INSIDE REPRODUCTIVE HEALTH PODCAST

Ep. # 35 - Gina Bartasi - Can a Direct Service Delivery Model Increase Access to Fertility Care?

Increasing access to care has always been a topic of discussion in the fertility field. On this episode of Inside Reproductive Health, CEO and Founder of Fertility Bridge, Griffin Jones, talks to Gina Bartasi, CEO of Kindbody, a women’s health company working to increase access by sending out mobile clinics to reach patients closer to home. They discuss ways that other clinics can meet their patients’ needs, as well as the importance of giving partners and team members positions that match their personality.

Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field. 

Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of inside Reproductive Health, Griffin Jones.

GRIFFIN JONES: Today on Inside Reproductive Health, I'm joined by Gina Bartasi. Gina is a seasoned entrepreneur and a thought leader, bringing over 20 years of experience and innovation to the digital healthcare space. She has a proven track record of building new companies from the ground up. You might know of a few of them such as Fertility Authority and Progeny. She has her degree from the University of North Carolina at Chapel Hill. And now she's the Chief Executive Officer of Kindbody, a company whose vision for this field is one that is very much in tow with the current demographic and we're going to score that in our conversation today. Ms. Bartasi, Gina, welcome to Inside Reproductive Health. 

GINA BARTASI: Thanks Griffin. 

JONES: I'm excited to have you here because I wanted to have you on the show when I heard you speak at the Midwest Reproductive Symposium. You gave the keynote at the CEO dinner and I was in the back with a few of my friends and I just thought, “Get ‘em, Gina, get ‘em!” as you were giving your talk--you know, if they don't listen to me say it, maybe they'll listen to you! You’ve worked with some more big companies than I have thus far and I think you're in a position to lead by example. So I want to talk more about it because there's some people that know a lot about Kindbody--have been following very closely. And then there’s probably just as many, if not more, that have heard the name and they thought, “Well, what is that?” and they haven't done anything yet. So I'd like to just sort of talk about Kindbody as I understand it and then you can fill in and correct me. 

BARTASI: That would be great. Thanks, Griffin. 

JONES: What I'm seeing right now is you’re based in New York and scaling up. Right now, you're in Manhattan-- you have a brick and mortar location in Manhattan. You have an IVF lab, you have REIs. What I think a lot of people think about when they think about Kindbody is the mobile testing that you're able to bring out to different locations. And that's also expanded into cities where you do FSH testing, AMH testing at particular remote locations, schedule appointments beforehand, and then women come to those locations for testing. Is that halfway accurate?

BARTASI: That is very accurate! Thanks Griffin. 

JONES: I'm seeing Kindbody booths that PCRS, and I think what probably, people wonder is, do you compete with other fertility clinics or do you complement other fertility clinics? 

BARTASI: I would argue that we do both for the last 10 years in the field. I have many many friends in the field. I think what we do at Kindbody, that more and more fertility practices are doing, is listen to the patient. And I would argue at Fertility Authority and Progeny, the early success of those two businesses really was about putting the customer at the center of the mission of the company. I think what's changed in the last 10 years is how patients purchase services. We know more and more--as we move into managed care, certainly--more and more is moving to an employer-sponsored plan. And so I think historically, 10 years ago was predominantly cash pay and primarily for fertility treatment was reserved for the top 1%. Fundamentally, we think that's flawed. What we believe again at Kindbody is improving access, and improving the patient experience, and allowing as many people to be able to afford and experience fertility treatment that want it. And so we offer everything from this mobile access--bringing care directly to the patient. We offer payment plans. And we're seeing lots of patient interest. One of the things, we measure everything, but one of the data points that were proud of is 47% of our patient population is non-caucasian and that's a deliberate marketing on our behalf that says, listen, for too long fertility was for--when I talk about 1%--it really is the white, wealthy 1%. And we’ve intentionally staffed with a diverse team with a diverse initiative that said we can get better as a team and as a group that looks like our patient population. 

JONES: So where does the mobile care--where does mobile testing come into that? At what point did you decide that that needed to be a part of Kindbody’s hallmark?

BARTASI: Yeah again, we do patient polls all the time and one of the top things--in fact, it's more important to patients today--this matter of convenience than it is of success rates. And a lot of people would “poopoo” that. We have data and we have surveys--some that have been outside focused, some that we've done with our internal efforts, but patients do now prioritize convenience over success rate. So if it is important to be convenient, to be where the patient is, we can't assume that everybody is going to travel to Fifth Avenue and 55th Street Manhattan to come see our fertility doctors. So, we bring care to the patients. Certainly, we use the data, again, to drop those decisions about where the mobile clinic will be. They’re in densely populated areas where women are 25 to 45 and have an expressed desire to build a family, whether that's surrogacy or IVF or IUI. We also have an initial interest, again, I mentioned diverse patient population, that means same-sex couples, it means patients that don't identify with one gender or the other. And so again, we really want our team, our marketing efforts, our business plan to look and be centered around the patient need. So the mobile efforts were early, they're growing, the reception has been more than we anticipated. And so I think you'll see more mobile clinics. Tight now, our mobile clinics are launching. We do use them to launch in markets. We're launching in San Francisco at the end of the month. And so our pre-launch strategy is always this mobile effort first and then often you'll see a “temp to perm clinic” as we're testing markets to see various neighborhoods, and if that's what our data shows, is that what real life proves out. And then we often have flagship locations, so you're exactly right, in Manhattan, we have three locations: one at 40th and Fifth, one at 55th and Fifth, and then our flagship is at 102 5th, which is 15 and Fifth Avenue. And we have the mobile. Those are all brick and mortar locations.

JONES: In New York, do those mobile locations remain there or they can go to other parts? 

BARTASI: They move. Yeah, they’ll move. And that's what's great about a mobile facility. So our mobile RV-- there are two full exam rooms with ultrasound scans, with phlebotomists, and it was in Williamsburg, Brooklyn. We anticipate them will be coming to Brooklyn in the next six to 12 months as well. The first thing we do is go test patient demand. Right now, when you live in the suburbs of Manhattan, Brooklyn--many, many Brooklyn people feel like they have to come into New York City to get high quality of care. We would argue that, when you asked earlier on, are we competitive or complementary to other fertility clinics? First of all, I can be the first to attest that there's extraordinary quality of care in terms of clinical care in Brooklyn. The question is, can we bring the Kindbody experience and do that well in Brooklyn? And we just tested that this past Saturday, and so Brooklyn will be one of the satellite offices that we open in the next 6 to 18 months.

JONES: How far can you go out with these moblie locations? One thing--and I talk about it on the show a lot--is lack of access to care in the interior of the country. I talk a lot about the doctors that are being recruited to their followship area or go to the coastal cities, very often not to places like my home city, unless they're from there. And I really see that being a problem in the next decade or so if we don't have other types of ways of serving those populations. How far out can you go? I mean if you're blocking appointments in chunks, could you go up to Poughkeepsie for a day or the weekend? Could you go up to Albany? You know, how far how mobile are these mobile clinics? 

BARTASI: Yeah, the mobile vans, or the mobile vehicles are unlimited. You can take them to Poughkeepsie, you could also take them to Kissimmee, Florida, you could take them to Topeka, Kansas. And so, you know, again, today it used to be that there was this huge mystique and opaque fertility industry. And today, we want to talk about increasing access and bringing transparency. We all know that there is only one day, your day of retrieval, that you truly need to be in clinic, for the egg retrieval and connected them with a high quality lab. But otherwise, those first eight to ten days leading up to the egg retrieval can be done in any satellite office. And I think, traditionally speaking, doctors and other industry executives did not embrace that, but they're embracing that rapidly today. Because I think all of us--I really do--these are best in class clinicians, whether they work for Kindbody or another clinic. We really all do share a sincere interest in increasing access and it's not just the coastal cities. You hear heart-wrenching stories in the middle part of the country. We know the middle part of the country is growing, and they deserve access just as people living in Manhattan, or San Francisco, or Los Angeles. 

JONES: You mentioned that sometimes you could meet with fertility clinics, sometimes that you can collaborate, or refer to them. At what point--when in the operations is that decision made one way or the other? If someone is at a certain location and they could go do retrieval and transfer at your lab in Manhattan? Or they could do their monitoring, etc. at the satellite offices? Or maybe they live further out and you refer to someone else? How does that work? When do they refer to you or refer to someone else?

BARTASI: Yeah, thanks Griffin, and that's great question. So Kindbody is setting up its own Centers of Excellence across the country and markets that we can't get to yet. And then we have criteria to be a part of our COE, just like any other partner would. The first part of our criteria and being a Center of Excellence in the Kindbody network, is more than 50% REIs must be female clinicians. And you'd be surprised, or maybe not since you're an industry executive, how quickly, if you map out all the fertility clinics in the country and your number one criteria is more than 50% have to be female REIs, how many clinics fall off the map. More than 50% of the clinics fall off the map pretty quickly. So, what you do is you establish your criteria around data and patient needs. So we know today that four out of five patients prefer a female REI, the other 20% check a box called, “Do not have a preference,” and 1% of the case, they'll choose a male provider. But this is women's health and it is remiss on us as individuals and as industry experts not to say--not to acknowledge that female patients want a female clinician. So that is our first criteria. The other criteria is more than 75% single embryo transfer. The other criteria is must meet national industry averages or above, must be a member of SART. But, we have a credentialing criteria of who our partners are in Houston and Chicago and Seattle in other markets. Again, it gets relatively easy for us to pick the partners when you're first criteria is patient-facing. When we know 80% of the time, patients prefer a female clinician, we're going to pick partners who really are building a fertility practice and share our methodology that women doctors--that patients want female doctors, and that female REIs deserve an equity position in their fertility clinic. That was another point I made that raised a lot of eyebrows at the Midwest Reproductive Symposium. 

JONES: Well, I would like to dig into it a little bit, because I want to talk about the “For Women, By Women” ethos that Kindbody has, and it is an ethos! It’s very much in the DNA of the company, it's in your writing, it’s in your talking, it's in how you deal with your team and operations. It's not just a marketing slogan. And I see the value in that, and I also wonder if you think that at some point, narratives like this could have an undesired consequence or an even greater divide in some areas. And what I'm thinking of, for example, is if you have a criterion for the Centers of Excellence who are partners, must be 50% or more female REIs and some point, does that create a group of REIs or male only groups? Because there are certain groups forming in parts of the country--practice groups that say, “We’re a female-only group. We got five docs, we are independently-owned or maybe were part of a big group, but we are female and we grew up.” And I can think of a few of these groups and I definitely see the value in that. I just wonder if it, by default, means that there has to be male-only groups because of those ratios and then they get split. I think of--I belong to two different mastermind groups that agency owners--marketing agencies, both groups are pretty male heavy. They're probably 70/30 and both the men and the women in both groups say, “Wish more women were here,” but there might be ladies agency owner mastermind groups. And if there are, by default, that would draw female members away from our groups and in our groups, the divide would become even greater because of that. So I wonder if you have you thought much about this? What do you think about that? 

BARTASI: We actually think about gender and gender parity often. So, a couple of points that you raised--first of all, when we look for Centers of Excellence, remember the patients prefer a female doctor 80% of the time. We could have had our threshold to join our COE be 80%. We said that that was unrealistic in the fertility industry that has historically been male ownership. And we can talk about how men just take risk more than women do, and women need to learn to take risks and start their own practices. So we reduced the threshold to make it more manageable--that 50% of the REIs should be female and, again, if we're making data-driven and patient-driven decisions, we feel really good and really confident about that. We also think it is not good for our business to be 100% female. One of our senior advisors is Dr. Jacques Cohen, who the industry widely acknowledges as a leading expert across the world. Jacques reminds me often, he's like, “Gina, you know, you need sperm to have a baby,” and I'm like, “Yes, Jacque. I know that.” Our HCLD is Tim Smith. Our head of real estate is Chris Perry. So we've seen the pendulum swing the other way. We also think it would not be as strong of a company if we were a hundred percent women. We need gender parity and gender diversity. We just think, when we think about clinicians and we think about building a company, we're going to build a company around the data that we've intake and this is patient data decision we're making. And remember, patients don't desire female clinicians a hundred percent of the time and we wouldn't be exclusively female. There's a culture that we create here that's about collaboration. It's about humility. It's about teamwork. It's about being open-minded and embracing failure and embracing mistakes. So it's not one-size-fits-all and all females go into that, because there's some females who would not work here culturally well, because they don't have their ego in check. But we're really mindful of that. So we want gender diversity at Kindbody, both on the clinical side, as well as the corporate side. 

JONES: Do you see that preference for wanting female REIs--have you've broken that by maybe 18 to 25, 25 and 35, 35-45, etc.? Have you broken into that anymore? 

BARTASI: No, we have not broken it into age groups. What we did break it down to see what is their preference at an IVF community versus an egg freezing community. And the preference is the same--this high percentage of preference for a female clinician. So some inferences can be made from there because the egg freezing patient population, at least at Kindbody, has a tendency to be younger, so you could infer, but we haven't seen any differences between IVF and egg freezing. The percentages are about the same. 

JONES: What do you suppose that means for male REIs, especially male REIs that might be ten years out of fellowship or still in fellowship or male OB/GYNs? Do you think that now positions might not be long for Women's Health? 

BARTASI: No, I think there are. I can think of 20 off the top of my head right now who are extraordinarily great clinicians,but they are very, very good at talking to patients. It does not mean that male REIs cannot be successful in the fertility world, on the contrary, I think many of them can. I do think what has to change is this very patriarchal system of healthcare and it's not just fertility. It's particularly obvious in fertility because the woman is often naked and disrobed and so there's a lot of vulnerability around that. But at Kindbody we teach our clinicians, our corporate team, everybody, that we're on a journey with the patient and we're in a partnership. We're on the same level as our patients and we're in the trenches with them. And you get rid of this again, very hierarchical, patriarchal, “I’m the doctor and your subordinate to me as the patient and what I say goes.” And I do think, regardless of gender, if there are any doctors that kind of believe that they're above the patient or they only know what's best or they talk to the patient in a--not a condescending--but in a lower, you know, that will have to go away. Those positions, regardless of gender, will either sell, retire, or go out of business because patients are too educated today and they won't tolerate being talked to like they're made to feel inferior. And so again, I think what we talked about and preach and hopefully is obvious to our patients, is this partnership and humility that we're here to support you and guide you and that doesn't mean a rushed IVF or a rushed egg freezing. The majority of our patients--and we're proud of this, now we're allowed to do this because we're venture-backed, most private centers don't have this same kind flexibility--but there's a huge mission and a huge education that we're trying to educate and empower patients. So, a large percentage of our patients that are coming in--again, we poll everybody--many of them are simply coming in to be educated. When you poll them, you know, are you interested in egg freezing? Are you interested in IVF? Or are you interested in just being educated? Many, many of them choose, “I just want to find out about my fertility.” And then when their test results come back in range, they can postpone their decision. And we're very prideful of that. It's hard to do that because if you want a private center and you really had to have your revenue to turn into cash flow to be able to make your bills every month, and pay your staff, and pay the electricity, you don't have that time to really educate patients. But, we are pretty proud of those statistics because that is our primary responsibility as a mission-driven company, is to educate more patients. 

JONES: So, you talked about some doctors and clinics with the mentality of, ”This is the way it is and you're the patient,” that can mean a number of different things. And they have a few different routes facing them, some of which might be going to retire, going to go out of business. I felt the same way for some time--don't necessarily see it happening yet. And so I wondered, Gina, I wonder if they're not hurting badly enough? And if that point does come, when is it? But, you might have heard the parable of a man goes to visit a homeowner, and the homeowner sitting on the porch with the dog, and the dogs whining. And a woman asks the homeowner, “Why is the dog whining?” “Because he’s sitting on a tack?” “Well, why doesn't he move?” “Because it's only hurting him bad enough to whine, it’s not hurting him bad enough to move.” So I wonder if that point comes, if it comes in an economic downturn. But, for the most part, I think a lot of people still have waiting lists, a lot of people still are at the capacity that they want to be. They are having trouble recruiting new doctors, and I see that's already happening. But in terms of their own volume, it seems that the demand is here and the supply of people that can meet the demand is still much lower. And so when does that point come? 

BARTASI: Yeah, yeah, I agree completely Griffin. I think you know the industry is growing so fast that there's room for a lot of behavior that you and I may not support. We know the egg freezing industry is growing at a 25% rate, IVF at 15%, so when the industry is just growing that fast you can accept work, not par behavior, because there's so much demand, there's not enough supply. I think the solution is, rather than hoping that some of the legacy, poor behavior changes, I think you have to rethink the paradigm about how you bring in more clinicians into the REI field. I mentioned my extraordinary relationship and respect for Jacques Choen, one of his former business partners David Sable--I’m a huge fan of David as well. So, David is passionate about this, too, about how we move service offerings to other clinicians. What else can nurse practitioners be doing? What else could OB/GYNs be doing in the fertility field? We know that this world of REI exists in the United States. Outside of the US, nurse practitioners and GYNs do your egg retrieval, and do your IVF, and do your egg freezing, and they also do a significantly more affordably. So I think the solution is, instead of saying these doctors are going to have to change their behavior or retire--there will be some of that--but I really think the way to correct this imbalance of supply and demand is we have to figure out how to bring more clinicians into the fertility field. And there's plenty of capacity and clinical capacity in terms of people-talent, as well as operational-talent when you look outside of this sub-specialty. And it’s one of the things that we think about it Kindbody is--we talk about having everyone perform at their top of their license that means--and I understand that some REIs don't agree with this, our Kindbody REIs do--REIs, in our opinion, should not be doing ultrasound scans themselves, an ultrasound tech should be doing the ultrasound scans. The REI needs to be doing the true professional sub-specialty stuff. But, everything else that can be moved to another clinical person can and should be. And then that way, if you really think about reordering the workflow, you can bring more people in the system because the REI is only playing at the top of his or her license. Instead of doing everything--when you poll REIs, they spend an inordinate amount of time working with managed care companies on reimbursements, explaining the plan designs that a same-sex couple could be trying for 12 months and they're still not going to have success. They just do a lot of things that don't require a medical degree. And our REIs, we want them, and they're happiest when, they're really doing a subspecialty stuff and we take away the minutiae. So I think that's probably a better solution than trying to get, for lack of a better word, the ogre to try to change behavior.

JONES: And by the way, by behavior, I don’t mean and I don’t think you do either, that there are so many people out there behaving like ogres, maybe there are some. But by behavior, I simply mean, you know, updating your practice, adhering it to the demands of the marketplace.

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BARTASI: Well, and one of the demands that we fundamentally believe on is technology and an EMR. It is too often the case. I would agree with you--we're not talking about ogres or bad folks. I've just said everybody in this industry intends well. We just think fundamentally, that paper is a bad thing for healthcare. Paper can get lost, most doctors cannot read other doctor's handwriting, you misspelled things including last names of partners, and you mix up charts. Use technology! You see too often doctors today still walking around with paper charts. And those are the behaviors that I think that we feel strongly that we can change is this adoption. You called it updating your practice. We would just tell you that fertility clinics by and large need to adopt technology more. They need to allow for online scheduling, online billing, like the way you run the rest of your life. It's interesting that, because you're so vulnerable and you want a baby so badly, you go through this very laborious experience, whether it's wait times or whether it's the phone tag, the turn your medication up or down. Most people that are going through this are like, “Wait a minute. This seems very archaic. Why does this have to be?” So we're more interested in bringing and utilizing technology. Then again, I think some of those behaviors are harder to change. 

JONES: A lot of people would say, well those are just the problems of healthcare, that's true for every subspecialty in healthcare, and it’s a much broader problem and conjunction of problems than just what's occurring in our field. But, are we in a better position because we're (I use the word elective in air quotes), but in some cases “elective” or some cases self-pay, or some cases just not within the traditional delivery of healthcare. Are we in a better position in some scenarios--or some senses--to lead changes that need to happen in the rest of healthcare.

BARTASI: I do think it's hard because fertility only affects kind of 1% of the population. One of our values at Kindbody is to be optimistic. So even though we're on the small sub-sliver of infertility, I refuse to believe that we can't make an impact. I will tell you what we're doing at Kindbody that is most often not being done, we are not choosing to stay in this sub-specialty vertical. So at Kindbody, we’re a Woman's Health company and we think about four buckets of patients we serve. Primarily, we serve 25 to 45 year old women that are trying to conceive. So what are the other buckets we think about when we think about the healthcare landscape? Well, we think about fertility--and that's IUI and IVF egg freezing and third-party reproduction--that's that bucket. But we also think about mental health, and wellness, and well-being and prepping your body either pre- or post- conception--all of that goes into it. And then, along those lines, nutrition and obesity. When you look at the middle part of the country and get away from the coast, we know that there's lots of problems around conception just around wait. So instead of accelerating you to IVF, what can we do to treat? Whether it's a PCOS patient or an overweight patient and get their nutrition on track before we fast-tracked into IVF. And in the fourth bucket, after fertility mental health and nutrition, is gynecological care services. So Kindbody actually is a Women's Health company. The only thing that we outsource is obstetrics. So we have gynecological care, we have mental health care, we have nutrition, and we have fertility. Now, that allows us when we think about building our tech stock in our EMR, about partnerships. So we're in San Francisco. When we do these temp to perm, we're partnering with an urgent care and a primary care clinical team that believes as strongly in technology as we do. So our EMRs will talk to each other. It is a big task, this interoperability of electronic medical records, but you know, we are mission-oriented, so it's a big problem we're trying to tackle. But, we feel like that we will remain optimistic and that we can make debt, because you when you talk to patients, it is a big frustration of theirs. When you talk to patients, they believe--I do not believe this but this is the patient feedback--that other centers, when they go and they change clinics and go to a different clinic, that other centers are intentionally withholding charts to prevent them from moving to another clinic. Now, I don't think that that is the case. I think it's just laborious to take a paper chart, make copies of the paper chart, they have to keep a copy of the paper chart, and then they have to send you with a copy of the paper chart. And so, we want to remove any friction from patients if they want to cycle at Kindbody, or they want to cycle at an urgent care clinic, or they want to cycle at the primary care clinic. But those records are electronic they're not paper. 

JONES: There's so much to adopt that you talked about, the doctor should be performing or provider--whatever class of provider they are, they should be performing at the top of their license. The REI should be doing only what the REI needs to be doing. And that's just on the clinical side. We're looking at a business side. So imagine we got the same dynamic where there's an REI that is doing all of these things clinically that they don't need to be doing, and then their in a partner position, maybe they're the managing partner. They've got all of these other business duties that they probably shouldn't be doing. A lot of our clients still pay us by paper check. It's still very often that the doctor is signing because there's not a CFO or someone in that financial position. And only once the agreement is signed, did they have the authority to decide on that. I even have that in my company-- I don’t do my own AR, my own AP. And there are a lot of partner positions--managing partners--in a whole lot of roles and I think it's slowing them down too much. We had Louis Weckstein on from RSC-Bay Area on to talk about what they do and he offered some great advice. I still think that they're among the much better examples examples. For most folks, I think it just slows them down too much to be involved in so many things that eventually, the amount of updates, the amount that they need to adopt to stay current, just becomes insurmountable. And then, here you come in. You're the Chief Executive Officer of this company. Your job is to keep the ship going in the direction that it’s going at full steam and there are other people and other seats in your company. I just don't see how most centers will be able to compete with that type of structure, and your company not being the only one there are multiple. But it to me--I made the analogy recently like, if you inherited this REI practice model, which is really the gentlest healthcare medical practice model of the mid-twentieth century--and that's what you're using today, it's more or less you're playing flag football, because that's how it happened, and then all of a sudden, a whole bunch of people come on with helmets and equipment start pasting people, because they're playing tackle! And I don't know, can they adopt the way they need to? Because some are small enough where I think it's just in their DNA that they're so close and so friendly that they’re going to be fine. It’s just their people just love them, both their staff and their patients. But there's a middle-size. And I just--I don't see how they can keep up. I don't know. I don't know what your view on that is?

BARTASI: Yeah, I think it's human nature to do the same thing every day. I don't think it's-- I think they're well-intended. I think it's just like the patient--human beings--you don't know what you don't know. I think the managing partner that's still coming in and signing his or her own checks, it's because that's the way they've been doing it for the last 10 or 15 years. They don't wake up the next day and think, “How can I make my business more profitable to pull more cash out to allow it to grow?” But they don't have, oftentimes, time to think about that instead. They think about “Okay, wait a minute. I have surgery in the morning. I have two new patient consults. I have a topic I have to address this afternoon.” Like patients are coming at them! Then, because the industry is growing so fast, they literally don't have time to stop and think about how they plan for growth. 

JONES: That's what I'm saying is the fundamental problem. 

BARTASI: It's gonna be hard. I do think they'll either merge or be acquired or it just will be harder when things get tough. I don't know when things get tough, going forward, even if there is a contraction which everybody is anticipating kind of in the next 24 to 36 months. We've already proven, if you look at SART numbers or anything else, in the 07/08/09, you know, yes, there was a recession, but the growth rates slowed, but the growth rates were never negative, they simply slowed. So that means that practices that are growing at 15 to 20% annually, maybe they only grow at 8 to 10% annually when the contraction comes. But the fertility industry has proved incredibly resilient, even in times of financial adversity. 

JONES: Your job is to think of future value as the CEO of your company. My job as the President of Fertility Bridge, is to think of future value. Even though my company is straight-up bootstrap--no commercial loan in the company or money from mommy or daddy, no venture capital project--we’re straight up bootstrap. Straight up build, deliver, sell, save, find a buyer, repeat. And so I'm still in a number of seats. But even when it was just me doing Facebook ads for the very first people, I still had an accountability chart. And now I'm maybe in a third of the seats, or not even--a quarter of the seats. Now, it's about getting me out of those seats out to the visionary role, just the visionary role, so that I can be responsible for the future value coming. That's your job. The reason why practices can’t adapt, the reason why it takes them months upon months to agree to like a very small marketing campaign, or why they can't get all of their people in one room to make a decision. The reason why they don't have Chief Human Resources Officer that can make a unilateral decision on payroll, or Chief Marketing Officer that can make a decision on a campaign, is that they don't have the structure in place. And it just continues to pile on and I just would like those that want to remain in independent practice for the next five, ten, however, many years, that looking at yourself in that role--whether you want to be or not, that is the primary position as the business owner. I can't just say, “Well, I don't want to learn accounting because I own my business.” So I have to learn accounting on a basic level. I mean my accounting is 1 of many core functions of the business and that's true for anyone that's owning their business. And so I wonder if you see practices being able to make that adjustment or if more acquisitions are simply the answers to this?

BARTASI: Yes, you know, I really think it has to do with DNA of the managing partner or the owner of the group. My first two businesses were bootstrap and it taught me a lot about managing people, and where my strengths and weaknesses were.

JONES: It seems like you feel like you can do everything now, right? 

BARTASI: You do, but the question is, “Do you want to?” There are people who still want to maintain this control, will have a hard time growing. You have to be able to trust other people. At the MRS symposium, I gave another speech on Saturday and some clinical questions came up and I was like, “Whoa, whoa, whoa, don't ask me anything clinically. I don't like blood or sperm or anything that moves.” I said, “You know, Dr. Lynn Westphal is our Chief Medical Officer!” So it goes back to the DNA of the individual. Are they prepared to trust and share? To trust other people with decisions about the business. To trust other people with financial decisions, with equity in their business to help them grow. Do you like to share in success or do you prefer this autonomy and independence and have to control everything? I don't have to control everything. In the beginning when I was younger, I probably thought I did, but now it is way better. You can build a much bigger company, much, much faster, when you learn to share in equity and decision-making and team building and collaboration. And so that's just me, tt sounds like you've made that transition that says, “I can’t get bigger without the support around me.” So some people either agree with me and you Griffin, or some people just say, “No. I have to touch everything.”I have friends in both camps that say, “I don't need to be in charge, making a hundred percent of the decisions,” and I just spent the weekend with a girlfriend who's like, “I like making a hundred percent of decisions.” I'm like, “But you don't have time to think or breathe or workout or meditate or anything else!” “Yeah!” That just seems foreign to me. I like being a mom. I like being a wife. I like going out to the Hamptons and drinking a glass of wine. And I couldn't do that if I made a hundred percent of the decisions, so it's about your own personal preference. 

JONES: Yeah. There's probably 90% of the things that we do as a company that I'm not that good at. Nobody really wants Griffin being their project manager. I don't need to be placing Facebook ads, people can do that better than me, our Creative Director is a lot better at designing the art. When you are in that visionary role, you do what you're good at. If that is, in fact, building the company and being responsible--you can sit atop of the mast and see where the ship needs to go. I can't say that I'm fully in that position yet, because I’m constantly going down to help adjust the sails, because we are--it is entirely self-funded. So, we're getting there, we’ve been getting there over the years. But, there is no question that that is where I'm going. That is the North Star, that we are headed to, come hell or high water. One of the things that you can see on the mast, in your case that you’ve seen very well, is this problem we call the telephone. Millenials don't like using it. And you talked a lot about that at the CEO dinner and I said, “Preach!” One of the examples that I often use is, when you think about when you were a teenager and you had to call the boy or a girl that you were attracted to, and I said, “Hey, this is Kowalski. Is Jenny there? Is Danny there?” That awkward conversation of, her brother picks up and starts teasing her. You can hear the brother start ripping into the family. Our patients under the age of 35, have never really had to do that. Our patients under 30 never had it.

BARTASI: No, I know! 

JONES: So you have adopted a means for people to not have to use the phone and can you talk about that? 

BARTASI: Yeah, again, you're going to be wildly successful Griffin because you, in my opinion, possess the skills: humility, self-deprecating humor, I think those are keys to a wildly successful leader. And so again, I can hear you talk about, “I'm not good at 90% of what I do and everything,” and I think those are really the strengths of what great leaders are built off of. Again, it's about humility, it's about listening to your patients, and your team members. We call them team members. We don't call them employees. I mean, it's just about how you treat other people and living by the golden rule--treat other people how you'd like to be treated. When you talk to patients again today, they don't want to be on the telephone. But when we talk about other team members and learning, I mentioned Lynn Westphall, but the Head of our Products and Technology is Joann Schneider. She said we should utilize technology--technology should be utilized for anything that's transactional. It’s billing, it's booking appointments. Human beings are incredibly special creatures and they should be reserved for anything that is a special and necessary discussion: a negative pregnancy test, a failed IVF cycle, a recurrent pregnancy loss, an initial patient consult. So we're not talking about removing the human component or removing the telephone all together, because when you have to convey a negative pregnancy test, we believe the technology is the absolute wrong tool for that communication. So we say technology for transaction. Every time there's a transactional decision--calling in a script, well, that's a transactional thing! Anything that's transactional, we constantly say, “How long did that take you? What can we use technology for?” And anything that we deem as critical and important, always we use humans for that. 

JONES: That's exactly right there anything that can be automated, should be and anything that shouldn’t, absolutely should not be. We all can get it mixed up because if we’re not automating what we should be doing, sometimes we just don't have time to tend to those things that are really important. And I 100% agree: anything that's transactional, automated. Anything that needs that human touch, make sure you’ve got the right people in that position with that emotional intelligence. Gina, you’ve given us so much to chew today. I’d like to conclude today with your thoughts, your concerns, your hopes for the field, and where you see it now and where you see it in a few years? Just what you’d like the audience to consider in conclusion?

BARTASI: Yeah, I’m really inspired by the industry as a whole. And I’ll finish where I started, with the overwhelming majority of clinicians and other colleagues in the space are doing right by the patient or doing right by the industry. And even if they're not going right, their intent is well-intended. They may not have the tools or the resources around them. I do think we're all on a mission to increase access. And so the question becomes, what does that access look like in the future? We anticipate more managed care, more employers. We do have to start telling the truth about success rates, what leads to success rates. If genetic screening and vitrification are ubiquitous across clinics, now, what does that do to success rates. I was talking to another colleague--a competitor colleague. I said, “What's the number one thing that contributes to success for a patient?” And he said, “The lab.” and I said, “Respectfully, it's the patient's age.” And so, you know again, there's not a clinician in the country that would dispute that claim--that the patient's age has a bigger determining factor than a lab and so we have to tell that story. But anyway, it's an incredibly humbling team and industry and we know it's growing and we just want to be respectful to the patient. So Griffin, you're a legend of the industry and I've enjoyed this afternoon and your time. So thank you, thank you!

JONES: Thank you to my team listening Gina just gave us our next eight podcast episode. Go ahead and put them in project management. Gina Bartasi, thank you very much for coming on Inside Reproductive Health.

BARTASI: Thanks, Griffin!

You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.