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Fertility doctors are burnt out.
Not all of them, but enough to warrant a real conversation.
Dr. Jason Yeh is a full-time fertility physician, a national medical director, an academic-turned-industry leader—and very much in the thick of this discussion.
In this episode, we unpack the often unspoken reality of REI burnout and why so many are struggling to stay engaged after a decade in the field.
In this conversation, Dr. Yeh shares:
What REIs think about exhaustion and disillusionment
Why the 7–10 year career mark is so critical for burnout
The impact of rising caseloads on quality of life (300+ cycles per year)
How Inception is trying to stay physician-friendly (and why autonomy matters)
Why executive roles don’t always protect physicians from burnout
His take on corporate vs physician-led leadership in fertility care
Whether you’re a newer fellow just entering the field or a seasoned provider feeling the weight of your career, this conversation is for you.
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Jason Yeh (00:03) we talk about burnout all the time, but there's a specific kind of burnout called moral injury. And moral injury is not like the, can't sleep and I can't eat and I'm just hating life. It's the, maybe this job is not ex. exactly like I thought it was, like when you go through training and then it turns into, you know, like, How many new patients did you see? How many IVF cycles did you do? And that just kind of on repeat, a lot of those skills kind of disappear into the void when it becomes part of the machine. a lot of these networks at the contract level are starting to sound very similar, the text, the boilerplate language, it's all the same, right? but the marketing campaign from inception is really different. And I think about sort of the honest journey of fertility rather than the of the, pictures of families and like, let's just throw 10 more pictures of families out there and let's make this sound like, bubble gums and unicorns. Like it's not like that.
Griffin Jones (01:09) fertility doctors feel burnt out today like the good outcomes no longer outweigh the frantic pace high demands and low points of being an REI I decided on the title for the episode me not my guest Dr. Jason Yeh doesn't suggest that all fertility docs are burned out and he talks about how he went the other way instead of going into the lull but this topic is at the forefront of what so many of you are talking about right now I decided it needed a strong title this topic might hit especially hard for those REIs who are seven to ten years into their career. guest comes from that peer group, Dr. Jason Yeh of Aspire Fertility in Houston, also on the Prelude Inception Physician Advisory Board. He comes from academic medicine before that at Duke. He knows the startup scene by sitting on advisory boards of companies like Sunfish. He's a full-time clinician and now national medical director for the network. No wonder why he's talking about burnout. Younger docs, you get to use this conversation to think about to get the most out of your personal family and work life. Docs who are a little bit closer to retirement, I wonder what you think. Jason describes the lull that many REIs, particularly those in his life stage and age group are talking about right now. He shares comments from a fertility physician Facebook group from doctors who are exhausted and disheartened. He talks about how doctors start to feel when they have to do more than say very generally 300 cycles per year. solutions that different doctors offer to stay engaged, grit and perspective. Why Dr. Yeh thinks Inception Fertility is a good place to work to stay engaged and their attitude that family comes first. Why physician executive leadership isn't necessarily an advantage. and why corporate leadership is sometimes better at giving doctors autonomy. I think this conversation applies to almost all of us in the fertility field, but if you're a doctor that feels underwater or feels like you've gotten over that lull, I would love it if you sent me a quick note and I bet Dr. Yeh would too.
Griffin Jones (03:37) Jason, welcome to the inside reproductive health podcast.
Jason Yeh (03:40) Thank you very much for having me. It is a pleasure to be here. No question.
Griffin Jones (03:44) So you have a full-time job. you decided to do something on top of your full-time job. Why did you decide to do that?
Jason Yeh (03:46) Absolutely. know, I'm about 10, 11 years out, and I think. to speak personally and also personally about some colleagues of mine, which I won't reveal their names, but there is sort of this lull, I think that's very common amongst physicians that are seven to 10 years out. I don't want to speak for everybody because everyone's got their own life, but you know, this particular job, you know, with any job, I think there's a lot of learning that happens, but at that seven to 10 year mark, I don't know what it is. but there is this feeling and I want to make it sound more positive than negative, but I'm sure the words will come out sounding more negative, but it's just kind of like, is this it? Is this all there is? Because the care is great. You know, the outcomes are great. You really feel partnered with a patient helping them achieve their dreams, literally complete their family dreams. But I think, you know, when you're doing something like hundreds of cycles, a year and you some days it could be dozens of transfers a day. There might be something that you're looking for. And this is often that time where you look around and you say, well, what else could I contribute? Because we were raised by a whole generation of academic physicians that kind of left their mark on the field. And, you know, I'll share also another kind of personal ish thought, you know, there's a Facebook group actually of fertility doctors and You know, we share all kinds of clinical questions, a lot of it's anonymous. So, you know, protect privacy and all that. But one of the most touching posts actually happened a few months ago where physicians were just kind of talking through that emotional burden, emotional stress that this job can give you. And the sense of whatever you want to call it, transference, where you take on the emotions of all of these outcomes. It's very easy to bring that into your own mind, into your own life. And some physicians really can struggle with that. And I think, you know, whether it's to create a more durable physician, someone that has more career longevity, whether it's professional purpose, you know, equipping yourself for that side of the clinical care, but then also finding some way to contribute back meaningfully to the field that could be very special. So there's something that happens at that seven to 10 year mark. And I think in these corporate networks, I really do feel like that may actually become even more front and center as the years go on because I've seen different practices just sitting in my same city and my same job. I've seen the transition, but we're about to see, I think a lot of jobs or a lot of fellows join a practice and maybe their, their entire career will be spent in these corporate networks. And there really needs to be a carve out for these professional developments.
Griffin Jones (06:37) So do you think at that seven to 10 year spot that it's often the case where people, they want to avoid the lull so they get the itch like you do and then they move on to something else or you think that the lull is what happens to many people at that phase where they just kinda say, I guess this is it now and then they just kind of go on autopilot?
Jason Yeh (07:00) I think it's a personal choice. think, you know, as with many things, you either choose to dig in or dig out. And I say this with affection, but you know, you can drink the Kool-Aid from one cup or the other cup or whatever purpose you find. But I think I want to share, if you don't mind, I'll read out. Actually, I prepared this as a separate thing, but I'll read the Facebook post and there's no names attached, but I think it's very special to hear and might give you an answer. So this was the first post. It said, I'm a decade into working at an IVF practice and have been struggling with burnout for the past year. There is increasing inertia to come to work. The positive pregnancy tests don't bring me quite the spark they used to. I also internalize the failed cycles and worrying that a lot of the growing numbness is a sign of burnout as well. Our high stress and demanding patients can be challenging. And then here's where maybe the answer to your question shows up. My salary is needed to support our family with two young children. We're under corporate management, but I have maintained a reasonable work-life balance. And although more time off would be nice, I dabble in a few consulting projects to keep things interesting. I have many hobbies. I want to last another 15 to 20 years. What are some strategies to keep us going? And that thing just blew up to the point where it was touching. you know, that summary of feeling, I don't think everyone feels it. But in my own job, think if I were to be honest with myself, I definitely felt it around year seven, eight. And it was a conscious choice to say, do I dig in or dig out? Do I think of this as an autopilot like robot job and find fulfillment in the small areas or can I find professional purpose? And I am a little bit lucky because our corporate headquarters are happening, you know, they're in Houston. So I'm well connected to that corporate team and I've found them to be, you know, great resources, fun people to hang out with. creative minds. So that's been great for me, but I think every physician kind of has to make a choice.
Griffin Jones (08:55) Do you think that's a generational thing? I want to talk about the workforce writ large, but I also want to talk about REIs. You've been doing this for 10 or 11 years that you've been in practice. When you think of those docs that were maybe closer to retirement or those docs that were 10 years older than you, were they working less hard than docs today? Were they working harder? it nets out at about the same. So I'm wondering, so many people feel burnt out today, but I'm wondering, is that an increase in workload and it's more than it was before, or is it something else?
Jason Yeh (09:35) I mean, I don't necessarily think it's a difference in work hours because the hours of the job are reasonable. And I think we're blessed and lucky to be in a specialty where most of us are walking around at three o'clock in the morning in a hospital operating, right? And there are many jobs in medicine that still require that. But I think it might be the pace of the job truly, because, you know, I'm talking to you from my home office. And in the throes of the morning, I got three monitors set up, you know, messages, emails, patients cycles, and it's just like clicking at a, at a pace that is unbelievable. Now it's not sustained over the whole day, but there's probably a good three, four hours where like, I couldn't really have a personal thought go through my head if I wanted to. And I think maybe it's the pacing of it. I also think, you know, burnout is a really interesting topic because I think a lot of medical communities, you know, call it the AMA or ACOG. Like we talk about burnout all the time, but there are maybe even more specific categories of burnout. I don't love this word because it sounds again worse than it actually is, but there's a specific kind of burnout called moral injury. And moral injury is not like the, can't sleep and I can't eat and I'm just hating life. It's the, maybe this job is not ex. exactly like I thought it was, you know, like when you go through training and you're going through labor and delivery and you spend three hours taking out, you know, some incredibly complex cancer mass with your cancer team, G wine oncology rotation. And then all of a sudden you show up with all of this training. mean, I'm, I'm, I would be remiss to say if all fertility docs graduating these days have world-class training and then it turns into, you know, like, How many new patients did you see? How many IVF cycles did you do? And that just kind of on repeat, there is a beauty to that. I will not deny that, but I think it may feel like the expectations didn't quite fit the job perfectly. And there's still a gap. think there's still a network responsibility. There's sort of a, it a field, call it an industry responsibility to help these super high charged. high powered physicians to kind of flex all those skills, whether they're leadership or clinical or research or whatever they may be, because a lot of those skills kind of disappear into the void when it becomes part of the machine.
Griffin Jones (11:59) The pace is interesting. wanted to, I'm glad that you brought this up because one of the things I've been thinking about recently is that everybody's underwater and I ask people at every conference I go to and if I'm speaking, I ask the audience and I ask them to raise their hand and I say, if you just feel completely underwater, will you please raise your hand? And so there's REIs, there's practice managers, there's folks from the business side, embryologists, people in the industry side. How many people do you think raise their hand Jason? Nearly everybody.
Jason Yeh (12:32) I mean, yeah, that's like asking if people are, yeah, does the Pope wear a funny hat? Right. Yeah, it's a hundred percent. Yeah.
Griffin Jones (12:36) Right. Yeah, yeah. Do you breathe oxygen? Virtually everyone raises their hand. And then I'll ask them in private conversation, do you feel completely underwater? One of the reason why I ask is because it makes me feel better. It's just like, okay, the grass isn't greener. We are all feeling underwater. And then I think about, okay, well, why do we feel underwater? We make good money. We're way better off than...
Jason Yeh (12:43) Mm-hmm.
Griffin Jones (13:03) most people out there, were definitely, we have more opportunity than most of the people who came before us. But whether you're industry or you're a doctor, an embryologist or a business side, you feel completely underwater. And I think it has to do with pace and maybe even more specific, more specifically than pace is like the franticness of the pace, right? Like the multi-directionality of like, have to work on this and now I have to work on this and now
Jason Yeh (13:27) Mm-hmm.
Griffin Jones (13:33) I have to work and I've got these eight different competing interests that everybody is telling me is an equally high priority and and and I have a really hard time rank ordering those priorities because if I let even one of them slip there's gonna be serious consequences that ripple so can you talk about like do you like can you talk about the franticness of REIs and what they're feeling?
Jason Yeh (13:55) Yeah, I mean there's so I want to take your pace and raise you actually, but let me say a few thoughts about the pace. You know if you believe Eduardo and Kate's research and say like OK, we're all going to hit 1600 cycles a year one day. You know these are publications in FNS. I mean who cares about our pace like we're about to quadruple everybody you know so we need to have mastery over skills and time to even accommodate for that. But I would also take it one step up. And this is sort of a concept that's taken from a fellows talk that I give at our sort of annual Park City retreat. And I don't actually think fellows are the perfect audience for this because half of them are first years, half of them are third years. And most of them are just looking at me like, okay, I get it. But I don't, I don't think they really get it yet. But it's this idea that our field, if you click on a website, go to any practice, You look at targeted flyers and Instagram ads or whatever. You would think that these success rates are incredibly good, like families everywhere, pictures of babies. And you kind of maybe expect a certain outcome when you pick up the phone or make that appointment. And there is data on this actually. So I would, I would love to ask you and if you don't want to answer, that's fine. But what do you think is the average patient? perspective on what a first cycle IVF outcome would be. Like what is the probability they think? That's a great guess. Apparently for a sample population, it's around 50 % is what they thought, which I think is fair. It's like a coin flip 50-50.
Griffin Jones (15:30) Okay, I would have thought that the average person would have thought it to be much higher.
Jason Yeh (15:34) I agree that that's actually my first observation is that I would agree. So now imagine that you are a fertility specialist and you're sitting in, you know, whatever city Indianapolis, Houston, Dallas, know, San Antonio, whatever. And you wait for a hundred IVF cycles to come in and leave. And after a hundred people do one cycle, what do you think is the total live birth outcome? for one cycle. And before you answer, would say, what do you think the real number is? And keep in mind, none of us have clinics where we're seeing exclusively 30 year olds or 25 year olds, right? We're seeing 38, 40, 41, 42. But I asked the fellows this, what do you think that number might be? And I think that might sort of back into the answers to your question.
Griffin Jones (16:24) So it's live births per 100 cases. Jason Yeh (16:27) Yeah, live births per 100 retrievals, all comers in the clinic, all the patients that do treatments as published by SART.
Griffin Jones (16:38) I would think that that's like 30-ish percent, and that's probably what the fellows say.
Jason Yeh (16:45) That's a, that's a wonderful guess. A lot of fellows actually guessed higher, right? And so 30 % some clinics are in the low twenties. Some clinics are in the mid thirties, but really no clinics above the mid thirties. And so when you think about the pace and the frenetic energy that we have, I really don't think a lot of that frenetic energy is directed at the one in three patients that have a success. mean, those are the great cases. You do a console, you get a follow-up, you plan for your cycle. You get your retrieval, you get your transfer, boom, everything just moves well. And those are the patients where you're just like high five everyone. And you know, you advertise those patients, but unfortunately, you know, everyone's got something it's, know, low sperm and uterine polyps, uterine fibroids, know, recurrent pregnancy loss. The next thing you know, you spend a lot of time basically working damage control. And this idea of, of, basically helping patients cope, whether it's you know, unhappiness, sadness, frustration, billing, insurance, whatever it might be, these practice managers, I mean, they'll tell you they don't spend their time dealing with the happy patients. They spend all of their time basically putting out fires and that gap, you know, the 65 % that are unsuccessful. The first try, we just got to try again. And that's probably where a lot of this energy is spent. And there are, if I may get a little, philosophical here, right? This is not an old, this is not a new idea, I should say. There's an old timey philosopher, I think he was a Catholic priest at some point, but basically said that whenever a field pops up in medicine, it can feel like something has been commoditized. And so now we chase these outcomes, like, like patients become the outcome or cycles become the outcome. And maybe our field has sort of forgotten a little bit on what it means to. teach the physician how to help patients cope through challenges. And that's how we spend most of our time. And that's why I think it kind of answers the whole seven to 10 year fatigue because those tough outcomes, negative cycles, unfortunately it's, it's a lot of our time actually. Most of my day is not high-fiving pregnant patients. Most of my day is dealing with, you know, second opinions from other cycles. I literally saw a patient today who's failed 15 transfers, right? And trying to find, a North Star for that patient. That is all consuming for the patient and for us. so, yeah, think finding that balance of helping patients through, I got a good friend in St. Louis, he jokes that if you look up the word a swage in a dictionary, that you're going to find a picture of a fertility doctor. Because that's basically what we do is we help as swage people as they get through their, you know, reproductive journeys.
Griffin Jones (19:28) to assure and to encourage, is that what eswayage means?
Jason Yeh (19:31) Swage less encouraged but more to sort of help get through the neck, like band-aid up someone's feelings or band-aid up someone's challenges to make things better, to ameliorate, know, let's practice some SAT words here, right? To just improve the feeling around something. And sometimes it's not a swaging. Sometimes it's like, man, I don't think this is ever going to work with any mathematical possibility, but sometimes You really do believe that it can and we have to assuage the situation and help someone through it.
Griffin Jones (20:05) So the seven to 10 year burnout that seems to be pretty commonplace, and I'm not just hearing it from you, I'm seeing it more. I'm seeing people, I'm seeing some people take sabbaticals or hiatuses at much younger ages than I would have expected to have seen that. There are some people that I think maybe are still kind of in the tire kicking phase, but some people that are really, really productive REIs in this space that have confided that, you know what, I might go be a medical advisor for some company for a couple years or I might go in a different field for a little while. And I think of what a loss that would be to the field, even if it were just for a couple years. And so you're hitting on something that's common. Have you heard that sentiment before as experts? by that Facebook commenter when he or she said the positive pregnancies or the pregnant families, that's not giving me the upside that it used to. Is that sentiment common? Have you heard that more often?
Jason Yeh (21:14) do you know I I stay connected to a lot of friends around my years plus or minus a couple is just kind of how we grow up together and it's a very private feeling that we share to each other because it doesn't feel good to say that out loud right like this is.
Griffin Jones (21:29) What is it? Is it like how pro athletes feel that losing feels worse than winning feels good? Is it that or is it something else?
Jason Yeh (21:36) interesting. I I think it might be something else. I think in the busyness of the day, our greatest joy should be to celebrate a kiddo that comes to the office with their parents. That should be the greatest top-end joy for our field. But I can speak that when I have three patients in the rating room, two saline sonograms, And you know a bunch of unanswered messages on teams and then a mom brings in the kiddo and says, hey, can we just hang out with you for five minutes? 100 % of my brain says I would love to spend time with you, but 110 % of my brain is like this is a very difficult time in my day right now. If you had come at 530 or 7 in the morning, this would be a totally different story. And so I think maybe it's time, maybe it's pace, maybe it's more than that. but there is definitely a feeling to that. And I think, you know, the human mind is really accustomed to contrast and, know, unless you start to see, you know, many, many different parts of the field, you know, by 10 years, I mean, you're thousands and thousands and thousands of cycles in, you know, like things just don't necessarily phase you as much anymore. And that's good and bad, but I was talking to a younger doc in my own network and He literally asked me this exact same question without any of this context, none of this conversation and saying like, well, how do you get through a day when you've had all these negative pregnancy tests? Because invariably if you're going to do 20 transfers over two days, you're going to have a bunch of negative tests. And some of those negative tests will hit a patient that's had like 10 negative tests before. And you're like, my gosh, like how do you do this? And I, I asked him the question timeout, you know, are you telling me that you're personal fulfillment and your daily happiness is tied with your patient's outcomes. And he's like, well, yeah, why wouldn't it be? And I'm like, time out, you know, that is not sustainable. You know how I think we have the luxury of having great outcomes, but you would never ask that a hospice care, you know, palliative care doctor or an oncologist, they have a lot more training than us for how to deal with these tough outcomes. And I would say that much of our job until you are attending in a fertility clinic. We don't really have any of that training. And you know, the, the fellows talk that I give ends with a whole series of slides talking about how, you know, you should develop your skills as a communicator, as a speaker, as an empath, you know, to know what your own stress response is, because knowing that and being able to move through those emotions, can literally mean the difference between survival and not surviving. You know, it's, I'm a huge tennis fan and, and Wimbledon is going on right now. And I know everyone hates Novak, but I freaking love the guy. I love him so much. And, know, maybe he was a little immature in his younger years, but as an older person, he has these incredible interviews where he talks about emotional reserve and the ability to move through something. And that might be his, greatest gift is that something bad happens. He moves through it. And when someone called it a gift, he actually shut that interviewer down and said, this is not a gift at all. This is actually a trained skill. When I lose a terrible point, I have to let that moment pass and move straight on. Because if I perseverate on that, let it consume my minute, my hour, I lose the match and everything is over. And the same sort of learning fact, I think is true for fertility docs, because we see immediate highs and immediate lows like diagnosing a miscarriage at 12 weeks at graduation. And then it's a, a sad moment that no one can describe unless you're there. I mean, it is sadder than anything someone can imagine. Right. And then you have to pop out, knock on the next door and be all hyped up for the next patient who's going through a stim and cheer them on their egg retrieval is, is around the corner and things are going to go well. that. sort of emotional back and forth. think it can be very taxing if you don't know yourself well enough to go through those motions.
Griffin Jones (25:46) So what you just described, some older generations and some cultures might just call grit and they might call tenacity. And I wonder how much of that do you think has been lost in the current generation and subsequent generations and is still needed? Because I think, yeah, I'm a millennial. I'm kind of like right in the core of the millennial years and I had grown up with a sort of notion that grit is this outdated thing and we should all be in touch with our emotions, we should all find our purpose and our passion and I think that for a lot of people that has caused a lot of unhappiness and one of the things that's really grounded me over the past few years is thinking why would I assume that we should all just have this magic purpose We feel so fulfilled and so happy all the time. Like what baseline, what imaginary world am I comparing that to when the baseline of reality is 200,000 years of poverty, oppression, war, starvation, like true human suffering for the most of our history as a species. I look at any of our ancestors, whether hunter gatherers or agrarians or those in the industrial age. They did not have it good most of the time and so if I think well I your job is to work for a certain period of time and you do the best by the people that you're serving and and you try to craft your skills so that you're having some self-actualization and and working towards building abilities and and and you manifesting more of it, but at the end of the day we are putting food on the table for our families and that life is pretty good compared to everybody else's, think like, yeah, to how with it if I don't feel fulfilled all the time? Just move on, just get on with it. So how much do you think it's like, it's just like, we need some more of that grit versus maybe some more of the tools that you were talking about.
Jason Yeh (27:58) I mean, it's gotta be both, you know, grit is beautiful. You know, I'm the kid, I'm the only son in an immigrant family. And when you hear stories that my parents tell me about their lives coming to the U S yeah, they had grid, they had grid more than I'll ever understand. Truly. You know, I wouldn't survive with their skillset back then with the situation that they were in of that time of that place. It would be tough. But I think physicians have a different kind of grit. think a lot of grit is a physical mental grit that we've cultivated from training. think, you know, maybe we didn't have three day call shifts like they did 30 years ago, but there were weeks I worked 120 hours. It was tough. But I think grit is just the output. It's the product, but maybe our generation, ours and those younger, I would say, cause I'm also with the very, very sort of the oldest possible one ale out there. you know, there's probably a gracefulness that you could carry yourself in through the field. And I know it's very metaphysical conversation at this point, but you probably do have, we have skills that we can learn. We know so much more about mental health and balance and professional purpose and how to find, you know, harmony in your life between work and family. These are all tools that we can use now. How do we communicate? So doesn't have to be, this, this swallowing of, of frustration that then shows up in other areas of life. If you just buckle down and have that grit, maybe your work output is good, but that stress is going to come out in some other area of life, whether it's your interpersonal relationships or your health or whatever is going to happen. My friends are going to crack up when they hear me use this quote, but, so Timothy Chalamet, has this interview and he says, you he's talking to some interviewer, You know, he basically says, you can be captain of your fate and master of your soul, but life needs to come from you and not at you. And sometimes that takes time to figure that out. And I think this job, if you have a strange mindset and you just kind of walk in, like you're not really fully prepared, it will feel like a job that is just coming at you. Like, I can say in Houston, it's not, I mean, we've got a great model and I think we could always be busier and we got great support staff and I love my teams. All of that is great, but I can say it would feel physically uncomfortable for doctors to start hitting 350, 400 cycles. That's where I think life starts to sound crazy. And I look at these other doctors that are hitting close to a thousand and I'm like, I don't even understand how that's possible. Right? So life might be coming at you, but if you can figure out how to make life come from you, Maybe there's some gracefulness in that. I, I, I think that medical school, it's, kind of a weird, sad joke, but medical school probably identifies people with a bunch of hobbies and extracurriculars because they know you're going to have to give all that stuff up for 20 years. And then hopefully you have some sort of core identity to fall back on when you hit that 10 year mark and you realize as an attending, it's like, all right, So you've passed your boards, you have mastery over your subject, you've got great clinical care, maybe you've got a family surrounding you, supporting you, whatever life has brought you, but maybe you have to have some core identity to kind of help push you through those last 20 years as well. And that's great. I think it's a great model, but maybe it's more than just, let's just bear down and fight it through and push through, because we're all missing some grit. That's what I would say. And I should say a disclaimer, my wife is a clinical psychologist. So, you we talk about a lot of this stuff at home all the time.
Griffin Jones (31:32) Speaking of clinical psychologists, do ever get to take advantage of Ali Domar and her work with Inception? as you're talking about, when you were saying oncologists get a lot more training, I'm like, yeah, nobody really trains fertility doctors on this stuff. And I was like, wait a minute, except for Ali. And she works for you guys. So do you ever get to take advantage of that?
Jason Yeh (31:51) She does. She's been a great resource. You know, she is involved in some research studies and there is a stint where she was traveling around the clinics, basically teaching about empathy and all of that. I, I love the role that she plays, although I do think this is probably more of a personal journey more than anybody could teach you. I don't think you're going to get these sentiments from like a book or a seminar, you know, and I, I almost hate to say it, but maybe you have to go through the paces yourself to like feel the burnout and feel the moral injury or have something happen in your life. Or then you kind of come out the other side with a totally different perspective. And I think it's great. I mean, I've had, you know, and even residency, the residency is a time where there's a lot of, a lot of self-sacrifice. Let's put it that way. And I was trained by this incredible team of docs and the chairman at the time, it was a dear friend of mine and we still keep in touch at his graduation speech for us. The first thing he said is that you guys are the first patients that you guys take care of every day, like us ourselves. And like, you don't really know what that means, but now I totally get it because when you deprioritize self, and you are trying to climb whatever corporate ladder or whatever the case may be, it is tough. And, you know, 10 years in, that's probably when that burnout starts to settle in and you might have to ask some tough questions.
Griffin Jones (33:17) If you didn't feel like there was another opportunity for you to get out of that rut seven to 10 years in, I'm guessing you would have found a different practice. What do you like about inception or prelude? What is it that you feel like they're able to offer people that are in that situation?
Jason Yeh (33:36) Totally. So on one hand, I think a lot of these networks at the contract level are starting to sound very similar, you know, from what I gather from these fellows, the text, the boilerplate language, it's all the same, right? And whether or not it's actually true, I think a lot of these networks are starting to be very different. And you wouldn't know that necessarily as a patient, cause I see patients from all different networks and they come to us, whatever second, third opinion. And maybe they're a little bit shocked to hear that I have like a hot take on all these networks. but inception I think is unique because it's not necessarily led by like this whole cadre of physicians, you know, and there's nothing wrong with physician leaders. I got a lot of them in these different networks that I call personal friends of mine. But I think when physician leaders are at the helm, Surprisingly, there may be a lot of rank and file behavior, like this is just the way it is because we've got the experience and it kind of has to trickle down.
Griffin Jones (34:35) Tell me more about this, because I think one of the criticisms that many people have about corporate medicine is that there's not sufficient physician leadership. You're saying there could be cons to physician leadership, if I'm characterizing correctly.
Jason Yeh (34:35) part two. That's part two. Well, there could be, there doesn't have to be, but let's rewind back to academic medicine. Academic medicine since its beginning, or let's use a pun, since its inception has actually been set up where the more you publish, the more professorship you attain, the more academic rigor you have, somehow that qualifies you to lead a department. And all of us have these unbelievable stories of how you promote somebody who has physician leadership skills by virtue of them having 300 publications. And then all of a sudden a department or division implodes on itself. So again, not generalizing as a monolith that physicians make bad leaders, but I think there's just been this history that like physicians should make great leadership. they, they should be great leaders because they've done X, Y, and Z. And I don't necessarily think you know, corporate leadership necessarily that Venn diagram of skill sets overlaps with anything that a physician has spent the last 20 years trying to figure out how to do. mean, for God's sakes, we've spent, you know, 3000 hours a year trying to figure out how to dissect out the ureter. Like how does that translate to like leadership skills? You know? So, you know, these networks are pretty different. I also think that, uh, here's a hot take, you know, I feel that evidence-based medicine is challenging. And although it is a nice guiding light for our field, we are one of the main specialties in all of medicine that is sort of testing the limits of evidence-based medicine. And I would even say that the fallacy of evidence-based medicine has actually shown up many, many times in our field because, you you apply Protocol a over and over and over again, because the evidence tells you to, but all of us have these experiences where you start to try these things. And next thing you know, you have a better outcome than what the evidence actually suggests. And so again, just a hot take, but inception was sort of built around a corporate team. And because they are not physician leaders, they've been able to sort of raise up physician leaders, which is cool. And I was talking to, will, I will not mention the name or the network, but I was talking to a junior physician a couple of weeks ago and they felt like there was a lot of, sort of a walls around how they could practice that they had to do it this way. They had to do it that way. If they wanted to deviate, they have to run it up the medical board. They didn't feel like they had a lot of clinical agency or autonomy in their life, which I thought was interesting. And then I said, well, why didn't you think about joining our team? And they said, well, I just thought that you guys would all work the same because you guys have these corporate leaders. And I said, well, interestingly, I think it's the opposite of way around because we have corporate leadership. A lot of those clinical decisions are left in the hands of physicians. And that actually means that we have a lot of autonomy. Would you believe that in Houston, we have many different doctors that have totally different philosophies on something simple as Day three or day five to test or not to test, you know? And she was shocked to hear that. She's like, why don't you guys advertise that more? And I'm like, I don't know, but maybe we should because that difference between networks may not be clear until you're literally a physician within that.
Griffin Jones (38:10) Do you think that has something to do with a leadership team that learns lessons, like, is willing to change? I have a little bit of a favorable bias towards your guys' leadership team, because I've done, and so there's a bias there, because I've done some business with you all, and I've done business with TJ, and there are things that you can learn about someone only when you do business with them. There are varying degrees of that, and I've never, like, gone and worked for you all, that's a different boat that I can't speak to. There have been times where it's just like, man, TJ did the right thing, that was the right thing to do. Lindsay, are there people on your, they did the right thing, and you can see them doing the right thing. if you had different people, would it be a very different situation?
Jason Yeh (39:02) Yeah, I think, mean, you know, in many ways I ended up in this organization through almost no choice of my own. And I'm lucky that I did because it, you know, life could have ended up in any other different way, but the people that came before me made decisions to partner with this network and I'm happy they did. know, TJ and Lindsay are good friends of mine. And, you know, I think if you've, I don't know if you see these marketing campaigns, but the marketing campaign from inception is really different. And I think thinks about sort of the honest journey of fertility rather than the of the, you know, pictures of families and like, let's just throw 10 more pictures of families out there and let's make this sound like, you know, bubble gums and unicorns. Like it's not like that. And so, yeah, I've gotten to know them, you know, fairly well over the last couple of years. And I would agree with your assessment. doing the right thing is a big part of it. You know, I wish I could take credit for that part of it, but I just got here when I got here and I'm lucky enough to be in Houston.
Griffin Jones (40:04) What did you tell, did you say anything to the person who commented on that Facebook post? If so, what did you tell them? If not, what would you tell them?
Jason Yeh (40:12) Well, how about this? I did not post because I'm more lurking than posting these days, but I actually have some of the follow-up posts afterwards. And unfortunately, I don't think there are easy answers. I think it's just more facets of the same side of the coin. So the second post goes like this. Perhaps my biggest regret after 25 years of practice is that I was always working when my kids were young. I had an epiphany when some friends and colleagues my age or younger developed serious medical issues or even died. And I decided to take the time to pursue the things on the list before it's too late. Who on their deathbed says, wow, I wish I did another retrieval. Post three, thanks so much for posting. You're definitely not alone. A few years ago, my older son said, mom, you're here, but you're not here. And that's when I knew I needed to make some changes. I had started to feel like a warm body in private practice and that is not how I wanted to feel at all. I switched to academics. I also launched a fertility coaching practice, which has been my passion project. And I also believe my purpose and legacy. Last year he said, mom, you're back. I feel it too. And I'm so grateful. The posts go on. I mean, they just go on and on and on. And I think the moral of the story when I zoom out is that there's not some sage advice that I could give these people and say, like, if you follow these steps, you won't find burnout or you'll get through your burnout. Like, I don't think that's a journey that I can call for anybody, but I think sharing these struggles publicly and bringing them to light, that's sort of step one and sort of knowing what signs to watch out for, having a plan in place before maybe the seven to 10 year mark. Because if you start to see those signs, it's not like this panic and be like, I have to quit my job. I have to change practices. I have to move cities. I have to switch to academics because I don't think that's necessarily the solution either. But if you know, and you can equip yourself and prepare and maybe dovetail your life where you've got whatever professional development, hobbies, clinical care, I think that's the most we can all hope for is some sort of graceful entrance, know, a great career, and then one day hopefully a graceful exit. But yeah, it's a personal thing, I would say.
Griffin Jones (42:25) Maybe a non-REI needs to say this because, as you mentioned, there can be a sentiment of the positive pregnancy tests just aren't getting me over the hump in the same way that they used to. And it sounds like that thought is present there where you get to the end of your career and you're thinking, will I ever regret not having done one more retrieval? And I think for somebody, they're gonna be saying, thank God that person did one more retrieval. It's someone's grandkids, someone's children, nieces, nephew. they are thinking, thank everything good that that person did that retrieval instead of not doing it. maybe they don't know to think of it in those terms because they don't know what you all are going through, but they do feel that at some level, or it's at least true at some level. If they were forced to think about it, it's so meaningful. I think, yeah, you're not gonna get to the end of your career and think, well, I wish I spent a little bit more time on YouTube. I wish I watched a couple more Netflix shows. I wish I...
Jason Yeh (43:34) I love YouTube, by the way.
Griffin Jones (43:36) I can get sucked into it too, but I realize that there are things in the middle that you have to declare war on. we all say, we all say like, well yeah, if I took this one more meeting, I'm not gonna get to my end of the life and regret that. But I would regret if I didn't build something, if I didn't push myself to the limit of my skill set, if I didn't build something that provided a really good livelihood for my family, I would regret that. And on the other hand, I would absolutely regret if I didn't spend enough time with my children if I didn't develop these hobbies outside of work, if I didn't get involved in these community activities. And so then the thing that we really regret at the end of our lives is anything that's not in those categories. Like anything that isn't an instrumental good or an inherent good is something that needs to go in the garbage. And very often that's the fantasy football, that's the video games, that's the happy hours. And I'm not saying anything against people can do those in more meaningful ways, but we all have a middle in in the society we live in where we've got multiple opportunities and multiple distractions and you gotta wage war on that. So that's the stuff that's gotta go because we have to work hard, because we have to do other things in our personal and family lives. What do you think is the most important thing for you to hang on to? When you get to the end of your life, what are you saying that, yeah, I'm glad that I didn't do any less of that?
Jason Yeh (44:58) Yeah, I mean, you know, even before I answer that question, I think this job has given us all so much this field, the subspecialty, whatever you want to call it. And, you know, I would still say it's the best specialty in all of medicine. You know, our worst, most boring day, like you said, we're changing lives and. Maybe it's easy to forget that because we are increasingly spending more time in front of a computer screen and less time doing the scans, you know, at bedside. Consults aren't necessarily life giving, I would say, because this job is a professional speaking gig. You know, you're only as busy as how quickly you can talk and there's just a lot of talking to be had. So, you know, how many hours a day can one person. You know, so it can feel like you're using a lot of mental energy to get through this, but that's sort of the downside. The upside is that this is a beautiful specialty. I'm lucky to be here and there are many versions of life where I wasn't lucky enough to be here and I'm fully aware of that. But you know, in terms of, you know, what I think are the most important things for me, I mean, I have a family that I love. think a lot of the inception team will say this too, that family comes before work. And, you know, when we have business meetings, there is a priority to sort of hopefully if possible, shut things down so we can all see each other's families and kids and put them to bed and all of that. Because, you know, I think in the seven to 10 year stage and probably before probably one reason why there's a burnout at seven to 10 years, Those are incredibly difficult years personally as well, not just professionally. Those are often years where you're, I don't know, trying to buy a house, trying to like raise little humans. Maybe you got one kid, maybe you're two kids, maybe you have three kids and you happen to be a female and society has unfortunately pushed a lot of the child raising responsibilities on the female partner, even though they're also physicians, right? It's like all of these things can really start to wear, but then you realize in your forties that This is this beautiful sweet window of time where your kids are young. They're not going to be young forever. And maybe time with them is really precious. And I would never regret another minute with my family, even though my two kids do fight as they should. But I also think finding that professional fulfillment life is about contrast. And I don't think I would be as good of a parent if I didn't have a professional life. to sort of engage my intellectual side and I wouldn't be a great physician without being a parent and knowing what some of these families are trying to achieve because I know it's so sweet that that final destination that they're after to see two people or one person or whatever the story may be that they're chasing this dream of a family. And I just know like, why, why did the universe make this hard for them? Like there'd be great parents and that really sucks, but maybe we can help them, you know, get that dream. So I think it's really special, but Yeah, I think the moral of all of this is that it's such a personal journey for each individual. And I think there's a lot of power in sharing these stories, knowing that physician burnout can be real, whatever you want to call it, moral injury, and that we give a lot of our lives to medicine. You know, if life was 300 years long and you sacrifice 35 of those years for medicine, all right, whatever, you know, that's cool. But life is not that long. But most of us are in our mid thirties before we start our first jobs. And that's wild. It's truly wild. So.
Griffin Jones (48:36) I've been enjoying getting to know you the past couple months, Jason. I'm glad you came on today. I'm definitely gonna have you back on because I know that you have captured something in today's conversation that's gonna resonate with people. So I'm gonna have you back on the podcast to talk more in the future and I look forward to it. Thanks for coming on the show.
Jason Yeh (48:55) Thank you for having me. That was super fun. We'll take care soon. a lot of these networks at the contract level are starting to sound very similar, the text, the boilerplate language, it's all the same, right? but the marketing campaign from inception is really different. And I think about sort of the honest journey of fertility rather than the of the, pictures of families and like, let's just throw 10 more pictures of families out there and let's make this sound like, bubble gums and unicorns. Like it's not like that.
