Should I fire my fertility center's marketing manager?

By Griffin Jones

Fertility doctors frequently ask me, “Is it better to have an in-house marketing person or contract an outside marketing firm?” You might expect me to favor the choice of hiring the firm. I don’t. The two are not mutually exclusive; each role is critically important to the other. In fact, across the board, your staff are paramount to your fertility practice's efforts to recruit new patients. There are assignments that your in-practice marketer should and should NOT be tasked with to maximize effectiveness and cost-efficiency. The same is true of your agency. Depending on the size of your practice, it may seem redundant to have both an internal marketing person and an agency on retainer. When used correctly, they will each pay for themselves and then some. 

marketing manager or clinic liaison?

If the practice has only one dedicated marketing person, his or her greatest productivity may very well come from the assignment of practice liaison. This is a function that is extremely difficult to outsource. As a marketer, my focus on digital media is owed only to its powerful results in attracting new patients. Digital’s proven ability to grow fertility practices doesn’t make physician referrals any less meaningful. Even in 2017, OB/GYN referrals still count for a tremendous share of new patients. Having someone who can regularly schedule physician-to-physician lunches, deliver semen analysis kits and information about infertility support, and educate OB/GYN staff in your area is tremendously valuable to the practice. Markets differ widely on the return on investment (ROI) of MD referrals, but in some cases, it may be a fertility center’s fastest path to growth.

physician referral case study

I asked an expert on the topic to share her experience on nurturing relationships with referring doctors. Shirley Sinclair is the practice manager of the Fertility Center of Chattanooga.

"For over 10 years, we’ve tried to find the magic source of how to bring in more patients and one of the top ways is still through referring physicians.  This process has taken us some time to fine-tune, but it has proven to be very successful.  We know our physicians are very busy, especially OB/GYN’s, so it is critical to remember that every minute of their day is valuable.  With that in mind, we developed a few different ways for doctors to easily consume our message.
•    Distribute referral packets in a beautiful folder filled with
o    information about our clinics
o     fact-sheets about infertility and testing
o    semen analysis kit.  
•    Provide a referral sheet for the referring physician, in which they can
o    add the patient name,
o    check off the type of appointment they are requesting (such as semen analysis, consult, etc.)
o     Fax back to our office

"We contact the patient to set up the appointment, thereby freeing up the referral’s time.  We take these packets to each office about every 6 weeks, along with some type of goodie for the staff.  This is not the time to ask to speak with anyone!  They will remember you more if you do not become a nuisance.  Also, do not leave too many packets; the idea is to show consistency and for you to become familiar with the staff.   

"Another great tip is to set up lunches with referring practices.  While this can be time consuming, this is a wonderful tool to use, especially when you have a new program or new protocol that you would like to share with the doctors.  Always take one of your physicians and, in addition, it is helpful to take someone from your staff that is familiar with the clinical side, as well as financial.  Physicians are always curious about what insurance will pay for as it is one of the first questions patients ask their doctor when they are encouraged to see a fertility specialist.  

"Use this time to assure the physicians that you would like to set up a partnership in providing the best care for their patient.  In other words, remind them that your goal is to help the patient become pregnant and send them right back!  Also, educate the physician that referring a patient sooner, rather than later, will save the patient precious time, money, and especially undue emotional stress.  Hanging on to a patient 6 months longer could be the deciding factor of what type of treatment the patient will end up having, therefore, adding additional hardship to the patient.  

"While these tips are vital, they are worthless unless you track them.  We use an EMR that is designed for fertility clinics, called eIVF, to track our referral sources.  Keep track of which physicians’ offices refer to you! In addition, make sure your physicians follow a protocol to send letters to the referring physician after the patient’s visit. Then send a follow up letter when you send the patient, hopefully pregnant, back to her OB/GYN.  Keeping your referring physician in the loop about their patients will solidify a long, successful relationship that will not only be beneficial to each of you, but, most importantly, to the patients for whom you both care!"

WAYS YOUR MARKETING MANAGER CAN HELP YOUR AGENCY

If you have more than one practice marketing person, or you live in a market where physician relations is not a full time job, your marketing manager is irreplaceable for a number of tasks that need to be accomplished within the practice. 

hiring a fertility marketing agency

Content sourcing. I don’t fly a member of my team to Honolulu every time we want to post a picture of the Fertility Institute of Hawaii’s staff to Instagram. Homemade and frequent content is vital to any practice’s content marketing strategy. In-practice marketers can serve as “brand journalists”, collecting the necessary images, stories, and videos to be sent to the agency for editing and distribution.

Operational changes.  You may find that your online reputation is not as great as it should be, simply because of one or two common patterns. Patients might love your staff, but report your response time to be abysmal. The practice manager super-serves the practice when he or she is able to implement systemic changes that are needed to improve the marketing imprint of the practice.

Tracking. Your marketing agency will be able to tell you how many people RSVPed to your practice’s IVF informational session. Your in-practice marketer will tell you how many actually showed up. If using a CRM or not, the in-practice marketer is critical in measuring and reporting the volume and sourcing of new patients.

WAYS YOUR AGENCY CAN SERVE YOUR MARKETING MANAGER

Not the first time I've included a Jerry Maguire meme on my blog 

Not the first time I've included a Jerry Maguire meme on my blog 

One stop shopping. Your practice manager has enough to do without searching for a website developer, a photographer, a graphic designer, a writer, or a cinematographer every time your practice needs something. Your agency can provide that to you under one roof. 

Social Media and Online Community Management. It’s not a good use of your practice manager’s time to respond to every comment on social media or online review sources, or to have to scour for content to post every day. Your agency can handle online interaction and take the lead from your practice manager when specific questions arise. 

Content Development. Your agency can turn the raw text, photo, and video your practice sends into polished infographics, edited e-books, and maximize their distribution on social media and the web. The creative content and design that your agency helps you create doesn’t have to stay on your online properties, either. Digital materials like infographics and guides make for valuable resources that turn your clinic liaison’s visits into less of a sales call, and into more of a service to the referring doctor. 

Advertising. It’s possible to waste a lot of money on bad advertising. Does your team know how to target same-sex couples, who married within the last year, who recently visited your website and live within 25 miles of your practice? Mine does.

Tracking. Your business manager doesn’t have to be an expert in Google Analytics or using a customer relationship management (CRM) software. Your agency can be in charge of mastering your conversion system. 

THERE IS NO "I" IN aggregate TEAM MARKETING EFFORTS

A clinic liaison or marketing manager can be very effective for your practice. So can a hired agency. When they work in tandem, they return their investment exponentially. Studies find that marketing leads convert seven times more frequently when employees are fully involved in the process.  Patients often mention their favorite staff when they leave positive reviews about their fertility center, and the compassion of team members can be invaluable in the fertility journey. Some personnel may want to be the star of a video, and others may prefer a “behind the scenes” role. From contributing to blog posts, to planning events like the baby reunion to promoting support networks, there are plenty of ways to engage staff in the practice’s marketing strategy.

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. 

 

Why Would Anyone Else Care About Infertility? How I Became an Ally to a Community I Had Nothing to Do With

By Griffin Jones

"Don't worry, you can always adopt"

I don't know if I ever had a conversation with anyone struggling with infertility (about the topic) before a few years ago. If I had, I probably would have said something silly like the above. I would have said it with the best of intentions, and hopefully, I would have kept an open mind. I knew nothing about infertility.  I had barely heard of IVF. I had no idea what a reproductive endocrinologist (RE) was. I am a young male with zero medical background and no personal connection to infertility. On paper, I was the least likely person to become an ally of the infertility community. And that's the very reason it seemed so important to become one.

caring about infertility

expanding the community

Whatever the issue at hand, progress will be limited if the consequences only apply to the people directly affected. This is true if we're talking about small issues at the local school board or large ones like repealing laws that ban same-sex marriage. Every community needs allies who are not "native" to their background for credibility and traction. I found infertility awareness to be an important concern that needed attention from more people than only couples struggling to conceive. It looked like they needed reinforcements, might be one way to put it. Still, there are infinite communities that I don't belong to that need support from the broader public. Why this one?

acknowledging the right to feel

There is a particular nuance in the way the infertility community is treated that piqued my curiosity. I still can't totally articulate it, but it has to do with we, as a society, not letting people feel what they need to feel. Responses like "at least you have one child already", or "stop worrying about it and it will happen" are pretty consistent with how we react to a lot of feelings that we don't totally understand. We jump to the "solution" because we want the feelings of hurt to end immediately. Sometimes out of compassion, sometimes out of laziness, and probably anywhere in between.

"You'll find someone else."
"You'll land a new job."  
"It's not so bad."

I wanted to shut up for a minute and allow people their right to feel.

ThAT blurry area between Sympathy and Empathy

Judging how other people should feel seems to stem from trying to equate someone's reality to our own. We often compare experiences as though they could possibly be the same, instead of drawing from them to imagine how someone feels. Dictionary.com describes sympathy as "feeling compassion, sorrow, or pity for the hardships that another person encounters, while empathy is putting yourself in the shoes of another".  The only way to know the pain of infertility (or cancer, or the loss of a spouse, or absolutely anything you could imagine) is to experience it personally.

Relating to imagine what people feel, not knowing exactly what they feel.

Relating to imagine what people feel, not knowing exactly what they feel.

We might not be able to fully understand someone's experience that we don't share, but we can usually empathize when we try.  I've never had to go through the "two week wait", but I know how anxious and frustrated I become when someone tells me to "just relax". People might not pester you about when you're going to have kids when that's what you want more than anything in the world. You may, however, know the soul-wrenching feeling you get when people ask you about a life goal that you're trying your best to achieve, and you have no idea when it will happen. Interacting with people with infertility has made me more aware of imagining what people might feel, in all kinds of scenarios, instead of judging what they should feel.

Playing for the team that drafted me

I noticed the community that emerges from this longing to be understood when I first started doing social media for fertility centers in 2014. Some people who had children because of assisted reproductive technology (ART) were so overjoyed that they wanted to tell the world about it. The emotional attachments they had to their doctors and care team was palpable. They exuded a sense of triumph that comes only from a prolonged period of hard times. I had worked with several other business categories in the past and never seen anything like it. Then I wondered about the people that haven't had success or are still on their journey. What do they need help with? So I took it upon myself to e-mail the group leader of every RESOLVE support group in America. You'll be able to read more about that in my memoir, The Unlikely Tale of How I Became Besties with the National Infertility Association. Turns out, you're not supposed to do that. Before the nice people at RESOLVE could contact me to say "hey knock that off, guy", I had already talked with dozens of people dealing with infertility over the phone and via e-mail conversations. Their reception of me sealed the deal that these were people I could get behind.

If you don't get this analogy, you're going to have to re-watch Jerry Maguire

If you don't get this analogy, you're going to have to re-watch Jerry Maguire

I was completely upfront about who I was. "Hi, I'm a marketer and I'm thinking about starting a business for fertility practices. I would love to know what information you really wanted from your clinic(s) that you just couldn't get". I'll translate this for you:

"Hey, I'm some dude that knows nothing about you, nothing about your problem, nothing about medicine, and I would maybe like to possibly make some money some day".

"Go f yourself" would have been a perfectly reasonable response. But I didn't get that at all (maybe once). Instead, people were generally very eager to talk to me. They told me a lot. They told me about a whole bunch of stuff I had never heard of before...stuff that most people would consider very private that I didn't even ask about. They even thanked me for doing my research. Thank me? A marketer? Didn't they know that marketer is just one or two rungs better on the scum ladder than investment banker? I had never been acknowledged like this before--why them? I realized right away it was because they were yearning to be listened to. I learned first hand how little they felt understood, even by their clinics. I felt armed.

I jumped on Instagram to engage with the #ttc (trying to conceive) community there. Same thing. "Hey everyone. I'm a marketer. I don't know your journey, but I promise I will out-listen anyone who tries to compete with me in the business I'm building". Once again, I've been totally humbled by the welcome I've received, both online and in person. I get occasional shout-outs, words of encouragement, and people keeping tabs on me. I've been a marketer for ten years now and I've never received that from any other segment I've worked with. That is a very rewarding thing about working with a population with whom the stakes are so high. Shit matters. People don't feel that way when they buy a Hyundai Sonata. Even though I work with clinics, and not directly with patients, it's the patients that get me excited about what I do.

Stay classy, #infertilitycommunity

My guardedly optimistic prediction for the future is that public awareness around infertility will grow significantly. When it does, I hope the discipline of listening to and trying to imagine the feelings of others wins over the comparison of struggles. Affording people their right to feel and the humility of using experiences to empathize instead of drawing contrast are amazing lessons in humanity. I realize that I am totally idealizing the values of a very diverse and massive population of people. But that's what they are--ideals. And those are what made me want to be an ally to a community I originally had nothing to do with. 

 

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!

5 Lessons from Advocacy Day That Will Teach You to Never Mess with The Infertility Community

By Griffin Jones

What a day. Legislation hasn't been this much fun since School House Rock. RESOLVE, The National Infertility Association, held their 2016 annual Infertility Advocacy Day at the Capitol on May 11. Over 200 advocates came to Washington, DC to meet with their legislators regarding a few key issues that deeply affect both the infertility and military veteran communities. This was the largest advocacy day that RESOLVE has hosted to date and we hope it's only a glimpse of the momentum that is building for the future. If the relationships made between advocates are any indication, this is a movement set for growth. If you've ever wanted to connect with the infertility community, you need to come out for Advocacy Day; plain and simple. Read on to determine if it's the right fit for you. Let's start with some background on the issues for which we went to advocate:

Some of the NY Delegation with RESOLVE's Barb Collura. Photo courtesy of @the2weekwait

Some of the NY Delegation with RESOLVE's Barb Collura. Photo courtesy of @the2weekwait

Women Veterans and Families Health Services 
S 469 in the Senate and its companion in the House of Representatives, HR 3365, introduced by Senator Patty Murray (D-WA), would lift the Department of Veterans' Affairs' (VA) current ban on IVF for veterans and expand Assisted Reproductive Technology (ART) services available to active duty service members through the Department of Defense (DOD). Senator Murray’s bill would also provide access to fertility treatment for spouses and allow for adoption assistance. This piece of legislation is extremely important to the infertility community and to U.S. military veterans. Call, e-mail, and tweet your lawmakers to ask them to co-sponsor this bill.

Certain Veterans with the Loss of Use of Creative Organs
A bill proposed by Rep. Jeff Miller (R-FL) in the House of Representatives (HR 4892) will allow for veterans wounded in combat to receive an extra $20,000 in compensation for family building purposes which may include ART or pursuing adoption. In my opinion, this is weak stewardship of our veterans, but it has bipartisan support and is likely to pass. We advocated for Congressman Miller's bill so that, in the meantime, veterans at least have some help in building their families.

Adoption Tax Credit Refundability
As an American voter and taxpayer, you would hope that bills S 950 and HR 2434 would be a no-brainer for both parties in the Congress. The Adoption Tax Credit has not been refundable since it was made permanent in 2012. We are asking for refundability to be restored so that adoption becomes more feasible for lower and middle income families. This bill has support across the spectrum, it just needs enough people to give it the attention to move to a vote.

"The Plan"
Rather than a piece of legislation, the National Action Plan on Infertility, issued in 2014, was a declaration by the Centers for Disease Control (CDC) that infertility is a public health issue. Advocates are looking for senators and representatives to champion the plan and stand up for infertility as a national concern. Will that legislator be yours?

1). Stand Up for our Vets

Now that you know a bit about the bills that we advocated for, the rest will make sense. On Infertility Advocacy Day, there is no distinction between the needs of military veterans and those of people struggling with infertility. The communities are united in their work for what is right. So there couldn't have been a more fitting way to open the welcome reception on May 10 than a few words from three wounded servicemen and their wives who were awarded with RESOLVE's hero awards. We heard from soldiers and Marines who were shot through the neck by an enemy sniper and suffered explosions from improvised explosive devices (IED). Americans are disgusted when they learn that our wounded warriors are unable to receive treatment for the consequences of the wounds they sustained while in service to our country. It's disgraceful that our government will not allow the VA to enable them to build their families.  Were there more public awareness about Congress's unconscionable ban on IVF for veterans, it would be lifted in a heartbeat. This is where we need your help in letting people know about #IVFforvets. Public awareness is growing, as is news coverage here, here, and here, but we haven't reached the tipping point yet.

These Hero Award recipients speak about their struggle to build a family. Photo courtesy of @Recombine

These Hero Award recipients speak about their struggle to build a family. Photo courtesy of @Recombine

2). Be the change you want to see in the world

RESOLVE President and CEO, Barbara Collura, introduced the vice-chair and chair of Advocacy Day (respectively) , Candace Wohl, a RESOLVE peer support group leader from Virginia and co-founder of Our Misconception, and RESOLVE board member, Lee Collins. "I decided to do what was just," Wohl said, referring to her decision to speak out about infertility and advocate for the opportunity of building a family for millions of people.

"I see a room full of world changers," Collins added as she addressed the crowd of 200 advocates. The speakers made clear that Advocacy Day is about taking action. It's an opportunity to make a visible and real change.

3). don't take no for an answer

Breakfast on Wednesday morning began our briefing on the issues. We continued with our veteran speakers as Rep. Tammy Duckworth (D-Illinois) spoke to us about her journey as a wounded warrior, and someone with infertility who utilized IVF to conceive her daughter. "Military women are twice as likely to be infertile as civilian women," Congresswoman Duckworth informed. Ms. Duckworth encouraged the advocates not to take no, maybe, or lip-service yeses for an answer. "This isn't my house, it's your house," Duckworth said of the Congress. "It belongs to you the American taxpayer"

Rep. Duckworth addresses the advocates/ Photo courtesy of @BarbRESOLVE

Rep. Duckworth addresses the advocates/ Photo courtesy of @BarbRESOLVE

4). Make democracy work

It was time to get work. Each state's team headed to their senate and congressional appointments. Most of us met with the staffers responsible for veterans' affairs and/or healthcare but some of us were lucky enough to meet with our legislators in person. I very briefly ran into Sen. Chuck Schumer (D-NY), Rep. Chris Collins (R-NY), and even got a bonus Charlie Rangel (D-NY) selfie! Some state groups were larger and some advocates went alone to their meetings. The RESOLVE staff did an excellent job of making sure that first-time advocates, or people who didn't feel comfortable flying solo to meetings, were accompanied by an Advocacy Day mentor; someone who has previously advocated for infertility issues on the Capitol. 

5). Reflect on the progress made and the work left undone

Finally, we wrapped up the day for a farewell briefing, to commiserate on what we had accomplished and largely to thank and congratulate the people who had done such a good job of putting the event together. The RESOLVE team did an incredible job of organizing the scheduling, messaging, promotion, recruitment, and followup for their day. The get-together at the end of Advocacy Day was a moment to appreciate how much RESOLVE does for people with infertility, and how the community wouldn't be nearly as cohesive without them. We owe them a debt of gratitude for everything they do to bring patients, physicians, medical professionals, mental health professionals, family building professionals, and allies under one banner. 

lasting impact

Sometimes people with infertility express a lack of control and a strong feeling of isolation with respect to their disease. But at least for one day, I didn't see any of that. I saw a powerful, focused community of people who were prepared and diligent in making an actionable change for their peers. In my opinion, the best part about Advocacy Day is the friendships that are made. When an advocate sees someone else walking the halls of the Capitol buildings with an orange ribbon, there is an instant bond that leads to taking impromptu meetings with congressional staffers together, or at least an #IFadvocacy selfie. Many of the advocates had met each other through social media, but never in person. The love and camaraderie between these folks is real and invigorating to be around but don't take my word for it, look at #ifadvocacy on Instagram and Twitter. I hope you'll experience it for yourself in 2017; if you participate in the infertility community in any way, there's no other day like it. 

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!

24 Things You Would Never Know About Infertility Until You #StartAsking

By Griffin Jones

Last night I had one of the coolest conversations that I've had in a little while. The best part, is, we recorded the whole thing. This week is National Infertility Awareness Week and I wanted to participate in the #startasking dialogue, not just with sound bytes or with a scripted narrative, but a candid, meaningful conversation between people who really want to see the infertility community receive the recognition they deserve. So I invited a few cool people to chat on Blab.

  • Chris and Candace Wohl, are a married couple who have been on their infertility journey for nine years. They have a daughter through surrogacy and they write the blog, Our Misconception
  • Angela Bergmann and her husband have unexplained infertility. Angie writes the blog, Rad Kitten, and she leads an infertility peer support group in Ohio.
  • Fran Meadows struggled with infertility for seven years. After she had her son she decided to break the silence about her experience and author the book, The Truth Behind the Secret "Infertility".

Watch our conversation about infertility and how much you can take control by promoting awareness.

Despite no shortage of technical difficulties, Mid-Atlantic thunderstorms, and Blab still being in beta (Watch this at 2:38 if you don't mind the f bomb), we farmed some really valuable ideas from our talk. Here's what you missed

On speaking out about infertility

"#startasking doesn't have to be about your personal infertility. We need people to start asking their employers, and doctors, and healthcare providers and anyone who will listen to give us access to the family building options that we just don't have access to right now". --Angie

"It's up to you to set the boundary of what you're willing to share and what you're not willing to share. Maybe you don't want to share anything at all and that's totally fine. You set those boundaries at the beginning".--Angie

" For the first two to three years of our journey we didn't tell anyone. We didn't have any support. We weren't seeking counseling." We didn't know about organizations like RESOLVE. I just felt alone."--Candace 

"Before we had our son, I felt like it was easier for my husband and I to deal with it as a couple than to open it up to the world to know every step we were going through."--Fran

"It is very common, that people keep silent [about infertility]. There are so many people that are afraid to open up and they relate to someone who felt their pain".--Fran

"Being able to talk to me, since I've always been open about infertility has helped people figure out that maybe they were being silent not necessarily because they wanted to, but because they didn't know how to broach the topic with their family members."--Angie

"We decided to take our struggle and make something positive out of it."--Candace 

"Even though we have our daughter, we still are infertile. Somehow getting all these voices together and talking about what we go through makes it that much easier" --Chris

"You can set boundaries with your family members: this is what I need from you, this is what I don't need from you."--Angie

"We realized that we needed to debunk the stigma. We need to help other couples who may be on the fence. We need to help couples who may not know there are options like counseling and organizations like RESOLVE that can help".--Candace

On the misunderstanding of infertility as a disease

"There's just a lot of misunderstanding as to what the options really are."--Chris

"I don't have to have had a child to have beaten infertility. I beat infertility every day because I own it. It's a disease. I could have five kids I'm still going to be infertile."--Angie

"The number one thing I get from people is 'well if you're having trouble having kids, that means you just get all kinds of sex, right?'. There's going to be a whole series of bedroom antics that have nothing to do with having fun".--Chris

"It's a disease. Would you be afraid to tell your family that you had diabetes?" --Angie

"Adoption solves the need for children. It doesn't solve infertility."--Angie

On being your own advocate

"Millennials are hungry for information. The key is to provide them with the right information. They need to look at SART data, at ASRM, at the CDC, and they need to look at RESOLVE. It's all about being your own advocate and taking this information to your RE".--Candace
,
"Being your own advocate gives you more confidence knowing what you're doing getting into whatever treatment you choose. The doctor is the doctor, but sometimes you have to question certain things to know that you are making the right decision."--Fran

"If REs have that bedside manor where they appreciate you asking questions it helps you move forward in the journey with trust". --Fran

On taking action to make a change

"We need to get more people to advocacy day. We're never going to make a change until they see 1,000 of us walking to our appointments. We need to get laws passed to get the national recognition we need".--Angie

"There's so many people who are angry and who want change. You can do it. You have a choice. You have the right as a U.S. citizen to make a change. Join us and change the world so that family building is no longer a financial barrier. So that people can get treatment for their disease. This isn't an elective. This is a disease. RESOLVE's Advocacy Day is May 11, and we're so close to 200 advocates".--Candace

"Millennials want to make a change. That's what they do. They get loud and they make change".-Angie

"Use your voice on the phone, with your e-mail, with your letters. Even if you can't make it [to advocacy day], you can still be really involved".--Fran

"[Advocacy Day]" is truly the most overwhelming and empowering day of your infertility journey to be able to take that moment of control".--Angie

"If you can't make it to DC, you can still support us. Take a look at resolve.org/advocacyday or follow us on social media and we'll lead you in the right direction".--Candace

 

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.

 

12 Nuggets of Wisdom You Missed at the New England Fertility Society 2016 Annual Meeting

By Griffin Jones

It was a weekend of fools at the New England Fertility Society's (NEFS) 14th annual meeting, which took place on April Fools'weekend, April 1 and 2. The meeting was set amidst the gorgeous landscape of Vermont's Green Mountains in the resort town of Stowe. Yes, we had dessert catered by Ben and Jerry's Ice Cream. NEFS President, Jill Attaman, MD, thanked the roughly 170 people in attendance, and introduced the April Fool's theme, with practical jokes played throughout the weekend. Yes, there were woopie cushions. If you weren't fortunate enough to have joined us for this year's meeting, here is a brief synopsis of what you missed.

1). 2014 SART reports expected to be released this week. Brad Van Voorhis, MD, the President of the Society for Advanced Reproductive Technology (SART) discussed Big Data for Personalized Medicine and the role that SART has played over the last thirty years as the nation's first national patient health registry. Dr. Van Voorhis reports that just under 400 treatment centers report directly to SART, with only roughly 30% of that number reporting directly to the Center for Disease Control (CDC).

2). Selwyn Oskowitz has left the building. Well, sort of. Selwyn Oskowitz, MD, the founding president of NEFS (then the Boston Fertility Society), retired from his storied career at Boston IVF the day before the meeting began. His colleagues paid him an emotional homage, and he received a standing ovation from everyone in attendance. "Is this real?" Dr. Oskowitz joked, referencing the April Fool's theme. Dr. Oskowitz will be traveling to Rwanda intermittently over the next year to provide pro bono medical services to those with infertility.

Dr. Oskowitz's colleagues remember his career fondly

Dr. Oskowitz's colleagues remember his career fondly

3). 60% of human embryos result in pre-clinical losses. Steven Young, MD, PhD, of the University of North Carolina School of Medicine lectured on Endometrial Receptivity. Implantation abnormalities are common causes of infertility, pregnancy loss, and pregnancy complications. Dr. Young believes that the next major breakthrough for infertility therapy will come from optimizing successful embryo implantation, which may have important downstream advantages in reducing pregnancy complications.

4). Focus on fertility preservation. Clarisa Gracia, MD of Penn Fertility Care discussed Ovarian Tissue Cryopreservation. With respect to reproductive function, high-risk cancer survivors in their mid twenties have measures similar to naturally aging women in their early forties. She adds that maturing immature eggs from tissue in vitro eliminates the risk of transplanting cancer cells.

5). Cryopreservation now routinely applied to oocytes and embryos. Terry Schlenker, of the Colorado Center for Reproductive Medicine presented on the Vitrification of Oocytes and Biopsied Embryos. Ice formation is avoided by loading the cells with high concentrations of solutes to convert the water into a  non-crystalline solid. Vitrification is now considered indispensable to ART.

6). May the force be with you. Judith Daar, JD, of the Whittier Law School reports that in February 2016, U.S. Secretary of Defense, Ashton Carter, announced a $150 million pilot program to fund egg and sperm freezing for all active duty military. Due to Congress's current ban on IVF, however, the frozen eggs might never be accessed once the soldier is discharged from service.

7). Stress on the rise. 44% of Americans report that their stress levels have increased over the last five years, according to a 2012 American Psychological Association study cited by Courtney Lynch, PhD, MHP, of The Ohio State University Wexner Medical Center. Though not yet conclusive, evidence is suggestive of an association between infertility and stress. 

8). You're not crazy. Rachel K. Ashby, MD, of Brigham and Women's Hospital talked about the importance of validation of feelings with respect to Patient Centered Care in an Infertility Practice. "Patients are worried, 'I'm crazy, I'm not handling this well, everyone else's relationship is stronger than mine'". Dr. Ashby emphasizes the importance of validating these patient experiences as common and that distress is an appropriate reaction. 

9). Triplets don't come cheap. Barbara Luke, ScD, of Michigan State University cited a 2013 American Journal of OBGYN study in her lecture on Designing Research to Assess Health Outcomes After Assisted Reproduction. The per infant cost of triplets counts at $135,733, compared with $8,327 for singletons. Media outlets often sensationalize high profile cases of multiple births but omit information regarding the highly common medical risks.

10). Politics is messy business. 132 Congressmen and Congresswomen have co-sponsored the leading federal embryo-personhood bill. Lee Rubin Collins, JD, spoke on behalf of RESOLVE on Infertility, Ideology, Patients and Politics. RESOLVE has fought legislation threatening IVF in 24 states and counting. 

11). We're not the only ones. "Why would they invite a Canadian to come speak on law regarding funding for reproductive health in New England?" joked Neal Mahutte, MD, of Montreal Fertility Centre. Dr. Mahutte shared the legislative challenges to ART in Canada and in Quebec. Like the United States and virtually every nation in the world, it is very difficult for lawmakers to write consistent laws pertaining to ART. In Canada for example, clinics can import sperm from paid donors in other countries, but donor compensation within Canada is prohibited.

12). People aren't having enough sex. That was the conclusion of pretty much everyone I spoke with. Well...you heard it here first.