesn't always come out right away. These are the things that you find out from actually doing and I don't know, I wonder if this is true for you, but actually starting a company actually managing a team actually creating systems and it has taught me to shut my mouth about things that I don't know that much about, do you find that at all?
DUKE 29:32
I agree, no, you learn to shut your mouth, you learn also to really become and use patience and your emotional intelligence, right? You know, you can't come into this with hubris. If you do that you're destined to actually not necessarily fail, but you're going to struggle a whole lot more than you need to. Because one of the things that I really am very proud about with my practice, and you know, we've been open now four years this November, and we have people who have been with us, or it's gonna be four years, for some, for the oldest person, she's gonna be four years here in February. And you know, the big thing that I noticed is allowing them to feel like they have a say, in the practice and the growth and the things that work and not making sure they know you're approachable. It's not your way or the highway kind of culture. And that's how things grow. Because they're the ones who are going to come to you and say, you know, Dr. Duke, in my case, I just went to like one of my samples, like I just went to a doctor's office for another specialty, yada, yada. And there's this thing that they did, that I really liked. Can we start that here. And it's been just amazing, allowing people to know that they could do that. We've had staff members who brought in other staff members, because they were somewhere they met someone and they're like, you know, I think this person will be perfect for what we're doing and our growth. And it's so important. It's something that I don't know, maybe there are textbooks that can teach that. But for me, a lot of it is what you call on the job learning you're learning as you go along.
JONES 31:08
And tying back to what we were originally talking about starting your own system. All of this is important to your building this culture. You chose the original network that you chose to start at the de novo clinic because of reasons of them buying into your vision for a culture. Your network has changed a few times, but it's not the only one. There's lots of networks that have changed and multiple times in the last five or six years. And I bet that we're going to see that happen a lot more than the next five years.
DUKE 31:38
I expect to, yes.
JONES 31:40
So how do you navigate those changes like hey, I made the deal with Sally and Rick, and now Johnny and Sue are coming In. And they've got a bit different bit--how does someone navigate those changes?
DUKE 31:56
Well, I will tell you though, as someone who's watched three transitions occur, I would say that the successful parts of the transitions always worked when the new people coming in actually did come in and say, it's my way of the highway, you know, coming in and understanding what works, what doesn't work listening, asking, What do you need? I think that is a true sign of leadership. I think another true sign of leadership is for you, the person who's on the ground. So if you're the director, the lab director, equity owner, I think the equity owner helps because people, everybody's invested in listening to you. But even if you weren't, I think, you know, it's not that mutual respect and recognizing what each person's role is, and I have to give credit to every single transition, I've never had someone approached me with any level of disrespect that didn't value my place in the practice, or my place in understanding my market, understanding how I built this and who my patients are. And I think that's another interesting thing about a de novo practice and then changes. The truth is the new people coming in are actually reliant on you, the person on the ground to describe what works and what doesn't work. And so staying quiet is possibly only going to hurt your practice. Unless your practice was already suffering, then maybe you're hoping for a change. But if not, then it's important that there be opening so they're being open to listening, what works, and you definitely sharing what works and what doesn't work about your practice. Because network or not, each market is different. Each market is different. Each patient population is different.
JONES 33:48
Would you bow out, or do you have any kind of escape plan? If it wasn't, there was a transition that was like, this isn't what I bargained for, would you wash?
DUKE 33:58
While I think it's possible, but I've also created enough contractual and legal frameworks that I don't think that will happen to me, I wouldn't have to bail on my, on something I've grown. You know, I think that it's important. So if you're someone out there looking to join a network, the important thing here is make sure you have your own legal team, your own legal team, whether you're looking to join as an equity owner, or as an employee, that is my critical advice that I give to everyone is you should have a legal representative who understands what you're doing. Now, it also helps that I have a good understanding of certain aspects of the legalities because part of doing your PhD is you're trained on the legal aspects of a number of things, including intellectual property, all that stuff. So you make sure that kind of thing is written in understanding what it means to indemnify and be indemnified, etc. And always having an escape plan, I suppose. But no, I have never felt like I was in a position where I'd be stuck, or where I'd have to just walk away.
JONES 35:04
Without discussing anything of your terms, but just in general for fellows to consider, or young doctors or anyone thinking of starting, you know, what is some of the framework, they should make sure that you mentioned that they should have their legal team, but what are some concepts that they should really be here to understand?
DUKE 35:22
Well, you know, I think for a lot of people, especially those coming right out of fellowship, or who are still very much early in their career, many times, our only focus is, how much is my paycheck, because I've got loans to pay, I got bills to pay. And so it's actually important, and I try to impress on people who are early career, literally preparing to enter the field to understand that financially, you have to think bigger picture. So it's not just what am I going to get as my take home paycheck per month. That's important, because you need to live, don't get me wrong, but you also have to consider other things, which is, what is the value of your work, let's say you're joining a practice and you know, you're going to be helping to build something, there is something to the word sweat equity. It doesn't matter how much someone's telling you about what they're putting in, you have to know what the value of your work is, and your effort and how much time that's going to take. You have to understand that you need to protect yourself on all levels when it comes to not just patient care, but any additional liability you may be taking on whether it's a rule, etc. If you're coming in, even if it's an already established practice, and they're asking you to take on a directorship, recognize that administrative work is work. And so while an off field, you know, at the end of the day, they're for profitability. They're looking at how many transfers, how many retrievals, etc. If you're taking on a director role, the time you spend away from doing all of the everyday bread and butter stuff is still worth, and it has a value for the practices, continued success for regulatory reasons, etc, you have to have a value to that. And one of the things I discovered, which is how I kept moving until I found myself the right team, in terms of like lawyers, etc, is some of the people out there who are negotiating on our behalf as physicians have no concept of that part. And some people get really carried away with the paycheck and they're like, well, you're getting paid well for your basic job, what else do you need, but there's so many other things you have to look at to protect yourself. And it's not just Oh, restrictive covenant, which I feel like is all people tell you about as a trainee, as you know, they talk about restrictive covenants, they talk about compensation. And some we'll talk about bonus structures that only have to do with physically patient care, but none of the other things that are involved including things like disability coverage and all that.
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I would be a bad fertility doctor, because I only want to take on the cases that I know are going to be successful. I only want people to say these sorts of things about me and my company, like Greg in Chicago: "Our resources are not endless. And I think that with Fertility Bridge, there's a much deeper dive." Or Dr. Young in Iowa, "I've gotten more positive feedback from patients from anything in the last 30 years of practice." Or Brad in Seattle, "You have multiple experts on your team and for, you know, a very small price to get that level of consulting for just a couple hours would be really valuable." Okay, you get the idea.
So this is how we set you up so you are 100% guaranteed to be successful in your goal over time. It's not a magical wand. Until you do this do not pass go, do not collect $200, and definitely do not get in any long term commitments or launching issues.
You sign up for the Goal and Competitive Diagnostic at FertilityBridge.com. You fill out your Business Needs Profile, we establish your benchmarks and desired outcomes. Then we meet for our 90 minute consult. We provide you with business Intel revenue estimates and a competitive overview of the field to facilitate the prioritization of your goals between your partners and leadership team. Then we have a 30 minute follow-up, we tell you exactly what you need to audit and strategize to build your plan. I'll also give you one big marketing idea that will make you say, "Damn, that's good!" If we fail to do any of these things, we give you your money back because it's only $597.
And because I need you to be successful, because I need you to say all those really sweet things about me and my company, maybe even a gem like this one from Holly and Dr. Hutchison from Arizona, "If we didn't have Fertility Bridge, honestly, I think we would be getting closer to retiring."
There's no long-term commitment whatsoever and there's a 100% money back guarantee. Send your manager to FertilityBridge.com, have them sign up for the Goal and Competitive Diagnostic. And I will see you and your partners on Zoom.
JONES 40:13
Is it okay, if we conclude with talking about a topic that has nothing to do with de novo and nothing to do with leadership is just one I loved pleasing in any single episode that I can? Is that alright?
DUKE
Yes!
JONES
To anyone listening to this episode that tuned in to your doctor to talk about leadership versus influencership, what to consider when starting to de novo clinic, you can go ahead and tune out unless you're as into this as I am, and it's about choosing cities because you have told me a couple times that you love Rochester the first time we exchanged email conversation, he said you still consider,I believe you said in the beginning of before we started recording, you mentioned that I just love Rochester, but it wasn't-- it didn't sound like it was on your sun list to me some live somewhere where it's sunny. So what were you in Rochester eight years?
DUKE 41:09
I spent eight years in Rochester 2001 through 2009. I was there for eight years. That's right.
JONES 41:16
So you loved it. What did you love?
DUKE 41:20
So yeah, I--there's so much about Rochester that I loved and I think--the first disclosure is Rochester is the first place in the United States I lived for longer than four years. So I think that's important to highlight. And maybe that's part of why it seems like home because it was someplace where I really established some roots. But also, you know, I had my brother with me. So I was that unique medical student who will help to raise my teen brother at the time when I was in med school until he went off to college. So we really form these familial bonds and Rochester. You know, him going to Brighton High School meant that we also worked with a lot of families who were just everyday people, raising families, etc. And so I really developed this network, through him being in school, but also my friends in graduate school, and then just that network growing, so I felt like I had family. I had a big community. At the University of Rochester. As you probably know, the medical school class size was never really greater than 100. And so it meant you really got to know all your classmates, you got to know your faculty doing my PhD work, you were in a lab of people who met those people. And so, you know, with Rochester, also about 15 to 25% of every graduating medical school class stays in Rochester, for training and many of them stay on for the rest of their career. So it meant that even though when I started medical school I started with the class of 2005 most of my classmates a lot of them stayed on after they graduated that first graduating class. And so I had all these friends who stayed on and I could keep growing my family in terms of family bonds for the rest of my eight year tenure there.
JONES 43:02
I'm digging into all of this because I bring it up whenever I can on the show because I'm so bullish about the smaller markets. Everybody knows I’m from Buffalo. I love it. It's my eternal home. I'm trying to die there. Right now--the reason why I'm saying here when I reference Rochester is because this is where I am now, my girlfriend studies at your alma mater, not an OB/GYN, but she's in residence here, residency here--So we’re right by Strong and I do really like it. I love small, beautiful people don't. And I feel like there's such a quality of life or someone that that might be wanting to, if you can put up at six months of love. I think that's right.
DUKE 43:46
No with a weather. But that said, you know, like, I tell people my eight years there, I didn't hate the weather. Right? I never found myself hating Rochester weather because the people the events, you know, as a matter of fact, I didn't even have a problem with winter until I moved to Baltimore because they had a different approach. So you know, in Rochester, you had to really have a true icing outside for them to say, okay, the city's gonna shut down. You know, life just went on. I think in all of my eight years there, the University only canceled classes, maybe two days once in eight years, two days total. And so no, for me, I think also I like smaller cities, which is probably why, you know, I moved to like Vegas when I was choosing a city is I grew up in the Caribbean, I grew up on an island at the time of 30,000 people, it's now 60,000 people. But when I was growing up, there are 30,000 people. I grew up in a village with 52 households. So I like that sense of people knowing each other and people making eye contact and talking to each other and having that shared sense of community. And I liked that about Rochester. I love that the University of Rochester also had a lot of things that allowed you as a student to get involved in the community. And so like, you know, as someone who was a math minor, I really wanted to keep teaching math when I was in medical school. So I taught math at the inner city, you know, tutoring and stuff. We did a lot of things that you probably wouldn't be able to do in other places because they're just so sprawling, and distance and travel will take so much time. So yes, I mean, I go back to Rochester when I can I stay in touch with all my friends and you know, I love going to Rochester Buffalo, Niagara, Canada, you know, Toronto, because we used to drive to Toronto so often for Rochester, it's still a favorite place of mine.
JONES 45:47
I pry on this, because when I speak to a lot of fellows, like you said, a lot of fellows, they're just thinking of the death and thing of the salary. And then and then the other consideration that I see hear them talking about often is the city. They want to be in New York, the Bay, Austin, and maybe 20 other cities. And I would say when--you're really seeing Pareto’s rule there were 20 cities. Well, that's not even 20% of the cities but they are taking up 80% of the fertility fellows that are graduating.
DUKE
Yeah.
JONES
And I would love for people to consider--whether it's a Rochester or a Buffalo or a Cleveland or other so many different Tucson, Arizona, Tulsa--Places like this, because, you know, the same things that you mentioned, we live right by the University of Rochester. And last night it was 75 degrees, which is normally not.
DUKE 46:42
Not in November.
JONES 46:45
But my girlfriend I go for a bike ride along the Genesee River. Beautiful Rochester campus and you see that you can see the city skyline from right, that's it. There's just so much here if you're willing to look past some of the or if you're willing to forego just some of the top things.
DUKE 47:06
Yeah. It's a very collaborative city. And that's something I mean, so I graduated from Rochester in 2009. This is the year 2020 COVID happens. And one of the first things that started I started thinking about well, oh my gosh, there are these unique research questions you can ask. And so I reached out to my then PhD advisor who's now the Dean for Research, so that probably helps, but I was like, Hey, you know, I have some ideas. Do you know anyone there who's doing COVID or might have folded tissue? And he was like, Oh, absolutely. And you know, within a few days, I was on zoom calls, coming up with grants, ideas and grant applications, etc. I'm in Las Vegas, mind you. They're in Rochester, New York. And it's the very thing I remembered from even when I was doing my PhD work, which is they're extremely collaborative. It's a great place to grow. You're nurtured. You know when I was in graduate school, Sorry, in fellowship, I applied for a grant. And I needed it was a crowdfunding grant. And so I needed to practice enough of my grant pitch and all that stuff. I didn't practice that with people from you. I practice that with my people from University of Rochester, they were on Zoom with me two Sundays in a row. And before that, they were reading over my grant for my application, and so forth. And then they were on the phone with me two Sundays in a row on zoom. So I can do my pitch, I can prepare my pitch, I can get feedback about media presentation, I'm pitching. And so I think you know, many people that I'm talking about Rochester, New York here, but I hear the same for a number of other cities around the country. And my hope is that the fellows who are listening, consider that, you know, I know it's glitzy everybody wants to finish, and go join the big practices we've heard about, we want to go work with the big people we've met at the conferences, I will tell you, the big people at the conferences will still know you if you're at other places, doing amazingly well. And your family's happy. And schooling is great. And cost of living is affordable. For me, you know, I love New York City. I'll visit New York as many times as I can. But for me, what I really had concerns about was quality of life based on the quality I was looking for. I was concerned about the cost of living, I was concerned about how long my commute would be. And I'm saying all that as a single woman I I was concerned about all that. But I was like I don't want to trade that but I might be in a different mind space as well. I just wasn't interested in that kind of struggle for someone coming out of fellowship to start and having to spend hours because you didn't that wasn't an interest for me at all.
JONES 49:54
If any one wants to hear more about that, but they want to hear more about leadership versus versus influencership or starting a de novo clinic and what that leadership role is like, we're going to link to all your info in the show notes. Dr. Cindy Duke, thanks so much for coming on Inside Reproductive Health.
DUKE 50:13
And thanks for having me.
***
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.