fertility clinic reviews

A Stern Warning for Fertility Clinics Who Complain About Patient Review Sites

By Griffin Jones

"Change is not painful. resistance to change is painful."

Consider this a gentle "love tap" from a friend. 

A direct warning from me is far milder than what the market has in store. If I don't speak up about this single issue now, then I am neglectful in my duty to help protect the field of reproductive health from cultural and technological shock, because the internet-led market has proven to be unforgiving.

easy part.jpg

When I entered the fertility world, I accepted the responsibility of preparing those inside the field from the disruption coming from outside. I built a company to help bridge the gap between the status quo of reproductive health and what's happening in the rest of the tech revolution. So that we're not dealing with contemporary business buzzwords, allow me to give this definition to what entrepreneurs and venture capitalists call "disruption":

  • Major enterprises losing double-digit market share or going out of business within 36 months due to brand new players who come from outside of their field. 

ONline reputation is hardly the tip of the iceberg

This article does not come in reference to any one particular conversation I've had (perhaps even with you) in the last few months...because I've had several. Some have been with clients, some with vendors, some with strategic partners; it's a recurring theme.

When I first started creating content for fertility practices, the topic of "online reputation" is what really piqued the interest of fertility doctors. Many of us are concerned with what people say about us online. We often find the comments to be unfair, untrue, or at the very least, unkind. As we explore, however, you may agree that the root of the issue has less to do with the comments of others and more to do with a strategically flawed grasp for control.

Technological and cultural change are sweeping through nearly every facet of society. We are dissecting online reputation in this instance, simply because it happens to be a very common pain-point. In this deep-dive, we closely examine

  • The cause behind the information shift of the last twenty years
  • Why patients have embraced it
  • The four principal reasons that practices have NOT embraced it
  • Why patients rely on social proof to make decisions
  • The real threat to a fertility center's online reputation
  • What to do once we've stopped resisting 

Many doctors tell me that negative reviews upset them to the point where they can't sleep. You've done everything you could, and if you could wave a magic wand, you would wish for nothing less than for your upset patient to have a healthy baby and a happy family. Before we separate your perspective from the patient's right to have and share a completely different perspective, let's first examine the informational shift that has happened over the last two decades.

the human need to move away from information ASYMMETRY

For any patient to think that she or he is more qualified to review her or his case after a few hours (or even hundreds) of internet research, must be insulting. If you're a fertility doctor, you've gone through four years of undergraduate studies, four years of medical school, four years of residency, and three years of REI fellowship. That's fifteen years of higher education, followed by some of the most demanding board exams in medicine. If you've grown accustomed to this legacy of information control, it's because you've worked extremely hard to do so. 

Information asymmetry, wherein the seller (provider) almost always has an information advantage over the buyer (patient) is wonderful...when you're the seller. Recall other pre-internet situations in which you have been the buyer. Call back to a time when you had to buy a car when only the car dealer knew the manufacturer's suggested retail price (MSRP) or its pre-owned history. Think of buying a house when only the realtor knew the last sale price, its home improvements, and recent sales in the neighborhood.  How did that feel? The best real estate agent in your market has a lot more experience buying and selling homes than you do. She may also be a very authentic and trustworthy professional. Does that mean she should expect you not to use Zillow and Trulia? You don't need me to explain the deep-seated human need to shift from information asymmetry to information parity. As consumers, we do it every day.

For over a century, virtually the only way for someone to obtain in-depth knowledge about any given medical condition was to attend medical school. Like our example of home-buying, patients had a scarcity of information, few provider choices, and no means to talk back. Contrast that with our very different world today.

The drive toward information parity

change coming for ivf centers

When I was a kid in the early 1990s, I wanted a million dollars so I could buy my own video game arcade. Now I have one on my phone (that I have never used). Every one of our patients walks around with a super computer in his or her pocket at all times. Within sixty seconds of being diagnosed with infertility, one can

  • Read various definitions of infertility
  • Study the most common causes
  • Research potential treatments
  • Compare providers
  • Watch video explanations from medical doctors from around the world
  • Find humor and relief from satirical and artistic content
  • Connect with thousands of other patients via social media

Information asymmetry is over. Forever.

patients often need to rely on each other 

Some of us are frustrated that just because our patients have access to virtually limitless information, that does not qualify them to make any diagnoses or prognoses. Correct; they are not medical doctors. They don't have to be. They are human beings with opinions and emotions and they have a right to share their experiences with each other. They frequently have to turn to one another for social proof to help them assess this information.

Also known as informational social influence, social proof is the psychological phenomenon where people rely on the actions and opinions of others to determine the appropriate behavior for a given situation. Talk about ambiguous social situations! What is the appropriate mode of behavior when someone learns that they've been diagnosed with infertility? When they've paid $18,000 of their life savings for two failed IVF cycles?

Social proof may be even more necessary for those dealing with infertility because of the tremendous social pressure to have children. When so few people in one's social network can relate to what they're going through, our patients frequently have to turn to the internet to find those who can empathize with their emotions and relate to their experience. 

information parity meets social proof meets technology

Imagine having to spend thousands of dollars of your own money on fertility treatment, and having no way of knowing which doctor or clinic could be the best fit for you. Along comes a fantastic user experience (UX), with sleek design and fields of search deeply relevant to those struggling with infertility. 

I don't own any equity in or have any commercial partnership with Fertility IQ at this time. Yet when I set myself free from my own desire to have perfect control over my paying clients' online ratings, and put myself in the position of the patient, it's easy to understand why they are using the platform in the hundreds of thousands. Instead of comparing apples to oranges on Google reviews, RateMDs, ZocDoc, Vitals, HealthGrades, or even Yelp, people with infertility read verified experiences from patients by their

  • Age
  • Diagnosis
  • Type of treatment(s)
  • Number of treatments
  • Success or failure of each treatment
  • Income level
  • Number of doctors seen

Complaining about Fertility IQ or any other review site is not as trivial as disliking a website. It's partaking in the exhausting struggle against what patients desperately seek. It is the hubris attempt to fight the human drive to move away from information asymmetry toward information parity. The market, whether through Facebook, Instagram, FIQ, Google, or any other platform will find a way to give it to them. It does not give a damn if we are inconvenienced.

the four main reasons for resisting patient reviews

Tech disruption in infertility field

I won't tell you to let go of control because we can't let go of something we don't have. If Muammar Gaddafi, the despot who antagonized western powers for decades, couldn't suppress social media, how could we? Why would we want to?

Well, after hundreds of conversations with fertility doctors, nurses, and practice managers, I've identified four principal reasons that we yearn to have control over what people say about us online, leading us down the path of most resistance.

  1. What we do is so hard and complicated. People don't have a right to criticize what they don't understand
    Consider the phenomenon of flight. What a magical experience. Distances that would have taken us weeks to travel a century ago, now take us a few hours. Instead of physical exertion, we're served snacks and alcohol while we enjoy unlimited entertainment on our personal supercomputers. The logistics, expertise, and technology required to provide this luxury to us are overwhelming.

    Left to my own devices, I would be lucky to mount a camel for a few miles. I still hate United Airlines, and so do you, and so do millions of our peers. Could we do a better job piloting, procuring maintenance for tens of thousands of aircraft, and maintaining schedules for tens of millions of travelers? Absolutely not. Should we have any right to complain when we're inconvenienced by what is still a tremendous luxury compared to the alternatives? Should is irrelevant; we do have the right, and we frequently exercise it. We are citizens of countries where free speech is (meant to be) protected by our constitutions. 

  2.  These reviews are fake
    Of the four reasons for resistance, this is the most legitimate, if the review is in fact illegitimate. False reviews are a real problem. Up to 15% of online reviews may be fake. If you are certain that a review is not from a patient at all, but from a competitor or an internet troll, flag it for review. I recommend flagging the review from more than one user account. At Fertility Bridge, we see fake reviews rear their ugly heads, and aren't always able to get them taken down. It's unfair and it pisses me off too. Because at least 85% of our reviews are authentic, let's focus on what we can control.

  3. Only unhappy people leave reviews
    A widely held assumption among fertility doctors is that IVF center reviews are overwhelmingly negative. This simply isn't true. In an analysis of 504 fertility clinic reviews, conducted by Fertility Bridge in 2015, 63% of reviews were positive and 37% were negative. Yes, there are reasons that people are motivated to leave negative and positive reviews about their practices. Someone may not have been able to become pregnant and want to take it out on you. Others may sing your praises because they were pregnant. Still, some centers are able to minimize their negative comments and maximize their positive ratings; that is our goal.

  4. Negative reviews use libel and slander
    If you'd like a good laugh with your morning coffee, read RateMDs' FAQs for doctors. In 12 paragraphs, they tell you how you can go pound sand if you think you're going to sue them. Vitals and HealthGrades do too, but RateMDs is the most humorous.
    Sometimes reviews violate the platform's terms of agreement by using hateful or vulgar language, and the site will remove them. Most of the time they do not.

the greatest threat to the accuracy of your reputation

Once we've moved beyond our four cardinal motives for resisting public feedback, we can focus on the real liability to the accuracy of our online reputations.

Last summer, in a summary of fertility doctors' responses to their online reviews, I corrected the old adage, "the customer is always right," to "the patients (plural, meaning the market) are always right". I'll use my own company as an example. Fertility Bridge served eight IVF clinics in 2016. If two of them were dissatisfied, one held a neutral opinion, and five were delighted with the service they received, I might be able to identify a few patterns. But what I would really want to do, is increase the volume of evaluation. Eight sources of feedback? Better than three, I guess. Thirty would be a heck of a lot better. 

The same is true for an IVF center's online reputation. When a fertility doctor has two scathingly negative reviews, one luke-warm review, and one glowing review, the public doesn't have enough information to accurately judge this physician. Very often, fertility doctors have unfavorable online profiles because they simply don't have a high enough volume of reviews on that particular platform. Forget these four motives for distrusting online review platforms; lack of volume is our worst enemy. The higher a clinic's volume, the more likely their reviews are to be positive. Period.

what to do now

Okay, Griffin. We've stopped resisting. We have a high volume of reviews but our ratings are still low. We still hate this. Make it go away.

disrupting the fertility field

If we've truly made it thus far, then we have the best road map for operational/personnel adjustments that we could ever ask for.  We have data to identify the most common problem areas in our practices and fix them. That's right, the same platforms that take control away from us give it right back...if we choose to act on it.

In my opinion, no review site makes it easier to evaluate customer service patterns than Fertility IQ. Clinics are rated by 

  • Operations
  • Scheduling
  • Billing department
  • Nursing Team

Physicians are rated by

  • Whether they treated their patient like a person or a number
  • Communication
  • How often they saw their patients at appointments
  • Response time

When we can measure how patients adore our nursing staff, and their disappointment in when their calls are returned, it's a lot easier to smoke out capacity-related issues that hinder the excellence of our practice experience. Of course we don't have to wait until patients leave our practice to listen to their stories. We can use tools like Press Ganey or Rep Check Up to solicit patient feedback, in-house. Public ratings are the final word, however, and in the eyes of the public, perception is reality.

a new review site is barely a baby serving of disruption

We've hardly seen the tip of the iceberg, my friends. If we cannot adapt to the reality of how patients use the internet to share their experiences, we are not long for what is to come. Regulation has sheltered healthcare from many of the market effects that have impacted other areas, but it won't hold forever. The executives of Zoc Doc, Vitals, and Health Grades are not worried about awkward run-ins at ASRM with physicians who subscribe to their premium offerings. They are interested in being the marketplace where patients find their providers.

FertilityIQ was started in the birthplace of many other innovative tech companies, the San Francisco Bay Area. It was started in the way most disruptive tech companies are, from outside. FertilityIQ doesn't receive funding from IVF clinics. They didn't need our permission to build their company and patients don't need our permission to share their experiences on their platform. This is what disruption looks like. Thousands of entrepreneurs are chomping at the bit to change healthcare in their own way. If we stay in the habit of yearning for control that we don't have, we will wistfully long for the days of unfavorable online profiles being our biggest pain in the neck.

Blockbuster Video chose to be nostalgic about the adventure of going to the video store. Netflix didn't. Marriott could have invented the world's most used lodging app; AirBnb was happy to do it instead. The largest taxi companies balked at the idea of hundreds of millions of passengers choosing to ride in a strangers' car; Uber bet the pot on it and became a multi-billion dollar company.

We are presented with an incredible moment in time to use new market opportunities to build the most successful versions of our practices. I started a company inside of our field, rather than outside, because it is far more agreeable to strategically adapt to technological and cultural change than to be rocked by the market. This is just advice, you certainly don't have to take it. Before you decide anything though, you might ask yourself if what you do now will make you right or wrong in the context of history.

-------------

To learn more about how to improve your fertility practice's online reputation, and to adapt to new patient behavior, download your free copy of the Ultimate Guide to Fertility Marketing

Why did these 9 patients just leave word-of-mouth referrals for their fertility doctors on Instagram?

By Griffin Jones

**Fertility Bridge does not endorse any of the programs or doctors mentioned. They come from responses from our Instagram community**

"The only thing that matters is the lab"

That's what a board-certified reproductive endocrinologist (RE) told me over lunch at the 2016 American Society for Reproductive Medicine (ASRM) annual scientific congress. "The patient experience doesn't matter. The only thing that matters is if they get a baby or not." My efforts to show him all of the evidence to the contrary were fruitless. That was the end of the conversation. Why try to convince the inconvincible?

In some perverse way, it excites me when people are so neglectful of what our patient population demands. Meritocracy might be a lofty ideal, but I love working with fertility clinics who take IVF cycles from people who think like that. A slop-eating grin came over my face as I stared at his plate and thought of the perfect metaphor:

I'm going to eat your lunch.  

Who are they and what did people say?

Who are they and what did people say?

Satisfied don't mean delighted

A 2014 study by Software Advice states that 61% of patients evaluate their new doctor before their first appointment. Over 40% of new patients of Fertility Bridge clients confirm having read online reviews before scheduling their first visit. Nearly 30% say they were referred by a friend.

Bain's Net Promoter System suggests that patients can be divided into three categories across a satisfaction scale from 0 to 10. The single question is, "how likely are you to recommend our practice to a friend or family member?" Those who answer between 0 and 6 are called detractors. They actively discourage others from coming to your practice. Those who respond with a 7 or 8, are labeled passive, because their referral rates are less than 50% of those who respond with a 9 or 10. Finally, those who respond with 9 or 10 are promoters, people who sing the practice's praises to anyone who will listen. You can read more about using your practice culture to turn patients into promoters in Chapter 2 of the free e-book, The Ultimate Guide to Fertility Marketing.

I know many of these promoters very well. They brought me into the field of reproductive health in the first place. After all, people don't get so fired up after they buy a power washer from the Home Depot. So, among thousands of people in the trying-to-conceive (#ttc) community on Instagram, who are actively undergoing or pursuing fertility treatment I asked them the question. Would you recommend your fertility clinic, and why?

1). By Name in New England

Absolutely and I actually have. The first place we went to was terrible and I've shared that with people who have asked for recommendations. I wish I had done some thorough research beforehand but I wasn't aware how common infertility is and how many clinics were out there. The second place was beyond anything I could have hoped for! We saw Dr. Gargiulo at the Center For Reproductive Care (CRC) in Stratham, NH. We are less than an hour away from Boston which is home to some of the top hospitals in the country so we fortunately have a large number of places to choose from. The entire staff at CRC was absolutely fantastic.

I was greeted by name every single time I walked into the office and the nurses were amazing when it came to making the entire process less stressful and knowing when to crack a joke to lighten the mood. The thing that really set CRC apart was the welcome packet. In addition to the typical insurance forms they included an illustrated book that talked about how to talk to all of the different people in your life from co workers to your spouse. Also, they make sure to include that due to the sensitivity of this journey, no one under the age of 18 is allowed into the office for any reason. Reading that one policy was the moment I knew we had finally found the place that truly focuses on their patients and not their numbers.

2). Memorable in Montana

I totally would! I should mention, my RE and her partner are the only ones in the state. Even if she wasn't, I would still recommend her. Her name is Dr. Stacy Shomento with Billings Clinic. Dr. Shomento is in Bozeman, and that is the staff I know and love! She has a pile of patients, but always gives you lots of time and takes a personal interest in you. She also has a stellar, amazing, outgoing staff. Infertility is very personal and invasive. Having a comfortable relationship with the medical staff is a must for me.

She took the time to make personal connections and remembered us, not just our chart. Really, because RE's are so busy, you end up dealing a lot with your nurse, so they really need to be awesome.

3). Compassion in California

I totally would!!!! Coastal Fertility in Irvine, CA is the best! So compassionate. Dr. Werlin rocks!!! He's amazing!!!

4). Knowledge in New Jersey

I would. More specifically, I would recommend my doctor, even though all the doctors are great. Dr. Marcus Jurema from Reproductive Medicine Associates of New Jersey (RMANJ) is what every reproductive endocrinologist should be. I'm thankful I have him in my corner. My doctor is part of RMANJ and was originally with IVFNJ before the merge. I've had several issues with several staff members with both practices.

There's very little communication within the company within different departments (billing, nurses, etc). I'm sure that's because the company is just so big. With that being said, RMA has the best labs in the state, maybe the East Coast. Because of that, I can't leave. Plus, my doctor is amazing.

He teaches as he goes. He knows I need technical info, good or bad. I can't have anything sugar coated. I'm a medical assistant so I research everything. He knows that and will give it to me straight, while also holding my hand through the bad stuff. He's been with me from day one, with every cycle and every loss.

5). Benign in Boston

We switched doctors for our last round of IVF, but we stayed at the same clinic, IVF New England. The nurses are magnificent and since that's who you're interacting with the most, it's invaluable. I never felt like a number there, even though they're a bigger clinic. I always knew I was in good hands, even after 4 failures with my first doctor. It took me a long time to decide to switch. It broke my heart to try someone new, because I trusted him implicitly.

My new RE, Dr. Pauli is amazing. I don't regret not going to him sooner but I'm so glad I did. We were successful on our first round with him and I'm currently 11 weeks pregnant. I love that both doctors called with results of the bigger tests (pgd, era etc) and called to check in on us. Dr. P. called me once with results while he was on vacation.

I have nothing but good things to say about IVFNE. They're not perfect, and some of their methods aren't for everyone. But they are perfect for us. Even if we never got pregnant, I wouldn't feel any differently.

6). Education in the OC

Yep!!!! HRC Fertility in Newport Beach!! I think the best thing about HRC is the coordinator is amazing financing and they can do preimplantation genetic screening (PGS) with a fresh transfer. My doctor was very, very busy all the time, but he did give me pregnant the first time. He never did an ultrasound which I thought was odd but I love the girl who did my ultrasounds.

My doctor was always kind, and answered all my questions but the relationship was definitely not personal. I don't care about that; I want results, and he provides results.

My tech was wonderful because she would walk me through exactly what she was doing. During stims, she would explain what she was counting, what she was looking for, and what she saw. Same after I became pregnant. They followed me for 11 weeks.

7). Making changes in Maryland

Our first one, absolutely not. We were a paycheck at [a very large fertility practice group] and never felt like patients. Our RE told me that our son "must have been a lucky egg and I wanted to go cry in the car, go ahead". It was the worst year of my life. My new doctor, Dr. Mary Ann Sorra with Natural Fertility, actually held my hand when I was put under for a laparoscopy. It feels so nice to finally be cared about.

8). Looked After in Louisiana

Definitely. Arklatex Fertility and Reproductive Health with Dr. Vandermolen. I just felt like they're all so patient. Any time I had questions, I could call the nurse and she would call me right back. They knew me by name. The success rate for the doctor is pretty high, which is always a plus. When I first went to him, he told me what was going on. I felt like I had options instead of having him tell me what I was going to do.

9). Genial in Jersey

Absolutely! RMANJ, because of their lab. I was told I was going to be treated as a number, but on the contrary, I got to talk with my RE personally. He even called me right before my egg retrieval to know how I was doing. The nurse was always on top of things and answered me right away.

The transfer was very detailed oriented. They addressed yeast infections and progesterone levels while my previous clinic always dismissed my concerns.

"A great lab is necessary, but not sufficient"--Jake Anderson-Bialis

While I chose not to include the names of these volunteer promoters, they are perfectly willing to share their experiences with thousands of other people in the infertility community on Instagram. We often believe that people only recommend their IVF center online if they become pregnant or have a baby. We're told that they'll leave negative comments if they have a failed cycle, but research from Fertility Bridge and Fertility IQ show that that's not exactly true.

True for almost every fertility clinic review we read.

True for almost every fertility clinic review we read.

"No question, if a patient has a good result, they're more likely to recommend their fertility doctor/clinic," says Fertility IQ co-founder, Jake Anderson. "With that said, when we look at patients who had failed cycles, it's very clear who is likely to recommend the doctor, and who definitely won't."

It seems that the contrapositive is also valid; when we look at patients who've had successful cycles, it's clear who will be the source of future patients in the form of word-of-mouth referrals. Many people have success at their fertility centers and are "satisfied", but we see in these recommendations that it's compassion and personal connection that turn former IVF patients into zealous promoters of their practices. So the next time a competing fertility doctor tries to convince you that the patient experience is meaningless, and clinical outcomes are all that matter, don't feel disappointed when you can't change his mind. Eat his f'ing lunch.

_________________

For strategy on improving the patient experience, read chapter 2 of my free e-book, The Ultimate Guide to Fertility Marketing, by clicking the button below.

 

 

 

The 7 Worst Responses to Fertility Doctor Reviews on the Internet

By Griffin Jones

"The customer is always right"

Who knew this hyperbole, coined by Harry Selfridge in 1909, declaring his department store's commitment to customer service, would go on to become a thorn in the side of employees everywhere? It's a terrific internal mantra to aspire toward, but it can be very harmful when interpreted as a universal rule. Customers, or in our case, patients, may sometimes project their frustrations on to you or your staff and no one has the right to be abusive to your team members. Maintaining the notion that a single patient's point of view is infallible can put unfair stress on our employees. Gordon Bethune, former CEO of Continental Airlines, says that when companies don't support their employees when a customer is out of line, resentment results and service deteriorates. If we don't care for and support our staff members, how can they in turn care for and support our patients? 

I can't say I agree with the first part of this sentiment, but certainly the latter

I can't say I agree with the first part of this sentiment, but certainly the latter

In the case of public reviews of our practices, feedback isn't necessarily valuable when it comes from a focus group of one, but rather when we observe recurring themes from multiple people. The patient (singular) might not always be right, but the patients (plural, collective) are ALWAYS right. We should err in favor of the patient's perspective because it defines for us a higher standard of performance. But how do we respond to a negative comment when it's just plain unfair or untrue?  If you know in your heart of hearts that a particular reviewer is in the wrong, and you've truly done everything you can to make things right, you don't have to respond at all. If you're uncertain, or you want to publicly affirm your practice's genuine concern for every single patient, I have a better axiom for you:

"the patient might as well be right"

Remember, we're dealing with the court of public opinion. Miranda rights apply; anything you say can and will be used against you. For that reason, I'm concerned with the way many practices (cough, physicians) react to defend their case. Prospective patients reading our reviews have no way of knowing what really happened within the walls of your office. They can only judge us by how we respond in kind. Instead of winning the benefit of the doubt, we may say something to fall out of favor.  What's worse, physicians frequently disclose protected health information (PHI) when they attempt to argue their side of the story. To show you just how much our words can produce a completely undesired effect, I pulled seven real-life examples of how fertility specialists and practice administrators have answered negative public criticism. Warning: they go from bad to worse.

7 worst responses to fertility doctor reviews on the internet

7). Less is more

This response starts and ends just fine, but the physician gives into the temptation to make a correction. Responses to negative reviews are not the venue to discuss treatment protocol, or success rates, for that matter. The first two and last two sentences would have been fine for this response. Keep it short and take the conversation offline.

6). some battles aren't worth fighting

I didn't include the review here because it was very long. It was indeed an attack on the doctor himself. For that reason, it's better not to respond. We should respond to all negative reviews where we can at least offer a resolution, and none of those to which we cannot. When the commentary is a direct attack, nothing can be gained from turning the monologue into a dialogue, especially when it is the only response on the page.

5). Let your positive reviews speak for you...not the other way around

We don't get to determine if a reviewer's post is "excessively negative", our readers do. People browsing the page will notice when most people have a very high opinion of us. Pointing it out to them makes us look defensive. Besides, referring to this patients' initial consult and following correspondence discloses PHI.

4). Let it go, just let it go

As you can see at the top of this review, this doctor has a stellar online reputation. This is one of his only negative reviews. He doesn't need to defend his honor, his most delighted patients have already done that for them. Still, the response goes on to drag out the argument and include PHI. Very dangerous. 

3). No one can tell patients how to feel

"Just relax" or "stop worrying and it will happen" are two phrases that our patients unequivocally detest. Though likely not intended this way, insisting that a patient's bad news was delivered appropriately, when he or she feels the opposite, follows a similar vein. The practice's rapport is undermined and once again, more PHI.

2). No, seriously. let it go

Another REI, whose patients overwhelmingly love him otherwise. Responding to this single negative review in this way leaves a poor impression that is probably not representative of who he is as a physician. I don't see any of the 18 identifiers of PHI in this exchange, but it strikes me as an unnecessary risk.

1). I know it hurts, it's just not the place

I didn't include this review because the response is plenty long as it is. Besides, the doctor painstakingly recaps everything. I won't mince words, this is the worst response to a fertility center review that I have ever seen. I don't necessarily fault the physician for feeling this way. These comments seem to have really hurt him. He may have really cared about this patient and put forth his best effort to provide her with exceptional care. It sounds like he wanted to be completely transparent about the potential outcome. The patient didn't receive it that way, and that must be terribly disappointing. It's simply not the appropriate place to express one's disappointment. This response is one of the only accounts that prospective patients have to judge this physician's personality. Without knowing anything else about this doctor, fertility patients are left with a very poor impression.

hold your fire

You have three options when someone leaves negative criticism about you or your practice. You can

  1. Not reply at all
  2. Have a trained, neutral representative answer on your behalf
  3. Wait until your head is clear enough to leave a brief, solution-oriented response

I don't share these seven examples with you in jest. The way in which our words can betray us is a very serious concern. It's a threat to your brand and often, a legal liability. What may feel vindicating for a moment could be disastrous to your public image for a much longer time. Your time and energy are better spent on constantly adapting to collective patient feedback and delivering the best possible experience to the people you serve. You have my permission to give yourself permission to not be perfect. While it's necessary to devoutly heed collective patient opinion, there are times when you just aren't able to please certain individuals. Our goal in responding to negative reviews is not to defend our case in a particular incident but rather to show that we deeply care about how our patients perceive their interaction with us.

You can read my six critical rules for responding to negative reviews right here. If you want to reply to a negative remark that someone made about you online, and you don't want to make matters worse, just send me an e-mail or give me a call. We'll write a much better response that could make the patient feel better, will hopefully make you feel better, and will certainly make prospective patients feel better about you. 

 

What 22 Infertility Bloggers Hated About Choosing Their Fertility Clinic

By Griffin Jones

"a prudent question is one half of wisdom"--francis bacon

Recently, someone who is very involved in the field of infertility reinforced what hundreds of patients have told me for two years; there's an astounding gap between the way many fertility practices deliver their services and what patients want and expect. That's exactly why our company has the word "Bridge" in its name. According to a study conducted in 2012 by Forrester, 80% of companies say they deliver superior service to their customers. Meanwhile, only 8% of those companies received a superior customer rating. If you're seeking treatment for infertility, the delivery of the services you receive should be nothing less than superior. No clinic is entitled to your selection. Even in states and countries where some rounds of IVF are covered, there are still many circumstances in which you could pay tens of thousands of dollars of your own money. If you live in a large enough area, or are able to travel, you have a choice. Your choice isn't an easy one to make, given how much is at stake. I don't own any fertility centers (...yet), but because we direct their marketing based on what you tell us, I'll speak about them in the first person voice.

Getting out of our own way

infertility blogger round up

As fertility practice groups, we sometimes spend a lot of money in an attempt to help you make that decision. Or at least we think we do. Sometimes we try to grow our practices without any strong understanding of what you need to feel comfortable (and eventually very satisfied) to move forward with treatment at our center or someone else's. We frequently forget that there is a simpler way of earning your choice. We could remove the unnecessary challenges, annoyances, uncertainties, and causes for anxiety that you face when you are searching for a fertility specialist. How do we build not just a proven marketing system, but an entire practice culture, around what goes through your mind when you debate coming to our clinic, another practice group, or seeking no treatment at all? This is a laborious and continuing process, but I had a crazy idea of where to start when I entered this field, and I decided to do it again.

I asked you.

In early 2015, I wrote a report from interviews with several infertility peer support group leaders. This time, I decided to ask over twenty prominent infertility bloggers to candidly answer the same short question. One question isn't enough to understand everything involved in how you decide which practice will play this instrumental role in your life, and what we need to do to make you feel very good about that decision. We need as much feedback as we can possibly get. We need to ask follow up questions, issue patient satisfaction surveys, read what you say anonymously about us online, take action on your collective input and repeat that process forever. Still, in their own right, the candid answers of several different people to the same question is very insightful. I chose bloggers because they have not only a wealth of personal experience, but also because they are each in contact with hundreds of other people who deal with infertility. They are on the pulse of the infertility community. As you'll read, there are several reasons why people choose clinics, and they're not mutually exclusive. 

20 infertility bloggers all answered one question

20 infertility bloggers all answered one question

What was the most annoying part about choosing your fertility clinic?"

OVERWHELMING OPTIONS

In Due Time , @caroline_induetime 
"There are too many clinics to choose from. It's so hard to choose one".

No Bun in the Oven @nobunintheoven 
"Choosing a fertility clinic is an overwhelming experience because it's an expensive process! The most annoying part of finding my clinic was finding reliable experiences about the doctors. Where is the Rate My Fertility Doctor website? Where can a couple go to find real life experiences on these professionals who are getting paid tens of thousands of dollars for treatment? It was hard to find and we were ultimately left shopping at several clinics before finding the 'right one' for us".

Hoping for a Best@hopingforbabybest
"Wondering if you made the right choice".

Anonymous 

"Just scared of making the wrong choice".

UNCLEAR COSTS/BILLING

Smart Fertility Choices, @SmartFertilityChoices
"It was difficult to understand the entire cost involved in doing a cycle".

Rad Kitten@RadKitten
"Cost first and foremost. Second is beside manner. I'm not just a paycheck, I'm a person".

TTC a Taxson Baby@ttcataxsonbaby
"The most annoying part about choosing my fertility clinic was finding out that they don't take either of our insurances! Annoying and frustrating"!

Happiness Glass@happinessglass_
"That insurance dictates where you can or cannot go. Also I chose based on location/convenience to me rather than quality of service".

Amateur Nester, @amateurnester
"I found it frustrating that most clinics didn't have their costs listed on their websites. It would have made planning much easier if we'd had this information up front".

Its Positive Living, @its_positive
"Insurance (not having many options to chose from in my network/being tied to my network ... I have an HMO)".

THE RIGHT FIT WITH THE RIGHT PERSONNEL

The 2 Week Wait, @the2weekwait
"It was finding both a doctor and suggested protocol I truly felt enthusiastic about. To me, success rates can be manipulated, other patient opinions can vary and ultimately - nothing is more reliable than your own gut. If a doctor clicks with you, if the treatment suggested makes sense and you feel good about, that's all you need".

PCOS Diva, @PCOSDiva
It is disappointing when doctors do not have a solid understanding of how to treat PCOS using lifestyle modification as first line therapy.

Expecting Anything, @expectinganything
The most annoying part for me was the "marketing" behind this process by doctors/clinics. I mean, I get that it's a business for them, but some doctors forget that we are human, and this is real life shit for us! They all have different "sell tactics". They either beat you down and make you feel really bad or depressed about your situation, or they try to be overly sincere and emotional. We just want some facts and compassion people! Is it that hard!? I don't need to see all of the trophies "ie, baby pictures" plastered on the walls or some premeditated sob story. Show me your success rates and that you give a shit. It's that easy!

Our Misconception@ourmisconception
"The gatekeepers. You know the receptionists. These are the first faces you will see and the first you speak to when scheduling a consult or an appointment. They will be the ones that set the tone for the rest of the patient/user experience. Having navigated a cacophony of medical offices, this is an area/industry where empathy, education of the patient and social etiquette need to be greatly invested in as it lacks in most cases. My husband once had to spell out craniotomy to the appointment scheduler of his brain surgeons office. True story".

Triumphs and Trials@triumphsandtrials
"The most annoying part was going in to it blindly. Not knowing what the doctors were like and if they would be a good fit".

Anonymous 
"I needed an individualized approach on my treatment and a specialist who is willing to spare time to answer my questions and stay on top of all the details about my case. Not every clinic can do that due to patient volume. I was glad I was able to find the clinic I dreamed for after trying a big center in bay area, CA".

A LACK OF ALTERNATIVES

Infertile Soil, @infertilesoil
"In Canada you need to be referred to a fertility clinic (sometimes clinics will charge you if you don't have a referral) and many times doctors will refer you to just one particular clinic.

SIFTING THROUGH COMPLICATED INFORMATION

Trials Bring Joy@chels819
"Navigating outdated SART data".

AN EASY CHOICE FROM A TRUSTED SOURCE

Secret Infertility@FranMeadows
"I had a transition with ease since my OB/GYN referred me over to a fertility doctor that they personally used. This helped me feel more confident from the moment I walked through their doors. There was nothing annoying about me choosing a doctor".

 Life Abundant@lifeabundant_jw
"Nothing. My OB is able to do everything except IVF and is very knowledgeable in infertility treatment practice after doing her residency in a fertility clinic, so I have gotten lucky and have the best of both worlds. If we need IVF, I'll have to go elsewhere, and I will connect with her residency clinic and the doctor she trained under".

LET'S NOT MAKE THIS ANY HARDER THAN IT HAS TO BE

Hilariously Infertile, @hilariously_infertile
Uhhh. Being freakin' infertile is the most annoying part about choosing a fertility clinic.

Waiting In Hope, @waiting_in_hope
Honestly the most annoying part about choosing a fertility clinic is having to choose one AT ALL. Having to acknowledge the need for a fertility clinic/reproductive endocrinologist is heart breaking. It’s an acceptance that something is wrong. You have to grieve the loss of having a baby the “normal OB/GYN” route. And that it just might not be "easy".

Give the people what they want

As much as it's a service to you to equip you with clear information to make your decision, really, it's in our own best interest. The most effective way to grow our practices is through the detailed execution of a very simple premise: give you what you want. You can't decide on a clinic because you have no idea how SART success rates are being presented? Guess we need to make a video explaining SART data in plain English. You can't compare IVF costs between our competitors because no one will give you a straight answer? Sounds like we need to make an IVF cost checklist that you can download to compare potential additional costs. You felt isolated during your time at our practice because we never told you about support groups in our area? Apparently we need to make sure all of our patients go home knowing about the online, professional, and peer support resources that are available to them. In the age of ubiquitous communication, there is no shortage of ways to be able to collect and validate your input. Some clinics will ignore you and tell themselves they do a great job of getting you the information you want. Others will heed your suggestions and grow because of it. These are the clinics that deserve your choice, because you deserve nothing less.

Do you have something you want to say about your experience with your practice? Good, bad, or neutral? Please leave a comment or send me an e-mail! I would love to hear what you have to say.

MRS 2016 Meeting Recap: How To Use the Patient Experience as a Business Strategy

By Griffin Jones

You could put summer-time Chicago against just about any city in the world, so we're all glad that Dr. Angeline Beltsos, MD doesn't hold the Midwest Reproductive Symposium international (MRSi) in February. From June 15-18, without a cloud in the sky and an oceanic view of Lake Michigan, we met at MRSi 2016 at the historic Drake Hotel in Gold Coast. The event boasted a Business Minds Meeting, a Nurses' Practicum, and a Scientific Program. I went back to Chicago this year for my second MRSi because it's just the right size. It's a great place to connect with colleagues who share your practice role and also for physicians, nurses, and practice managers to share programming and meaningful conversation with one another. If you haven't been, add MRSi to the list for next year. You'll be able to talk to people and listen to topics that you won't always be able to get to at ASRM.

Panel discussion at MRSi Business Minds Meeting

Panel discussion at MRSi Business Minds Meeting

While I did attend some of Friday's Scientific Program, I'll use this post to run down Thursday's Business Minds Meeting for some of the things that you really need to know about utilizing different aspects of your clinic operations to grow your practice.

The ART of Incorporating the PATIENT EXPERIENCE as the Center of the Business Strategy

Janet Fraser, Board President of Fertility Matters and the COO of Atlantic Assisted Reproductive Therapies (AART), co-chaired the meeting with Derek Larkin, CEO of Boston IVF. 

“Improving our patients’ experience makes our patients happier and it’s better for our business”, Fraser mentioned of the day's theme. The thought was reinforced by all of the speakers; fine-tuning our operations so that our patients are more satisfied is measurably beneficial to the top line of the practice. Larkin emphasized the importance of continually adjusting to patient needs. "Patient expectations are continually evolving, and so must the experience that we provide to them. It's an unending process."

Incorporating Emotional Support to Decrease Patient Burden During Infertility Treatment

Dr. Alice Domar, PhD of the Domar Center for Mind/Body Health at Boston IVF talked about the importance of focusing not only on patient recruitment, but also on patient retention. “It’s human nature to pay attention to the patients in front of you, and not the ones who you don’t see (those who have dropped out of care). Studies have shown that people who were depressed were far more likely to drop out of their IVF cycle." Domar points to a 2004 Boston IVF study: Of 112 respondents, 40% displayed psychiatric disorders while going through infertility treatment. A separate 2011 study shows that care was significantly higher of a priority for patients, as opposed to physicians, for whom the greatest priority was success rates. "67% of people declined to fill out a survey on self-reporting depression because they didn’t want their physician to know how depressed they were," Domar adds. To date, four different studies show that infertility patients have the same levels of anxiety as cancer patients. 

Boston IVF tested retention techniques in a 2015 study that was published in Fertility and Sterility. Drop out rates reduced 67% in the intervention group."If you have effective communication with your patients, they perceive that you spent more time with them". Domar brings to attention the dollar amounts that practices spend on marketing to new patients, and how little is spent on retaining them by responding to trends in drop outs. 
 

Getting Staff Buy-In On The Importance of The Patient Experience

Hannah Johnson speaking on patient retention, courtesy of Vios Facebook page

Hannah Johnson speaking on patient retention, courtesy of Vios Facebook page

“Intrinsic motivation tends to be lost when we only focus on the extrinsic motivators, so we have to focus on activities where the reward is inherent in what we’re doing". Hannah Johnson, Director of Operations at Vios Global dives deep into how we motivate and empower our team members to take personal interest in each of their patient interactions. We need to allow our team to step back to appreciate the positive difference they make, including making sure they are aware when they are named in positive patient comments. We also need to empower them to correct errors. "It’s okay for your staff to make mistakes. Let’s talk about how we can make the patient feel really good about what happened.”

 

The Magic of Using the Patient Experience as a Focal Point of Your Employees' Day

“People don’t do what the mission of the organization states, they do what their managers pay attention to.” Lisa Duran is the CEO of Reconceived and has trained dozens of fertility centers in North America on how to build a patient-focused culture. Duran says that when many practices don't feel like they're fulfilling their mission statements, it's often because of a breakdown in the details of execution. We broke out into separate teams to identify challenges that different members of our team face in their day-to-day duties, and how we might be able to support them. Departments and staff need reinforcement and understanding from one another. “I want to know that my opinion matters,” Duran says of the most common desire that staff report before going into training.

In their own words

We had the privilege of hearing the first hand account of a couple who has gone through infertility treatment for many years. When asked what would have most benefited them to know when they first began their treatment, they each replied
"Don't be complacent if you're not getting the answers you need. Keep asking". 
"I wish that I wouldn't have waited so long. I wish I would have sought out treatment much earlier".
Hearing from patients in panel-form was a first for me at MRSi, and should be common practice at our conferences...imho.

Strategic Planning: Folding the Patient Experience into Your Business Plans

"Perception is reality. What patients feel is what they share." Rick Dietz, Chief Business Officer of Boston IVF, spoke in detail about the constant feedback loop of implementing and adjusting to patient input. Dietz says that practice strategy should be informed by a number of different metrics, and that self-reporting from patients is only one method at our disposal. "We can use patient surveys to give us clues and direction. But they don't tell the whole story."

Never Underestimate the Role of the Nurse in Patient Retention

"Nurses need proper training of how to talk with patients or you're going to get a lot more questions." Lori Whalen, RN, of HRC Fertility spoke about the importance of nurses as agents of patient retention. Whalen reminds us that nurses frequently have the most contact with patients and can be excellent sources of what patients want or what about our operations might be frustrating them. They can even find other solutions to patient problems, such as helping them find ways to save money. "Shared donors can cut costs in half for patients who wouldn't be able to afford it otherwise," Whalen says.

The Vital Role of Digital Media in Recruiting New Patients 

It was my first time speaking in the field and I was very pleased to have a great audience that asked meaningful questions. What can I say in this single post that isn't better summarized in greater detail throughout the blog? Suffice it to say that I reaffirmed what matters above all else in fertility marketing: the attention of people dealing with infertility. When we know what people with infertility are paying attention to, then we can measure how we will increase IVF cycles, increase patient-to-patient referrals, and improve our conversions of prospective patients to scheduled patients. You can view the first half of my talk here:

It takes a village

The strongest recurring theme of the Business Minds meeting was the critical involvement of everyone at the practice. I frequently see public feedback when patients are happy with their physicians, but not their staff, and vice-versa. Patients form their opinions about their experience based on every interaction they have with us; from the receptionist who greets them, to the medical team that cares for them, to exceptional customer service both online and offline. When we support all of the role players on our team, and learn about best practices from clinic groups across North America, we can dramatically improve both our delivery of care and patient satisfaction. Now that's an excellent foundation for growth. I recommend that at least once a year, you accompany a few of your team members to an inter-role meeting like MRSi to identify how you can improve your practice operations. You might be pleasantly surprised by what you learn from your own team, and what they learn from you.

See you next year at MRSi 2017!

6 Topics You Need to Know to Run a Successful Fertility Practice: 2016 ARM meeting recap

By Griffin Jones

Time to get down to business

Thursday, May 5th and Friday, May 6th marked the 2016 annual meeting of the Association of Reproductive Mangers (ARM). The professional group of the American Society for Reproductive Medicine (ASRM) convened on a pair of gorgeous near-summer days in downtown Chicago. Roughly 100 practice administrators attended, coming from single-physician fertility clinics to multi-state practice groups. At the welcome reception on Thursday, ARM Chair Brad Senstra invited the group to introduce themselves and enjoy dinner with someone they hadn't yet met. It was an in-person networking and educational opportunity that isn't especially common for practice admins. Here's some of what we learned

1). Salary Surveys, Benefits, and Calculation of Total Compensation

Sara Mooney, Human Resources Manager at Seattle Reproductive Medicine (SRM), opened the meeting on Friday by addressing many of the common issues that we face when reviewing and rewarding our team members. Sara recommends an online tool called Payscale, to review the pay averages of positions by geographic area and years of experience. Tools like Payscale generate reports that you can share with your employees, so that they understand when you are compensating them at a higher percentile relative to your competitors. Even when pay increases are not in the budget or may simply not be timely, there are other ways of rewarding your team, such as peer recognition from employee comment cards, added vacation time, and small gifts such as restaurant gift cards or sweets.

Carla Giambona, Director of Human Resources at IntegraMed Fertility, tackled the topic of benefits and calculating total compensation. It's important that employees know what your practice pays into their health and overall benefits package. Very often, employees view their salary as their total compensation. In reality, the practice may well be spending an additional 50% of that on health insurance coverage and other benefits. Premiums are among the biggest staff expenses to practices so engaging your team in wellness activities is a way to reduce your premium costs. Carla cautions however, that wellness engagement is a longer term strategy whose benefits will likely not be seen in the form of premium reductions within two or three years. 

2). Values Development and Implementation

Marianne Kreiner, Chief Human Resources Officer at Shady Grove Fertility, shared a meaningful (and very fun) exercise from one of the most successful practice cultures in the country. The total audience was divided into small groups of around eight people. Each subgroup was given a list of 150 words; desirable qualities for any team. Teams were welcome to add a word to the list if they preferred a quality that wasn't mentioned. Each person selected their twenty most preferred words and then group voting reduced the list to twelve and finally three words. The subgroups merged with one another and repeated the process with their combined word pools until finally the two halves of the entire audience came together as one to decide upon the chosen values that they felt represented their group culture. Want to know something about this ARM group? You must be hiring class acts. Independently, both halves of the audience chose "integrity" among their final three characteristics, a word that wasn't listed in the original 150. 

3). Leadership 

"Leadership does not carry a title," asserts Brad Senstra, Executive Director at SRM. Senstra explains four ways that leaders can encourage leadership, and therefore exhibit it in themselves. 

  1. Clarifying Values
  2. Inspiring a Shared Vision
  3. Enabling Others
  4. Encouraging the Heart

Above all, what sustains leaders, is that they love what they do. "Leaders build character by enabling others to act."

Example of leadership from Brad's talk. If the  story of these two dogs  doesn't rock your soul, then you don't have one.

Example of leadership from Brad's talk. If the story of these two dogs doesn't rock your soul, then you don't have one.

4). National Public Health Action Plan for the Detection, Prevention, and Management of Infertility

Dmitry Kissin, MD of the Centers for Disease Control (CDC) delivered some reassuring news about the agency's efforts to address infertility as a public issue. The mission of the National Assisted Reproductive Technology Surveillance System (NASS) is to promote the health of women and men who receive infertility services, the health of pregnancies achieved through these services, and the health of infants conceived through these services, by conducting surveillance and research, creating and maintaining strategic partnerships, and moving science to practice. Among NASS's goals to address infertility as a public health concern, are to develop a standardized case definition of infertility and to eliminate disparities in access to affordable infertility services.

5). Patient Services

Lisa Duran, CEO of patient focused, Reconceived, facilitated an exercise that can be replicated with both your patients and your personnel. Duran uses the Myers-Briggs personality survey to identify how people with different personality profiles communicate in distinct ways. The 16 distinctive personality types are determined by a combination of preferences.

Learn where you fall in this spectrum.

Learn where you fall in this spectrum.

  • Do you prefer to focus on the outer world or on your own inner world?
    • Extroversion (E) or Introversion (I)
  • Do you prefer to focus on the basic information you take in or do you prefer to interpret and add meaning?
    • Sensing (S) or Intuition (N)
  • When making decisions, do you prefer to first look at logic and consistency or first look at the people and special circumstances?
    • Thinking (T) or Feeling (F)
  • In dealing with the outside world, do you prefer to get things decided or do you prefer to stay open to new information and options?
    •  Judging (J) or Perceiving (P)

Duran says its helpful to know patients' preferences because people with different personality profiles frequently equate to "speaking a different language to one another". I learned that I'm an ENFJ (the teacher) and I found the summary to be pretty spot-on.

6). The Knights at the Round Table(s)

I could only attend one of the round tables, and it certainly won't surprise you that I chose marketing. Jacqueline Sharp of HRC Fertility moderated the table of very different practice groups. All four squares of the big market, small market, small practice, large practice quadrant were represented. I continue to be fascinated by how different practices use different models to affect patient volumes.  Some groups follow the recommended 3-5% of total revenue as a marketing budget. Many practices have no planned budget at all, but rather approve or reject marketing investments as they arise. Proving return on investment (ROI) is a challenge for all of us--and I'm excited to  continue to address that challenge.

Come one, come all

This was my first ARM meeting and I plan to be back next year, which means I would recommend it to you. The content of the meeting is beneficial not only to administrators and those involved in practice development, but also to nurses and physicians. The ARM group offers what is probably the most team-comprehensive programming within ASRM. The input of others in our professional society helps us to build teams that grow, super-serve patients, and are just downright pleasant to work with. If you'd like to get to know the group and their topics before you board a plane to Chicago next year, join us for some of the incredible round-tables and symposiums that they'll be hosting at the ASRM Scientific Congress in Salt Lake City. See you in October!

5 Hidden Patterns Uncovered Across the Top 25 Fertility Doctors in Patient Reviews

By Griffin Jones

What a world it is where patients can form an opinion about their fertility doctor before they even schedule an appointment. A 2013 study shows that 90% of respondents reported that online reviews influenced their purchase decisions. Through public feedback from their peers, people dealing with infertility have a plethora of information to make their decision from online review sites that exist for the benefit of the patient. Here's where it gets interesting.  Fertility centers can also benefit from online reviews--good, bad, or neutral--by using them to deeply understand and adapt to patient habits. By carefully examining the online reputations of the most highly rated fertility specialists in the country, we have further decoded the messages that patients are sending loud and clear.

We know from initial research that the success of an individual's treatments using Assisted Reproductive Technology (ART) greatly influences how they write their review of their fertility clinic. Positive fertility clinic reviews are three and a half times more likely to mention a baby or pregnancy than to mention lack of success or make no mention at all. Equally, negative reviews are three times more likely to reference leaving the practice before success than to mention a baby or to make no mention at all. We also know that positive fertility center reviews outnumber negative reviews by more than 2 to 1. Getting some ideas from Joseph Davis, DO of RMA of New York, we wanted to dig beyond these observations to try to answer more questions: 

  1. Do the same patterns apply to fertility doctors with almost no negative reviews?
  2. Does an REI's rating correspond to his or her practice's success rates?
  3. Do the clinics with the highest success rates have high online ratings?
  4. What is the correlation between an REI's gender and his or her online reputation?
  5. Are younger docs rated more highly than their veteran colleagues? 

Limits to the data

First,  several review sites are popular for rating fertility doctors, and they are not uniform. Some sites, like Healthgrades, offer only star ratings without qualitative responses. Other sites likes Fertility Authority, Vitals, Google, and Zocdoc have the option to leave star ratings with or without comments. Yelp and RateMDs include qualitative responses with their reviews. Yelp tends to be more deeply populated by place (practice) reviews as opposed to reviews for individual doctors. In the latest phase of this research project analyzing fertility doctor reviews, I chose to use RateMDs because it is the easiest platform to search by sub-specialty.

There are 2,264 reproductive endocrinologists listed on RateMDs, mostly from the United States and Canada. We can search them by both highest-rated overall and per metropolitan area. Still, RateMDs isn't a perfect source. There are many duplicate profiles and only 1,205 (53%) of the physician profiles have any reviews at all. Furthermore, the rate of adoption for every review site varies widely by market. On RateMDs for example, there are 929 reviews of reproductive endocrinologists in Toronto, but in a very similarly-sized market, Houston, there are only 380. Lastly, you may be listed as an OBGYN, and not as an REI (or both in the case of duplicate listings). With that said, when we check someone's RateMDs rating (if they have ten or more reviews) against reviews on other platforms, we find they are consistent. 

I'm really excited by a newer review site that Dr. Dan Nayot brought to my attention, called Fertility IQ. You may have thought it was my site if I sent you the link to your listing. It isn't. Though I sometimes wish it was, because much of the data that I aggregate manually, they will soon be able to export with the click of a button. Most doctors don't yet have enough reviews for meaningful comparison, but I see this site becoming very popular over the next six to twenty-four months. The user experience (UX) for patients is outstanding and the site validates patient authenticity. Both the qualitative and quantitative questions are more in-depth than any other channel. Above all, there is a market need for a uniform, clean, and extensive platform to compare fertility doctors and clinics, and I hope this is it. In the meantime, I manually scour reviews for data like a cyber caveman.

Fertility IQ's home page

Fertility IQ's home page

Of course, there are limits to ranking clinics by IVF success rates as well. Partly because the Society for Assisted Reproductive Technology (SART) appeals that success rates not be used to compare clinics. Consequently, they don't rank them in a spreadsheet that we can easily pull. So we use the site, fertilitysucceessrates.com. While Fertility Success Rates makes it easy to check the top 25 clinics in the United States, some clinics are missing from the site's overall listings, even though their data can be found in the annual CDC report. Despite the limits in our data, we continue to notice some interesting patterns. 

1). Do the same patterns apply to doctors with almost no negative reviews?

Yes...and no. I analyzed the first ten reviews of each of the top 25 rated reproductive endocrinologists. Of the 250 reviews

  • 164 explicitly referenced a baby or pregnancy
  • 70 contained neither a reference to a baby or pregnancy nor mention of lack of success
  • 1 mentioned a lack of IVF success
  • 10 described that they were still in treatment
  • 3 referenced treatment other than ART
  • 2 were negative reviews
Top 25 fertility doctor reviews mention pregnancy

So these doctors were actually even more likely to have their reviewers mention a baby or pregnancy than their colleagues at large, 66% compared with 60%. What's interesting is that their reviewers were also almost twice as likely to make no mention at all, 28% to 16%. The difference came from those who described still undergoing treatment; 14% for all positive fertility clinic reviews and only 4% for these top 25. Only 1% of these reviews were negative or explicitly referenced a lack of success in treatment. What could be the reason? We know these doctors don't enjoy IVF success rates of 99%. Let's come back to this after we investigate how clinical success rates impact online reputation.

2). Does an REI's rating correspond to his or her practice's success rates?

No. Watch as we take the top 25 ranked reproductive endocrinologists on RateMDs. Then we check them against the top 25 clinics from the 2013 SART reports. Do you have any guesses of how many doctors appeared in both spreadsheets?

Randle Corfman, MD of the Midwest Center for Reproductive Health was the only one. In other words, while success of ART treatment largely predicts how someone will leave a review, success rates do not directly correlate to a physician's online reputation. 

These are the highest rated reproductive endocrinologists on ratemds.com 

These are the highest rated reproductive endocrinologists on ratemds.com 

3). Do practices with higher success rates have higher online ratings?

Not by much. It should be stated that practice ratings can be even more difficult to garner than individual physician ratings. For those in the top 25 in success rates, I used the review site that offered the most ratings per clinic. If there were less than ten responses for a clinic on any one review site, I left their rating blank. In a rating scale of one to five, the ratings of 19 of the top 25 clinics in success rates ranged from 2 to 4.5. The mean rating was 3.7 and the median was 3.5. The median for fertility centers at large lies between 3 and 3.5. 

Top 25 U.S. fertility clinics by 2013 success rates

Top 25 U.S. fertility clinics by 2013 success rates

4). What is the correlation between the gender of the REI and his or her online rating?

The correlation (or lack thereof) of a physician's gender to fertility doctor reviews will be interesting to further explore.

  • Do patients have higher standards of judgement for one gender?
  • Does each gender tend to employ different communication styles that are more or less effective?
  • Do patient biases cause a message to be received differently from one gender than another?

This is what the current data show us:

  • Of the top 50 rated REIs on RateMDs, 22% are women and 78% are men.
  • Of the bottom 50 (of those with a minimum of ten reviews), exactly 50% are men and 50% are women. 
Top 50 rated fertility doctors in US
*Of those with ten reviews or more

*Of those with ten reviews or more

To try to offer some context, Valerie Baker, MD, President of the Society for Reproductive Endocrinology and Infertility (SREI), references a recent REI workforce study published by Fertility and Sterility. 38% of the respondents were female and 61% were male. 

5). What is the correlation between ratings and years in practice?

I often hear people say that new physicians coming out of residency and fellowship are more savvy of their online reputations than are veterans in the field. I don't know that we have a sufficient way of being able to validate or disprove this inference at this time. We would have to know the year that every REI completed her or his fellowship and their ages; data that isn't easy to find. I can only offer some marketing insight.

I see at least three doctors in the top 25 who I know are under age 40. Two of them are the top rated fertility doctors in metro areas of larger than six million people. Newer doctors can leverage a high online rating to negotiate a partnership plan with a recruiting practice because they can build their online reputation and social media loyalty to become the highest rated fertility doctor in their area before they even complete their fellowship. Conversely, recruiting clinics can look at a physician's online rating and social media presence to make more educated personnel decisions. 

Decoding the bigger picture

What lessons are we left with? No clinic and no physician can boast IVF success rates of 99% or anywhere close to it. Yet we count at least a few dozen doctors whose negative reviews are less than 1% of their online reputation. When we look even closer, we see that while success of individual ART treatments influences patient reviews, clinics' success rates don't necessarily predict their online ratings.

This shows us that we are not destined to have a third of our patients report dissatisfaction. As success rates majorly improve across the field, we see that patients still expect more from their care experience than just clinical treatment. Patients who haven't found success through ART may not leave rave reviews or promote their practice on social media and we can appreciate that. Still, if we can deliver to them a better experience than they ever would have had without us, they may not feel as though their only recourse is to express their disappointment online. Analyzing how fertility clinic ratings relate to ART success rates helps us understand exactly to what patients hold their fertility centers accountable.

 

How Much Does IVF Really Cost? Why No One Will Tell You The Plain, Ugly Truth

By Griffin Jones

How do people feel about the financial charges associated with IVF? I don't know, you tell me.

  • "Incompetent or possibly fraudulent insurance practices"
  • "Almost a year later I am still unable to officially take care of my billing issues"
  • "They have no problem with asking me for money but pointing out there was a descrepancy [sic] in billing no one would answer"

All of these comments come from real fertility clinic reviews. Is this frustration familiar to you? Financial stress is one of the biggest pain points in dealing with infertility and it sometimes negatively influences your relationship with your fertility clinic. As if infertility didn't already give you enough to deal with, its best medical solution is one of the most expensive endeavors you'll ever face. Some people talk about the cost of IVF in terms of financial infertility, because it is the most common obstacle that prevents couples and individuals from seeking treatment. We frequently see GoFundMe and other crowdfunding campaigns to raise money for IVF. In most U.S. states and Canadian provinces, the expense of IVF is paid out of pocket. Even in the United Kingdom, where the National Health System (NHS) covers most health expenses, there are still many people in the U.K. who don't qualify for the terms of coverage and they too have to pay from their own accounts.

Organizations like RESOLVE advocate for broader and deeper coverage of fertility treatment and you can join them for their 2016 infertility advocacy day on May 11.  Still, even in states like Massachusetts where insurance companies are mandated to offer IVF coverage, you find plenty of complaints about billing and unexpected charges.  At issue, there are many items you can be charged for because needs vary from patient to patient. It's not uncommon to see posts from people who say they've spent over $50,000 on costs associated with IVF. That's a wide leap from the IVF packages listed at $7,500. 

This variance poses a problem to you as you search for information to properly plan your budget. In the spring of 2015, I surveyed a small group of people dealing with infertility who listed cost confusion as one of their three most common pain-points in dealing with their clinics. You want a clear answer.  You want the transparency that you enjoy in almost every sector in which you spend your money. You instantly pay for everything else at fixed prices from Amazon, Priceline, Fandango, and Blue Apron. Why can't you get a straight answer about how much IVF will run you? You need to know what costs you'll incur and how much of it will be covered by insurance in order to budget for your treatment. Why aren't clinics more transparent with you? 

The answer is multi-faceted, so let's dig into it.

Hidden costs in IVF

proven fact: insurance is the devil

Let's start with one of the very few, axiomatic, incontrovertible laws of the universe: insurance is a nightmare. Remember the national debate we had about healthcare coverage just a few years ago? Effectively, the arguments centered around whose solution would make our horrible payer system even more horrible. The problem certainly isn't unique to fertility care; all of healthcare is plagued by the problem of cost uncertainty.  A study conducted by Consumer Reports shows that billing disputes are the third most common complaint Americans have about their doctors. Why can't a provider tell you how much a service will cost before you decide to go through with it? CEO of tech startup, PokitDok, Lisa Maki, says that people "are trapped by a system that requires that they agree to a service with no knowledge of what the outcome or what the consequences might be to them financially". It's a conundrum. Put yourself in the position of the billing manager; they hate it just as much as you do.

does insurance even cover ivf?

Glad you asked. Every U.S. state and Canadian province is different. In the United States, some states have mandated coverage. If you don't know the universal definition of mandated coverage for infertility...it's because there isn't one. It's helpful that RESOLVE grades states based on how much coverage is mandated. Some states like New York and Texas may be considered mandated states, but their coverage varies. In New York, insurance companies are mandated to cover certain treatments like IUI, but not IVF. In Texas, insurance companies are required to offer coverage in plans to employers, but employers do not have to purchase those plans.

IVF cost confusing

Even in states like Massachusetts and Illinois, the law doesn't apply to certain types of employers, such as those who self-insure. What's more, you may live in a mandated state, but if your employer is not based in that state, then your home state's coverage doesn't apply to you. Don't forget about deductibles, either. You may need to spend a certain amount before insurance will pay for anything. Certain tests and medications might be covered and some might not. If you'd like to take a look at your clinic's website to see what insurances they accept, that won't help much. Every person's coverage depends on their individual plan. What might be covered for your co-worker might not be for you.

the ivf package price is not the total cost of treatment

Is your head spinning yet? We'll table the idea of insurance for the moment. Let's approach this as though you're paying entirely out of pocket. What other costs might you incur in addition to the price of the IVF cycle?

  • Tests. Ask your IVF coordinator if your package has a limit on labs or ultrasounds during treatment. If there is a limit, how many labs and ultrasounds are included and how much is each additional?
  • Medications. Which drugs are included in the package and which are not? How much do they cost? Is your doctor able to prescribe generic or other brand labels that might be covered by insurance? Are you allowed to buy them on your own?
  • Labs. Does your clinic have an in-house endocrine lab or are your labs sent out to a third party? Labs will be drawn throughout your treatment that need to be resulted the same day. If your labs are sent to a third party, there may be an additional cost to you. 
  •  ICSI. Is Introcytoplasmic Sperm Injection included in the package? According to Sher Fertility Institute, ICSI is often required when cases involve the severest degrees of male infertility. 
  • Embryo freezing. Some clinics will store your embryos in cryopreservation for six months after your IVF cycle, and some might include it for a year. How many months are included in your IVF package? What is the fee for each additional month of storage? 
There are even more potential costs associated with IVF

There are even more potential costs associated with IVF

  • Anesthesia.  If the clinic doesn't disclose whether or not anesthesia is included, it is likely that they charge an additional fee.
  • Donor eggs. Donor egg prices are not included in IVF packages unless specifically mentioned in separate pricing. The clinic may have their own donor bank or they may use a third party. If this is a need of yours, it will mean additional costs.
  • Surrogacy. If you have this need, the total cost of surrogacy may be as high as $150,000. 
  • PGD. Preimplantation genetic diagnosis can greatly improve pregnancy success rates by carefully selecting embryos. For older women, and women who have suffered early pregnancy loss, PGD may be all but necessary. Rarely do IVF packages include the cost of PGD.

See? Now you understand why it's so hard for clinics to quote one all-encompassing price for IVF, beyond the most basic IVF package. Rachel Gurevich of About Health reports that the total cost of IVF treatment averages around $20,000, as opposed to the $12,000 average cycle price. There are so many moving parts, it's virtually impossible to give you one set price. As far as clinics are concerned, they need to start displaying "sample pricing". As far as you're concerned, it's better to estimate very conservatively.

then why the heck doesn't my clinic just tell me all this?

This is a great question and it's part of the reason I wrote this post. Fertility practices need to get better at educating prospective patients on cost complexity. From my observation as a marketer, some fertility centers aren't good at discussing finances for two main reasons.

  1. Doctors don't like to talk about money. Generally speaking, they find it unbecoming of the conduct of a physician. They hold the patient-physician relationship to be very sacred and they don't want to cause you to think otherwise. They want you to know that they are invested in your care and not the financial arrangement behind it. I see two scenarios play out in online reviews--one that validates physicians'reluctance to talk about money and one that reveals an adverse effect. In the first scenario, the doctor is perceived as "money-grubbing" or trying to "sell" IVF. In the second, people are surprised by a bill and they lash out at their practice for a charge they weren't expecting. Finance isn't an easy subject to bring up, and that's why most physicians leave the discussion to their billing department. The appropriate sales conversation for infertility treatment is content for another post.
  2. Clinics are afraid to be punished for doing the right thing. What happens when a fertility practice tells you to budget $20,000, and you get a quote of $8,000 from one of their competitors? To a degree, this concern is justified. Tests show that, if not supported by the necessary context, pricing can sometimes drive people away. I would know. I am not the cheapest marketer that someone can hire and I never want to be. When I quote someone for a price, I want to include everything they might need. If I tell someone they should budget for a marketing strategy at $6,000/month, I include an advertising budget, graphic design, web development, etc. Someone else might tell them that they charge $600 per month for marketing services. That $600 doesn't do much but it sure sounds better than $6,000. No matter the service, people often ask about price before considering the total value being offered. This creates an undesirable cycle: you won't tell me your pricing until I'm more interested; I'm not interested until I know your pricing. This is very annoying for both parties involved, fertility centers and their patients.

be an educated consumer, and make sure they know it

So why should your  fertility clinic show you detailed sample pricing? Are they trapped in a catch 22? Tests prove that the advantages of publishing prices far outweigh the disadvantages Think of it this way. Do you ever stop shopping before you know what the price is? What is the cost of a ride across town? You won't know until the cab stops and adjusts their meter. So you choose Uber, because you see the price in advance, and peer reviews validate the experience you're looking for. To compete for your selection, fertility clinics need to be more upfront with pricing. Leave that part to me.

For your part, the more educated you are as a patient-consumer, the more information practices will have to provide to you ahead of time. You are now conversational in the basics of infertility financing. You will be fluent by the end of your journey. To start, you have some background knowledge of which costs to investigate. Clinics are reluctant to share more information on pricing, partly because they are concerned that their competitors will get away with cost ambiguity. Don't let competing fertility clinics win by giving you less information. As an educated patient-consumer, you have the power to let transparency rule the day.

 

 

5 Essential Questions Your Fertility Clinic Needs to Answer at Your First Appointment

By Griffin Jones

"They treat this place like a baby factory. Doctors spend so little time with patients."

Factory. This is a word we hear very frequently when people are unhappy with their fertility centers. Do you feel like your fertility clinic is a factory? Do you see your doctor as much as you expected you would? Are your phone calls promptly returned? Do the staff remember your name? Now, some of these issues matter more to certain people than they do to others. Some people are perfectly happy with a "baby factory", provided that the factory produces a healthy baby. Some are really only concerned with the final result and less so with the process that leads to it. From a small group of patients I surveyed, slightly more than half would have preferred a doctor with an atrocious bedside manor but with exceptionally high success rates. The other half preferred  a personable, compassionate doctor whose success rates were well within the standard of care. Surveys conducted by Dr. Francisco Arredondo of RMA of Texas conclude the same. There is no right or wrong decision, so long as you are perfectly aware of the decision you're making.

IVF clinic as a baby factory

A baby factory may be exactly what you want. After all, the reason you're parting with ten, fifteen, or twenty thousand dollars of your own money is for the end-result. I recently spoke with someone who had all but decided on a very large clinic in her area. She wasn't thrilled with the group, but she understood the decision she was making. She was disappointed with the bedside manor of the staff, but as the largest fertility practice group in her area, she felt their labs were the absolute best. To me, her decision is sound. Like any personal decision, no one can judge it right or wrong as long as your objective is clear, you are aware of the pros and cons, and you fully accept the cons and risks in pursuit of your objective.

There's never a guarantee

I feel compelled to mention this because so many people have told me they were unaware that there is never a 100% probability of success for IVF. Some fertility groups have been blamed for leading you to think otherwise, but in many cases, the probability of not having a baby is higher than that of having one. The Society for Assisted Reproductive Medicine (SART) reports that the national average of IVF cycles resulting in live births for women under age 35, was forty percent in 2013. That percentage decreases with each successive age group. SART says that their data shouldn't be used to compare centers, but the site, Fertility Success Rates, uses SART data to demonstrate that the top clinic in the country has more than double the success rate of the national average. Extremely impressive, and still nearly a one in five chance that the cycle will not be successful. You have a right to know that. You're dealing with calculated probabilities and not certainty. It's your finances and your emotional energy. Everyone's personal condition is different, and your reproductive endocrinologist (RE) will be able to give you a better idea of your own probability of success. For some, a 5% chance of success might be worth the try; it completely depends on the personal needs of you and your partner. To inform your decision, here are five questions for your first appointment. 

1). How much time will you spend with your fertility doctor?

"You hardly ever see your actual doctor," is a very common complaint about larger fertility practice groups. Still, I read this criticism almost as frequently among smaller practices. Ask your clinic

  • Who will you be communicating with the majority of the time? 
    • The doctor?
    • The nurse?
    • The IVF coordinator?

It might be perfectly fine to spend most of your interactions with the IVF coordinator, but if you had been hoping to speak with your doctor, you should be prepared for that. REs are very busy people. None of them have an abundance of unallocated time. If I could invent something to sell to doctors, it would be any solution that somehow gave them back some of their time. Everyone wants your fertility doctor's time. You want it, because you want your concerns to be directly addressed. Their staff want it for guidance. I want it so I can move forward with their approval. Their families want it because REs are human beings too. Some may have more time to give you, and quite frankly, you've earned that time. Decide how important individual time with your physician is to you and ask how much of it you can expect.

2). How will your fertility practice communicate with you?

I help fertility centers manage their Facebook pages and Instagram accounts. Often, I see people using these channels to ask their clinics about their treatment protocol. The office can't answer these questions on social media because of privacy concerns. Still, it's clear that you might prefer speedy, electronic communication. Do you want to send an e-mail to your IVF coordinator or do you expect to be able to talk with your doctor over the phone? Some clinics use patient portals to communicate with their patients. You see many clinics with the eIVF logo on their website, for example. You can use the eIVF portal to communicate with your care team in a way that is convenient and concise. Patient portals like eIVF can be of great benefit to you when you want individual answers or easily accessible information. Just remember, the power of any tool depends on the person using it. How prompt/clear is your team is with their responses? 

3). When can you expect a response?

Lack of communication is one of the top complaints about fertility clinics.

  • "Barely return your phone calls/no communication",
  • "The IVF coordinator almost never returns my calls,"
  • "Bottom line--there was no sense of communication here".
Get to know your fertility doctor

These quotes come directly from negative fertility clinic reviews. You might be leaving a message on your practice's Facebook page because no one at the office returned your phone call. You will have a lot of questions during treatment. You might even pose your questions to the #infertility community on Instagram. It makes sense to hear from people who have went through similar experiences, but many times, people ask the #ttccommunity because they either haven't heard back from their doctor, or they don't feel like waiting for a response. Peer opinion can be helpful under certain circumstances, but you won't find specific medical advice on social media.

In general, communication is one of the greatest problem areas in all of healthcare. Fertility treatment is not exempt. Dr.  Arredondo recommends that physicians give patients a time frame that the doctor can realistically meet. This way, you will be pleased when your doctor gets back to you earlier than they said they would. It's clear that not all care teams do this, so you have to be your own advocate. Politely inform your practice upfront that prompt responses are very important to you, and you would like to know how long you should expect to wait for an answer.

4). How long did you have to wait?

I try to cut docs some slack here. Their time is constrained to the max and their attention is pulled in every direction. That doesn't make your time any less valuable, however, and some doctors seem to be inexcusably late. We can't hold REs to an unfair standard; we rarely if ever see our doctors at the very time of the appointment and this has been true since pediatric care. What you're really looking for here is how your doctor handles being late. Does he offer any explanation? If your doctor is late to your appointment because she spent a few extra minutes with a patient who really needed it, and she extends the same courtesy to you, I personally would accept that. If your doctor is forty-five minutes late in meeting with you and then rushes away without addressing all of your concerns, this office may be accepting too many new patients for their physician capacity.

5).where's the love?

High IVF success rates and wonderful bedside manner are not mutually exclusive. You may be able to find an extremely compassionate doctor and staff with outstanding success rates. On the other hand, you may find yourself in a situation where you have to prioritize one over the other. You can usually get an idea for for a staff's compassion from their online reviews. Some REs have mixed reviews and that can be very confusing. How can one person say a doctor is "very knowledgeable, compassionate and extremely kind" while another says "he doesn’t listen, interrupts and is very arrogant".  

My research on fertility clinic reviews suggests that positive reviews are three and a half time more likely to mention a baby or pregnancy than to make no mention at all. Equally, negative reviews are three times more likely to reference a lack of success than to make no mention at all. Nevertheless, there are REs with dozens of positive reviews and very few if any negative reviews. I have worked with some extremely compassionate REs and I will tell you, I rarely if ever read an ill word about them. Even in negative reviews if someone is dissatisfied with other staff members or billing, the reviews often start out "Dr. _____ is amazing, but...". These doctors don't boast IVF success rates of 100%, but they are better at setting the stage of your overall experience with communication and compassion. You will be able to tell from your first appointment if your doc falls into this category. 

you don't have to know it all

You don't know the answers to all of these questions yet; that's perfectly normal. How would you know what you prefer in your treatment relationship before you go through it? Don't fret if you don't have the answers. We don't know exactly what we want until we actually live the experience. No clinic has IVF success rates of 100% so there are other aspects to consider regarding the overall experience they provide. Understand that an initial consultation is not a commitment to treatment. Use that to your advantage. You shouldn't feel like you have to give someone $20,000 just because you already paid them $200 or $300. You are free to decide to go elsewhere if you really aren't comfortable after your first appointment. You are spending massive amounts of your money, emotional energy, and time. You are entitled to leverage them for the best possible experience for you. Consider what factors are most important to you when you go into your first appointment, and only move forward if the clinic has earned your selection...on your terms. 

 

 

5 Alternatives to Letting Your OB Choose Your Fertility Doctor That You Can't Afford to Ignore

By Griffin Jones

You alone decide, but you are not alone in informing your decision.

I've been writing a lot for clinics recently and I owe a lot more content to you, especially when you have big choices to make about which fertility specialist you're going to see. It's not an easy decision and it's not one a referring doctor or even a close friend can make for you. The choice is yours. This is the value that I've proposed all along; help practices improve so they can attract more patients and help patients be wise and clear with their decisions so that practices have to continually improve. Though I haven't created much content for you in the last several weeks, I have been doing a lot of listening. I really appreciate the feedback you've given me on Instagram about how you found your fertility clinic and what factored in to your decision making process.

Awesome Dr. Seuss quote, via brightdrops.com

Awesome Dr. Seuss quote, via brightdrops.com

Frequently, people choose their reproductive endocrinologist (RE) because he or she was the closest to home, their OB referred them, or they were recommended by a friend. Maybe you put a lot of consideration into the matter.  Maybe you didn't even realize how much of a choice you had. Sometimes, that turns out just fine; the closest RE might be absolutely incredible. In other cases, people really wish they had chosen someone else. 

May the best doc win

All fertility doctors are brilliant. There are only about 1,300 board certified REs in the entire country. They go through four years of medical school, four years of OBGYN residency, and three years of REI fellowship. Then they get to take the hardest exams of their lives. Including undergraduate studies, that's fifteen years of higher education and training! There's not a dumb one in the bunch is what I'm saying here. Still, that doesn't mean they're all the same. REs are people. Like chefs, boyfriends, contractors, break dancers, and internet marketers...some are just plain better than others. 

Some are better surgeons, some are more personable, and some have better staff. I believe I've done more research on fertility reviews than anyone. People leave their opinions based on a number of factors. First, it's true that people are far more likely to leave positive reviews if they've become pregnant and far more likely to leave negative ones if they have not. You should be aware of this skew, because you would expect it to influence a doctor's rating. Somehow, however, there are a few dozen REs and practices in the United States and Canada who each have very few complaints and dozens of glowing reviews. How? There is no such thing as a fertility practice with anywhere close to a 100% success rate. It suggests that there are some all-stars who simply provide a better overall experience.

Find the right RE

Having read thousands of fertility doctor reviews, spoken to hundreds of people who have struggled with infertility, and met at least a few dozen REs in person, I discern my own very unscientific conclusion. 20% of fertility doctors over-deliver in nearly every aspect of the care experience, 20% are absolutely atrocious with patient relations, and maybe 60% fall somewhere in the middle. I feel as though many in this majority are good, honest physicians whose practice experience may vary from patient to patient because they haven't quite been able to embed that outstanding service into every facet of their operation.

I've told you before that fertility treatment is a business. I don't say this disparagingly, I love meritocracy. Even if you live in a state or province like Massachusetts or Ontario, it's still likely that you will be paying something out of pocket. You still have a choice of who receives your reimbursement. The value that I can provide to you is helping you utilize your leverage in your business relationship. We want the best REs and fertility clinics to be booked solid. The people who go above and beyond to deliver a better care experience deserve to make more money than those who do not. I really believe that. Those that stubbornly ignore patient feedback and don't invest in patient relations aren't entitled to stay in business. Let's cut our losses with the bottom 20% in patient satisfaction, I don't think we can change them. When we see 20 of 28 reviews describe  a fertility doctor as someone who "just wants your money," this suggest that this person just doesn't get it. So the question becomes, how do we impact the 60% majority to improve the overall standard of care?

vote with your feet

Let's start with the most highly rated REs, the ones people "can't thank enough." They have very few complaints and a great many compliments. These doctors are early adopters and innovators of a better care experience. They super-serve you because they are fascinated by exceptional care, or because compassion is simply one of their signature personality traits. The Diffusion of Innovation Theory asserts that the majority "needs to see evidence that an innovation works before they are willing to adopt it." In fertility terms, practices will invest more in individual attention, responsiveness, and empowerment when they see how excellent service boosts their competitors' top line.

early adoption in fertility care experience

You may live in a remote area where you really don't have more than once choice. That's a sad truth for many, and one we can only change with broader awareness of infertility and advocacy for better access to care. For everyone else, you don't have to choose someone just because your OBGYN referred them to you. You have several ways of exploring your choices.

1). Look at the clinic's success rates

Every fertility clinic in the country has to report their success rates to the Center for Disease Control (CDC). The Society for Assisted Reproductive Technology (SART) also requires its member clinics to report their IVF success rates. SART says that their data shouldn't be used to compare centers because patient populations may vary from clinic to clinic. That makes sense if the goal is statistical purity. Your goal, however, is to have a baby and some clinics have as much as double the success rate of others. You should be comfortable with a clinic's success rates before you decide on them.
 

Note: You should also reflect on how important this clinical metric is to your overall experience. In a brief report I conducted on people coping with infertility, slightly more than half said that extraordinary success rates with an awful bedside manor were more preferred than a compassionate, personable team whose success rates are well within the standard of care. There isn't a wrong decision here. It's your money and your emotional energy.  You may be able to find the best of both worlds, but you should decide which is the greater priority so you know what you're looking for.

2). Check their online reviews

Vetting a fertility center by their online reviews is an absolute must, even if you were referred by a close friend. Think of it this way. Do you hate your friend's favorite restaurant?  Imagine describing that restaurant to a third person. If the new person only heard about the restaurant from your friend, it would seem like the obvious choice. It's only when the newcomer has additional opinions to consider that her judgement is balanced. I've written in detail about how to use reviews to choose your fertility center because the more experiences you have to consider, the more whole your preview of the clinic will be. In addition to the platforms I've recommended before, a new site has caught my eye. Fertility IQ shows how patients rate their doctors on communication, response time, and even if they felt like they were treated like a number or a human. Patients answer qualitative questions about their experience and they rate the clinic on nursing, billing, atmosphere, and more. At this time, the site has too few responses to be able to adequately judge most doctors and practices, but keep it on your radar, because I think it will provide a tremendous amount of value to prospective patients. If you have already seen a fertility specialist, it would really help the community to leave a review there.

Fertility IQ home page

Fertility IQ home page

3). Press your OBGYN

Maybe your OB knows the RE that she is referring you to very well. Maybe she's never even met him. Ask. Inquire about what opinions she has heard from her returning patients. Once patients finish with fertility treatment, they return to their OB, so your doctor should have plenty of feedback regarding the RE.

  • Were the patients delighted with their experience?
  • Were they disappointed?
  • What other REs would she consider referring you to?
  • What have patients said about them?
  • Why does she recommend that RE as opposed to others?

People sometimes tell me that they were really disappointed with the RE or clinic that their doctor referred. Make sure your OB knows if you weren't satisfied with your experience. REs aren't entitled to referrals and your doctor should be informed to protect her patients' best interests. 

4). Ask people in your support group

There are hundreds of infertility support groups out there; independent groups, faith-based groups, ones led my mental health professionals, and those that are peer-led. If there is a RESOLVE support group in your area (or a Fertility Matters group in Canada), you should visit one of their meetings before you even choose a fertility center. These are people who have faced the same challenges you face. They have felt the same loneliness, the same longing, the crushing disappointment, and the financial hardship. Most of them have already been to a fertility specialist. Tapping in to their collective knowledge will help you learn from their wins and avoid duplicating their regrets. They also have a good idea of how proactive the practice is in empowering patients to find support resources. You don't want to be left to fend for yourself when it comes to finding community and professional support.

5). Talk to people on social media

The #infertility hashtag has been posted more than 143,000 times on Instagram alone. There is a vibrant #ttc (trying to conceive) community on Facebook and Pinterest as well. On Instagram, I often see people from the same city discussing their experience at their fertility center. Take advantage of their knowledge. You can send private messages to people who have left reviews on Facebook and Yelp. Reach out to those who have left negative and positive reviews. Talk to as many people as you feel gives you an accurate picture of what is important to you.

The choice is yours

We don't live in 1981 when the first IVF cycle was performed in the United States. Back then, your only option to find a fertility specialist would have been from a referral from your doctor. Today, you have so many options at your disposal to make the best decision. You are going to let a very important person play a role in a very delicate part of your life and you will most likely spend thousands of dollars of your own money. A fertility practice isn't entitled to your money or your emotional energy just because one doctor referred them. You deserve the best attention, considering what you are putting into it, and frankly, fertility clinics with a better patient experience deserve to do better than those who ignore what their patients want and need. If you have already been to a fertility practice or have undergone treatment, I hope you share your experience in detail with anyone who is considering the same.