Today’s Advertiser helped make the production and delivery of this episode possible. But the themes expressed by the guests do not necessarily reflect the views of Inside Reproductive Health, nor of the Advertiser. The Advertiser does not have editorial control over the content of this episode, nor does the Advertiser's sponsorship constitute an endorsement of the guest or their organization. The guest's appearance is not an endorsement of the Advertiser.
Doctors used to dream not just of earning well, but of controlling how they practiced and how they cared for patients.
Doctors Cristin Slater, Kevin Maas, and Kyle Tobler—partners at the independently owned Idaho Center for Reproductive Medicine—explain why that dream feels so far away for many.
Here’s what we cover:
Why Dr. Maas says he’d never go back to a private equity-owned network
Hidden legal clauses & earn-outs that can trap REIs
The tug-of-war between business interests and clinical decisions
How independent practices can innovate (including the tech they love)
The advice they’d give to any fellow or young REI thinking about their future, and how they can still live the dream
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Dr. Kevin Maas (00:00)
So you've signed this agreement that you think is going to protect you if that company doesn't uphold its end of the bargain. And then when it collapses, suddenly we find that we may be beholden without our input to another private equity company that can swoop in and assume control of the clinic. So there was a fair amount of expense that we had to incur to become independent through no fault of our own.
Griffin Jones (00:37)
hadn't thought of it like this before, but the vanishing fertility doctor dream feels a lot like the vanishing American dream, doesn't it? Or whatever country you're in where this is true, young people shut out of stability, drowning in debt, unable to build the life they imagined. The same story is unfolding in REI, isn't it? Doctors used to dream of not just earning well, but also having control over their finances, how they practice and how they care for patients. Three guests helped me see it that way. Doctors, Cristin Slater, Kevin Moss, Kyle Tobler, they're all partners at the independently owned.
Griffin Jones (01:08)
Idaho Center for Reproductive Medicine in Boise. They used to be an integra-med group. Dr. Moss says he'd never go back to with a private equity owned network. And they explain why. Earnings squandered, legal clauses hidden in Delaware law, clinical decisions overruled by business interests. If you're a younger doctor thinking about your future, you need to hear this. I'm not saying all network or private equity firms are the same. They're not. There are pros and cons. But when someone says, handle the business, you focus on the medicine. These doctors give examples of how that often ain't the case. Dr. Tobler shares a moment from the fellows Park City retreat when he was a fellow that made him know that he wanted to go into private practice ownership. We talk about the challenges of keeping doctors engaged in private equity groups after they can't buy into a certain equity or if they've sold after they hit their earn out.
I press them on innovation for independent practice groups. And that gets us talking about the tech stack that they've invested in that they really like and the tech stack I think every practice needs to have. If you're a younger doc and just want to talk to someone who's been there, I've gotten to know these three over the years. They're kind, open, and I'll happily make an intro for you. If you have no intention of going to Boise, you want to go someplace completely different, I bet they would still be happy to give you their time.
They're that kind of people. Enjoy this conversation with the partner team at Idaho Center for Reproductive Medicine.
Announcer (02:35)
Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of inside reproductive health, nor of the advertiser. The advertiser does not have editorial control over the content of this episode, and the guest's appearance is not an endorsement of the advertiser.
Griffin Jones (02:57)
Two episodes in a row where I've had all the docs from an independent practice on board. I'll tell you that Carolina Conceptions had all 5 docs on, but I'm so honored that I've all the docs of these different independent practices. To me, it's an honor. Kevin, would you ever sell your practice to a private equity backed fertility network again?
Dr. Kevin Maas (03:20)
We've had offers in the past. It's something that we've partners have discussed several times. And I think we all agree that that's not something we're interested in doing. ⁓
Griffin Jones (03:32)
Why not?
Dr. Kevin Maas (03:33)
You know, I think we want to maintain control of the clinic. We've been part of a network previously. And, you know, I think when you join that type of private equity network, there's kind of promises made, you'll have access to resources. You'll have the backing of these big financial resources to grow the practice how you want. But we found that when it really came to wanting to expand our practice when we were in the network. We really didn't have the freedom to do it the way we thought we would.
Griffin Jones (04:04)
Did you want to expand your practice?
Dr. Kevin Maas (04:06)
I think, example, this was a while ago when I think it was Dr. Slater and myself and Dr. Slater, can clarify if I get anything wrong. But for example, we were looking at wanting to purchase some additional incubators to expand the capacity of the lab. you know, ended up, you know, and then on a different occasion, we want to purchase an in-house hysteroscopy set up to provide hysteroscopic services in-house.
And in both cases, we approached IntegraMed at, you know, with our proposition. In both cases, they turned it down. And as part of the agreement, if you purchased some of these things with kind of pre-tax earnings from the business, the equipment belonged to the private equity group, not to the clinic. So it made it like, it was an extra disincentive to not want to do things. actually ended up being kind of.
an inhibitor for growth and expansion to meet the demands of our patient population.
Griffin Jones (05:07)
To me, Cristin, maybe you can chime in on this, but I've always never fully bought the idea that we do the business stuff and then we don't interfere with medicine. To me, I don't think there's any way of completely forcing that. To me, that seems like an example. We want these incubators. No, you can't have those incubators. I between the business relationship and the clinical decisions when you're a physician trying to have that control.
Dr. Cristin Slater (05:38)
With the clinical practice, know, and the financial part of that, they're intimately evolved and they work together. And I think you have to have all of your interests and values aligned. And if some of your values are expanding clinical growth, but the financial aspect isn't, then they're not aligned.
Griffin Jones (05:55)
Where are there examples that you can think of. Like where you wanted to go a certain direction and they said that they weren't going to fund it.
Dr. Cristin Slater (06:05)
Yeah, I wanted to building a new building. You we thought that they would help us to build a new building. you know, initially they said no, and they said, we're going to give you this interest rate, which is higher than the interest rate that I could get from the bank.
Griffin Jones (06:19)
Would you have had? Could you have? Could you have?
Griffin Jones (06:20)
to borrow from them? Borrowed from the bank or did you have-
Dr. Cristin Slater (06:25)
Yeah, could borrow from the bank, but the bank was a lower interest rate than the private equity.
Griffin Jones (06:30)
And so, and then at that point, if you're having to do that, it's kind of like, well, why am I working with a- that's right.
Dr. Cristin Slater (06:36)
You feel like, okay, you've got someone who's got capital and this is a great benefit that you can do these things you normally wouldn't do on your own.
Griffin Jones (06:45)
I did an episode with Dr. Schnorr, two or three ago, called an IntegraMed autopsy. And it was a really good episode and he talked in a lot of about his situation. But what audience might remember is that IntegraMed did own equity in some practices. It did not own equity in other practices, rather it had a management contract. Did they own equity in your business?
Griffin Jones (06:48)
three years ago called
really popular.
detail
for you.
Dr. Cristin Slater (07:12)
We were a management contract clinic.
Griffin Jones (07:16)
Was that easy or to rec... There's still a lot of...
Griffin Jones (07:18)
cover from or what
things that were dropped in your lap.
Dr. Cristin Slater (07:24)
The most painful thing was when they went bankrupt. I don't know if people are aware, but we would give our money to IntegraMed and they would give us back to it for our distribution. We would do it quarterly. So when they were going bankrupt, they had taken our quarterly money, didn't get it back. A little painful. Another thing is the bankruptcy law is completely different than any other legal system. So we had to pay lots of money at the bankruptcy court and so we paid money to lose money. It was just an interesting experience with the legal system.
Dr. Kevin Maas (07:56)
And I think along the lines of what Cristin's saying, it was kind of eye-opening with the legal process because when IntegraMed kind of went bankrupt, you know, there's language in the contract we had with IntegraMed that basically said if they defaulted on their fiduciary responsibility to the clinic, that, you know, this contract's null and void, but, you know, this was kind of...
litigated in the state of Delaware where that language isn't binding, apparently. So you've signed this agreement that you think is going to protect you if that company doesn't uphold its end of the bargain. And then when it collapses, suddenly we find that we may be beholden without our input to another private equity company that can swoop in and assume control of the clinic. So there was a fair amount of expense that we had to incur to
become independent through no fault of our own. was their kind of financial recklessness that endangered our clinic, took away a quarter's worth of our earnings from us. And then at the end, we had to fight for our independence on top of it, even though we thought there was language of the contract that protected us.
Griffin Jones (09:12)
referring to an assignment clause is what was in that contract that they call their contract to another company or is there something else about in the state of Delaware that you learned about?
Griffin Jones (09:17)
could sell.
was breach.
Dr. Kevin Maas (09:27)
Don't trust me legally because I'm probably not the person. I just know it was something that we ended up having to contend with that was a major issue. I'm not sure, you know, it was years ago, so I'm not sure in terms of specific language in the contract, whether it was kind of one or the other, but it was something we had to deal with definitely in order to gain independence from kind of what happened.
Griffin Jones (09:47)
Did you just walk into all of this?
Dr. Kyle Tobler (09:49)
Yeah. Well, I actually, it's funny you asked because I was in 2020, I was getting out of the army looking for practice to join. And this was spring of that, I was doing in the winter. I actually was going to join a practice elsewhere thinking it was independently owned. And I had actually signed a contract and it was, I was told to me that the way they explained it, sounded like it was only to, I thought that had a business, a business contract, but they found out this practice was outright owned. And they talk about
you know, you become a partner and shares and all that. When you assume partner, you think ownership, but it was like, wait, you're not going to be a true partner. This thing's already owned. So I backed out of it and kept looking. And then I aligned myself with, you know, Kevin and I have known each other for years since fellowship, we did fellowship together, same year group. Anyway, so I reached out to Kevin and said, hey, are you guys looking? Because Boise looks like a cool place. You guys are definitely, you know, a small group that I'd love to join. And then just kind of lined itself. But the sad part was,
Griffin Jones (10:25)
What?
Dr. Kyle Tobler (10:48)
Then IntegraMed, where I was gonna join them that spring, and that's when IntegraMed fell apart, and they took the hard decision. They had a major financial hit, and they still brought me on as an employee, even though they were in a tough spot. I really appreciate, and COVID was happening. they had a lot going on, and I really, I do appreciate them not saying, hey, sorry, dude, and still taking the risk with me.
Griffin Jones (11:12)
I also could have been a risk for you.
Griffin Jones (11:13)
sounds like a
too it sounds like there's a mutual mutual how much how much did you know not
Griffin Jones (11:18)
Whereas
Dr. Kyle Tobler (11:21)
I mean, they kind of explained the situation where and I was kind of aware of it because I was watching practices that IntegraMed was not doing well and the practices associated with them were getting hurt. But as far as kind of how much they were out of pocket and the details in that, I wasn't privy to
Griffin Jones (11:36)
If you're a fertility practice owner, you're either thinking, heck yes, I'm with these guys. I'm going to be independent. I'm fulfilling this dream. I love it. I'm going hard. Or you're in the other camp and you're thinking, yeah, it's okay for you guys. I might be ready to be out of this. If you think you're even close to that second camp and you're thinking about selling your practice as your fertility company, talk to the guys at MidCap Advisors. To help you understand your current transactional value, we will teach you things about what drives the value of your specific practice or business.
They'll show you that for the long term as well as the short term. And they will keep you informed on what's going on with other practices in the M&A landscape because they do a lot of deals in the fertility space and they don't charge anything for that. They represent the sell side. They're advisors on the sell side. You, the practice owner, the business owner thinking about selling your company. They don't charge for any of that unless you sell your company. They do a ton of free consulting, way too much in my opinion. They're too patient in my opinion. You know those calm, rational, measured people, the kind of people that you want to room in a crisis? It's those guys. Aren't they the worst? You can talk to Bob Goodman, Brijinder Minhas, Richard Groberg at MidCap Advisors. Go to midadvisors.com or ask me, I'll make the intro. It's midcapadvisors.com. And so, Cristin, why hire another doc during that time?
Dr. Cristin Slater (13:02)
Well, honestly, I mean, the amount of money that we were giving IntegraMed was quite a bit. So if we hire another doctor and we're not having to give IntegraMed that money, honestly, it financially worked out better. It's like, it's better for Kyle to join where he's not giving X percentage to the private equity company. Truly, you know, in our situation, it really was.
Griffin Jones (13:25)
So tell me about, so I'm not quite totally understanding the quarterly money that didn't get paid back, help me understand that.
Dr. Cristin Slater (13:34)
It's a strange setup. So they would get all of the money for the quarter. And I think other clinics may have done it monthly. And then at the end of the month or end of the quarter, the true up, then they take the expenses out and then they give the distributions. But it just so happened we were on a quarterly basis. So they had all the money from the quarter and never gave us back those distributions. Plus didn't pay all the bills because they were taking all the money, paying the bills, giving us their distributions. so that last quarter, they took the money, they didn't pay all the bills, they paid some of them, not all of them, and then we didn't get distribution. So we lost that. So that was that financial mishap. And then also with contracts, when you're working with a private equity, in the contract, it'll say you give a certain percentage to the private equity. But when we're not with private equity, we're not giving that percentage. So that is saving money. And we can use that money to have a good accountant and have a good office manager and extra money, typically there is extra money. And so at that point, it really wasn't a risk to Kyle. We would have told him if it was, but it really wasn't.
Griffin Jones (14:42)
And Boise is also kind of up and coming market too. think that people that don't know about Boise, you go there and it's, yeah, listening, the doctor giving the hush signal because I think nobody wants another Denver or Austin on their hands if they're from a Western city like that. If you're looking for the new Denver, you're looking for the new Austin, go there before it gets ruined. 15 years, it's going to...
Griffin Jones (14:43)
Cool.
cool app, but it is.
Dr. Cristin Slater (15:11)
Good quality of life, good outdoor activities, that's for sure.
Griffin Jones (15:14)
Yeah, it's a really cool spot. Kyle, did you come for the con... You said you had looked at a different practice. You... It was...
Griffin Jones (15:18)
come control reasons because you found out that
private equity owned and that bail on that reasons of control or something else.
Griffin Jones (15:27)
had you been was that for the
Dr. Kyle Tobler (15:32)
Well, I just wanted the opportunity to be in like a small beam practice where I'd actually have the opportunity to become a full partner with the ownership on both sides as a medical practitioner, but also as an owner of the business. And so I was actively seeking practices where that would still be that kind of model is, know, kind of little by little was even this is back, you know, six years ago was kind of fading away. could see it actively fading away. So I was, I was seeking practices with that.
Griffin Jones (16:03)
Did the IntegraMed practices work together during all of this as you're all going through this, is it kind of every practice for itself in all of this? Yeah, they work together. then some decided to move forward, to remain independent. do you that decision? To re- Yeah, as opposed to saying, okay, let's go. That are building anew or was everybody...
decided to go together, others decided.
you decide that.
Dr. Cristin Slater (16:24)
independent?
Griffin Jones (16:27)
go with the folks that
Dr. Cristin Slater (16:29)
I after that whole experience, there was no reason to jump into another contract. We're doing fine. There really wasn't a reason. And also a little bit, maybe I'm old fashioned, I do like, if we can manage this to be our own business owners and we've got our medical practice, but to do that. And also for the next generation, I do feel sorry for the next generation. When I was in fellowship and I got to join.
practice where I could be full partner and have control and I don't think it's fair to the next generation.
Griffin Jones (17:04)
Tell me more about that, Kristin. As you put it in those terms, it's making me think of public conversation around it's not fair to this generation that six figures in student loans, it's not fair to this generation that they can't buy, that they can't. ⁓ Do you think of it in sort of the same terms that there's?
Griffin Jones (17:09)
The
they have.
house that they pair up.
Dr. Cristin Slater (17:28)
Yes, I do. feel like, you know, this is the dream and you know, whether the American dream or the REI's dream when they nurse their fellowship, what kind of practice they're going to have. It's just nice to have that option. Now everyone may not want to do that. Maybe some people want to join, you know, an institution that's like that, but at least you have that option.
Griffin Jones (17:50)
What do you remember the dream being? I know I'm asking you to go down memory lane, but when you think of yourself in medical school, residency,
Griffin Jones (17:58)
specifically as you can recall, what was it that you really hoped to have?
Griffin Jones (18:02)
we're dreaming about. What did you
Dr. Cristin Slater (18:05)
That's mostly just patient care, honestly. I didn't even think about the business. know, Kevin was saying that's something we don't even, you know, we don't have that brain, that lobe of our brain that really thinks that way. And so I was just, my dream was to see patients and things. But then after you do it a while, you know, you see the benefits too of having more,
Griffin Jones (18:26)
Kevin looks like he got something to add.
Dr. Kevin Maas (18:28)
Yeah, I I agree with Cristin. It's something, you know, in med school, all of your training, all of your focus is on learning medicine, caring for patients. And there really isn't, you know, through medical school, through residency, through fellowship, there isn't a discussion on how do you run a business, you know, because we're not exposed to it. It's usually not at the top of our line. I think, you know, maybe now, you know, when we were graduating, you know, there were
podcast, there wasn't this information disseminated. So it's something where, you know, I don't feel like I was really fully educated and really that aware of, you know, equity-owned practice or not when I finished my fellowship. don't remember whether people aren't completely transparent about it, because I do feel like there's an element where people who are part of these equity practices aren't totally transparent about it, kind of like Dr. Tilt, where it was
was mentioning, but I feel like when I finished my training, it wasn't something that was even on my radar. But now looking back hindsight being 2020 is like, yeah, this is important. This is something that should be taught to, you know, medical practitioners at some point during their training.
Griffin Jones (19:44)
Kyle, when you went into private, you weren't coming out of fellowship. You had been in the army. How long were you in the army for?
Griffin Jones (19:45)
practice.
Dr. Kyle Tobler (19:51)
six years. So I finished fellowship in 14 and I fulfilled my commitment in 20 at 2020. Along those lines, so kind of I've been watching, I knew I was going to exit the Army. wasn't going to retire. I didn't have a long commitment to kind of push me over to that point. And it was interesting. This was a Park City retreat. And I still remember this. It's in the field, just REI alone. There's just not a lot of discussion. what's the gorilla in the room is money.
Like how much money can you make? How much money is someone going to take from you to help you see your patients? And not only take your money, tell you how to do it too. And it was super interesting. So we go to the Park City retreats and then they had this kind of the panelists and there was a lady there, private practice by herself, California. And they said, hey, well, how much money do people make? This is for the fellows, right? No one would say, the academics would say, and it was kind of what I was expecting. And then the lady in private practice, she's like,
my God, I had no idea how little money you guys made. I'm, I'm not comfortable saying and it was it was like, what? So she wouldn't say but she was so shocked. And then it's like, they're all seeing the same. And then it kind of came, it's like, we're all doing the same thing here. It's not like these people from these other practices are only doing research and writing papers. They're they're moving volume. And then it kind of came, well, how much volume are you moving? How many patients are you seeing? And then it kind of like, wow, so that the
Dr. Kevin Maas (21:18)
feel
Dr. Kyle Tobler (21:18)
filled
with money and how much money you make and for you're getting paid to do, it's not necessarily even whether it's an academic, like the folks who are not seeing the patients have to get paid. And a lot of them have really big salaries and you're the only one who's actually see the patient. that was kind where my mindset is like, huh, don't, think I really, cause in the military I started presenting being told what to do, but at least no one was taking my earnings from me. But the military was definitely my big boss. I'm like, you know what?
another layer on that when I can like look at how much money I'm making and how much money all I call them the good idea fairies floating around where there are these people that have all these good ideas, but you're the one who does the work. And so was like, I just don't want any part of that because I think I'll resent it.
Griffin Jones (22:02)
So this was at the Park City retreat before your six years of honor.
Dr. Kyle Tobler (22:07)
This is why I was still in a fellow. This was why I was in fellowship. I just remember as a fellow, this is before I was in the army, and it was just, you know, as a fellow, you're thinking about your paper, you're thinking about your research, just get me through fellow, I want to be a good doctor. And then it came kind of came up because the this like started talking about this job market. And it's like, huh, this is I didn't I just opened my eyes like, wow, this is this is not all even. And that would kind of prompted me to kind of really dig into like, what do want to do when I get up the military?
Griffin Jones (22:35)
So you're saying the physicians at academic were sharing how much they made and it was the owner that's, I don't feel comfortable sharing now because I make so much more than you. So then, all right, so you're seeing the opportunity and the control and maybe that's where your REI American dream is being born and you wanted to hold on to
Griffin Jones (22:39)
they were
private practice said.
That's where.
So is that partly why Boise Place is like, you could still have the
Griffin Jones (23:02)
came into
Dream.
Dr. Kyle Tobler (23:07)
Yeah, that's absolutely. Well, it's a great place to live. So I was kind of looking for, okay, where do I want to move my family? And then where can I pursue this? You know, the kind of like, how I view it, like what Cristin's saying, how do I view myself in the future? And what do want to? What? What do I want to try to tackle? And that's what that's how I, that's why I saw it. And who do I want to work with? What was the other thing is like, okay, they're great people.
Griffin Jones (23:30)
So, do you buy in right away? Plan out.
Griffin Jones (23:31)
Did or was there a how
did that work?
Dr. Kyle Tobler (23:35)
Yeah, so there was kind of a term of kind of ⁓ a lead up as an employee for about about two and a half years. And then with always the plan right up front that no, no, you're going to join this and we will make you partner. So it was upfront. These are these are my expectations joining your practice is I want to be a partner and that yeah, that we want you to join our practice to be a partner. And our expectation is when you become a partner, we're going to make you even with us. didn't we didn't pencil out every single detail. But at the same time that there was
on paper was that expectation. This is how we're going to treat you and what our expectation of you and align with what I want.
Griffin Jones (24:11)
Kirsten and Kevin, I've...
Griffin Jones (24:13)
talked with doctors, two to three year phase.
Griffin Jones (24:15)
that have been in that two days
and they thought that they were on a partnership track and then didn't happen and both kind of parted ways feeling like they got screwed. And then I've also, she wanted partner, no way. It wasn't even close. Artie in that situation has felt like they were the ones that got the short end of the stick. It seems like they weren't.
Griffin Jones (24:23)
parties.
but each part
Griffin Jones (24:43)
specific enough in the beginning of what the expectations were? What expectations did you
Griffin Jones (24:47)
You
specify that this is a, Kyle, you're.
Griffin Jones (24:51)
This I will know.
partnering up with us.
Dr. Cristin Slater (24:55)
When you're a partner in our model, it's going to eat what you kill. You're pretty motivated to see patience because you're getting compensated. It's a very, very sick affair or way of doing things. I think it really just motivates you to want to build up your practice. When you are a partner, then you're in charge of your destiny. If you don't want to work that much, you're not working as much and you're not getting compensated as much. You want to work a lot, you're getting more compensated.
share the call, the weekends and things like this.
Dr. Kevin Maas (25:26)
Yeah. I mean, I think it was kind of like, it was laid out kind of early, like has been mentioned with the group that yeah, it's like a two, three year period where you're an employee and the goal is for you to become partner. I think we had the advantage of knowing Kyle and knowing that, you know, we were pretty selective in terms of, you know, we wanted to find the right person to join the practice. So we kind of.
We talked with a few other people, but it wasn't something we were opening the door to just anyone. We wanted to make sure they felt like they were a right fit from the beginning. So we're pretty selective upfront with who we brought in, kind of knowing that they were going to be a good fit. And I think that that would be the case again, moving forward. So far, our partnership track has been a hundred percent people we've invited on. The intention is you're going to be a partner and you know, we are looking for people that
be hard workers, provide great patient care, and work with the team well. And I think we've been pretty good in terms of being selective upfront and being transparent with what the timeline is. ⁓ And, you know, so it's worked out well for us so far.
Griffin Jones (26:42)
Was there a minimum number of patients that he had to be seeing or minimum number of articles or minimum revenue billed?
Dr. Kevin Maas (26:49)
And the truth is, it takes, like, I feel like it takes at least a year to get a critical mass where you're even really kind of bringing in some revenue. And it's like, you just have to have a realistic expectation. I mean, I think Kyle's schedule was full upfront, but you know, you have patients that are coming in as new patients, you're doing diagnostic testing, that testing takes two or three months to get these results, come up with a diagnosis.
A lot these patients don't want to do IVF upfront and they don't need to do IVF upfront. So they do less aggressive treatments. There's a few that do need IVF based off the diagnostic criteria, but it takes a while to get that clinical volume where you're breaking even and then making a profit. But you have to be realistic. That is at least a year, even with someone like his schedule from what I recall was pretty much almost full from he hit the ground running. know, it's like you said, this is.
a growing area, pretty much the main clinic for the state. And so we've got a built-in population. We knew that, you know, things were growing. And like on top of just meeting the needs of our domestic patients, we had a growing international component. We do a fair amount of egg donation surrogacy that also was kind of growing.
So we kind of knew right off the bat that we could fill another physician's schedule pretty easily, but you have to be realistic. takes some time for them to get the patients through, worked up to the point where you're seeing returns on that.
Griffin Jones (28:23)
You know, what do you think? Are you with these guys independent practice owner for life or you thinking about selling stepping back? Just focusing more on medicine and management if you're used to being that second group talk to the guys at MidCap Advisors will take the time to understand your goals I can't endorse them because I've never sold a business a bunch of people that have seemed to like them I've really enjoyed getting to know them over the course of the years because they are good people that do what they say they're going to do. And they will model deals for you. They'll talk to your attorneys, your accountants, and they'll do that without you paying them a dime because they only charge a fee for your business. So in the meantime, they're free consultants. It's MidCap Advisors. If you're thinking about the next chapter, it's MidCap Advisors, go to midcapadvisors.com. What's the biggest challenge for independent practices right now?
Dr. Kevin Maas (29:10)
I think number one, it's like we alluded, we're not trained in business is I think definitely a challenge. You know, it's like we've never been trained to read a P and L sheet. don't have the legal background in terms of, you know, what are some of the legal elements for partnership? Uh, you know, so I think there's, you know, and then just dealing with the growing staff and like, what's the appropriate level of staffing? What do you, what's appropriate compensation for different roles in the clinic?
You know, there's all these things that you don't think about until you're there trying to deal with it. You're like, oh, okay. It's not, you know, and clinics don't necessarily share this information freely. So you want to be free. You want to be fair with the employees, but it's like, you also have a business and you have to have a bottom line that you're meeting too. And so it's a, you know, but we don't have any training in that. So it's something that, you know, you kind of try and learn along the way.
But honestly, I think we'd be even better served if there was formal training in some of this before you got into the workforce.
Dr. Cristin Slater (30:14)
Luckily, we don't have this problem, but I have seen where there's small independent practices and they want to retire and maybe they haven't gotten someone that wants to buy into their business, you know, for various reasons, then that makes it harder because some of these people can't retire because they have no one to buy their business. But if you're with private equity, you know, you can just, it's not your issue. I mean, they're the ones that have to keep the practice going and things like this.
Griffin Jones (30:40)
which they'll do if you're in a city where there's other docs or if there are like
But for those doctor groups that are in areas where
Griffin Jones (30:54)
There's not any other REIs around. They're kind of auto-
Griffin Jones (30:57)
luck for-
Dr. Cristin Slater (30:58)
creating.
Griffin Jones (30:59)
for being able to. And oftentimes.
Griffin Jones (31:00)
to sell their practice.
It's the groups that do have the opportunity to sell to others that can get the biggest payload from private equity. ⁓
Griffin Jones (31:06)
do have the most other younger docs. ⁓
And so
kind of eats into the REI version of the American dream that we've been talking about.
Griffin Jones (31:22)
this
of house
because the big
Griffin Jones (31:31)
Property management companies that own thousands of Airbnb properties are driving up the rentals and Chinese investors are driving up the costs. It's kind of that version of what happens in Ferrari. You're somewhere in the middle of a... You're not the... the... ... attribution in terms of your docs. You got the docs, you're in growing market.
Griffin Jones (31:35)
properties are
of real estate.
I practice. Of those groups. Biggest group, but got a good district. Three.
Obviously people have called.
Griffin Jones (31:55)
called
you since the IntegraMed break. Have you gone into any of those suits? I've called on you.
Griffin Jones (31:58)
up how far have you
Dr. Cristin Slater (32:03)
mean, there was only one group that we talked 40 minutes, but no, we haven't really, we just not actively interested.
Griffin Jones (32:11)
So you're not really even interested in having the conversation with those kind of folks.
Dr. Cristin Slater (32:18)
I'm curious about it, but I don't think unless we're all really interested that it's even fair to their time.
Dr. Kyle Tobler (32:26)
I've viewed it as like how our age is and you know, like I said, you get the big payout and it's like well, so for the retiring doc, it's like a great thing. But I'm like, got a lot of years of work even with a big payout. still, you know, I'm, and I was like, well, what am I going to do once you get to that point of what I, or what I keep working for these people? And that's, I'm just kind of curious what's, you know, this evolution of the doctors, the primary owners.
Dr. Kevin Maas (32:45)
Please?
Dr. Kyle Tobler (32:54)
who are now fulfilling their obligations, what's going on with these guys that are now, they've met their obligation, are they hanging around or are they gonna just kind of stop? So that, I'm really curious what happens with that. Who picks up the torch? Because they don't really have anything to sell the young people.
Dr. Kevin Maas (33:09)
There's like even like an additional element of control. You know, like why you have the initial private equity group that purchases the practice. They pump in money to try and grow, show how profitable practice is. And then when that practice, when that private equity group sells to another group or there's some merger or something. Now, what happened, you know, maybe the group you were first with has a certain vision you feel like you're in line with, but you've been sold off to this other group. You don't have majority shares.
You're not involved in that decision. Now you've further lost control with a group that may be interested purely in slimming down as much as possible. The point where it could create dysfunction in terms of staffing and providing patient care. So there's like the initial purchase and joining of private equity, but there's the evolution of the handoff from one equity firm to another that you don't necessarily have control over. And I could see that creating even further drift in terms of.
retirement plans, that the new groups being in line with the physician's goals and, you know, wanting to serve the community. so I think that's something that's completely out of your control when those handoffs start happening.
Griffin Jones (34:24)
The next one has to get even more out of it. If I'm buying something for $10 million,
Griffin Jones (34:25)
to get right because.
I've got to be able to sell it for 30 or 40.
Griffin Jones (34:33)
You
know, I've got maybe 20.
Griffin Jones (34:35)
or thirty I've got to be able to
Griffin Jones (34:37)
sell it for in some years time and then if I buy it for 20 or 30.
Griffin Jones (34:40)
then I've to sell it for 40 or 50. ⁓
Griffin Jones (34:42)
And in order how going
to increase the multiple that much. think that goes a little bit in into your point, Kyle. I for not retiring. I don't know what the incentive is.
Griffin Jones (34:47)
Bye.
for these docs that are
is
to stay because
just just just for the
Griffin Jones (35:06)
take
around numbers and then you sell, you know, you're equity, you know, you're the one who's to to the buyout. But then why are you going to go make $400,000 a year if that earn out is done? I don't know how they answer for that. And it sounds like you caught on that too.
Griffin Jones (35:09)
that you sell 60 % equity there to get the rest.
after that.
Dr. Kyle Tobler (35:27)
know the numbers, guess you'll be okay. So it's still, you know, they're still paying relative not relative in absolute money is like, yeah, that's a great salary relative to doctors. But if you are never privy to what your true potential is as a business owner is so like, and I feel like one of the things like, till I got here, it's like, I had no I actually had no idea what the numbers what the potential was, or what you could expect. I knew it was better than having an actual employer, but but you just don't know. And I feel like
People in fellowship being trained by academics, they don't know that these senior docs, have. And because they've been in academia and then they're coming out and they're like, wow, they're, they're offering me a great salary, but they actually don't know how that relates to no, no, no. If you actually take the risk, find that right. Dig a little more instead of just going out to dinner with these guys and like wooing you with, we'll pay for your research and this and that.
Dr. Kevin Maas (35:59)
idea.
Dr. Kyle Tobler (36:22)
that they actually just don't know. I feel kind of sorry for them, but it's just people are so private with their numbers and that's human nature.
Griffin Jones (36:31)
Maybe they're not totally understanding the potential reward. Second thing is that maybe that placing a real big emphasis on the risk. So let me steel man that for a second, because if I'm coming out of fellowship and I'm in debt, I went to Vanderbilt, I went to a really expensive undergrad school. went to then medical school. I've got a bunch of debt from, I didn't make
Griffin Jones (36:33)
totally understand
because ⁓ to yell.
to
Griffin Jones (36:59)
hardly any money for seven years between residency and fellowship. And now this is the end. I'm starting my family and we finally want our forever home. Now I'm starting to see, give me that one, just give me that, that money right off the bat to, I don't want to take on any financial risk. This is terrifying. And the landscape is also changing is sure that might've worked for the docs in the two thousands, but now
Griffin Jones (37:11)
Yeah, just-
because his ter-
We have payers of all
Griffin Jones (37:30)
consolidating. We have
sorts of different companies coming in, driving up competition. Maybe the lab is going to be automated and what is that
Griffin Jones (37:40)
So how do you help docs out the right
Griffin Jones (37:42)
I hope younger think about risk.
Dr. Cristin Slater (37:45)
You've
got to talk to the older doctors too and it's all education and talking because when, you know, when anyone buys a house, if you didn't know, said, you're to have to spend whatever half a million, a million for a house or 40,000 for a car. That's daunting itself. But then when you talk to people and say, this is the usual trajectory and you know, this is how it works. It's okay. And they have more long-term information than you're not as nervous, but you have to.
You can't just have that short-term vision. have to the long-term vision.
Dr. Kevin Maas (38:19)
think you have to see what's the history of the clinic in terms of bringing on new doctors. How have, you know, when they bring, have brought on a new partner, what proportion of those members have gone on to become full partners? You know, cause there, there are clinics out there that have a reputation for burning through new fellows. And, know, it's like, you know, I think when I finished fellowship, I knew some of these clinics that had a reputation of burning through
new hires and then discarding them. So it's like, think when you bring someone on, be transparent, what's your track record? And I think like Dr. Slater said, you know, this is what, you know, be transparent. This is what you're going to make salary wise for this period of time. This is our track record of bringing someone on as a full partner. And once you become full partner, this is what that salary looks like. This is what the earning, the shared earnings look like in addition to the salary that you make.
And I think that providing that kind of transparency and your track records, something that should provide some reassurance.
Griffin Jones (39:25)
The track record would provide
Griffin Jones (39:26)
some reassurance and there's a lot of independent practices and that's a decent predictor.
Griffin Jones (39:29)
is with good track record. The pattern is a picture
of the future, but it would totally assuage
Griffin Jones (39:36)
I don't know that
my concerns, let's stick with the home analogy for a second. ⁓
Griffin Jones (39:42)
lot of people have the opportunity
to overpay for what they used to be able to get a dis... As a fixer upper. So it used to be a big... ...HVACs... ...needed to update... ...those types of projects still...
Griffin Jones (39:47)
count on as an
big difference in the home price. If you had to the new roof on, had to do a new A system and you need to get the kitchen and bathroom. And now it's
cost a ton of money. So instead of saying, well, yeah, but I could own the equity and I actually invest in that and I could make it better. Saying, forget it. I don't have, I don't care that I'm throwing money away for rent.
Griffin Jones (40:10)
could slow. Better people. Care that equity.
I would rather go to this.
Griffin Jones (40:22)
know, condo complex and be part of an HOA and have everything taken care of me and taken care of for me so that I don't have those things. In the case of disownership, think a lot of younger look and they say,
I don't, I think that they're probably going to have a new lab. think probably going to have to buy a bunch of new incubators. think they're to invest in a new, completely new intake that's going to cost them a lot of money or EMR, I think they're really going to have do GYNs and APPs. And I just don't know if they can do that because they're caring for the patients in front of them. Nobody has time to be the business visionary.
Griffin Jones (40:48)
software or a new bet, they're probably really have to figure out how to use OBJ.
because they're so busy.
He has.
How do do you, how how how you, do you,
Griffin Jones (41:09)
How do you invest in future as an independent practice when you're so busy today?
Dr. Cristin Slater (41:15)
I mean,
I think you always have to forecast those things. And if you've got a good office manager and a good accountant, you've got to rely on your people.
Dr. Kevin Maas (41:23)
Yeah, you, think rely on people that have expertise, you know, it's like, yeah, like Dr. Slay said, have a practice manager that's kind of like finding a good practice manager also isn't easy, honestly, but you find someone who's right. They want to grow the business and make the business successful. think having, you know, you know, maybe having an accounting for help with the books. So you have some double check, you know, backgrounds, you know, some kind of.
backup steps with people kind of buying kind of revenue and relying on their expertise because you know, honestly, you can't do everything you're to have to rely on some other people to help with some of those type of decisions. But I'd also argue, you know, it almost sounds like you know, what you're talking about is like here, here's a pre package deal, you're going to make more money upfront for this, you know, for this guaranteed path. But where does that cap at, you know,
And where is the potential that you could be at? And what's that delta? know, are you okay making a better salary upfront, but your full realized potential is going to be a fraction of what you could be earning? And is that worth it? I think the flip side is what are you sacrificing? Private equity companies aren't going into this to not make a profit. And who are they making a profit off of? They're making it off of the physicians. So, you know.
We're the ones who are actually providing the skill and the value. They just know how to run the businesses and have come up with these slick packages that make it difficult for you to realize what you're really giving up. but I think that Delta you give up is considerable. And you know, it's a matter of, you okay? Satisfy, you know, if, if that comfort is worth it to you, fine. But you know, I think if you want that control of your destiny,
If you want the control of how your practice grows, if you want to have the full potential of what you could be getting out of this, then maybe you might want to take that.
Griffin Jones (43:29)
I've got to get better at.
Griffin Jones (43:31)
I've got to send this question together ahead of time so they have time to think about it. I'm putting the three of you on the spot, but what are some technologies or solutions that you've either invested in in the last two years?
Griffin Jones (43:33)
us
that you're really happy with that you feel have added value or.
Griffin Jones (43:45)
that you're looking at now.
Dr. Cristin Slater (43:46)
Happy with our EMR.
Dr. Kyle Tobler (43:50)
Yeah, it's great.
Griffin Jones (43:52)
Which almost no one says
Dr. Kyle Tobler (43:55)
Well, the other as far as technologies go people wise, think, and it just kind of, you know, the risk reward, know, it's just as a business is a risk. And it just, you know, you have to like, we've kind of bumbled through it is to say, you know, we're talking and we're happy with our decision. That's why we're sitting here, but at same time to say, we're not afraid of our future and that we're not concerned about these different things that are occurring or
Well, yeah, absolutely. think about it. talk about it every single day about what's going on in like economy and kind of the scaling that's going on around us for sure. But it's the same time we still view ourselves at an advantage. But I feel like one thing is just people like looking at us like, what's a problem? Embryologist. This comes up all the time. like, if we lose an embryologist, are we going to shut down or is that going to slow us down?
And so we made a really big investment in them as far as ⁓ having enough overlap and expertise, even though it's costly, but we feel really secure with that and they're good. And really, I feel like we've been really lucky because it's not like there's other programs around us that we can like ⁓ pull them from. ⁓ And so I think that's probably in my mind, that's the one that pops in, not necessarily a technology like a fetal score or the every
Dr. Kevin Maas (45:09)
I
mean, I agree with what Kyle's saying. think investing in employees is actually probably a really good, like even finding, you know, to have an IVF coordinator, to have a surrogacy coordinator, to have an egg donor coordinator, that takes a lot of training, a lot of time to get someone that can do it well and do it confidently. And, you know, I think having enough redundancy in the system, having
investing employees so that they want to stay and have a long-term future with the clinic is really worth it. You know, cause that turnover, if you're not adequately staffed and you lose a key employee, it can upset the balance.
Griffin Jones (45:53)
Which EMR are you using? asked the same thing of the Carolina Conceptions people. said the same thing. They couldn't figure out what they Why did nAble win out?
Dr. Kevin Maas (46:07)
I think it's user friendly. Like anytime you pick up a new EMR, there's always a learning curve, but it's fairly user friendly. I feel like a lot of things, you know, is you have all these labs coming in and you're trying to make fast decisions. The work list that populates, you can filter the only labs that have been reported come up so you can focus and make decisions quickly without having to sort through like a list of a hundred patients. It instead pulls up.
the 15 patients that have an ultrasound in their lab is back. I feel like it's user friendly and it lets you be efficient and it didn't take too long and it's catered towards IVF. So it's easy to find embryology information. It's easy to find an IVF cycle or a clomid IUI cycle. So yeah, I think it's well designed and well suited for what we do.
Dr. Kyle Tobler (46:55)
It's also cloud-based. You can access it on any device.
Dr. Kevin Maas (46:58)
⁓
nAble
Griffin Jones (47:04)
Believe me, Kevin, I'm going to be hitting them up after two in a row. You mentioned the embryology vulnerability, Kyle, and I see this from small market practices. But if you're in LA, you can just fork over a bunch of money and poach somebody else's embryologist. Whereas if you're in Boise, you can
Griffin Jones (47:08)
after
is especially every practice of course. If you have to.
Griffin Jones (47:31)
in Ohio or Greenville, South Carolina, you might not be, not as easily. And when I do small consulting engagements for doctors thinking about starting a new practice, help them them through all of the potential trip wires and we, their recruitment pipeline, we go over the pipeline and then it's a, we're good, we're See, they'll able to get patients in the door and then we talk about the lab and
Griffin Jones (47:34)
able to do that or at least
or die.
over.
hearing you can see that they'll be able to get it set up.
about ⁓ what about
that's where they go yeah that's gonna be the hard part so I would worry if I was just you've you
Griffin Jones (48:06)
practice owner of J. Who
sounds like you've spent some money to have some redundancies ⁓ embryologists that can cover if need be. And I think that's important.
Griffin Jones (48:12)
that you've got.
but I would still feel.
Griffin Jones (48:19)
really
vulnerable to that. Have you invested any technologies in the lab that allow
Griffin Jones (48:23)
allow
for you to get more
Griffin Jones (48:26)
of each embryo.
Dr. Cristin Slater (48:28)
We haven't done any witnessing program, witnessing AI yet. I mean, was just thinking things we're looking at, but we haven't, yeah, we haven't done that.
Dr. Kevin Maas (48:36)
And just actually going backwards to kind of like, think one of the things we've realized, kind of going back to investing in staff is a lot of we've found that having kind of upward trajectory in the clinic is something that kind of gives long-term retention. So if we have medical assistants, they have to do everything. They work with the EMR. We can see who's sharp similarly on the lab side. You have the andrology phlebotomy side.
And you can see people who are smart. You start picking out people who you think have the ability to be an embryologist. You invest in them to become an in-house trained embryologist. You have someone that's going to be loyal to the clinic because you've raised them up from an entry position into a position that really does very well. so I think, again, kind of going back to investing in the employees, having these upward trajectory paths where you invest in the people that
kind of give back or you think have the potential to take on additional roles and flagging those people and make them aware, hey, we will invest in you if we get a commitment out of you to kind of stay with us, you know?
Dr. Kyle Tobler (49:49)
Griffin, I have a question for you. There's something on your mind right now that you're like wanting, like, I'm kind of curious. What do you, ⁓ you have some technologies in your mind. like, I'm curious if they've thought about X, or Z. And what is the X, or Z you're thinking about, technology wise?
Griffin Jones (50:05)
I,
well, I'm definitely
Griffin Jones (50:08)
definitely
interested in time-lapse. I'm definitely interested in embryoscope. I'm definitely interested in witnessing technologies and monitoring from a safety. I try to opine myself less on the...
Griffin Jones (50:20)
lab stuff because
Griffin Jones (50:21)
I'm not a clinician and I'm not a scientist. My mind tends to go more automation of the patient journey and anything that triage. I'm really interested in this whole of companies like can frame like very, like whatever engaged MD is going to do next. And I need to do a where those companies overlap and where they don't. kind of just put them in a
Griffin Jones (50:24)
my towards
that helps with whole clout, levy health, like seive, like bare fertility.
better job.
Cause I
Griffin Jones (50:51)
but
Griffin Jones (50:52)
that's too broad, but I'm because I am I worry that boutique practices the boutique practices with people. Somebody I work really closely with ⁓ boutique practice that I have
Griffin Jones (50:55)
am interested in that because...
is cannot be.
I'll give you an example.
went to a ... I've
been in myself multiple times, know the doctor, know the people there. One of the leanest shops I've ever been in, really, really loved ... had a miserable experience, not because of anything that the ... the person I know couldn't track down the next step, was doing her own case management because, can I get my meds yet? you ... just know you got to call the pharmacy. Know you have ...
Griffin Jones (51:15)
people.
because the or the staff did just.
When you've got to call the practice, you to
call progeny or whoever the like.
Griffin Jones (51:35)
employer benefits and just boom,
being kicked around, kicked around, kicked around. And she's like worried that she's not going to be able to trigger and not be able to get her meds or not, or going to miss her date. She's doing all this case management. And I'm like, I'm pretty sure that one of the comp, at least one of the companies that I just mentioned can all of.
Griffin Jones (51:49)
Tour.
Griffin Jones (51:57)
I need to do a better of like figuring out it is that that is an area. Just in general, I think that independent purposes and booting purposes need to be.
Griffin Jones (52:09)
tech stack in order to be
able to provide individualized care because while that ⁓
Griffin Jones (52:17)
If technology can do it, then you can do it. You want is the dial.
No, you know what? I'm going to pop into your ultrasound scan for a couple more minutes today, or I'm going to take a couple more minutes with you on this consult. If everything is really dialed down from an operations perspective, and that's an area.
Griffin Jones (52:26)
Take a
where
I worry a little bit with taxes I see the upper agree with you guys
Griffin Jones (52:37)
independent practice. See all of the opportunities and think that
they can win the day. That's an area where I think independent practices can run into trouble. They don't have the time to invest in that operations. They're so busy with the day-to-day responsibilities.
Griffin Jones (52:48)
because
with
Dr. Kyle Tobler (52:55)
So the bigger companies from you've seen have like a liaison that kind of facilitates that some sort of person that's like, well, I guess case manager for the patient.
Griffin Jones (53:06)
Yeah. That stuff. So yeah. Yeah. So, you know, like the very beginning, like all that stuff is,
Griffin Jones (53:06)
And they're starting to automate that.
Dr. Kyle Tobler (53:09)
automated like an AI kind of.
Griffin Jones (53:11)
There are some that that automate.
triaged
and before it goes to a call center and an AI agent can answer sort of questions, then there's things that boom, it sends you right. And it sends you gets everything ready and.
Griffin Jones (53:24)
to LabCorp. It your labs and
it has you do the checklist before that visit with
Griffin Jones (53:31)
You're even able to get
dock and implementing those is above my grade starting to get there.
Dr. Cristin Slater (53:40)
Yeah, if you have a long waiting list, then that makes sense to do. On board before they meet. We take a lot of stuff internally. We hire on the admin side someone who does the pre-office, someone who does order the medication. So that's all internal so that the patient experience is pretty smooth from a financial standpoint as well as a clinical standpoint.
Dr. Kevin Maas (53:43)
I mean, I think it's kind
Griffin Jones (54:04)
Here's one thing that I heard somebody say recently, and I think it was a network ⁓ see
Griffin Jones (54:10)
that said that.
Griffin Jones (54:12)
If you
ask any practice owner, they'll think that the patient experience is smooth.
Griffin Jones (54:18)
you
if I asked that that that that booty if I asked that ⁓ boutique practice do you have a really good
Griffin Jones (54:24)
owner, patient
experience that that person would say.
Griffin Jones (54:29)
Of course, but that's because they had to call, they to call the, they've had to call, they've had to deal with all of that stuff. So, I, that stuff is regardless, because I have, right about very practices. This place is a baby factory. It's not a privately.
Griffin Jones (54:31)
They haven't been in the situation where the progenies, had all the pharmacy.
And so.
I think that the relevant, the list of volume and weight, people, seeing people, small practice.
I'm like ⁓ equity
on network, they're doing 150 person still thinks this is a.
Griffin Jones (55:00)
Decycles a year, but that baby
factory because the What it could be but Get better at I will get bad before you come
Griffin Jones (55:08)
patient journey was not. I will.
Dr. Kyle Tobler (55:12)
Fair point.
Griffin Jones (55:15)
Mapping those out. I
promise. Next year, 26.
If you were coming out of fellowship now in 2025 or 2026,
Griffin Jones (55:29)
But you have the
Griffin Jones (55:31)
benefit of knowing everything that you've learned and retaining all the experience that you have, what actions would you take?
Griffin Jones (55:38)
What?
Dr. Cristin Slater (55:40)
think
it's talking to physicians, whether it's one year, three years, 10 years above you in different scenarios and asking them pluses and minuses and trying to get the true.
Dr. Kevin Maas (55:52)
I think it's also important, know, what, like, what are your goals? Like, it like kind of like you were implying, what's your risk tolerance? What are your goals? You know, if it's something where stability and you don't want to take a lot of risk, maybe, you know, choosing a position, but I'd also argue going with a private equity company has its own set of risks.
And, know, like there's that lack of control. If a different equity company takes over, is that going to be aligned with your priorities and goals as a practitioner? So, you know, even going with that kind of safe, stable option may not be as safe and stable as you think it is.
Griffin Jones (56:30)
as he
Griffin Jones (56:30)
As you guys learned the hard
Dr. Kevin Maas (56:32)
Yeah. You know, it's like, you're making, may not get out of it. What they promise you upfront, you know, it's like, Oh, you have access to all these financial resources, but actually you're going to have to pay for all of it. And it really doesn't help free you up. And in fact, it can inhibit you a little bit, but I think, you know, find out what your priorities and goals are. What's your risk tolerance, find out the, the trajectory, the history of the clinic that you're going to be joining, you know, talk with, you know, the
Don't talk just with the physicians, talk with the employees that work there and get a sense of the culture of the clinic. And then make a decision that feels right to you. Make it educated. Don't feel like you're, don't make a rush decision. Take your time, you know, and you know, is this clinic busy? Am I going to have a full schedule early on? I know when I, before I interviewed with Cristin, I didn't know the equity kind of stuff, but I know
I looked at all the clinics on the West Coast. knew I wanted to be somewhere kind of on the West Coast. I looked at the SART numbers, the number of IVF cycles the clinic was doing, and then I'd go to that clinic's website, see how many physicians were working there, we'll create a ratio and found where there's the biggest mismatch in terms of volume going through per physician. And then I'd reach out to the clinics that had that biggest mismatch, because I know pretty good chance I'm going be busy early on. And Dr. Slater had a big mismatch.
Dr. Cristin Slater (57:57)
Thankfully you joined.
Dr. Kyle Tobler (58:00)
I would say, know, it's a tough question because, everyone's priorities are different. It's like the first thing like, mean, just follow your gut. I mean, everyone, all these REIs are, you know, everyone's smart in this field and like hard working. They want the best. I don't think anyone's truly malignant, like going out to like get you. But at the same time, like follow your gut with things. If something doesn't seem right, it's probably not right. Or it's just like, oh, that just doesn't seem too good to be true. It's probably too good to be true. The other would be just dig in, like, like Kevin was saying, dig into the history of the practices.
Like who was there before you? Is it someone just like you? Did they leave? Chase that person? We're a small world. Like I think we can touch someone, like within one person, we all know each other. I'm pretty sure of that. And so it's pretty easy to chase down somebody like, hey, I heard this person was there and like, and ask them, what was your experience there? And I did that a couple of times where I saw advertisements where I called him the lone wolves. And it's like, ⁓ he went through three other fellows. There's no way that it like, there's a problem here.
Even though I talked to him on the phone, seemed amazing. It was telling me everything I wanted to hear. Why did three other guys leave or two other guys? so, know, I would, the history matters. ⁓ And then we're good concerns. If you're going to join private equity practice, you probably should really understand private equity. Don't, know, that you're going to be part of it and you're going to have resent it. If you're not, if you don't believe in it, ⁓ I would think you're like, you gotta be kind of eyes open.
Griffin Jones (59:28)
It's made enough sense to me and I you this conversation. I hope you'll come back. Thank you all for taking the time. Dr. Cristin Slater, Dr. Kevin Moss, Dr. Kyle Tobler, thank you for joining me on the Inside Reproductive Health.
Announcer (59:48)
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