In this episode, Griffin chats with Dr. Lora Shahine about the importance of public relations and content creation. Dr. Shahine is an REI specializing in infertility and recurrent pregnancy loss at Pacific Northwest Fertility and IVF Specialists in Seattle, WA. She has written three books and many blog posts for outlets such as the Huffington Post, not to mention her social media presence. You can find her on Twitter and Instagram at @drlorashahine.

Griffin Jones: Today I have a friend on the program. It’s Dr. Lora Shahine. She’s an REI specializing in infertility and recurrent pregnancy loss at Pacific Northwest Fertility and IVF Specialists in Seattle. Dr. Shahine completed her medical school at Wake Forest. She did her residency in OB/GYN at UC San Francisco, and she did her REI fellowship at STanford. She’s all over social media. She’s been featured in and written several blogs, including in major publications. She’s written three books, two of which are “Planting the Seeds of Pregnancy” and the other is called “Not Broken.” Because of this, she is on our show today. Welcome to Inside Reproductive Health, Dr. Shahine— Lora.

Lora Shahine, MD: Thank you so much for having me, Griffin! It’s a wonderful opportunity.

GJ: I kinda want to start this backwards, which is because you’ve done so much in terms of creating content, being featured in content… I want to start this backwards because we wanted to talk about the different hats that physician partners have to wear. You being interested in these different activities… why did you want to join an independently-owned practice and become part of that leadership team? To me, it seems like it would have been a lot easier to work for a health system or a university or a large practice group and do what you wanted to do separately.

LS: That’s great...That’s a good question. You know, my dad was an entrepreneur. He taught it in university as well. So I always learned from him… I’ve always been very interested in doing my own thing. So joining a practice where I had the ability to eventually become partner and be part owner was very appealing to me.

GJ: Did you think about it for awhile? What was your decision… can you recall back to it?

LS: Sure… I was really trying to think about academics vs. private practice as the first decision. I felt there was a lot more opportunities in private practice to be a little bit more independent. I knew that I had different interests, such as being creative and I always wanted flexibility. At first, I was definitely drawn to private practice, and I was really looking for opportunities on the west coast because of my husband’s job. I found Pacific Northwest Fertility in 2009 and just knew immediately when I met them that our visions were aligned and I really feel very fortunate to join that practice.

GJ: Let’s talk a little bit about that, about how you know when your vision is aligned with someone and what needs to be spelled out. There’s gonna be people who are hiring new doctors who are listening to this, there’s going to be new doctors who are going through that same decision you went through in 2009. I was saying in an earlier episode, one of the things that I like about owning Fertility Bridge is that it’s a dictatorship. I get feedback from my clients and my employees and I take it really seriously in how I make my decisions, but at the end of the day, there’s one person making those decisions. In my opinion, that makes things a lot easier. When you’re discovering the vision of the practice that you want to join and comparing that to the vision you have for your own career, what did you go through and what does somebody need to consider when they’re experiencing that?

LS: Sure. So, one thing that was different about Pacific Northwest Fertility was that it was owned and founded by two physicians, Lorie Marshall and Lee Hickok. They really went out on their own, got a loan from the bank, and used their experience in the community and their own brand and started it completely anew. I really appreciated their entrepreneurial spirit. By the time I was joining, they were already four years in and doing quite well, even through the recession. This was back in… I joined in 2009. I just knew if I joined a practice that was partly owned by a business or had shareholders to account to, I would have limited flexibility. I really liked their independent spirit.

GJ: Can you talk about a little bit about that last part? Which is you were attracted to the flexibility? When I’m talking to people coming out of fellowship, what I’m hearing from them is that they perceive more flexibility with either larger groups or a university system. “I get a paycheck, I go home, but I’m not necessarily drawn into everything that’s going on in the practice, which would limit either when I can work or when I can’t, or what I’m able to do.” So you saw more flexibility with independent practice… can you talk a little more about that?

LS: First, I think if you join a university or a practice that’s part owned by someone else, then there’s definitely other people that are involved in making decisions. If it’s physician-owned, and you can eventually be one of the physicians that is owning it, you’re gonna have a lot more independence. Everybody could have very different experiences, and when you’re first looking for a practice, it’s very much like dating. Partnership is like a marriage. You’re trying to look for similar values, you’re thinking about where you want to live, and imagining what your future practice is gonna look like. But until you’re in it for a few years, you can’t really know whether it’s gonna be right. I just got really fortunate that my first job is the one that I really liked and stayed with.

GJ: Let’s stick with the dating analogy. Dates 1-3 going perfectly, swimmingly… this person is marvelous. Dates 4-8, we find out they drink a little too much, or they’ve got some real deep-seated resentment against their relatives. At what point, what is that process like for people when they date and realize they want to enter into a partnership agreement. What date-- how do they put their toes in the water before there’s a bunch of contracts and several years into it?

LS: Well, I do think it does take several years to be sure you like the community and you like the partners that you’re working with. I think you can get a pretty good feel for people in the first six months to a year about whether it’s gonna work, and I think it still takes a couple more years to be sure it’s really a good fit. I think something that’s really important to align with is values. You figure that out pretty quickly when you see the things physicians have to deal with, whether it’s difficult patients or financial issues, difficult employees. Watching my partners work through difficult situations that came up , I learned a lot from them and I realized we were aligned on a lot of the same values such as patient care comes first. AS long as you’re focused on that and you’re giving excellent patient care, the patients are gonna keep coming, referring providers are gonna be there, finances are gonna be good. Also, just really taking care of the team. I really appreciated that. Really trying to focus on team development and career development within the practice. I thought that was really unique, and I enjoyed watching them mentor not just me, but other people on the team.

GJ: So, exploring these values is crucial for when you’re determining if this person will be the right partner and aligning those values. How do you keep those values aligned over time? I see some practices with ten partners, twelve partners, they might not all have the same equity or share, but that’s a lot of decision makers. ONe of the things I like about being a single-owned business, is that I make that decision and if i’m wrong, I have to correct it. But I can make them relatively quickly because I’m not necessarily having to get on the same page with another person who has the equal amount of say in it that I do. When it comes to things like, when do we sell equity? When do we sell equity in our practice or in our lab or what marketing should we do or how do we want our culture to be or who are the key people we want to hire.. It seems like if an ownership team isn’t super well aligned, any one of those decisions would start to chip away at that cohesiveness. How the heck do you do that?

LS: Absolutely. I think that we’re very fortunate that we’ve always been aligned, on the same page. I think one of the most important things is communication. I can’t overemphasize that. Part of that is weekly meetings where we get together and talk about things… business meetings, but also getting together a little bit socially, just to relax a little bit. Regular strategic planning meetings with an outside professional, someone to lead us through leadership training and kind of at least once a year getting together to align and discuss big business decisions that we need to discuss together moving forward. It’s all about communication.

GJ: I like that. In those meetings, the more frequent ones, do you keep the patient cases and other things-- anything non-business- out of it? Is it exclusively business or does it overlap a little bit?

LS: It does overlap a little bit, but also something that’s unique about our practice is that we do rounds every day at lunchtime. We get together to talk about all the patients and the cases coming through. We do touch base a little bit every single day, so those weekly afternoon meetings are mostly business or discussing big picture items.

GJ: I’m glad you said that about overcommunication. With my team, I call it the Amazing Race principle. I always call it the Amazing Race principle, because if you watch the Amazing Race and you saw these fathers/sons, mothers/daughters, college roommates, spouses, and you just watch them in the task, you would think that they hated each other. Or worse, they would think they hated each other. I always say, we might be elbows deep in a project, and we have a culture where there’s no name-calling or swearing or anything angry, but you can be chippy when we’re trying to get something done. I try to pull out our interaction from that and keep it separate. And I call it the Amazing Race principle, where we’re just talking about the relationship in this case. We’re just talking about them as an employee/team member, me as a boss/manager, as opposed to what’s going on in this client’s project, because I think if you don’t overcommunicate, that’s where that cohesion starts to fall apart. That’s why it doesn’t surprise me— a knee-jerk reaction might be, “Wow, once a week is a lot.” But then again, with what you’re dealing with, no, it isn’t. For me that seems probably pretty reasonable.

LS: I agree.

GJ: So how do you then agree upon who’s responsible for different key functions of the business, just like in a marriage, one person might be a lot better at finances, one person might be better at taking this particular role with the kids, one person might be better at planning… how do you break that apart within partners and say, “Ok, this is your seat, this is my seat, this is this person’s seat.”

LS: I do believe it’s important to divide and conquer and to trust your partners, because really you all can’t do it all. We sort of all naturally drifted toward things we’re drawn to and we come together for big business decisions, but there are definitely some of us that like to focus on, you know, marketing and social media; others that like to focus on the whole donor egg bank, or third party reproduction that we have in our practice. We definitely have different types of personalities on our team. Some are more visionary and thinking about big picture, some are in the trenches of protocol and thinking about details. We’ve been working together for so long, kind like a marriage. We don’t know if we all started out that way or if there were different personalities that sort of grew in different ways because we balanced each other. It’s hard to say.

GJ: How do you bring new people on, then? You mentioned when you started it was Dr. Marshall and Dr. Hickok, then Dr. Hickok retired, then you came on and others came one. How do you evolve? To me, it would be easy to say, “Ok, we’ve got this many people that are partners now, we’re doing really well with what in a lot of cases would be a much more fragile relationship to attempt, let’s not rock the boat.” How do you bring new people into it?

LS: Yeah, well, I think you have to bring people in and then see what their personality and how it fits. I think there’s gonna be different types of physicians. There are gonna be a lot of people that are drawn to more of a clock in-clock out type of model, where they aren’t gonna have to worry about marketing or making business decisions. There are gonna be people who aren’t worried about that, who don’t see it as stressful but see it as exciting. I think it depends on who that person is and how they jive with the practice.

GJ: So one of those roles for you that you gravitated towards was, I think it’s pretty fair to call you a connector. You connect with folks on social media. ONe of the ways you do that is through creating content-- you’ve written books. Did you know that about yourself before you joined the practice, or how did that come to be?

LS: I definitely would say that I have learned that I enjoy connecting with other people more in the last few years than I realized. I think that the process of writing and the process of using social media has allowed that part of my personality to come out. I truly do enjoy it.

GJ: What came to you first? Did you start posting on social media? Did you start writing blog posts? What was the most natural for you?

LS: Writing. My very first project— an acupuncturist in town, who happens to be— Stephanie Gianarelli— she happens to be the first person to refer a patient to me in Seattle, back in the summer of 2009. We just got to be friends. She had been working on a book for five years and really wanted a western approach to her eastern medicine book. So I just started writing chapters and it turned into more chapters, and it ended up being half the book. So we co-published it together. I realized how much I enjoyed writing; most of my writing had been research based and it was pretty prolific in fellowship. I continued to publish a little bit after fellowship. I found that I really enjoyed creative writing more than the scientific writing. I started writing blog posts and got them on Huffington Post. It was sort of fun, like, “Wow, I have a voice, I have something to say.” With my Center for Recurrent Pregnancy Loss, I found that patients really have a lot of the same questions, over and over and over again. I realized there’s only so much you can absorb in only one to two visits, so I wrote, “Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss,” truly as a tool to give to my patients so they could continue to learn and when they had a question about why we did a certain test they’d have a place to look it up, and it just kind of took off. I started using social media honestly as a way to connect with other people and get my books out there, and it’s sort of turned into a way to connect with people all over the world with similar interests in miscarriage and fertility help and coaches and it’s been wonderful.

GJ: I see the thought leader aspect of it because you’re able to connect with so many people all over the world, other experts… how does it impact relationships with new patients when somebody has a chance to read hundreds of pages of the spillings of your brain before they even say hello to you? What’s that like?

LS: Sometimes it’s a little weird. Sometimes people are like, ‘Oh, I’ve read your book and that’s why I’m here.” But then there’s still a lot of patients that haven’t read it, and even at the end of the intake appointment, I’m like, “Well, we’ve got a little something you might want to read and take with you… are you interested in that?” I don’t tell them that it’s a book I wrote. I just sort of hand it to them and walk out because I’m still sort of.. I don’t know… humble or something. I just really want it to be useful and helpful to people.I’ve gotten a lot of positive feedback about it.

GJ: Not just the book- on Instagram, somebody sees you… what is this like? I guess this was not the case in 2009, so what is it like for you, practicing medicine now when ostensibly you have more people that are more familiar with not just who you are, but what you’re like, coming to see you- a lot more than they were ten years ago?

LS: That’s a great question. I think most of the patients find me after they’ve seen me. I don’t see a lot of patients that say, “OH, I saw you on Instagram and that’s why I’m here.” I will say, sometimes while I’m doing ultrasounds, they’ll comment on a post I did, and say, “Oh, you know, I really appreciate you doing that post, I was kind of wondering about that question,” or, “Would you post on something else?” So it does kind of lead to conversations, but maybe not as often as you might think.

GJ: They’re peeking at you.

LS: Yeah, exactly.

GJ: I always wonder- this is not something I have a concrete answer for and might not, but it’s something I talk a lot about with guests on the show, I’m not sure where marketing and public relations ends and the practicing medicine begins as another tool of communication, as a way of distributing your ideas, as a way of educating the patient, as a way of building rapport with the patient. What might start as, “I might take a lead on marketing,” eventually there are aspects of that where you want other key stakeholders in the practice to also do. Maybe you don’t have more of a crystal clear answer than I do, but I wonder does everyone in the practice, or at least let’s say the physician owners, do they all need to be involved with this in some way. If not, why? If so, to what degree?

LS: I think that they should be involved if they want to, but I definitely don’t think anybody should force themselves to try to do social media if they’re not drawn to it or they tried it for awhile and don’t really like it. Because it really is a personal connection, and you are… I connect more with other female physicians and fertility providers and kind of ask questions that way… I don’t know. I just don’t… I truly enjoy just being creative and sort of thinking about how I can do a post and I only do it if I think of something. I’m not planning it out and being strategic about it. I think if it started to feel that way, I think it would be less fun and I don’t think I’d enjoy it as much. I definitely wouldn’t do it if I didn’t enjoy it.

GJ: That’s fair. What would you conclude about this--with the thesis of this episode being that marketing and public relations and content creation are one hat that practice owners wear. What else would you want practice owners to consider about the multiple hats they have to wear if they’re deciding, “Should I go into a track where I’m either buying into a partnership with an independent practice or opening up my own independent practice,” What other hats should they consider?

LS: I think they should consider how much research they’d like to do, if that’s a really important part of what brings them joy. You would have more access to research and clinical trials in an academic setting. Teaching, I think, is really important, my practice is unique in that we teach the UW residents their RE exposure. That was something I was drawn to. I was nervous about giving that up if I didn’t go to academics. But you don’t necessarily have to go into academics to teach. I think it’s really important to figure out-- and it’s ok if you don’t figure it out in your first job or in the first couple of years-- whether you really do want to run a business or not. It’s absolutely ok to not do that. There are a lot of people who are really happy just seeing their patients and clocking in and clocking out and being an excellent provider without the stress of running a business and making those decisions. If you go to a place that honestly has more physicians or does have an outside somebody that’s running business or marketing or you go to an academic center, there’s a lot of the pieces of the puzzle you’re not going to have to worry about. You can maybe even focus on other things. The great thing about being a physician si that you can wear all these different hats, you can find the right practice that allows you to be creative, or do research, or teach, or run a business.

GJ: Whenever i get impatient with perspective or even current clients, sometimes I think, “Ok, picture everything you have to do to run this business and then do 200 egg retrievals in a year.”

LS: Exactly!

GJ: It’s among other things…

LS: You should see us at our business meetings on a Tuesday afternoon after a full patient day. Sometimes we just sit there for a good 15-20 minutes and just chat because we need to let off some steam.

GJ: Yep.

LS: Yep.

GJ: What’s your long term prediction for the field? I have a lot of people asking me, “Do you think private equity is gonna come in and gobble up every practice and every practice is gonna be large corporate groups and there’s only gonna be one or two or three of them?” I have my own opinions about that, but what’s your knee-jerk-- or maybe well-thought-out-- reflection on that?

LS: I think I’m just gonna kind of wait and see. I will definitely say that at ASRM two years ago in San Antonio, there was just such a huge buzz about BC money and people buying out. I think two years later it hasn’t happened as much as people were predicting. I’m interested to see where the future goes.

GJ: IN conclusion, what haven’t I asked you about content creation, public relations, writing, social media, that other physicians should consider?

LS: I think that it’s something to consider if they’re interested in trying it. I have people ask me, “Gosh, where do you find the time?” Or “How do you write? It’s so hard!” I think writing is like a muscle. You have to exercise it. You don’t just sit down and all of the sudden just kind of write something. But if you have something to say, you’re interested in it, just try and see. You certainly don’t have to publish on Huffington Post or get a huge voice in the beginning. You can do your own website and do your own blogs and just see where it goes.

GJ: A woman of many hats, Dr. Laura Shahine. Thanks for coming on Inside Reproductive Health.

LS: Thank you! I really enjoyed it, Griffin.