INSIDE REPRODUCTIVE HEALTH PODCAST

Ep. #45 - From Patient to Fertility Entrepreneur, An Interview with TJ Farnsworth

While outcomes are so important in the field of fertility, the patient journey can easily be lost. After going through his own journey, TJ Farnsworth founded Inception Fertility, a group of fertility practices across the country hoping to provide positive experiences for their patients. On this episode of Inside Reproductive Health, Griffin and TJ discuss the culture of Inception Fertility and how empowering your employees to be champions for your patients can have a meaningful impact on their experience. TJ also shares his thoughts on increasing collaboration between fertility clinics across the country and how that can mean success for everyone.

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, my guest here on Inside Reproductive Health is TJ Farnsworth. TJ has a 20-year history of innovation and successful startups. In 2005, TJ founded SightLine Health, which grew to be one of the largest and fastest growing providers of radiation oncology services in the United States. After a two year journey with infertility, TJ resigned his position as CEO at SightLine on a mission to ensure that patients coming after he and his wife would not have many of the same frustrations that they experienced. TJ also sits on the board of directors of CureDuchenne, which is a nonprofit dedicated to finding a cure for Duchenne Muscular Dystrophy. He was named one of Houston’s 40 under 40 entrepreneurs in 2011, and he was the 2014 winner of the Ernst & Young Entrepreneur of the Year for Healthcare. Mr. Farnsworth, TJ, welcome to Inside Reproductive Health.

TJ FARNSWORTH: Thank you for having me, Griffin. Excited to be here. Sorry it took so long to get this scheduled, but I appreciate your persistence.

JONES: Well, I'm glad we did because it's an interesting story. I remember seeing in 2014 or 2015, Rebecca Flick from RESOLVE had sent me a note saying, hey, you should check these guys out. And she was specifically referring to you and your wife and the journey that you went through and she said something to the effect of, these are people that went through the patient experience and decided to build a practice group network from it. And so let's start a little bit with that story. We don't need to go into all of the personal details, but I am curious about--yeah, there's a lot of different avenues that and entrepreneur can take. I guess tell us enough about the journey to help us understand why you felt that there was something missing in the market and why you felt that you should and could fix it.

FARNSWORTH: Yeah, so being an entrepreneur, I think I come at everything just curious about how things work--I think that's part of what being an entrepreneur is-a certain level of curiosity and investigative interest in the nuts and bolts of things--and in particular being a healthcare entrepreneur at the time. My wife and I got married later in life, and she was incredibly patient while I was building my last company and very focused on that. And you know, like a lot of couples would never even considered the fact that it would be difficult for us to start our family when we wanted to do and we wanted to start our family right after we got married. Both my wife and I grew up knowing that we wanting children, knowing that children were going to be part of our lives. We got pregnant on her honeymoon, experienced our first pregnancy loss shortly thereafter, and that began the 2+ year journey for us in infertility. And we went through all of it. We went through trying to time cycles, we went through IUIs, we went through medicated IUIs, until finally we pulled the nuclear option, as I like to say, and went through IVF. And we went through our first round of IVF and got pregnant, lost the baby again. Went through a second round of IVF, got pregnant, had a heartbeat on the 6th week ultrasound which we're super excited about, and then went to, as they call it at the IVF clinic, the “graduation appointment” and had lost the heartbeat. And then, luckily, we got pregnant with our third round again and we have a 5 and a half year old son from it. And it's a really short synopsis of a very long journey of a lot of tears and heartache, and as much as we loved the clinic we were with, we loved the physician we were working with, we loved the nurses we were working with, there were a lot of what I would just call a “service failure,” a lot of what I would refer to as just badly run doctor's office things that we would get feedback to them on. Badly run doctor’s offices are the rule, not the exception, and not just in our speciality, in all specialties it seems like. My wife and I, as I mentioned, both grew up wanting children and neither one of us dreamed ourselves of having our children in a laboratory somewhere. And the journey to create your family shouldn't be one where it was a struggle. And it was a struggle not just because of the emotions of what was happening to us on the infertility side of things, but it was the struggle with things that could have been easier, but just weren't because there was a focus strictly on outcomes and not really what you were experiencing and the journey to get there. That was interesting to me and has really resonated with me because of the position I was in before in oncology. And oncology, as a specialty, learned a long time ago that there's only so much you can do about the outcome, there's a lot that you can do about the journey. And so it just sort of sparked a thought in my mind. I went to ASRM the year that it was in Honolulu and it rained the entire time. I went just as an attendee with no new business--I was still the CEO of my last company. I walked out of that saying, there is no question an opportunity to build a niche within the industry as the business known for building a unique patient experience and known top-shelf customer services.

JONES: I suppose we could--even that subsect is enough to go into for a long time, but I'm sure, as you mentioned, there's a few things you--do any of them come to top of your head specifically? When you said you felt that the journey was often very outcome focused and there were some things operationally that could have been fixed. Do you remember some of those pain points? What were two or three of those that you felt, you know, we can fix this?

FARNSWORTH: Absolutely, I could take up a couple hours of your podcast talking about, which I know you don't want! But I’ll give you a couple of examples. One of the examples I like to use a lot because it encompasses something that is truly important for us as the company. There was an instance where--we had several cancer centers in Los Angeles and myself and one of my senior executive who is now with us at Inception, we were at LAX and luckily my flight was delayed by three or four hours and I get this phone call from my wife and she is just crying so uncontrollably that she can’t even get her words out. I said, “Hand the phone to somebody.” She hands the phone to somebody who identifies themselves as the front desk person at this fertility clinic and she explains to me that our balance had not been paid yet and because of that, she would not release the Rx for the trigger shot. That was their policy. And I was flying home to be able to give the trigger shot to my wife the following night--and this was actually our third round of IVF. And this young lady at the front desk was was explaining to me that unless I had called my credit card company in advance, I couldn’t give her my card number over the phone, it was too large of a charge, and I was trying to explain that she should not opine on my relationships with American Express, like, let’s just try this out and see if it works. And, of course, my wife is standing there and there's a line building behind her at the front desk, and they’re only hearing one side of the conversation of you haven’t paid your bill, your credit card’s not going to work--those types of things. And finally, my argument to the woman behind the front desk was, let’s just give her the prescription and if we don’t pay when we come in for the retrieval, then we don’t do the retrieval! I mean, it’s simple, which I understand, you need to be paid in full before you do the retrieval. But I'm trying to have a discussion, and it ends up being a much longer conversation than it needed to be, finally talked the young woman into running my credit card over the phone and it works! And we all go on about our day, but it's an example of that person behind the front desk at the fertility clinic was not empowered to make the right decision for the patients. And there was a policy that was in place that was a rule, it wasn't thought through, and the employee, as part of this clinic, was not trusted and powered to make the right decision for the patient. And that was a major, what I refer to as, service failure. We had other instances where on our second cycle where we got pregnant and had a heartbeat, then no heartbeat, neither one of us thought we were needing to take the rest of the day off of work and answering there trying to be tough for my wife, and the sonographer announces there is no heartbeat without even asking the physician to come in like this is the third time it has happened today. And I had to go find a place that I can cry by myself, not in front of my wife, and that was the men’s room because there are very few men in the fertility clinic! Just so I could collect myself. Things like that that we try to focus on what we can do, knowing we can’t be perfect and knowing that none of these patients envision being in our clinic to create or expand their family. Those are things that--there are pieces of things like this that we can improve upon and there's a lot of things we can't think of that we can entrust to our teams to make the right decisions for.

JONES: I think what you just shared is evidence to what I speak a lot about on the show, nearly every episode, which has to do with the infrastructure of the practice and that the average REI practice has inherited the model of mid-twentieth century general practitioners practice model, and that's also their business model. And the reason why a lot of people aren't in places to make decisions, or to change processes, or to critically reflect on processes, to update them is because there is not that infrastructure from the top where someone's steering the entire ship in a particular direction and then the people in the right seats to be able to execute against that vision. That's where somebody as a Chief Executive Officer comes in and I think that there are a lot of pros to that. I talk about that. There's also some skepticism about it. But the point that I make is that if someone who is an REI is also in the visionary seat, and then also has to be in a few of those other executive seats, that's just such a daunting time commitment and distraction of focus for what is already a full-time--being an REI and having that caseload and the procedures and then plus all the things to run the business--I imagine if I tried to run my business and then do 200 retrievals of the year and see 400-500 patients, there's no way I could think of the future value and adapt the operations of the business. So maybe you can talk a bit about the advantages of being in that visionary seat and not being a physician. Then we can explore the counter argument to it.

FARNSWORTH: Yeah, I think the advantage--it really does create a great unique relationship between myself and our physician partners. They get to focus on practicing medicine, but I approach things as a patient. I approach things maybe a little differently than a lot of CEOs would because I come at this from the perspective of being a patient. And so they come at this from the perspective of being the doctor. I come at this from the perspective of being the patient. And you know, we're able to collaborate and build the best of both worlds. And then we have the infrastructure in place as a management partner with our physician practices where we can execute on that together, and they get to still be doctors through that process.

JONES: So the counter argument sometimes, and I hear it a lot, which is having someone own the practice or own the group or the concern with private equity coming in, is that there are corporate interests and there are business people that are not physicians making key decisions that affect the standard of care. I hear it a lot. It's been said on this show, multiple times. How do you respond to that concern?

FARNSWORTH: You know, I think it's important as business people, we’re not making clinical decisions, but I do think that we’re naive as business people to think that our clinicians don't have great input for the business decisions being made and we’re naive to think that the business people don't have great input on decisions being made about the operations of the clinic, not necessarily in medical decision-making. And yeah, I think again, I can't speak to the other, we’ll call, corporate-backed player in our industry, but I do think that I come at this from the unique perspective, being a patient. I’m not coming at this purely from being CEO that saw this as an opportunity in a high-growth industry to roll out a bunch of clinics for an exit, this is a personal mission of mine. I started a very successful business that I started literally on my kitchen table to serve another one of my kitchen table with a ton of risk because when my wife and I very much believed that there was an opportunity for us to create a better type of experience for patients who really should have a positive patient experience. And part of a great patient experience is a great clinical outcome and having great physician partners--they’re the ones are gonna drive that. Both the physician partners and our scientific partners that are back in the lab serving as our patient’s first babysitters.

JONES: Let’s explore that idea of “kitchen table risk,” because I think that is a real difference between an entrepreneurial venture and then starting up practice a few decades ago because you just wanted to leave the university system. And not that either model is inherently better or worse, but when they're juxtaposed next to one another to serve the patient market, they can certainly play out very differently because one is inheriting that model from the mid-20th century and is likely slower to make decisions, not necessarily process-focused, and not necessarily pursuing particular goals where--. This is now your second major venture, and now, you’re at the head of one of the largest fertility networks in the Western World, and it didn’t exist 5 years ago.

FARNSWORTH: Yeah, so we opened our very first practice from scratch. We didn’t want to inherit ideas--and not that ideas from established practices are bad, we’ve got some fantastic practices that are part of our network that have been around for 20, 25, 30+ years that bring a lot to the table--but we wanted the opportunity to be able to experiment with things and ask the questions of why are things being done the way they are? And the answer being, that’s just the way they’re done, is always a bad answer. There may be a lot of great answers, but that’s just the way it’s always been done is never a good one. So that allowed us to challenge what we can do and experiment. We look at it as the best of both worlds. And then we have practices that are part of our network that have been around for--with Houston Fertility Services in Houston which was our first acquisition practice, they had been around for 25+ years, to the Prelude Network with RBA and PSC and NYU, they bring a ton to the table and the idea that we can bring the knowledge base from all of these places, from people who are challenging the norm and saying, “Why can't we do things differently?” With de novo development from scratch operations to established practices that have been doing it in such a way that really does work and does work for a really great reason and we can take the best of all worlds and combine them together and it's sort of been the unique approach to how we grow the business. It's allowed us to grow, and as you pointed out, we’re one of the largest networks in the world and we’re very proud of that. Mostly, we’re very proud of the fact of the way it came together because it came together in such a way that lots of different people bring a lot of different talents, a lot of great experiences, and a lot of really great processes to the table that we can blend to create the best of all worlds.

JONES: But, you can't create those best of both worlds without an entrepreneurial vision and entrepreneurial spirit at the core of the organization and especially at that speed. The gasoline on the fire is entrepreneurial talent and I often look--if you look at entrepreneurial talent at a scale of 0 to 100, and you think of the Warren Buffetts and the Bill Gates and the Steve Jobs as the 100, and then someone like, you know, like my aunts who would never even start their own paper route because of the fear of the risk is the 0. In the United States, you can be somewhere at maybe while we might call it a 63 or 64 and make six figures and do pretty well for yourself because we live in this country at this time, but I think the further you go up the scale towards the 100 is speed is one of the biggest differentiating characteristics. And right now at Fertility Bridge, I'm building it very slowly. Also started from similar to a kitchen table, but doing it much more slower. I haven't got any venture capital, any private equity, there’s not even a commercial loan against my business. I sell, I deliver, I hire, sell, deliver, hire. And it’s slow, but I just need to do it at this speed because it's the learning curve of the entrepreneur. So I need to do at this speed and I envision being a much faster entrepreneur within the coming decades, but you came in and you went to that rainy ASRM in Honolulu and then you start some de novo clinics, you get some backer to be able to do that, and then you buy another group, and then you merge with another one, and so just talk about that because that could seem really risky to a lot of people.

FARNSWORTH: Yeah, it was so. I'm sure there's a certain degree of--I think that my entrepreneurial spirit is certainly a blend of stupidity along with the beliefs that it could be done. I was raised by an entrepreneur--my mother started seven venture-backed businesses, private equity-backed businesses from scratch back in the 70s, and so I watched her do that growing up. And so the risk and, you know, it's there. Starting at my last company, I was single and I had not yet met my wife and I thought to myself, look, if this doesn't work, I’ll call bankruptcy and it's just me! Now having two children and a wife, that's a little different--little different risk profile. But having done it already once makes a little bit less risky to me because I have the experience and know how to do it. And it's also caused me to move faster with Inception than I did with my last company because I know how to do it. And to your point about how you’;re building your business, as you get more and more experience with it, you're going to build it faster and faster and faster, that’s just the nature of things. I truly think that having an entrepreneur as the CEO isn't always the case, sometimes some of these businesses were roll-ups by private equity firms the plug in hired gun CEOs. Before private equity was ever involved with Inception, I started this from, like you said, my kitchen table and was building it myself, and taking the risk myself, so I think it gave me a certain level of understanding of the business from day one. That is unique, but not necessarily better or worse than where others come from--just unique from where it comes from. But, there is no question that there are different levels of risk tolerance as entrepreneurs and I'm probably a little more immune to that because of, number one, my background having done it before, and number two, having watched it be done growing up as much as I did.

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JONES: We could call it risk, on one hand, if we’re being more skeptical, if we’re being more bullish on the value of entrepreneurship, we could call it a tendency to view things as an investment and you’re simply assessing if any particular initiative is going to return investment towards the objective in a way that is effective and valuable enough. And I think the tendency of any specialist who essentially forms a business by accident--this doesn't have to mean fertility or even healthcare practices--it can mean any specialist who is good at their particular field then simply forms a business or practicing means of providing that service versus an entrepreneur who is creating an organization, is that the former tends to look at things almost always as an expense and the latter, the entrepreneur, looks at it as an investment and it either is likely to return the investment or is less likely and so they make those decisions much more quickly because they have an objective in mind. And for you, I know a lot of your team and I knew a lot of them before--almost all of them before they worked for you. And you know, I haven't really gotten a chance to powwow with them, but I see them on LinkedIn, and they see pretty, at least four more of a bird's-eye distant view, it seems like they feel supported. And so can you talk about that as an entrepreneur? You know, when you're investing in people, some of whom come with a big price tag. or you're investing in initiatives, and I've also talked to people you've hired and they said, “Yeah, he's letting me take this initiative or he's letting me do this.” Talk about that tendency whereas if someone's just risk-averse and looking at everything an expense, things just don’t get built that way.

FARNSWORTH: Yeah, I think that the most valuable asset we have on our balance sheet as Inception is the people--it’s the, what I’ll call, human capital, and part of that is culture. So for me, I'm very proud of the fact that several members of Senior Management over here have followed me to people all the way down in the accounting department have followed me from my last company because of the culture that we build. We all work a lot of hours and we should all enjoy what we do and who we work with. And part of that comes with, if I’m going to make you accountable for something, I’m also going to make you responsible for it, I’m going to empower it to execute on it, you’re going to be responsible for my decisions made on it, and you’re going to be held responsible for that. And some people love that and some people don't, but those that thrive in my organization love that. And yeah, I think that there's no question that we, as an organization--senior management is there to serve the rest of the organization. My job is to give the tools necessary to my management team and I expect them to give the tools that are necessary in their clinics and their operations below them to make them successful and that's how the organization becomes successful. And I think that is a critical cultural development that is necessary for success, at least necessary for success in the way that I see it. You know, everyone--I’m not here to say that my way is the best way or that it’s like this all the time, there’s 10 different ways of doing things, one way is my way, one way is wrong, and there's eight other right ways of doing things--my way of doing things is building as positive of a culture as possible and a culture of responsibility and accountability across the network. And once you've done that, you've got a team of people and team of talent that is by far the most valuable thing that you have, and there's no question that that's what we have.

JONES: So how do you maintain that culture when you're bringing on different groups or different practices that are in very different parts of the country that may have very different teams? One thing that I love about building the culture of my company is that thus far, it’s all homegrown and Griffin’s at the top, so I dictate what the culture is and get to make those personnel decisions--if it's not a good fit or if it is. And now you're bringing on other groups and other teams and don't give me the politically correct answer because I know they’re good practices, but I don't care how freaking good a practice is, there's gonna be people that are not a good fit, that probably weren't a good fit for the old version, much less than new, more cohesive thing that you're building. So how do you do that?

FARNSWORTH: Well, I think that what I just said, a culture of responsibility and accountability is not for everyone, and we all know that person that's part of the office or practice that doesn't take responsibility for things, is not accountable for things, passes off decisions onto people, those are people who are never going to thrive in an environment like ours. I’m not here to say that we pulled someone into the Inception family of businesses and every single person fits in perfectly and they fit the culture, that's just not the case, but they will adapt to the culture that we’ve built or they will not survive. But there's no question that on the whole, at least so far in this experience, we have found more talent that we want to retain than talent that we don't, but I'm not going to give you the politically correct answer that everyone we meet as part of the practices that become part of the Prelude Network or any of the enterprises as part of the Inception family of companies, we say all of them are going to be a good fit, they’re just not. And a lot of people will be much more successful in a different organization and it's the right decision for them, and for you, to put them in a place where they can go and find the right organization that’s a good fit for them and their style. But it certainly is a challenge when you're doing de novo and growth from scratch, maintain that culture is simpler and you’re doing a lot of the minae work. You have to pay attention to that culture and as long as you're paying attention to it, and it’s top of mind, it’s being driven by everyone in your management, it can be done.

JONES: For many people, those decisions get difficult when the person might be a good fit at their particular role, but they're not a good fit for the culture. And those things are not mutually inclusive, meaning if you’re good at one, that does not mean that you’re great at the other. You can have someone in billing that they know every code, they know how to get every dime from the insurance company, they know exactly how the billing and reimbursement process in and out, but they might make their coworkers miserable or they might be undermining the culture that's coming from the top. How do you make those distinctions of you know what, this person is really good in this seat and this particular seat, it's gonna take us three months to find somebody, should we just leave them there for another six months?

FARNSWORTH: You know, Griffin, I can teach somebody all the billing coding or accounting. I can’t teach them to be a few positive influence in the office and I can’t teach them to be a reliable and trust-worthy co-worker for their team. And difference between hiring--well, what I say--hiring for talent and hiring for skill. I can teach you skill, I can’t teach you talent. And so if their talents don't fit our culture, then they're not going to be the right--a good fit-- no matter what their skills are.

JONES: Where do you see this all leading to? As an entrepreneur, you’ve got a vision and I would have to guess that a practice network is only part of it. Where else do you see that either Prelude/Inception or TJ Farnsworth as an entrepreneur--where is this leading to in this space?

FARNSWORTH: Yeah, we started this business--my wife and I--we started it with the idea of creating a family of businesses all focused on the patient experience. The Prelude Network, that takes some time, but we’re starting with a very good platform between, you know, Aspire is now part of the Prelude Network. The Prelude Network we refer to it as our network of fertility clinics that are really focused on this patient experience concept. And then we have My Egg Bank, we’ve got other verticals coming as part of the Inception family of businesses. They will have one unifying trait and that is they're focused on that patient experience. We want to be seen within the industry, our identity within the industry for patients, for clinicians, for people looking for what teams they want to join, that we're the patient experience people. And that's the mission that we're on. And certainly, there's no question that there's more coming from us. It won’t take you very long to imagine what other verticals that touches a patient that we would see a patient experience improve upon, but the Prelude Network, which is the core of what we do in our clinics, is what drives all that. So they will come. I'd love to stand here and lay out our business plan for your blog, but I’d get a phone call from my board, so I can't do that. But at the same time, what I can say is it'll all be core-focused on expanding the service of lines where we can provide--can create an integrated network of fertility companies that are all focused on the patient experience.

JONES: More broadly then, what verticals are you paying attention to now? Mobile care, artificial intelligence, are there a couple that you’re paying attention to in our field?

FARNSWORTH: Yeah, we’ve already been involved with mobile care. The first iteration of our own patient communication tool set was previously in the first iteration as Aspire Connect, and the second generation, Prelude Generation, will be out in the next couple of weeks, which is our own app. We communicate with our patients who are going through the fertility Journey when our clinics in a way that is seamless, in a way that is 21st century, that is not a nurse leaving voicemails for you back and forth. That is just not how our patients want to be communicated with and are used to being communicated with. There is no question we’re paying attention to AI, genetics, a couple of years ago you had said that was the next frontier of our industry, well we’re already there! I think that the second biggest pain point for patients when it comes to the customer service experience perspective thing is pharmacy. There's things like that we’re paying attention to. We’re obviously paying attention to technological developments within the market. Things that are on the cutting edge that are several years away, but things that we believe will drive down the cost of care for patients and make things more accessible and make things a better patient experience for them. And we’re paying attention to all of that because with a quote within a network of our size we getting pulled some of that in effect. I'll pass the with a network of our size, we can influence some of that and affect how fast it can or can’t come to market.

JONES: What are the biggest challenges facing both you and all in the field right now?

FARNSWORTH: You know, I think that the challenges facing us as a company, we have a lot of integration work to be done, as you play it out, Inception as a company, you knew about us three or four years ago, but I would say most of your listeners probably didn’t. Now, I would say, most of them probably do and I think that there's a lot of work to be there and putting a business together like this and not paying attention to the integration work that needs to be done, is a recipe for damaging and destroying the culture and that is the critical component to bringing what it is we’re trying to do--which is this patient experience-focused environment and culture. And I think that, as an industry, I think we’re facing a ton of pressure from the outside and there’s a lot of the lack of understanding of what regulatory influences do exist within our industry and it seems like every few months I’ve got an email from a cousin or an aunt asking me, “Do you know this clinic that this disaster is happening at all over CNN?!” And you'll see that the sound byte is that we’re a bunch of cowboys, we’re a bunch of physicians who are operating in an unregulated environment which--

JONES: It’s funny you bring this up. I’m interrupting because my creative director texted me this morning, and she said, “Have you all seen this?” and then there's a drama about--so it's not a documentary, it’s a drama show, and I’m not sure how many episodes the network has booked or if it’s just the pilot, but it sounds like it's gonna premiere on Fox and it’s about adult children that are meeting together that are all the biological offspring of the fertility doctor who used his own sperm in the lab. Not a sperm donor, but a rogue fertility doctor. And it’s like, oh great. This is great…

FARNSWORTH: Yeah, yeah, this is just what we need. I had not heard about that specifically, I had heard there was a fictional drama coming out. I hadn’t heard some of those details, but those are things that we’re going to be faced with having to answer questions about. When you watch the news talk about some of these stories and the level of inaccuracies that they speak with, it’s a challenge for us to be educating those who are not we are industry about the regulation that does exist, how serious we as an industry take the safety of our patients and the security of the way we do things and we’re going to face increased pressure to change things and I'm not sure that those changes--we as an industry can either be driving those changes and helping ensure that they're done in a way that actually makes sense and don't increase costs for patients because that's one of the things that is a real concern when you start layering on additional regulations. This is already--we have an access problem in this country when it comes to fertility and the cost of providing services and we’re constantly looking for ways in which we can be providing a high level of care that we want to be providing for our patients and doing it for a lower cost. And the more and more regulation you add on there that is done wrong, it can be done in a way that seriously increases costs and decreases access to patients. If it’s done right and we engage in it in a healthy and constructive way, rather than just trying to resist it, I think that’s going to be a real question for us as an industry in the next couple of years.

JONES: Is the mid-size or small independently-owned REI practice going away?

FARNSWORTH: No, absolutely not. I think there’s always certain physicians who are much better off and they can be very successful in operating an independent practice. Being part of the networker like ours isn’t for everybody and it’s completely incumbent upon us to talk to those who want to be part of our practice and those who evaluate that, to make that assessment honestly. And the good news is this is a very underserved--the patient population in the United State is very underserved. There is a lot of opportunity for all of us. This isn't the question of whether or not an independent practice can survive or does everybody has to join a national network like Prelude under Inception, or can live independently or is academic medicine their only other option? There is opportunity for them and there will continue to be opportunity for them.

JONES: TJ, whether it's about entrepreneurship in medicine or whether it's about advancing the field, how would you like to conclude with our audience?

FARNSWORTH: Yeah, I think that as a field, you know, thinking about how to advance the field, I’d love to see a whole lot more collaboration within our industry. I think that coming out of a different specialty, I am surprised at every turn at how the lack of cooperation that exists between all the big national networks and the independent practices in terms of sharing best practices, what can we be doing to make them successful--to the extent of the other national networks are successful and to the extent that other independent practices are successful, that’s good for me, that's good for Inception, that's good for all of us as an industry. We want to see people be successful and, you know, we need to focus less on our competition amongst ourselves and more on our customer as our patient and that can be done through greater collaboration among both clinicians and the business people.

JONES: Comparing that to oncology, do you feel that there's less in the fertility field?

FARNSWORTH: There's considerably less in the fertility field, yeah. I think that--and maybe it’s because the oncology specialty has united behind this concept that they’re fighting cancer, or it was a long time ago the determination that the reality is that Mayo Clinic and MD Anderson are not doing things really that differently and they can be a whole lot more successful by collaborating with one another even though they are competitors. I don't know what drives that, but I definitely feel that within that sort of speciality there’s a whole lot more collaboration. And not just among clinicians, this is a criticism I have of myself and of the business side of things. And this is something that dialogue should be started and will be started soon. There should be a great degree of collaboration existing between all the administrators and business people within the system because there are all kinds of things you could be doing together to affect legislation, reimbursement, sharing business best practices, and doing things that elevate and accelerate our industry in a way that works together that increases the chances of all of us being successful.

JONES: I just got back from a digital mastermind meeting--the group that I belong to other digital agency owners, and who should be more cutthroat with each other than internet marketers! But I’ve been apart of this group for--this is my fourth meetings, we do it every year and we also have a Slack channel that we contribute to different topics and we talk with each other, and we open up about frickin’ everything! How we bill clients, the type of pricing models that we use, what services we’re offering, how we structure our account management/project management deliverables, what project management software we’re using, sometimes people open up their books! It is about as transparent as can be with people who, theoretically, could be cutthroat competitors and we just advance so much that--and perhaps it's because our field is so much bigger, there's literally thousands of agencies. So having 40 people in the room, we don't have to look at each other as competitors, but I do see this opportunity and I see a resistance to it and it might be fear-based that someone thinks that somebody else is going to take this special sauce, but I think in many cases, people don't have anything to lose. And I was at this meeting and I was thinking, I've had this thought several times that I should get this together with different independent practice owners because I'm in a position to do that, maybe just getting ten in a room and doing something similar. And the reason I haven't done that yet is because I made the assumption for them that they wouldn't. And so I’m testing it now and I've just reached out to a couple people on the plane ride home yesterday that seemed interested in doing so, but I completely agree with you that there's an opportunity to have more collaborations.

FARNSWORTH: You can count on me being at that meeting! So in oncology, in the industry that existed for me before, diagnostic imaging, even though I wasn’t an entrepreneur in the space, just an executive, the same kind of thing. When we opened a cancer center in a new marketplace, the competing cancer centers in the marketplace would come down and introduce themselves, the staffs would bring over gifts, if you needed some supplies, some clinical thing you were having to wait for, people would loan things to you. That is not a gift in this industry. There’s a level of collaborativeness that is missing here, I think. I'm not a clinician, but I've certainly heard from other clinicians that they know that exists, certainly from business people being one of them. And I can always say that I'm being critical of myself as well here because I am done anything about it either. We will be doing more to collaborate with one another to help each other because the rising tide lifts all boats.

JONES: Well, yeah, you heard that! If you see TJ at ASRM or another meeting, pop over and say hi! He's a nice guy. He's not gonna bite. TJ Farnsworth, thank you very much for all your insight and coming on Inside Reproductive Health.

FARNSWORTH: Thanks for having me, 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.